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Prosthetics&Orthotics > L2:P&O: Post-Sx and Early Rehab Phase > Flashcards

L2:P&O: Post-Sx and Early Rehab Phase Flashcards

1
Q

OBJECTIVES:

A
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2
Q

Ray amputations include:

A

Usually 1st and 5th

*breakdown from GRFs

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3
Q

Midfoot amputations

A

Chopart

Lisfranc (TMT Jt.)

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4
Q

Hindfoot (rearfoot) amputations

A

Syme (most common and easiest to fit prosthesis)

Pirogoff

Boyd

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5
Q

Other partial foot and Syme amps

A

Digit amps

Metatarsal amps

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6
Q

Surgeons and prosthetists prefer Syme amputation due to what?

A

Ease of sx and fitting for prosthesis

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7
Q

Surgeons prefer Syme, BUT better function reported for which amps?

A

Lisfranc

Chopart

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8
Q

One complication of any rearfoot sx is _________

A

Muscular imbalances due to severed DFs unable to oppose intact triceps surae

NOTE: Triceps surae is gastroc/soleus complex

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9
Q

Partial foot and Symes amps

preservation of these 2 things is crucial

A

Ankle jt and heel

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10
Q

Challenging for a proper fit prosthesis

A

Length and shape of RL

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11
Q

MORE RL length====

A

More surf area==less pressure==less skin breakdown

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12
Q

Usually partial foot and Symes amps are able to WB w/out prosthesis

T/F??

A

TRUE!!!

*prosthetic protects skin and allows for norm gait mech’s

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13
Q

Partial foot and Symes amps

Clinical presentation

DECd what?

A

DEC strength in lower leg mm’s

DEC surf area→ proprio loss=balance deficits

DECd sensation→ severed nerves

DECd anterior lever arm→ no anatomical rockers remain

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14
Q

PRIMARY GOAL post-sx w/ all partial foot and Syme amps

A

Preservation of remaining foot

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15
Q

SECONDARY GOAL post-sx all partial and Syme amps

A

Maximize gait quality and metabolic efficiency

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16
Q

Partial foot and Symes amps

Gait implications @ IC:

A

may or may not be heel first gait depending on sx

*if can-→ emphasize heel strike if still have calcaneus

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17
Q

Partial foot and Symes amps

Gait implications @ IC→MSt

A

DECd shock absorb due to DECd ecc quad strength

  • pt compensates by keeping knee in EXT (now GRF remains ant. to knee jt)
  • INC likely knee pain/breakdown
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18
Q

Partial foot and Symes amps

Gait implications @ Mst-TSt

A

Early heel rise (prop to length of forefoot)

GRF moves more quickly behind knee jt→ INC need for quad activity

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19
Q

Partial foot and Symes amps gait implications

IC>MSt>TSt

A

see pics

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20
Q

Partial foot and Symes amps

Gait implications @ TSt→PSw

A

W/out prosthesis or toe filler to lengthen foot, active lifting/swinging of foot vs passive rollover and energy storing in triceps surae

Pot for skin breakdown here→ shear forces

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21
Q

Partial foot and Symes amps

Gait implications @ ISw→TSw

A

UNAFFECTED unless limb too long (prosthesis too long or poor fit)

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22
Q

Partial foot and Symes amps

Temporospatial changes

Q&A

A
  • DECd contralat step length
    • Foot down faster
  • DECd velocity
    • Decd step length
  • INC width BOS
    • Balance
  • INC DS time
    • Stability
  • INCd energy expend.
    • less momentum
    • TIP: use UBE***
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23
Q

Partial foot and Symes amps

Gait implications

Normal lever arm vs reduced lever arm and step length results

A

see pics

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24
Q

Partial foot and Symes amps

Prosthetic Mgmt

More proximal amputation (foot/toes)===MORE LIKELY

A

supramalleolar containment needed (support)

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25
Q

Partial foot and Symes amps

Prosthetic Mgmt

Length and flex of the _______ affect the _______ which directly controls __________

A

Length and flex of the forefoot affect the anterior lever arm which directly controls foot and ankle motion

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26
Q

2 Main Goals of foot prosthesis and/or shoes:

A
  1. Anterior support for missing parts of foot→ controlled fulcrum for third rocker of gait
    1. normal step length and gait symm.
  2. Min pressure @ ampd distal end
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27
Q

Toe fillers and modified shoes:

Rocker bottoms assist w/ what?

A

Rollover and DEC plantar surface pressure

*challenge providing enough lever arm support w/out add. pressure to RL

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28
Q

Custom shoe inserts and toe fillers

A
  • Typ w/ hallux or first ray amps
  • Goal: provide flex anterior extension (like Great toe ext.)
    • Improve 3rd rocker during TSt-PSw
    • supports medial arch and normalize GRFs
    • spacers

s

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29
Q

Cosmetic Slippers

A
  • Transmetatarsal amps
  • little biomech. advantages
    • mostly cosmetic

ideal for swimming*

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30
Q

Prosthetic boots

A
  • Gaining pop→ Transmet and Lisfranc and distal amps
  • Greater prox encompassment to reduce distal motion and inc control usually w/ hinged ankle mech.
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31
Q

Syme’s Amps aka

A

Tibiotarsal amputation

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32
Q

Symes Amp

What is it?

A

Disarticulation of the talocrural joint w/ the forefoot completely removed

  • Calcaneal fat pad preserved and anchored to distal tibia
    • ==> limtd distal WB w/out prosthesis
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33
Q

2 Drawbacks to Symes Amps

A
  1. Migration of distal heel pad
    1. usually avoid WB until receive prosthesis
  2. Poor cosmesis→ may shave malleoli to improve
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34
Q

Syme’s Amps

Prosthetic Mgmt

Understand there are diff options

A
  • Walking cast
  • Canadian Symes
    • drawback: posterior panel
  • Medial opening Symes
    • Most commonly used Symes prosthesis
  • Sleeve suspension (stovepipe) Symes
    • slides into flex insert
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35
Q

Most commonly used Symes prosthesis

A

Medial Opening

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36
Q

Bulky, stronger prosthesis chosen for obese or very heavy duty user

A

Sleeve suspension (stovepipe) Symes

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37
Q

NOTE about all Symes prostheses

A

All designed for total contact to improve comfort and dec chance of breakdown

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38
Q

Which is the primary goal of the surgeon to preserver whenever possible?

A

Talocrural Joint!!!!!!

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39
Q

Amputee Evaluation Components

NOTE Categories & Examples

A

See pics and be familiar

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40
Q

Amputee Evaluation Components

NOTE Categories & Examples

A

See Pics and be familiar

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41
Q

Amputee Evaluation Components

McGill Pain Questionnaire

A

See pics

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42
Q

Post-Op PT: Amputee

Early Goals:

A
  • Wound care
  • Volume stab/stump
    • rigid and semi-rigid dressings, ace wrap, shrinkers
  • Pain mgmt→ meds, e-stim, desens, WB
  • Mobility
    • ax crutches, SW
  • Strength
  • ROM
    • Pt pos’ing
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43
Q

PT Evaluation for Amputees

FOMs

A
  • Amputee specific FOMs
  • Functional scales
  • Ferraro really emphasized this one!!!!
    • L- Test (functional mobility***): mod’d TUG
      • youtube.com/watch?v=glyN3TPZaiU
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44
Q

Amputee Specific FOMs:

A
  • Amputee Mobility Predictor w/ Prosthesis (AMPPro)
    • IN BOOK (L&N p552)
  • Locomotor Capabilities Index (LCI)

*NOTE: if bolded KNOW IT!!!

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45
Q

Amputee Specific Functional Scales

A
  • Amputee Activity Scale (AAS)
  • Functional Measure for Amputees (FMA)
  • Houghton Scale
  • **L-Test (functional mobility)

NOTE: If bolded KNOW IT!!!!

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46
Q

Medicare Prosthetic Functional Levels:

K- Levels

A

Functional Classification for Pts w/ a Prosthesis

*BE FAMILIAR w/ K0 from K4

see pics

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47
Q

Transfers for Amps

Ex’s and factors

A
  • STS, slide board, stand-pivot
  • Safe and Efficient: look @
    • UE strength
    • Intact limb strength
    • Assist @ home
    • Furniture set up
    • Safety awareness***
    • Prosthesis don/doffed
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48
Q

Transfer type Ex’s

*NOTE: transfer to intact side first, but check BOTH!

A
  • WC→Bed
    • Sit pivot, stand pivot, slide board
  • Front on/Back off
    • *B/L amps
49
Q

What is a MAIN GOAL for post-op amputees?

A

CONTRACTURE PREVENTION!!!

50
Q

Prevention of Contractures:

TFAs

Most Common and how to Avoid

A
  • Common:
    • Hip flex (>30d=problems) > hip abd > hip ERs
  • To avoid:
    • pos pt in prone OR
    • supine w/ hip EXT and ADD
51
Q

Prevention of Contractures:

TTAs

Most Common and how to Avoid

A
  • Common:
    • Knee flex (>15d=problems) > hip flex > hip abd
      • almost always knee flex
  • To avoid:
    • pos prone OR
    • supine w/ distal LE propped (knee EXTd)→ put something under heel
52
Q

ROM/Pos’ing

A

GET THEM PRONE!!!

53
Q

GEN GUIDELINES FOR PT PROGRAM

Acute Care

Day 1-3

*be familiar→ notice the general goals/themes/flow

A
  • Bed mobility sit ←→ supine
  • Pos’ing
  • Inc sit endurance
  • Transfers
  • Amb w/ walker or static walking
  • Exercise**
    • Glute/Quad sets
    • Gentle PROM to RL
    • AROM or PREs to all jts of sound limb
    • UE shoulder depression (seated push-ups)
      • transfer help from UEs***
54
Q

GEN GUIDELINES FOR PT PROGRAM

Acute Care

Day 3-10

MONITOR VITALS CLOSELY DURING THIS STAGE!!!***

*be familiar→ notice the general goals/themes/flow

A
  • Cont ed. for limb pos’ing
  • Inc sit time
    • ADD reaching and functional exercise in sitting→ can always do trunk strength***
  • Cont SL amb w/ walker
    • inc stand endurance
  • Educate RL dressing/edema control
  • Exercise:
    • AROM for RL→ progress to gentle resistance (cautious of sutures)
    • UE erg
  • MONITOR VITALS CLOSELY DURING THIS STAGE!!!***
55
Q

Phantom Pain/Sensation

A

Pain that feels like it’s coming from a body part that is no longer there

orig’s Brain + SC bc nerve connections from the periphery→ brain remain in place***

56
Q

Phantom Pain/Sensation

A
  • 5-10% severe enough for med care
  • Higer correlation of Ph.Pain w/ those that had pain BEFORE amp
  • Hrs, days, mos later
  • Cramping, aching, burning, shock-like sensations
  • Adjunctive therapies:
    • acupuncture
    • biofeedback
    • sx
    • meditation
57
Q

Phantom Pain/Sensation

Pt tech’s to reduce Ph Pain

A
  • Wrap RL warm towel or hot pack
  • Cold packs
  • Mental ex’s as if limb still there
  • Active ex’s in prox musculature
  • Pos changes freq.
  • **Donning prosthesis/WB
  • Massage
  • Supps
58
Q

Phantom Pain/Sensation

PT Techs to reduce pain:

A
  • Cold pack
  • Hot pack
  • Estim (derm pattern OR surrounding sx site)
  • Desensitization
  • Active ex.
  • INC/DEC prosthetic wearing time
59
Q

Phantom Pain/Sensation

PT Techs to reduce pain:

3 that Ferraro BOLDED!!!

A
  • Desensitization
  • Active Exercise
  • Inc/Dec prosthetic wearing time
    • Early use/wearing time as well
60
Q

PT Program Amputees:

Day 10-14

*be familiar→ notice the general goals/themes/flow

A
  • Progress sitting tolerance (even more)
    • should be IND
  • Walking endurance
    • interval training program
  • Cont edema control→ limb wrap or compression as indicated
  • EXERCISE→ cont’d gentle resistance to RL and PREs to sound side
    • SL bridging
    • SL squats (progress depths, off table like you do)
    • Cont’d UE ex’s + UBE
    • Sitting/Standing balance + coord
      • Dynamic reaching out of BOS
        • you know ALOT of these!!!!
61
Q

Post-Op Dressings for Amputees

Purpose?

A

Volume control/shaping of RL

62
Q

Post Op Dressings: Vol Control/Shaping

Rigid dressings/Immediate Post-Op Prosthesis

IPOP

explain…

A
  • Immed post op resembles hard cast→ bivalved for dressing changes
    • may be used to ambulate (supracondylar suspension)
63
Q

Post Op Dressings: Vol Control/Shaping

Rigid dressings/Immediate Post-Op Prosthesis

IPOP

BENEFITS vs Drawbacks

A
  • BENEFITS:
    • Protects suture line
    • Aggressive volume mgmt
    • Prevents knee flex contraction (TTAs)
  • DRAWBACKS:
    • Diff to inspect incision
    • Not prop designed→ skin irrit and breakown
    • Full cast heavy to mng.
64
Q

Post Op Dressings: Vol Control/Shaping

Removable Rigid Dressings (RRDs)

The “Cap” one

explain…

A
  • “Cap” cast worn over directly on compressive dressing→ see pics
  • MOST APPROP for incisions in initial stage of healing OR those w/ incd chance infection
  • Skin inspect every 60-90 mins and then if no negative effets may be left on perm.
65
Q

Post Op Dressings: Vol Control/Shaping

Removable Rigid Dressings (RRDs)

The “Cap” one

BENNIES vs. DRAWBACKS

A
  • BENNIES:
    • Easy to don/doff
    • Comfortable
    • Aggressive shaping RL
    • Protects suture line
    • Promotes IND care of RL
    • Easy mgmt w/ fluctuating edema
  • DRAWBACKS:
    • NOT effective w/ drastic limb circumf
      • distal and prox
66
Q

Post Op Dressings: Vol Control/Shaping

Semi Rigid Dressings (aka DEC hardness of cast)

Types

A

Polyethylene vs plaster or fiberglass

67
Q

Post Op Dressings: Vol Control/Shaping

Semi Rigid Dressings (aka DEC hardness of cast)

BENNIES vs. DRAWBACKS

A
  • BENNIES:
    • Easy to don/doff
    • Aggressive shaping RL
    • Protects suture line
    • Easier to clean**
    • Lighter + more mngable than RRD
    • Stimulates feel prosthetic socket
  • DRAWBACKS:
    • NOT effective w/ drastic limb circumf:
      • dist and prox
    • More skill required from CPO
    • INCd $$$
68
Q

Post Op Dressings: Vol Control/Shaping

Pneumatic Compression:

What is it and how much pressure?

A

Air cast typ w/ 35-40mmHg air pressure

69
Q

Post Op Dressings: Vol Control/Shaping

Pneumatic Compression:

BENNIES vs. DRAWBACKS

A
  • BENNIES:
    • Easy to don/doff
    • Aggressive shaping RL
    • Protects suture line
  • DRAWBACKS:
    • Uneven compression compromising shape of RL
    • Hot
    • Limits functional mobility***
70
Q

Post Op Dressings: Vol Control/Shaping

Soft Dressings

Types

A
  • Ace wraps
  • Elasticized stockinette/Tubigrip
  • Elastic shrinker garments (shrinkers**** YOU KNOW THESE!!!)
71
Q

Post Op Dressings: Vol Control/Shaping

Soft Dressings

BENNIES vs. DRAWBACKS

A
  • BENNIES:
    • BEST when sig wound drainage remains ****
    • Inexpensive
  • DRAWBACKS (ACE WRAP specifically)
    • Does NOT protect incision
    • Reqs skill + manual dexterity to apply
    • Freq reapplication due to loosening
      • Max 4hrs
    • LEAST aggressive method of vol mgmt/shaping
72
Q

LEAST aggressive method of vol mgmt/shaping

A

Ace Wraps

73
Q

Ace Wrapping Gen Concepts:

A
  • Distal→ Proximal pressure gradient*****
    • drives edema back prox.
  • Posterior→ Anterior (TTAs)**
    • helps to prevent knee flex contractures
  • Avoid overlapping directly w/ wrap (circulation)
    • typ oblique cross hatch pattern
  • 6in width wraps
  • Ed. pt + family “how” and “why and when”
  • ALL distal areas wrapped evenly
  • Tape or plastic to fasten….NOT LITTLE METAL PIECE (skin integrity)
  • Use caution w/ unhealed wounds and poor circ.
74
Q

Ace Wrapping Gen Concepts

Pressure gradient directions and WHY?

A

Distal → Proximal

*drives edema back proximally

YOU KNOW THIS!!!

75
Q

ACE Wrapping Concepts

W/ TTAs…direction of wrapping and WHY?

A

Posterior → Anterior

*prevent knee flex contractures

76
Q

TFA Volume control/shaping

Ace Wrap w/ TFA

A

see pics

77
Q

Amputees and HEP

How many exercises?

A

3-5

78
Q

Amputees and HEP

TFA specific:

A
  • Stress strength hip EXTs + ABDs
    • ALLLLL that SL stuff you saw!!!
  • Static stretches for hip flexors
    • prevent contracture!!!
79
Q

Amputees and HEP

TTA specific:

A
  • Stress knee and hip EXT strength
  • Static stretches for hip and knee flexors
80
Q

Pre-Prosthetic Take Home Message****

A
  • Prevent infection + contractures
  • Optimize shape + WB tolerance for RL
  • Max. strength and cond of entire body
  • Inc tol to upright postures/gait
  • Be aware of contralateral limb*****
  • EDUCATE Pt!!!!
81
Q

Desired tensile gradient when ace wrapping for edema control???

A

Distal → Proximal

*drives edema proximally

82
Q

TFA HEP

What needs to be strengthened?

A

Hip EXTs and ABDs

83
Q

TFA HEP what needs to be stretched?

A

Hip flexors

84
Q

TTA HEP

What needs to be strengthened?

A

Knee and hip EXTs

85
Q

TTA HEP

What needs to be stretched?

A

Hip/knee flexors

86
Q

Components of Transtibial Prothesis:

4:

A
  1. Socket + Interface
  2. Suspension Mechanism
  3. Shank (or pylon)
  4. Prosthetic foot
87
Q

Components of Transtibial Prothesis:

Socket + Interface

A
  • Socket
    • Where RL is housed (what the limb actually goes into)
  • Interface
    • Anything that goes bw RL and socket
      • ex. cotton ply (sock)
88
Q

Components of Transtibial Prothesis:

Suspension Mechanism

A

ANY system that secures RL comfortably in socket

keeps it in there snug

89
Q

Components of Transtibial Prothesis:

Shank or pylon

A

The metal piece**

Component connecting socket and foot

90
Q

Components of Transtibial Prothesis:

All components together

A

see pics

91
Q

Transtibial Prosthetic Socket Interfaces:

Hard Socket

ADV’s vs Disadv’s

A
  • ADV’S
    • Just the socket
    • Intimate fit→ less shear
    • No liners needed
    • easy clean, less bacteria
  • Disadv’s
    • unless PERFECT, hard to modify as socket changes
    • NOT approp for fragile skin as RL changes
      • bc its only skin on socket***
92
Q

Transtibial Prosthetic Socket Interfaces:

Socks

aka “Plys”

1 ply=thinnest and then they inc from there ***

ADV’s vs. Disadv’s

A
  • ADV’s
    • cushion forces to RL
    • **Easy to accommodate to changing limb vol.
    • wicks moist. away from skin
  • Disadv’s
    • cosmetic
    • wrinkles**
    • uncomfy in warm weather
    • clean often
93
Q

Transtibial Prosthetic Socket Interfaces:

Socks

*NOTE about Socks!!!

A
  1. Some pts use nylon sheath bw socket and prosthetic sock
  2. Prosthetist often design hard socket to accommodate to 3 ply as a baseline to preserve intimacy while still providing cushion
94
Q

Shrinkers****

For when?

A

Used when prosthetic NOT ON!

95
Q

Transtibial Prosthetic Socket Interfaces:

SOFT LINER

ADV’S vs. Disadv’s

A

*MOST COMMON SOCKET INTERFACE USED TODAY!

  • ADV’S
    • best for bony prominences
    • easy adjust
    • Cushions RL and protects from ext. forces
      • best for function
  • Disadv’s
    • absorbs sweat→ hard to clean
    • liners compress w/ rep’d loading
    • inc bulk of prosth.
      • high lvl/sports this decs somatosensory input→ not preferred
96
Q

Transtibial Prosthetic Socket Interfaces:

Soft Liner

*NOTES

A
  1. MOST COMMON socket interface used today
  2. Usually amp. will use sheath, then approp. ply, then soft liner
97
Q

Transtibial Prosthetic Socket Interfaces:

Roll-on Liners*

*Rubber or polyeurothane
*think thing that lock pin hangs off of

ADV’s vs. Disadv’s

A
  • ADV’s
    • disperse forces during gait (esp shearing)
    • good for fragile skin/breakdown
    • accommodates for minor changes in volume w/out adj’s
  • Disadv’s
    • rxn to liner material→ dermatitis, bact. infxs, follicular irrit.
    • strength+dexterity in UEs to don
    • incd care to clean
98
Q

Transtibial Prosthetic Socket Interfaces:

Roll-on Liners

*NOTE: rxn to liner causing blistering, rash→ dermatitis, bact. infxs, follic. irritation

Caused by?

A

Caused by change in skin tension @ the interface and alleviated often by some non-water soluble lube

99
Q

Suspension Systems

What is it?

A
  • Anything holding prosthetic limb onto anatomical limb
100
Q

Suspension Systems

2 types of Pre-molded

A
  1. Patellar tendon
  2. Supracondylar suspension
101
Q

Transtibial Prosthetic Suspension Systems:

Sleeve Suspension

Explain it

A
  • Goes on outside*
  • Placed distally around shank of prosthesis and proximally rolled upward over several inches of skin as the inner surf. grabs skin
  • Uses friction and negative pressure to hold prosth.
102
Q

Transtibial Prosthetic Suspension Systems:

Sleeve Suspension

*the one that goes on outside

ADV’s vs. Disadv’s

A
  • ADV’s
    • Thinner→ more cosmetic
    • waterproof
    • easy to use
  • Disadv’s
    • limtd durability→ tears/stretches
    • retains heat
    • skin irrit and sweating esp in hairy pts
103
Q

Transtibial Prosthetic Suspension Systems:

Supracondylar

Explain it

A
  • Captures femoral condyles to hold prosth.
  • AKA PTB-SC (Patellar Tendon Bearing Supracondylar)
    • where wt. is distributed on patella tendon
  • PTB-SCSP (same as above but also SupraPatellar)
    • → high ant. wall added over patella w/ quad bar to help w/ suspension
104
Q

Transtibial Prosthetic Suspension Systems:

Supracondylar

ADV’s vs. Disadv’s

A
  • ADV’s
    • provides med/lat knee stability
    • don/doff is easy
  • Disadv’s
    • NOT effective when clear def. of femoral condyles not present
      • muscular or obese
    • prox high walls obv. thru clothes
    • PTB-SCSP incs patella compression
105
Q

Transtibial Prosthetic Suspension Systems:

Cuff Suspension

Explain it

A
  • Leather webbing in shape of X attached distally to prosth. capturing femoral condyles proximally
  • “X” attached just sup. to patella and wraps posteriorly to hook w/ buckle
  • Success of susp. related to pos. of attachment on the prosth.
  • Attach. points should be posterior to the center of the socket so the line of pull falls posteriorly @ the proximal portion of the patella
106
Q

Transtibial Prosthetic Suspension Systems:

Cuff Suspension

ADV’s vs. Disadv’s

A
  • ADV’s
    • Pts of attach easily modified to control hyperEXT
    • don/doff easy
  • Disadv’s
    • impinge soft tissue→ obese not good option
    • compromised circ. if belt too tight
    • diff. sitting/kneeling
107
Q

Transtibial Prosthetic Suspension Systems:

Roll-on Suction w/ Pin-Lock

Explain

A
  • 2 Components
    1. Pliable silicone polymer sleeve (1-9mm thick)
    2. Short peg or pin
  • Pin locks into lock. mech. in base of prosth. providing friction bw sleeve and skin suspending prosth.
108
Q

Transtibial Prosthetic Suspension Systems:

Roll-on Suction w/ Pin-Lock

ADV’s vs. Disadv’s

A
  • ADV’s
    • incd limb aware.
    • decd shearing forces on skin→ excellent option for fragile skin proximally
    • audible click from pin***
  • Disadv’s
    • $$$
    • tear/stretch
    • sleeves must be cleaned
    • skin irrit, heat
    • incd shearing distally due to fixed pin
    • liners can get stuck in pin-lock
    • pin can be locked in crooked
109
Q

REVIEW:

INTERFACE

A

Refers to material that is in contact w/ skin

  • Hard socket
  • Socks
  • Soft liner
  • Roll on liners
110
Q

REVIEW:

Suspension

A

Refers to the system that holds prosthesis in place

  • Sleeve
  • Supracondylar
    • PTB-SC, PTB-SCSP
  • Cuff suspension
  • Roll on liner w/ pin-lock
111
Q

*NOTE: Various combos of interfaces and suspensions may be used to optimize___________

A

Comfort and function

112
Q

FIT of the prosthesis can only be assessed WHEN????

A

IN STANDING!!!!!!!! ******

113
Q

Transtibial Donning Technique

Typical Technique + Pics

A
  • Sitting– prosthetic nylon sheath (not a ply)
    • Prosthetic socks-thinnest→thickest; no wrinkles***
      • seam of socks should be // to suture line
    • Soft insert
    • Hard socket
    • Straps/elastic sleeve
114
Q

Transtibial Silicone Sleeve w/ Pin

3S

Donning

A
  • Sitting-→ sleeve rolled inside out first
    • Place on end of limb and roll UP
    • Pin placed into receptacle inside socket
    • Locks when standing (clicks into place)
  • *NOTE: may need to add socks to outside of sleeve before socket is donned if loose
    • special socks w/ hole in bottom for pin
115
Q

Pressure Tolerant Areas***

2 Primary

A
  1. Femoral Condyles
  2. Patellar Tendon
116
Q

Pressure Tolerant Areas

ALL

KNOW THIS!!!!!!

*Can only assess after WB in prosth.

*Areas will be dark red

A
  • Anterior Surface:
    • *Patellar tendon
    • *Femoral condyles
    • Medial tibial flare
    • Tibial shaft
  • Lateral View:
    • *Patellar tendon
    • Anterolateral compart.
    • Fibular shaft (head no good)
  • Posterior Surface:
    • Popliteal fossa structures
117
Q

Pressure INtolerant Areas

A
  • Anterior view: Pain in any of these 3===== Subtract a ply
    • Head of fibula
    • Tibial crest
    • Distal ant. tib
  • Laterally:
    • Fibular head
  • Posteriorly:
    • HS tendons
118
Q

Wearing schedule

NOTE:

A

NOTE:

Redness

Pain score

of socks needed

AD Y/N?

Prosthetics&Orthotics (19 decks)

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