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Lower Extremity III > Week 2- TransTibial > Flashcards

Week 2- TransTibial Flashcards

(117 cards)

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1
Q

What is considered a very short Transtibial?

A

Less than three inches

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2
Q

What is considered a short Transtibial?

A

3-5 inches

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3
Q

What is considered a normal transtibial?

A

3-7 inches

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4
Q

What is considered a long transtibial?

A

Greater than 7 inches

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5
Q

What is a symes amputation?

A

Removal of the tibia and fibula above the malleoli and covering it with the heel pad.

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6
Q

What is an ankle disarticulation?

A

Does not cut through the periosteum but may adjust the pointiness of the tibia and fibula and wrap the heel pad around it.

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7
Q

What does PTB stand for

A

Patellar Tendon Bearing

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8
Q

What does TSB stand for?

A

Total Surface bearing

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9
Q

What are the pressure intolerant areas of a PTB socket?

A

Patella
Fib head
Distal end of fib and tib
Medial side of Tibial plateau

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10
Q

What are the pressure tolerant areas of a PTB?

A

The Patellar tendon bar

The length of the fibula and tibia

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11
Q

What shape does the PTB create?

A

A triangular shape

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12
Q

What are the indication for a PTB?

A 
Previous wearer
Extreme Atrophy 
Selective Hot Spots 
•  Neuromas 
•  Callusing
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13
Q

Where are the pressures during initial contact?

A

Has greater Distal anterior pressure

Greater Proximal posterior pressure

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14
Q

What are the pressures during Loading Response?

A

less pressure distally

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15
Q

What are the pressures during Terminal Stance?

A

More pressure proximal anterior and distal posterior

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16
Q

What should be the main goal of the socket?

A

Distribute pressures from intolerant areas to tolerant areas

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17
Q

What are the different types of support or interface options for PTB sockets?

A

Lines
Hard
Soft
Air Cushioned

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18
Q

What is an example of a lined interface for a PTB socket?

A

Pelite liner or similar

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19
Q

What is an example of a hard interface for a PTB socket?

A

Hard Plastic

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20
Q

What is an example of a soft interface for a PTB socket?

A

Distal pad

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21
Q

What is an example of a air cushioned interface for a PTB socket?

A

Flexible liner

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22
Q

What are the different types of suspension options for a PTB?

A

Cuff
Side Joint and Thigh Lacer
Supracondylar
Supracondylar/suprapatellar

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23
Q

What are examples of a cuff suspension for a PTB socket?

A

Leather or Dacron

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24
Q

What is an example of a supracondylar suspension for a PTB socket?

A

Supracondylar lateral brim-Fixed or removable medial wedge

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25
What is an example of a supracondylar/suprapatellar suspension for a PTB socket?
Supracondylar lateral brim-Suprapatellar anterior brim
26
What is assumed for a TSB socket?
Even distribution of pressures | Total contact fit
27
What are the indication for a TSB socket?
Majority of Patients Mild to Moderate Atrophy Patients with Skin Conditions or considerations Unstable volume or Edema
28
What does a TSB often involve?
A gel liner
29
Which socket should be used when the patient has a very short fibular compared to Tibia?
PTB
30
Which socket should be used when the patient has a bulbous end?
TSB
31
What is the definition of a flexed socket?
The Proximal socket moves anterior in relation to the distal end
32
What is the definition of an abducted socket?
The distal end of the limb is in an abducted position. The lower leg of the prosthesis will compensate.
33
Where should the foot be in relation to the blumbob line?
12mm or 1/2 inch inset or directly under line.
34
What is the bench alignment for the foot bolt?
1 inch anterior to the midline of the lateral brim of the socket
35
What is the bench alignment of flexion?
5-10 degrees of flexion
36
What is the bench alignment for adduction?
2-5 degrees of adduction
37
What produces a flexion moment of the knee?
Force proximal posterior and distal anterior
38
What produces a varus moment of the knee?
Force proximal lateral and distal medial
39
What produces an extension moment at the knee?
Force distal posterior and proximal anterior
40
What produces a valgus moment at the knee?
Force distal lateral and proximal medial
41
What moment at the knee is desired at midstance?
Varus moment at the knee
42
What is never desired at midstance?
A Valgus moment
43
What influences the amount of force?
The distance. | The bigger the distance the greater the force
44
What is the equation for pressure?
Pressure=force/area
45
What are the forces in the coronal plane of the socket/
Fulcrum at MTP Distal Lateral Forces Proximal Medial Forces Loading Pressure Tolerant Areas
46
What are the forces in the sagittal plane of the socket?
Proximal Posterior Anterior Pre-tibials Proximal Anterior Patellar Tendon
47
What are the biomechanical goals for a socket?
Maximize the weight-bearing capacity of the residual limb Provide ML stability at Mid-Stance on the prosthetic side Encourage knee flexion throughout stance phase
48
How do you maximize weight-bearing capacity?
``` Even distribution of forces Inclination of forces •  Loads pressure tolerant anterior surface •  Encourages knee flexion at heel strike •  Prevents knee hyperextension Total contact •  Minimize edema •  Increase proprioception •  Improve weight bearing ```
49
How do you provide ML stability at Mid-stance?
Floor reaction line is medial to the knee joint (NHL) Varus moment at mid-stance (NHL) •  Prosthetic Alignment: Foot initially inset at 12mm (medial) •  Excessive Varus Moment: •  Increased distal-lateral and proximal-medial pressure Insufficient Varus Moment: •  Valgus moment produced •  Proximal-lateral and distal-medial pressure
50
What occurs when distal-lateral and proximal-medial are loaded?
Base of support is narrowed •  Decrease in energy expenditure •  Loads pressure tolerant areas and relieved pressure sensitive areas
51
What happens to the force when mass is increased?
Force increases on the limb
52
What happens to the force when the foot is excessively inset?
Increase force on the limb
53
What happens to the force when the limb is lengthened or long?
decrease force on the limb
54
What happens to the force when the trimlines are increased?
decrease force on the limb
55
How do you encourage knee flexion throughout stance phase?
``` Prosthetic Alignment: •  Initial foot placement at 37mm posterior to ankle bolt •  Foot is dorsiflexed •  Socket aligned with 10o flexion •  Proper heel stiffness ```
56
What could be the problem when there is excessive knee flexion at early stance?
heel too firm, foot too DF, excessive socket flexion, foot too far posterior, heel too high, shoe too tight, keel too soft
57
What could be the problem when the knee is too hyperextended at late stance?
Foot too far anterior, foot too PF, inadequate flexion of socket, heel too soft, keel too stiff
58
What could be the problem when there is Premature loss of anterior support at late stance (drop off)?
Foot too far posterior, foot size too small, keel too soft.
59
What are the different modes of suspension?
``` Joint and Corset Suspension Belt or Cuff Suspension Compression Sleeve Suspension Anatomical •  Supra-Condylar (SC) •  Supra-Condylar, Supra-Patellar (SCSP) Suction/Expulsion Valve Suspension Elevated Vacuum ```
60
What are the indications for using a joint and corset suspension?
Incorporates thigh weight bearing-for patients who cannot weight bear on limb Improves ML stability Heavy duty user Patient preference Hyperextension problems- has back check to encourage flexion
61
What are the advantages of joint and corset suspension?
Increases weight bearing surface Unloads the residual limb Increases ML stability Knee extension control
62
What are the disadvantages of the joint and corset suspension?
Heavy, un-cosmetic, inherent pistoning
63
What are the contraindications for using a joint and corset suspension?
New users- combersom and can cause atrophy of the thigh
64
What are the indications for Supracondylar cuff?
Many of TT users prefer Patients with stable ligaments Juvenile patients-easily adjustable Long residual limbs
65
What are the contraindications for the supracondylar cuff?
Unstable ligaments- suspension can exacerbate the problem by allowing more movement at the knee
66
What are the advantages of the supracondylar cuff?
Provides good suspension over patella Adjustable Can be used in combination with waist belt
67
What are the disadvantages of the supracondylar cuff?
Can be restrictive | Does not increase ML stability, un-cosmetic
68
What can be used instead of the suspension cuff?
A figure 8 strap
69
What are the materials that can be used for a sleeve suspension?
Silicone | Neoprene sleeve
70
What are the indications for a sleeve suspension?
Many of TT users prefer Patients with stable ligaments Juvenile patients Long residual limbs
71
What are the advantages of the sleeve suspension?
Provides excellent suspension Conceals trim lines Variety of materials available
72
What are the disadvantages of the sleeve suspension?
Can cause skin problems Can increase perspiration, hard to don May not be indicated for vascular patients
73
Where does the sleeve suspension have to be touching in order to suspend?
The patients skin posteriorly | The socket distally
74
What are the contraindications for sleeve suspension?
Upper extremity involvement | Poor circulation-can compress and cause further circulation problems
75
What are the indications for the supracondylar/patellar?
Patients with very short residual limbs Patients requiring ML stability Patients who want less straps
76
What are the advantages of the supracondylar/patellar?
Increase weight bearing surface Improved ML stability Improves cosmesis
77
What are the disadvantages of the supracondylar/patellar?
Can inhibit some motion and activity Difficult to use on obese or muscular Difficult to kneel on
78
What is the trimline for the patella on a supracondylar/patellar?
Patella is enclosed in trimline
79
What are the indications for a supracondylar suspension?
Patients with very short residual limbs Patients requiring ML stability Patients who want less straps
80
What are the advantages of the supracondylar supsension?
Less restrictive than PTB-SC | Improved cosmesis
81
What are the disadvantages of the supracondylar supsension?
Loss of rigid hyperextension stop | Difficult to use on obese or muscular
82
What are the indications for the silicon suction?
Patients with good subcutaneous tissue Full function of upper extremities Want less straps
83
What are the advantages of the silicon suction?
Excellent suspension Eliminates pistoning Increased proprioception Good torque absorption
84
What are the disadvantages of the silicon suction?
Can be difficult to don | Good hygiene is required-can have bacterial problems in not cleaned properly
85
What are the indications for the vacuum and suction suspension?
Patients with good subcutaneous tissue Patients who want less straps Patients who can’t tolerate distal pulling from a lock and pin
86
What are the advantages of the vacuum and suction suspension?
Excellent suspension Eliminates pistoning Increased proprioception
87
What are the disadvantages of the vacuum and suction suspension?
Maintenance is required Can loose vacuum Can be complicated to use for some
88
What are the different components involved with Transtibials?
``` Socket •  PTB, TSB •  Endo, Exo Suspension •  Joint and corset, cuff, sleeve, silicone suction, vacuum Interface •  Dependent on socket design Pylon Ankle Feet ```
89
What are three examples of ankle components?
DAS MARS OWW Earthwalk Multi-flex Ankle
90
What are the indication for ankle components?
Torque absorption is needed Special situations Accommodation to various surfaces
91
What are the indications for Shock Absorbers and Rotational Units?
Torque absorption Active users Special situations and activities
92
What are the different prosthetic feet avaliable?
``` SACH Single Axis Multi-Axis Dynamic Response/Energy Storing Multi-Axis Dynamic Response External Power ```
93
What are the indications for SACH feet?
Many lower limb users | Juveniles
94
What are the contraindications for SACH feet?
Active individuals When inversion/eversion is required When knee stability is required
95
What are the advantages of SACH feet?
Cosmetic, quiet, little maintenance
96
What are the disadvantages of SACH feet?
Deterioration of soft materials | No torque absorption
97
What's the indications for single axis feet?
Patients needing knee stability
98
What are the contraindications for single axis feet?
Many lower limb users Active users When torque, inversion or eversion is needed
99
What are the advantages of the single axis feet?
More shock absorption | •  Promotes knee stability
100
What are the disadvantages of the single axis feet?
No torque absorption | Requires bumper replacement
101
What are the indications for multi-axis feet?
Torque absorption needed Special activities Need for in/eversion
102
What are the contraindications for multi-axis feet?
When other components can be used
103
What are the advantages of the multi-axis feet?
Absorbs torque, shock | Foot conforms to surfaces
104
What are the disadvantages of the multi-axis feet?
Cosmesis, increased weight | Increased maintenance
105
What are the indications for dynamic response feet?
Active ambulators | Community ambulators
106
What are the contraindications for dynamic response feet?
One speed ambulators
107
What are the advantages of the dynamic response feet?
Smoother gait, less energy expenditure | Light weight, cosmetic, energy storing
108
What are the disadvantages of the dynamic response feet?
Material durability, limited sizes, expense
109
What are the indications for the MULTI-AXIS DYNAMIC RESPONSE feet?
Active users, Varying cadence ambulators | Community ambulators, Athletes
110
What are the contraindications for the MULTI-AXIS DYNAMIC RESPONSE feet?
Single speed ambulators
111
What are the advantages of the MULTI-AXIS DYNAMIC RESPONSE feet?
Multi-axial capabilities, dynamic response | Energy storing capabilities
112
What are the disadvantages of the MULTI-AXIS DYNAMIC RESPONSE feet?
Expense | Maintenance
113
What are the indications for the externally powered feet?
Potentially, all mildly active ambulators
114
What are the contraindications for the externally powered feet?
K1 level ambulators | Wet or corrosive environments
115
What are the advantages of the externally powered feet?
Anatomical power and propulsion | Anatomical limits for PF and DF
116
What are the disadvantages of the externally powered feet?
Batteries, weight, cost Processing speed Limited environment use
117
What are the basic gait deviations for transtibials?
``` Inadequate flexion or extension Medial or lateral leaning pylon Drop off Erratic movement Heel lever and Toe lever Whip(s) ```

Lower Extremity III (9 decks)

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