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Year 3: Prosthetics and Orthotics > Lecture 10: Lower Extremity Prosthetics > Flashcards

Lecture 10: Lower Extremity Prosthetics Flashcards

1
Q

partial foot and toe amputations are common in what populations

A

those with dysvascular disease and/or diabetes

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2
Q

functional deficits for minor LE amputations (toes, great toe, ray, MTP and proximal)

A

toe = minor gait abnormalities

great toe = loss of push off

ray = decreased gait speed, limited LE ROM

MTP and proximal = decreased stability, decreased gait speed, and other gait deviations

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3
Q

what is a syme’s amputation/ankle disarticulation and type of prosthetic used

A

heel pad attached to distal end of tibia

may include removal of malleoli

complicated prosthetic fit due to limited space

can ambulate without prosthesis

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4
Q

ideal length for transtibial/below knee amputation

A

ideal length = mid tibia
- if <9 cm should consider removing fibula

if < 5 cm should consider knee disarticulation

fibula should be 0.5-1 cm shorter than tibia for prosthetic fit

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5
Q

what is a knee disarticulation

A

uneven functional knee joint centers

distal femur can bear weight

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6
Q

what is a hemipelvectomy

A

resection of part of the pelvis

common due to cancer or trauma

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7
Q

what is a hip disarticulation

A

amputation through hip joint

pelvis remains intact

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8
Q

what are k levels used for

A

to assess pts potential for functional ability

determines reimbursement for componentry

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9
Q

what is a K0 or K level 0

A

does not have ability or potential to ambulate or transfer safely with or without assistance and prosthesis does not enhance their quality of life or mobility

  1. cognitive ability insufficient
  2. prosthesis does not improve mobility or transfer ability
  3. wheelchair dependent
  4. bedridden + no need/capacity to ambulate/transfer
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10
Q

describe K level 1

A

ability or potential to use prosthesis for transfers or ambulation on level surfaces; typically limited to household ambulator

  1. sufficient cognitive ability to safely use prosthesis
  2. capable of safe but limited ambulation in her or on similar flat surface with or without AD and with or without assistance
  3. requires use of WC for most activities outside of residence
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11
Q

describe K level 2

A

ability or potential for ambulation with ability to transverse low level environmental barriers such as curbs, stairs, or uneven surfaces

typically limited to community ambulatory

individual can with or without AD and/or with/without assistance
- perform Level 1 tasks
- ambulate on flat/smooth surface
- negotiate curb
- access public/private transportation
- negotiate 1-2 stairs
- negotiate ramp built to ADA specs

may require WC for distances beyond perimeters of yard/driveway, apartment, etc

only able to increase their generally observed speed of walking for short distances or with great effort

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12
Q

describe K level 3

A

ability or potential for ambulation with variable cadence, typical of community ambulatory who has the ability to transverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion

with or without assistance/AD pt can:
- walk on various textures/level
- negotiate 3-7 consecutive stairs
- walk up/down ramps
- open/close doors
- ambulate through crowded area
- cross controlled intersection within their community within the time limit provided
- access public or private transport
- perform dual ambulation tasks

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13
Q

describe K level 4

A

ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact stress or energy levels typical of prosthetic demands of the child, active adult, or athlete

with or without AD/assistance they can:
- run
- repetitive stair climb
- climb steep hills
- be a caregiver for another person
- home maintenance

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14
Q

K1 prosthetic components at the foot/ankle and the knee

A

foot/ankle = external keel, SACH or single axis

knee = mechanical knee with constant friction

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15
Q

K2 prosthetic components for foot/ankle and knee

A

foot/ankle = flexible keel feet, multi axial feet

knee = mechanical knee with constant friction OR mechanical knee with variable friction (hydraulic or pneumatic) OR microprocessor

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16
Q

K3 prosthetic components for foot/ankle and knee

A

foot/ankle = flex foot, energy storing feet, multi axial or dynamic response feet

knee = mechanical knee with variable friction (hydraulic or pneumatic) OR microprocessor

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17
Q

K4 prosthetic components for foot/ankle and knee

A

foot/ankle = any, includes microprocessor

knee = any

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18
Q

what outcome measure can be used to predict K levels

A

AMPPRO

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19
Q

describe reimbursement for prosthetic devices

A

every 3-5 years depending on insurance

maintenance to current device allowed

manufacturer warrantees

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20
Q

2 ways to fabricate a socket

A

casting- more traditional

scan

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21
Q

more pressure sensitive areas of residual limb with TTA

A

fibular head

end of fibula

shin bone

hamstring tendon (back)

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22
Q

more pressure sensitive areas of residual limb with TFA/KD

A

greater trochanter
ASIS
pubic tubercle
adductor tendon
IT
pubic ramus
distal femur

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23
Q

what is a patellar tendon bearing socket

A

indentation over the patellar tendon

specific pressure points

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24
Q

describe total surface bearing socket

A

distributed weight bearing

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25
describe a quadrilateral socket for TFA
horizontal posterior self for ischial tuberosity and glutes medial brim same as posterior shelf anterior and lateral brims 2 1/2 - 3 inches higher
26
describe an ischial containment socket for TFA
medial lateral walls are more narrow anterior wall lower can encroach on pelvic alignment resulting in APT
27
describe a subischial containment socket
not as common "brimless" soft tissue must be able to tolerate WBing less APT
28
what must a socket provide for a hip diarticulaiton or hemipelvectomy
adequate coronal support sagittal capture of pelvic movements secure comfortable suspension appropriate weight bearing surfaces and contours socket will typically encompass affected relics, gluteal tissues, and ITs medial lateral stability provided by compression of the contralateral pelvis
29
socket suspension for hip disarticulation and hemipelvectomy
use of pelvic band trim lines above iliac crest suction or vacuum suspension
30
describe thigh corset suspension system
heavier and may facilitate poisoning difficult to don
31
describe pin system suspension system
shuttle lock system helps with poisoning commonly used
32
describe the suction suspension systems
use a 1 way valve pistoning can occur will use liner, can add sock ply as needed for volume fluctuations COMMON
33
describe a true suction suspension
use a 1 way valve socket fit must be very snug worn without a liner
34
benefits of a vacuum assisted sock suspension system
promote fluid exchange reduce moisture build up regulate volume fluctuations increase proprioceptive awareness of limb helps control pistoning may help with wound healing *expensive, heavier, and can be noisy
35
what is osseointegration
option for pts who do not tolerate traditional prosthetic sockets common complications = infection and soft tissue irritation at stoma 2020 - FDA approved OPRA implant system for TFA
36
timeline for osseointegration
1st sx = fixture implant bone healing x 6 months 2nd sx = abutment placed partial WBing x 6 months Rehab
37
suspension aid examples
supracondylar trim lines outer sleeve thigh corset other strapping mechanisms
38
types of non-articulating feet
SACH feet (solid ankle cushioned heel)
39
types of articulating feet
single axis multi axis dynamic response/energy storing feet multi axial dynamic response feet hydraulic microprocessor
40
describe the SACH foot
lightweight inexpensive low maintenance wooden or metal keel that extends to MTP joints rubber heel allows for shock absorption and PF at loading response
41
describe a single axis foot
some sagittal motion allowed and controlled by interchangeable anterior and posterior bumpers no transverse or frontal plane mvmt no energy return heavier More maintenance required than SACH
42
describe multi axial feet
allows for some pronation and supination (inversion and eversion) to cope with uneven terrain along with sagittal DF/PF more expensive can be heavier for people who function in areas with uneven terrain, active amputees, golfers, and dancers
43
describe energy storage/dynamic response foot
leaf spring (metal or nylon) keel stores energy during 2nd rocker and releases it in the 3rd rocker as cadence or activity level increases, more spring comes into play resulting in greater return
44
describe multi acial dynamic response feet
combo of articulated foot and dynamic response closest to the functional foot replacement
45
describe hydraulic feet
multiaxial with vertical shock absorption energy return expensive, not as durable smooth rollover
46
describe microprocessor/power feet
identifies slopes and stairs after first step during gait, automatically provides DF during swing phase that allows sufficient ground clearance active ankle motion also allows users to tuck both feet behind their knees when getting up from a chair or sitting down automatically PFs the foot for more natural appearance when seated
47
advantages of microprocessor feet
provides push off increased self selected gait velocity 9.9% less energy expenditure
48
disadvantages for microprocessor feet
poor battery life heavy expensive
49
types of alignment to look at for prosthetics
"bench" alignment static = sitting/standing dynamic = gait, STS, and stairs/ramps
50
things to look at with static standing alignment assessment
equal weight distribution? level pelvis? ASIS, IC, PSIS? foot in plantigrade? knee position? position of pylon? pain?
51
alignment parameters to look at
1. leg length 2. heel height 3. transverse plane foot RT 4. socket sagittal plane alignment 5. foot AP alignment 6. socket frontal plane alignment 7. foot ML alignment 8. DF/PF
52
why do some prosthetics have adjustable heel height
to accommodate different styles of shoes
53
how is the prosthetic generally placed in transverse plane RT
typically mimics anatomical normal of 5-7 deg of toe out
54
why might a socket be placed in flexion and how does this affect the alignment
may be to accomodate knee flexion contracture dampens shock and smooths COM rise and fall will prevent genurecurvatum helps resist tendency of residual limb to slide into socket and potentially bottom out no change in sagittal plane moments
55
why might a socket be placed in extension and how does this affect the alignment
to attempt to correct knee flexion contracture peak knee flexion moments increased peak knee extension moments decreased
56
anterior and posterior translation of the socket has what effect on the prosthetic foot
anterior socket translation = posterior translation of foot posterior socket translation = anterior translation of foot
57
what happens with socket adduction
foot must be laterally displaced increased knee valves moment mimics medial translation of the socket
58
what happens with socket abduction
foot must be medially displaced increased knee varus moment mimics lateral translation of socket
59
what happens with the foot of the prosthetic is placed lateral to the socket (socket medial to foot)
widens BOS increased knee valgus moment
60
what happens when the foot of the prosthetic is placed medial to the socket (socket lateral to the foot)
maintains fairly normal BOS and loads more pressure on medial residual limb decreases pressure on fibular head increases knee varus moment
61
types of prosthetic knees
single axis hinge ploy centric linkage constant friction variable friction pneumatic hydraulic microprocessor
62
describe single axis knee joint
simple hinge mechanism light weight K level 1
63
describe polycentric knee joint
have 4 or more pivoting bars provide greater knee stability than single axis
64
describe constant friction mechanism
amount of friction doesn't change for set cadence/walking speed K1/K2
65
describe variable friction mechanism
friction changes during swing 1. initial swing = high friction to prevent excess knee flexion 2. midswing = friction decreases to allow knee to swing easily 3. terminal swing = increase in friction to prepare for IC. K3/K4
66
describe pneumatic (air) friction control system at the knee
compresses air as knee is flexed, stores energy, then energy is retuned to put knee into ext
67
describe hydraulic (fluid) friction control system
provide more friction and smoother gait heavier, more expensive, require more maintenance use a liquid medium such as silicone
68
describe microprocessor knees
K2-K4 sensors detect movement and timing then adjusts pneumatic or hydraulic control as needed benefits = decreased falls, more active, enhanced confidence heavier, expensive, need battery
69
why might a TFA socket be placed in flexion and what is the effect
to accomodate hip flexor contracture weight line (TKA line) shifts posterior to the knee joint center = increased knee flexion moment
70
describe the control mechanisms for knee stability
alignment of knee joint axis in the sagittal plane inherent mechanical stability of knee voluntary control swing muscular power microprocessor controlled
71
key components of prosthetic training for a pt with bilateral TFA
1. build confidence- work on strength, endurance, weight management, and psychological stress 2. start with short prosthetic limbs "stubbies" w/o knee joint - COM lower to ground - reduce fall risk - less energy expenditure - help improve strength 3. gradually increase prosthetic height 4. pt will progress to full length/long prosthetic limbs with knee component
72
commonly observed step length/single leg stance time asymmetries
stance time = prosthetic < intact step length = prosthetic > intact if short step is observed on prosthetic side, possible cause = knee flexion contracture
73
factors that contribute to step length/single leg stance time asymmetries in pts with prosthetic limbs
pt confidence pain proper weight shifting needs gait training
74
causes of contralateral vaulting deviation
residual limb discomfort fear of stubbing toe short residual limb painful hip/residual limb
75
causes of hip hike deviation
weakness of hip flexors difficulty initiating knee flexion
76
causes of circumduction deviation
abduction contracture poor knee control - inability to initiate knee flexion weakness of hip flexors lack of confidence/training to flex knee painful anterior distal residual limb
77
prosthetic causes of swing phase deviations (i.e. contralateral vaulting, hip hike, circumduction)
long prosthesis locked knee inadequate suspension loose socket foot plantar flexed
78
functional significance of swing phase deviations
assist with foot clearance increases energy expenditure due to displacement of COM
79
prosthetic causes of ipspilateral trunk lean during prosthetic limb stance
prosthetic length too short sharp or high medial wall (TFA/KD) prosthetic aligned in abduction (TFA/KD)
80
anatomical causes of ipsilateral trunk lean during prosthetic limb stance
poor gait training inadequate loading of prosthesis abduction contracture weak abductors hip pain instability short residual limb lack of proprioception poor balance hypersensitive or painful residual limb

Year 3: Prosthetics and Orthotics (10 decks)

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