15. Prosthetics

Question 1

What type of prosthetic system is characterized by a hard, plastic outer shell and hallow inside? What’s another name for it?

Answer 1

Exoskeletal System - Crustacean

Question 2

What are the advantages and disadvantages of an Exoskeletal System?

Answer 2

Advantages: - Durable Disadvantage: - Cosmetic - Lack of easy adjustments - Increased weight, especially at higher amputation levels

Question 3

What type of prosthetic system is characterized by a pylon system covered by a soft outer shell? What’s another name for it?

Answer 3

Endoskeletal System - Modular

Question 4

What are the advantages and disadvantages of an Endoskeletal System?

Answer 4

Advantages: - Cosmetics - Weighs less, especially at higher amputation levels - Can change components - Permanent alignment adjustability *It is possible to make angular, linear and height changes in the alignment of the prosthesis after it has been finished Disadvantage: - The soft foam cover is less durable and may often need to be replaced

Question 5

What’s the best ankle foot assembly for a trial or someone with no insurance? Why?

Answer 5

SACH Foot - Cheaper than Articulated Foot

Question 6

Which Prosthetics foot is made up of… - Wooden or Metal Keel - Rubber like body - Wedges - Toe Belting

Answer 6

SACH Foot

Question 7

What are the advantages and disadvantages of an SACH Foot?

Answer 7

Advantages: - Cosmesis - Shock absorption - Quiet - Little maintenance *components lighter than articulated foot Disadvantages: - Deterioration of soft material - No torque absorption - Moderate durability

Question 8

What type of people are SACH Feet contraindicated for?

Answer 8

• Active amputees - Amputees that lack knee stability - Amputees requiring torque absorption or inversion/eversion (saggital foot movement)

Question 9

What type of action does a uniaxial foot provide?

Answer 9

Plantar/Dorsiflexion

Question 10

Give one type of foot prosthetic that is good for a community level ambulator.

Answer 10

Uniaxial (single axis)

Question 11

What type of indications are SACH Foot for?

Answer 11

• Majority of Lower limb amputees - Juveniles

Question 12

What type of patient is a Uniaxial Foot Prosthetic indicated for?

Answer 12

Patient that requires more knee stability (doesn’t have knee stability)

Question 13

Which prosthetic foot has the action of… - Toe section that bends by deforming soft material - Ankle dorsiflexion and plantarflexion

Answer 13

Uniaxial Articulated

Question 14

What are the advantages and disadvantages of an Uniaxial Prosthetic Foot?

Answer 14

Advantages: - Somewhat smoother push-off action - More shock absorption (posterior bumper) - Promotes knee stability (in those lacking) Disadvantages: - Toe sets dorsiflexed (extended) - No torque absorption - Frequent bumper replacement

Question 15

Which prosthetic foot has components such as… - Toe apron and sole in one piece rubber or polyurethane foam - Belting - Ankle bolt - Plantarflexion bumper (* dorsiflexion bumper in pg.1368)

Answer 15

Uniaxial Articulated

Question 16

What type of patient is a Uniaxial Foot Prosthetic contraindicated for?

Answer 16

• Majority of lower-limb patients (most use SACH Foot) - Active patients (no torque, limited movement) - Patients requiring torque absorption and inversion/eversion

Question 17

What type of addition can provide the action of… - Internal and external rotation - Adjustable range of rotation

Answer 17

Transverse Rotation Unit

Question 18

What are the advantages and disadvantages of an Transverse Rotation Unit?

Answer 18

Advantages: - Absorbs torque - Can be used with SACH foot (*book says also uniaxial foot) - Can be place in shin or thigh section Disadvantages: - Cosmetics - Maintenance - Weight

Question 19

What type of patient is a Transverse Rotation Unit indicated for?

Answer 19

• Active Patient - Patient requiring torque absorption - Specific functions

Question 20

What type of patient is a Transverse Rotation Unit contraindicated for?

Answer 20

• A patient that does not require torque absorption

Question 21

An energy storing device can have only a toe section, but what makes it a true energy storing system?

Answer 21

Having a heel and toe energy storing capacity

Question 22

An athlete that uses an energy storing foot for running typically uses less energy than a healthy limb. T/F

Answer 22

False (the stored energy propels them to run very fast and they perform like a normal limbed person. Doesn’t compromise energy or limit endurance)

Question 23

What is a Dynamic Response Energy Storing Foot’s actions?

Answer 23

• Heel wedge compression - Compression of internal mechanism from midstance to heel-off - Dynamic push-off of keel from stored energy - Some feet provide inversion eversion and rotation

Question 24

What are the advantages and disadvantages of an Energy Storing Feet (Dynamic Response)

Answer 24

Advantages: - Smooth gait - Less energy expenditure (vs other prosthetics) - Very light weight - Cosmesis - Dynamic energy component Disadvantages: - Durability of new materials not known - Variety of sizes limited in women and juvenile styles - Expensive

Question 25

What type of patients are Energy Storing Feet (Dynamic Response) contraindicated for?

Answer 25

- Household ambulators - One speed ambulators

Question 26

What type of patients are Energy Storing Feet (Dynamic Response) indicated for?

Answer 26

- Active Patient - Community ambulators

Question 27

Which prosthetic foot has components such as... - Soft heel cushion - High tech material for keel mechanisms - Soft toe function

Answer 27

Energy Storing Foot (Dynamic Response)

Question 28

Which prosthetic addition has components such as... - Rotation inner assembly - Torque bearings

Answer 28

Transverse Rotational Unit (Multiaxial)

Question 29

What are the advantages and disadvantages of a PTB Supracondylar prosthetic?

Answer 29

Advantages: - Less restrictive than PTB SC-SP (can have SP without SC. Very unlikely) - Improves cosmesis Disadvantages: - Does not provide a rigid hyperextension stop - Can be difficult to achieve suspension on patients with obese of muscular thighs

Question 30

What are the advantages and disadvantages of a PTB Supracondylar, Suprapatellar prosthetic?

Answer 30

Advantages: - Increase the weight bearing surface - Provides a rigid hyperextension stop - Increases M-L stability - Improves cosmesis Disadvantages: - Enclosing patella can inhibit some activities - Difficult to achieve suspension on patients with obese or muscular thighs

Question 31

What are the advantages and disadvantages of a PTB with Supracondylar Cuff prosthetic?

Answer 31

Advantages: - Provides good suspension over the patella - Adjustable - Provides kinesthetic hyperextension stop - Can be used in combination with a waist belt Disadvantages: - Can be restrictive in sitting - Does not provide maximum M-L stability - Increased time required to don - Can be uncosmetic

Question 32

What type of patient is a PTB Supracondylar indicated for?

Answer 32

Indications: - Patients who require increased M-L stability - Patients who want unrestricted knee extension\* - Patients who request less suspension straps

Question 33

What type of patient is a PTB Supracondylar, Suprapatellar indicated for?

Answer 33

- Patients with short to very short residual limbs\* - Patients requiring increased M-L stability - Patients who request less suspension straps

Question 34

What type of patient is a PTB Supracondylar with Cuff indicated for?

Answer 34

- Majority of Transtibial amputees\* - Patients with good ligamentous structure\* - Juvenile amputee\* - Patients with longer residual limb lengths

Question 35

What are the advantages and disadvantages of a PTB Supracondylar with Removable Wall prosthetic?

Answer 35

Advantages: - Can be more cosmetic around the proximal thigh - May be easier to don than the conventional PTB SC prosthesis\* Disadvantages: - Components can make the prosthesis heavier\* - Can increase the bulk around the knee\*

Question 36

What are the advantages and disadvantages of a Transtibial Prosthesis with Joints and Corsets?

Answer 36

Advantages: - Increases the weight-bearing surface\* - Unloads the patient’s limb\* - Provides maximum M-L stability\* Disadvantages: - Heavy - Uncosmetic - Inherent pistoning\*

Question 37

What type of patient is a PTB Supracondylar with Removable Wall indicated for?

Answer 37

Indications: - Patients with large differences between the M-L dimension of the knee and the proximal M-L dimension of the thigh

Question 38

What type of patient is a Transtibial Prosthesis with Joints and Corsets indicated for?

Answer 38

Indications: - To increase weight-bearing - To improve M-L stability - Patient preference\*

Question 39

Within the Overview of Prosthetic Feet, what are the general characteristics to be had of a S.A.C.H.?

Answer 39

- Durability - Simplicity

Question 40

Within the Overview of Prosthetic Feet, what are the general characteristics to be had of a Single-Axis?

Answer 40

- Rapid foot flat (plantarflexion after heel strike)

Question 41

Within the Overview of Prosthetic Feet, what are the general characteristics to be had of a Multi-Axis?

Answer 41

- Hindfoot Inversion/Eversion - Transverse Rotation

Question 42

Within the Overview of Prosthetic Feet, what are the general characteristics to be had of an Elastic Keel?

Answer 42

- Smooth Rollover - Shock Absorbtion

Question 43

Within the Overview of Prosthetic Feet, what are the general characteristics to be had of a Dynamic Response?

Answer 43

- Active Push-Off (toe off)

Question 44

Within the Overview of Prosthetic Feet, what are the general indication(s) to be had of a S.A.C.H.

Answer 44

- Utility (easy, go to for many) - Juveniles

Question 45

Within the Overview of Prosthetic Feet, what are the general indication(s) to be had of a Single-Axis?

Answer 45

- Need of increased knee stability

Question 46

Within the Overview of Prosthetic Feet, what are the general indication(s) to be had of a Multi-Axis?

Answer 46

- Accommodate uneven terrain

Question 47

Within the Overview of Prosthetic Feet, what are the general indication(s) to be had of an Elastic Keel?

Answer 47

Ease of ambulation

Question 48

Within the Overview of Prosthetic Feet, what are the general indication(s) to be had of a Dynamic Response?

Answer 48

High Activity

Question 49

Within the Overview of Prosthetic Feet, how expensive are the cost of a S.A.C.H?

Answer 49

Low

Question 50

Within the Overview of Prosthetic Feet, how expensive are the cost of a Single-Axis?

Answer 50

Low-Moderate

Question 51

Within the Overview of Prosthetic Feet, how expensive are the cost of a Multi-Axis?

Answer 51

Moderate-High

Question 52

Within the Overview of Prosthetic Feet, how expensive are the cost of an Elastic Keel?

Answer 52

Moderate

Question 53

Within the Overview of Prosthetic Feet, how expensive are the cost of a Dynamic Response?

Answer 53

High-Very High

Question 54

Within the Overview of Prosthetic Feet, what is the weight range of a S.A.C.H.?

Answer 54

Low-Medium

Question 55

Within the Overview of Prosthetic Feet, what is the weight range of a Single-Axis?

Answer 55

Medium-Heavy

Question 56

Within the Overview of Prosthetic Feet, what is the weight range of a Multi-Axis?

Answer 56

Medium-Heavy

Question 57

Within the Overview of Prosthetic Feet, what is the weight range of an Elastic Keel?

Answer 57

Low/Light-Moderate

Question 58

Within the Overview of Prosthetic Feet, what is the weight range of a Dynamic Response?

Answer 58

Very Light-Heavy

Question 59

Within the Overview of Prosthetic Feet, how is the reliability of a S.A.C.H.?

Answer 59

Very High

Question 60

Within the Overview of Prosthetic Feet, how is the reliability of a Single-Axis?

Answer 60

Moderate

Question 61

Within the Overview of Prosthetic Feet, how is the reliability of a Multi-Axis?

Answer 61

Moderate

Question 62

Within the Overview of Prosthetic Feet, how is the reliability of an Elastic Keel?

Answer 62

Moderate

Question 63

Within the Overview of Prosthetic Feet, how is the reliability of a Dynamic Response?

Answer 63

Moderate-High

Question 64

Within the Overview of Prosthetic Feet, what is the performance expectations of a S.A.C.H.

Answer 64

Low

Question 65

Within the Overview of Prosthetic Feet, what is the performance expectations of a Single-Axis?

Answer 65

Low

Question 66

Within the Overview of Prosthetic Feet, what is the performance expectations of a Multi-Axis?

Answer 66

Moderate

Question 67

Within the Overview of Prosthetic Feet, what is the performance expectations of an Elastic Keel?

Answer 67

Moderate

Question 68

Within the Overview of Prosthetic Feet, what is the performance expectations of a Dynamic Response?

Answer 68

High-Very High

Question 69

What kind of liner should be used for bony residual limbs?

Answer 69

Soft Liner

Question 70

What kind of liner should be used for extensively scarred residual limbs?

Answer 70

Soft Liner

Question 71

What kind of liner should be used for peripheral/systemic vascular disease?

Answer 71

Soft Liner

Question 72

What kind of liner should be used for volumetrically unstable residual limbs?

Answer 72

Soft Liner

Question 73

What kind of liner should be used for pt preference?

Answer 73

Hard or Soft Liners

Question 74

What kind of liner should be used for well healed soft tissue?

Answer 74

Hard Liner

Question 75

What kind of liner should be used for well padded and muscular limbs?

Answer 75

Hard Liner

Question 76

What kind of liner should be used for good systemic circulation?

Answer 76

Hard Liner

Question 77

What kind of liner should be used for volumetrically stable residual limbs?

Answer 77

Hard Liner

Question 78

Even though not a completely hard material, what is considered to carry the same rules as a hard liner?

Answer 78

Silicon

Question 79

What are sources of weight bearing in a transtibial prosthesis? a. Older: b. Newer:

Answer 79

A: More weight bearing on specific areas (patellar tendon bearing) B: Total Surface Bearing (smaller PTB indentation)

Question 80

What does a SACH foot acronym stand for?

Answer 80

Solid Ankle Heel Cushion

Question 81

How many socks can be added before a new socket will need to be made?

Answer 81

15 plys

Question 82

Why are socks a good acute use and long term use for some patients?

Answer 82

Acute: - Edema - Venous Return Long Term: - Adjustable - Inexpensive

Question 83

What type of suspension would work best for a obese transtibial patient?

Answer 83

Transtibial Prosthesis with Joints and Corset (Corset, Pelvic Strap)

Question 84

What type of foot would work best for a highly active prosthetic patient?

Answer 84

Dynamic Response (Energy Storing Foot)

Question 85

Where are the the sources of weight bearing in a transfemoral prosthesis?

Answer 85

Quadralateral: (4 areas of relief are the 4 areas of redness/ skin checks) - Anteromedial: Adductor Longus T. (Obturator N.) - Anterolateral: Rectus Femoris M. - Posteromedial: Hamstring T. (Sciatic N.) - Posterolateral: Gluteus Maximus M.

Question 86

Where is the source of weight bearing in a transfemoral prosthesis with a plug socket?

Answer 86

.

Question 87

Where does the adductor longus tendon sit in a quadrilateral socket?

Answer 87

Anteromedial

Question 88

Why is the quadrilateral or ischial containment socket set in slight flexion?

Answer 88

Quadrilateral: - Enhance position of ischial tuberosity on posterior brim Ischial Containment Socket: - Facilitates Hip Extensor Contraction - Reduce Lumbar Lordosis - Provide a zone for the thigh to extend for taking steps of equal length

Question 89

What differeienciates a suction socket from a non-suction socket? Explain.

Answer 89

- Suction Socket: Release/Check Valve - Non-Suction Socket: Hole without Valve

Question 90

What patient characteristic are contraindicated for a suction transfemoral socket? (Give 3 examples)

Answer 90

- CHF - Lymphedema - Cancer (Tumor Removal) - Kidney Failure

Question 91

Can you identify seven characteristics on the temporary plug fit transfemoral socket?

Answer 91

- SACH Foot - Uniaxial - Hinge Joint (knee) - Pelvic Strap with Lateral Metal Hinge - Temporary Plug - Padding (posterior for quiet sitting) - Quadrilateral Socket -

Question 92

Why would a patient use a thigh lacer system (Corset) in a transtibial prosthesis?

Answer 92

- Maximum M\L Stability - Good for Obese - Fluctuating Leg Girth - Increased Weight Bearing Load Distribution