Prosthetic Components and Wearing Flashcards
(60 cards)
1
Q
Socket
A
- Portion of the prosthesis that encompasses residual limb
- Made by casting of residual limb; making bony prominences to be built up
- Avoid pressure on bony prominences; weight bear through patellar tendon
2
Q
Transtibial Sockets
A
- Medial and lateral brims extend above femoral condyles for increased stability
- Posterior wall lower medially
- Picking sockets depends on patient’s anatomy
- May need multiple sockets because residual limbs change in size so often the first year
3
Q
Patellar tendon bearing (PTB)
A
- Type of transtibial socket
- Patellar bar - indentation in socket at patellar tendon for WB purposes
- Posterior wall stabilizes and maintains contact of patellar ligament on bar
- Medial tibial flare is other major WB surface
- Relief given at fibular head
- Sockets are total contact but not WB through end so gives change for distal edema
- Socket in 5 degrees flexion but with extension puts pressure forward
4
Q
Total surface bearing (TSB)
A
- Type of transtibial socket
- Distributes pressure throughout residual limb
- Will incorporate PTB components
- Will permit WB on soft tissue of residual limb
5
Q
Supracondylar/Suprapatellar
A
- Type of transtibial socket
- Socket extends above patella
- Similar to PTB with addition of quad bar above patella that goes into quads
- Increased stability particularly for short residual limbs
- Is its own form of suspension
6
Q
Symes amputations
A
- Expandable wall socket
7
Q
Quad socket (square-like)
A
- Transfemoral socket
- Narrow anterior to posterior
- Ischium sits on posterior brim
- Wide medial to lateral
- Abducted femur in stance
8
Q
Ischial containment or ischial ramal containment socket (IRC)
A
- Transfemoral socket
- Narrower medial to lateral
- Pushes femur into anatomical adduction
- Wider anterior to posterior than quad socket
- Improves muscle contraction
9
Q
Marlo Anatomical Socket (MAS)
A
- Transfemoral socket
- most similar to ischial containment but has differences
- Variation of IRC
- Posterior trim line lower than IRC
- Allows more freedom of glut max and improved comfort in sitting
10
Q
Subischial Socket/Elevated Vacuum socket
A
- Transfemoral socket
- Only used with elevated vacuum suspension
11
Q
Interface
A
- What goes between patient and socket
- More interface, more protection from shear forces of socket
- ADds more padding for purposes of WB
12
Q
Sheath
A
- Type of interface
- Very thin nylon
- May be silver impregnated
- Disperse moisture
- Reduce friction/shear on skin
- Helps with patients who get very sweaty
13
Q
Gel Liners
A
- Type of interface
- Can be used for protection or suspension
- Thicker side in front; inside is sticky on skin
- Silicone elastomers or gels
- Urethane - good for custom liners for limbs that have unusual shape or bony prominence
- May be donned directly on skin or over sheath
- Reduce pressure
- Decrease shear
14
Q
Prosthetic socks or ply socks
A
- Type of interface
- Comes in different thicknesses
- Decreases moisture
- Reduce pressure
- Decrease shear
- Adds extra cushioning
- Also used over gel liner to maintain optimal fit of socket with residual limb volume changes
15
Q
Soft insert
A
- Type of interface
- Made of dense foam for further protection
- Good for patients with bulbus distal end - more flexible
- Molded similar to socket
- Separate from socket, don separately
- Extends slightly above trim line of socket
- Should have interface between skin and soft insert but does provide pressure relief
16
Q
Flexible inner socket
A
- Type of interface
- Made of flexible but firm plastic
- Adheres to inside of rigid socket
- Adds cushion; improves pressure distribution
17
Q
Suspension
A
- How prosthesis adheres to body
- Form of suspension is determined by length of limb, shape of residual limb, shape of body/body habitus, sensation/propioception (esp UE), dexterity of individual, cognition
18
Q
Belt Suspension
A
- Type of suspension
- Inverted Y and waist belt (transtibial, elasticized to allow for hip extension & knee flexion, elastic recoil assists with limb advancement during swing, waist belt attaches to Y strap at anterior thigh)
19
Q
Silesian Belt
A
- Type of suspension
- Transfemoral
- Generally not used as sole form of suspension
- Difficult to control rotation of limb inside socket
- Strap secured to lateral socket, buckled around waist or to anterior socket
20
Q
Total elastic suspension (TES) Belt
A
- Type of suspension
- Transfemoral
- Similar to Silesian belt
- Neoprene cuff around socket with velcro secured waist belt
- Not used as only form of suspension
21
Q
Cuff Strap
A
- Type of suspension
- Transtibial
- Thigh cuff, secured with buckle
- Above femoral condyles and proximal brim of patella
22
Q
Thigh Corset
A
- Old form of suspension
- Transtibial
- Corset secured to thigh
- Hinged knee joint
23
Q
Sleeve Suspension
A
- Transtibial
- Neoprene and other elasticized material with silicone inside
- Fits snug around thigh
- Must be incontact with skin for several inches if using other interface
24
Q
Locking or suspension liners
A
- Gel liners for comfort or shock absorption that has some sort of suspension to them
- Types: Pin locking, strap suspension, KISS, coyote lock
25
Pin locking
- Transtibial or transfemoral
- Pin secured to end of gel liner and will drop in hole in prosthesis
- Shuttle lock at bottom of socket
- Push button on outside to release
- Allows for rotation
26
Strap suspension
- Transtibial or transfemoral
- Strap secured to end of gel liner
- Feeds through hole in bottom of socket
- Velcros back on itself once fed through D ring attached to outside of socket
- Allows for rotation
27
KISS (Keep it simple suspension)
- Transfemoral
- Same as strap suspension distally
- Has window in upper part of socket for strap
- Has buckle attached to anterolateral thigh which feeds through hole in socket
- Strap attaches back onto buckle vs. D ring on outside of socket
28
Coyote lock
- Transfemoral
- Looks like ski-boot clip
- Buckle attached to anterolateral thigh feeds through hole in socket
- Locks into attachment on outside of socket
- Can help prevent more rotation than suspension
29
Suction Suspension
- Not appropriate for patients with fluctuating edema
| - Types: True/pull-in, seal-in, elevated vacuum
30
True Suction/Pull-in suction
- Transfemoral more common
- Negative pressure, one way air valve
- Skin to socket, no interference
- Dooming sock/parachute
- Lubricant
- Do not use with new amputee
31
Seal in suction
- Transfemoral or transtibial
- Negative pressure, one way air valve
- Cushion liner with rubber seal
- Donning parachute
- Can use ply socks with bottom cut off but cannot cover gasket
32
Elevated vacuum
- Transfemoral or transtibial
- Creates negative pressure via vacuum pump on outside of socket
- Cushion liner with rubber seal
- Helpful for short residual limbs
- More expensive than other suspensions
- Most intimate
33
Initial wearing
- Progress much like wearing an orthosis (begin about 1-2 hours)
- Patient education (skin checks before or after; areas that blister; decreased ability for temp regulation; increased potential for shearing; should not wear lotions on skin; should not shave; volume changes)
34
Selection of Dynamic Prosthetic Components
1. Cognition
2. Functional goals
3. Functional level
4. K levels
5. Amputee Mobility Predictor Assessment
35
K0
- Patient does not have ability or potential to ambulate or transfer safely with or without prothesis
36
K1
- Patient has ability or potential for transfers or ambulation on level surfaces only at a fixed cadence
37
K2
- Patient has the ability or potential for ambulation with low-level environmental barriers
38
K3
- Patient has the ability or potential for ambulation with variable cadence and can traverse most environmental barriers
39
K4
- Patient has ability or potential for ambulation and activities that exhibit high impact stress or energy levels
40
AMPPRO
- Used for single LE amputation of any level with prosthetic donned
- Can be done with or without assistive device
41
AMPNOPRO
- Used for single LE amputation without a prosthesis
42
AMP-B
- Bilateral LE amputation with bilateral prosthesis donned
43
Toe fillers
- Improve gait kinematics and prevent mobility and shearing inside shoes
- Insert in bottom of shoe with custom lace up shoe/boot
- Foot orthosis with attached filler for toes
- Symes feet - similar to other feet but made with lower profile
44
K1 feet
- Solid ankle, cushion heel (SACH foot)
- Heel allows for shock absorption
- Flexibility for toe off comes from rubber forefoot
45
K2 feet
- Single or multi-axis ankles
- Flexible heel
- Full length toe
- Adjustable flexibility
- Much more stable than K3
46
K3 feet carbon fiber
- May be called energy storing or dynamic response feet
- Full length toe, split toe design
- Split toe - helps with pronation, supination, inversion, eversion
- Multi-axial ankles
- Adjustable flexibility of plantarflexion response
47
K3 microprocessor
- Respond to changes in terrain
- Adjust PF and DF to inclines
- Weights more than carbon fiber
- Most have split toe design
- BiOM generates PF power to replicate gastroc
- Must be customized/programmed and requires charging
48
K4 feet
- Special activity feet for running, swimming, rock climbing, cycling, and skiing
49
Covers & Add-ons
- Torsion rotator - decrease impact on leg and knee; can add height
- Shock absorber - decrease impact on leg and knee
- Adjustable heel height
- All feet except K4 have cover to fit in shoes and provide lifelike appearance
- Knee rotator for transfemoral prosthesis allows for prosthetic components to rotate at attachment at socket
- Silicone covers/cosmetic covers are not covered by insurance
50
Pylon exoskeletal
- Transtibial socket is attached to ankle via hard frame shaped to match the contralateral limb
- Durable
- Difficult to adjust
51
Pylon endoskeletal
- Most common
- Generally tubular structure connecting socket to ankle
- May or may not be covered to provide lifelike shape & appearance
- Highly adjustable
- Modular parts
52
Integrated pylon
- Foot is continuous with pylon
- Lightweight
- Decreased adjustability
53
K1 prosthetic knee
- Single axis knee
- Hinge that swings freely from flexion to extension; most have locks because of poor stability
- Constant friction determines speed of swing
- Unable to vary cadence
- May have extension assist
- Difficult to stabilize in stance
- May have manual lock and can be used when locked in extension
54
K2 polycentric knee
- Also called four knee bar
- Moving center of rotation based on several hinges that work in relation to one another
- Shortens once flexed, improved symmetry of gait for patients w/ long residual limb
- Unable to vary cadence
- Improved stability in stance
55
K2 weight-activated stance control knee
- Essentially a single axis knee but with breaking mechanisms
- Break is weight reactive to prevent further flexion while WB
- Provides increased stability during initial contact and throughout stance
56
K3 & K4 pneumatic knees
- Use of air pressure & compression to control knee extension
- Increased compression force yields increased speed of extension
- Allows for variable cadence
- Can be affected by temperature (cold worse)
57
K3 & K4 Hydraulic knees
- Similar mechanism as pneumatic knee but uses fluid
- Heavier than pneumatic knee but more consistent due to increased density of fluid
- Can be affected by temperature (cold worse)
58
K3 & K4 swing and stance (SNS)
- Combination of hydraulic knee with weight activated stance control
- Allows for break in flexion while WB
59
K3 & K4 microprocesser
- Use of sensors determines relationship of knees to ankle jt, pressure of ground forces, speed & direction of acceleration
- All used to determine flexion v. extension and speed of progression into knee extension
- Must be customized via computer
60
Bilateral transfemoral prosthesis - stubbies
- Used for initial prosthetic training to achieve ability to balance, core stability, weight shift, and ambulate without added complexity of knee joints
- Sockets are same as other sockets
- Have short pylons and feet are flat discs/ovals
- Heights can be progressed
