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Trans-Fem Prosthetics Flashcards

(95 cards)

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1
Q

What does axial load through amputated side rely on?

A
  • body weight distribution through remaining anatomy
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2
Q

What does coronal plane stability rely on

A
  • socket fit and alignment
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3
Q

What does swing phase control of the prosthetic knee rely on?

A

hip ROM/musculature

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4
Q

what does stance phase control of the prosthetic knee rely on?

A

hip ROM/musculature and manipulation of body weight

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5
Q

3 Types of TF socket Designs

A
  • Quadrilateral
  • Ischial Containment
  • Sub0Ischial
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6
Q

Quadrilateral (Quad) Socket

A
  • Ischial weight bearing
  • Rectangular shape, tight AP
  • Scarpa’s triangle
  • Accommodates functioning muscles
  • Total contact
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7
Q

What is the issue with a quad socket?

A

lack of proximal/medial stabilizing force

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8
Q

Ischial Containment

A
  • boney weight bearing
  • femur stabilization
  • controls transverse forces, triangular
  • has coronal stability unlike quad
  • Ischial weight-bearing + containment on medial side
  • Total Contact
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9
Q

What muscles does ischial containment accommodate

A

hamstrings
adductor longus

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10
Q

advantages of ischial containment

A
  • enhanced stability
  • improved confort
  • less soft tissue distortion/injury
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11
Q

disadvantages of ischial containment

A
  • a lot of variance in design
  • may be challenging to fit well
  • possible ROM restriction
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12
Q

Sub-ischial brim

A
  • hydrostatic loading (controls varus moment through suction or vacuum)
  • improved hip ROM
  • sitting comfort
  • not having ischial containment has a lot of advantages (scissor legs/touching toes)
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13
Q

What should you consider with TF suspension

A
  • additional weight
  • transverse forces
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14
Q

Lanyard

A
  • use for someone with balance issues
  • works well for sock ply- good for someone who is changing volume
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15
Q

Suction - skin fit

A
  • put bare residual limb into socket
  • at bottom, open the valve and pull nylon bag through to create hydrostatic load
  • good for very short residual limb
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16
Q

suction - seal in liner

A
  • most TF will have this liner
  • a lot more soft tissue so seal can just absorb into it
  • a lot of athletes
  • more proximal seal
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17
Q

vacuum

A
  • seal in liner with vacuum
  • liner and suspension sleeve with vacuum
  • seal between outside of liner and inside of socket
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18
Q

TES Belt

A
  • total elastic suspension
  • mostly auxiliary
  • good for peds/congenital limb anomalies
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19
Q

Silesian belt

A
  • non elastic
  • rotation control
  • may be stand alone
  • made out of seat belt material
  • prevents unwanted transverse deviations in the socket
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20
Q

Hip joint and pelvic band

A
  • coronal stability
  • rotation control
  • Someone who has laxity at the hip
  • Previous use
  • Very short/almost hip disarticulation level
  • Very rigid hip joint
  • Involves side is contoured leather
  • Prevents dropping away laterally/Trendelenburg type
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21
Q

Suspenders

A
  • non elastic
  • correction tension to allow flex/ext
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22
Q

what purpose does a knee serve

A
  • Enable sitting
  • Swing phase clearance
  • Efficiency
  • Safety with resistance
  • Accommodate to various postures
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23
Q

how to achieve stability

A
  • Voluntary control
  • Alignment
  • Knee design- mechanics
  • Resistance/friction
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24
Q

To what extent can the patient contribute to stability?

A
  • hip strength (extensors)
  • residual limb length (lever arm)
  • balance, body weight manipulation
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25
TKA Line
- line from troch to ankle - identifies knee inherent stability from an alignment perspective
26
3 knee alignments
* Trigger alignment: directly through the knee * Overly stable: slightly ant - sitting on end (ext) stop - "safe" alignment * Post (unsafe): nothing to rest on - going to bend the way it want to
27
Prosthetic knee- friction
to primarily control knee during swing phase - flexion: limit heel rise - extension: prevent terminal impact
28
two types of friction
mechanical fluid
29
Mechanical Friction
- K1/K2 * Constant force * 1 speed ambulators * Several designs * Light weight * Low maintenance ** medicare only covers friction knees for K1/K2 (will not pay for fluid knee for K2)
30
Fluid Friction
- K3/K4 * Hydraulic or pneumatic * Supports variable cadence * Controlled in a variety of ways * More expensive * Adds weight * ramps up resistance to the force you are putting on it
31
Extension assist
* Limits heel rise to make the knee ext faster (knee responds quicker) * Helps achieve full knee extension * Safety for new users * Adjustable * Add a terminal impact, they should feel when it is fully extended to know when it is safe
32
single axis knee
- less moving parts and simple - lower fabrication cost - less stable at heel strike - one axis to absorb forces applied
33
polycentric knee
- inherent stability at heel strike - easy to initiate swing phase - often heavier - increased maintenance - instantaneous knee center - indicated for long residual limbs - K2 is mechanical friction - K3/4 if fluid friction
34
manual lock knee
- K1 or K2 - optional lever release on socket
35
single axis knee
constant friction (k2) or fluid control (K3)
36
multiaxial knee
- additional stability through geometry - slide/glide articulation at knee
37
microprocessor knee
- sensors to predict action - stumble recovery - real time knee adjustments - allows for step over step
38
TF Biomechanics - Coronal Plane Goals
* ML stability of the pelvis @ midstance * Conserve energy by minimizing lateral displacement of CoG
39
TF Biomechanics - Sagittal Plane Goals
* Provide AP stability of the knee joint during stance, smooth advancement. * Step length symmetry.
40
Coronal Plane - ML stability of the pelvis during midstance
* Slight varus moment of the socket * Minimal socket gapping due to boney lock or other means of stabilization * No trunk compensations
41
coronal plane - varus moment factors
* Prosthetic alignment * Limb length, soft tissue structure * Socket fit
42
More coronal plane stuff
* Foot should start beneath the ischium, should produce a varus moment at the hip * Pelvis drops to unsupported side * Hip abductors fire * Femur ABducts
43
Coronal Plane Socket Design
* Adduction angle: Femoral/pelvic angle is assessed * Lateral wall: Maintains femoral angle * Medial wall height: Counterforce, boney lock * ML dimension * Hip joint and waist belt: If unable to ABduct
44
Alignment in coronal plane
* Inset foot = increased varus moment * Outset foot =decreased varus moment
45
Sagital Plane priority
- AP stability of the knee joint during stance - alignment - voluntary control - knee selection - foot selection
46
softer feet
the softer the feet the easier it is to control the hip
47
sagittal plane alignment
- TKA reference line maintains GRF ANTERIOR to the knee joint
48
sagittal plane - component selection
- knee - foot (single axis foot, heel stiffness)
49
sagittal plane - step length symmetry
* Often a prosthetic socket is pre-flexed * 3-5 degrees beyond Thomas test measure
50
Step length Requirements
* 3 deg lordosis * 5 deg femoral ext * 7 deg knee flexion (stance flexion) * = 15 degrees
51
more step length stuff
* Knee must be fully extended to stand on prosthesis. * 3-10 deg lordosis * 5-12 deg femoral ext * 1st step with sound leg * Accommodation vs therapeutic alignment.
52
Prosthetic cause of gait deviations
* Identify alignment or design aspects of the prosthesis that can cause or contribute to the deviation. * Determine what adjustments or modifications to the prosthesis can be made to correct the deviation
53
amputee cause of gait deviations
* Identify habits, activities or conditions that the patient is doing that can cause or contribute to the deviation.
54
therapy goals
* Determine what therapy or gait training intervention can be provided to assist the patient to correct or address the deviation.
55
medial whip - prosthetic cause
* External rotation of the knee * Tight socket * Incorrect foot rotation
56
medial whip - amputee cause
* Gait habit * Socket not put on properly * External rotation of hip at toe off/hip flexion
57
medial whip - therapy goals
* Encourage proper donning * Strengthen internal hip rotators and hip extensors * Modify activity that may increase external rotation
58
lateral whip - prosthetic cause
* Internal rotation of the knee * Loose socket
59
lateral whip - amputee cause
* Gait habit * Socket not put on properly * Internal rotation of hip at toe off/hip flexion * Tight adductors, int. rotators, flexors
60
lateral whip - therapy goals
* Encourage proper donning * Strengthen external hip rotators * Stretch hip flexors and adductors * Modify activities that increase internal rotation of hip
61
Abducted Gait - Prosthetic Cause
* Prosthesis too long * Medial wall too high * Insufficient femoral stability in socket
62
abducted gait - amputee cause
* Abduction contracture * Pt insecure and wants wide base
63
abducted gait - therapy goals
* Stretch abductors * Strengthen core, residual limb and sound leg * increase proprioception
64
Circumducted Gait - Prosthetic Cause
* Long prosthesis * Excessive knee friction/stability
65
Circumducted Gait - Amputee Cause
* Lack of confidence in flexing knee * Abduction contracture * Weak hip flexors * Habit, using entire hip and pelvis to initiate gait
66
Circumducted Gait - Therapy Goals
* Stretch abductors * Strengthen hip flexors * Gait training
67
Vaulting - Prosthetic Cause
* Long prosthesis (or heavy) * Poor suspension * Excessive plantar flexion of foot * Excessive knee resistance or stability * Inadequate knee extension assist
68
Vaulting - Amputee Cause
* Gait habit, fear of catching toe * Weak or improper initiation of hip flexors on residual limb
69
Vaulting - Therapy Goals
* Strengthen hip flexors * Work on timing and symmetrical pelvic rotation * ADL training
70
Heel Rise - Prosthetic Cause
* Inadequate extension aid * Insufficient knee friction
71
Heel Rise - Amputee Cause
* Excessive use of hip flexors to initiate swing phase, overpowering knee unit
72
Heel Rise - Therapy Goals
* Work on coordination and encourage symmetrical motion of the femurs * Work on timing of flexor firing
73
Knee Instability - Prosthetic Cause
* Excessive dorsiflexion * Knee aligned in unstable position…TKA * poor socket flexion or foot alignment * Incorrect knee settings
74
Knee Instability - Amputee Cause
* Weak hip extensors * Hip flexion contracture
75
Knee Instability - Therapy Goals
* Strengthen hip extensors * Stretch hip flexors
76
Uneven Timing - Prosthetic Cause
* Socket Pain * Weak extension aid * Unstable knee* * Leg length discrepancy * Poor suspension
77
Uneven timing - amputee cause
* Patient insecurity* * Weak hip muscles * Poor balance
78
Uneven Timing - Therapy Goals
* Strengthen hip flexors and extensors * Improve balance and proprioception during ADL
79
Lateral Trunk Bend - Prosthetic Cause
* Foot too far outset * High medial wall * Aligned in abduction
80
Lateral Trunk Bend - Amputee Cause
* Inadequate balance * Short residual limb (or weak GM) * Habit
81
Lateral Trunk Bend - Therapy Goals
* Improve balance * Strengthen core * Activity modification and retraining during ADL
82
Toe Drag - Prosthetic Cause
* Long prosthesis * Excessive plantar flexion * Excessive knee friction
83
Toe Drag - Amputee Cause
* Weak hip extensors * Weak hip abductors on sound side * Poor posture * Poor gait habits
84
Toe Drag - Therapy Goals
* Strengthen hip extensors and hip abductors * Encourage pelvic motion to initiate enough knee flexion for swing phase
85
Wide Gait - Prosthetic Cause
* Prosthesis too long* * Medial wall too high* * Insufficient femoral stability
86
Wide Gait - Amputee Cause
* Abduction contracture * Poor gait habit, patient insecure and desires wide base in belief it will increase stability
87
Wide Gait - Therapy Goals
* Stretch abductors * Strengthen core, residual limb and sound leg
88
Internal Foot Rotation - Prosthetic Cause
* Internal knee rotation * Internal foot rotation * Excessive quad pressure
89
Internal Foot Rotation - Amputee Cause
* Improperly donning socket * Flexed at the hip during gait, typically with walker or crutches, looking down at ground
90
Internal Foot Rotation - Therapy Goals
* Work on donning correctly * More upright position during ambulation
91
External Foot Rotation - Prosthetic Cause
* External knee rotation * External foot rotation * Socket design * Tight adductor channel in socket
92
External Foot Rotation - Amputee Cause
- improperly donning socket
93
external foot rotation - therapy goals
work on donning correctly
94
Skilled therapy should be a combination of :
* Strengthening * ADL analysis, modification and retraining * Proprioception activities * Balance activities * Donning and doffing for consistent alignment * Decrease fear/increase confidence resulting from lack of sensory input in prosthesis
95
I dont feel like we need to know osseointegration but idk maybe im wrong

Prosthetics Final (5 decks)

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