L2:P&O: Post-Sx and Early Rehab Phase Flashcards
1
Q
OBJECTIVES:
A
2
Q
Ray amputations include:
A
Usually 1st and 5th
*breakdown from GRFs
3
Q
Midfoot amputations
A
Chopart
Lisfranc (TMT Jt.)
4
Q
Hindfoot (rearfoot) amputations
A
Syme (most common and easiest to fit prosthesis)
Pirogoff
Boyd
5
Q
Other partial foot and Syme amps
A
Digit amps
Metatarsal amps
6
Q
Surgeons and prosthetists prefer Syme amputation due to what?
A
Ease of sx and fitting for prosthesis
7
Q
Surgeons prefer Syme, BUT better function reported for which amps?
A
Lisfranc
Chopart
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
9
Q
Partial foot and Symes amps
preservation of these 2 things is crucial
A
Ankle jt and heel
10
Q
Challenging for a proper fit prosthesis
A
Length and shape of RL
11
Q
MORE RL length====
A
More surf area==less pressure==less skin breakdown
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
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
14
Q
PRIMARY GOAL post-sx w/ all partial foot and Syme amps
A
Preservation of remaining foot
15
Q
SECONDARY GOAL post-sx all partial and Syme amps
A
Maximize gait quality and metabolic efficiency
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
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
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
19
Q
Partial foot and Symes amps gait implications
IC>MSt>TSt
A
see pics
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
21
Q
Partial foot and Symes amps
Gait implications @ ISw→TSw
A
UNAFFECTED unless limb too long (prosthesis too long or poor fit)
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***
23
Q
Partial foot and Symes amps
Gait implications
Normal lever arm vs reduced lever arm and step length results
A
see pics
24
Q
Partial foot and Symes amps
Prosthetic Mgmt
More proximal amputation (foot/toes)===MORE LIKELY
A
supramalleolar containment needed (support)
25
Partial foot and Symes amps
## Footnote
**Prosthetic Mgmt**
**Length and flex of the _______ affect the _______ which directly controls \_\_\_\_\_\_\_\_\_\_**
Length and flex of the **forefoot** affect the **anterior lever arm** which directly controls **foot and ankle motion**
26
2 Main Goals of **foot prosthesis and/or shoes:**
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
27
Toe fillers and modified shoes:
## Footnote
**Rocker bottoms assist w/ what?**
Rollover and DEC plantar surface pressure
\*challenge providing enough lever arm support w/out add. pressure to RL
28
Custom shoe inserts and **toe fillers**
* 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
29
Cosmetic Slippers
* Transmetatarsal amps
* little biomech. advantages
* mostly cosmetic
ideal for swimming\*
30
Prosthetic boots
* Gaining pop→ Transmet and Lisfranc and distal amps
* **Greater prox encompassment to reduce distal motion and inc control usually w/ hinged ankle mech.**
31
Syme's Amps aka
Tibiotarsal amputation
32
Symes Amp
## Footnote
**What is it?**
_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
33
2 Drawbacks to Symes Amps
1. Migration of distal heel pad
1. **usually avoid WB until receive prosthesis**
2. Poor cosmesis→ may shave malleoli to improve
34
Syme's Amps
Prosthetic Mgmt
**Understand there are diff options**
* Walking cast
* Canadian Symes
* drawback: posterior panel
* Medial opening Symes
* **Most commonly used Symes prosthesis**
* Sleeve suspension (**stovepipe)** Symes
* slides into flex insert
35
Most commonly used Symes prosthesis
Medial Opening
36
Bulky, stronger prosthesis chosen for obese or very heavy duty user
Sleeve suspension (**stovepipe)** Symes
37
NOTE about all Symes prostheses
All designed for **total contact** to **improve comfort** and **dec chance of breakdown**
38
Which is the primary goal of the surgeon to preserver whenever possible?
**Talocrural Joint!!!!!!**
39
Amputee Evaluation Components
NOTE **Categories & Examples**
See pics and be familiar
40
Amputee Evaluation Components
NOTE **Categories & Examples**
See Pics and be familiar
41
Amputee Evaluation Components
## Footnote
**McGill Pain Questionnaire**
See pics
42
Post-Op PT: Amputee
## Footnote
**Early Goals:**
* 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
43
PT Evaluation for Amputees
## Footnote
**FOMs**
* Amputee specific FOMs
* Functional scales
* **Ferraro really emphasized this one!!!!**
* **L- Test (functional mobility\*\*\*): mod'd TUG**
* **youtube.com/watch?v=glyN3TPZaiU**
44
Amputee Specific FOMs:
* **Amputee Mobility Predictor w/ Prosthesis (AMPPro)**
* IN BOOK (L&N p552)
* Locomotor Capabilities Index (LCI)
\*NOTE: if **bolded** KNOW IT!!!
45
Amputee Specific Functional Scales
* **Amputee Activity Scale (AAS)**
* Functional Measure for Amputees (FMA)
* Houghton Scale
* **\*\*L-Test (functional mobility)**
NOTE: If **bolded KNOW IT!!!!**
46
Medicare Prosthetic Functional Levels:
**K- Levels**
Functional Classification for Pts w/ a Prosthesis
\*BE FAMILIAR w/ K0 from K4
see pics
47
Transfers for Amps
Ex's and factors
* STS, slide board, stand-pivot
* Safe and Efficient: **look @**
* UE strength
* Intact limb strength
* Assist @ home
* Furniture set up
* Safety awareness\*\*\*
* **Prosthesis don/doffed**
48
Transfer type Ex's
\*NOTE: **transfer to _intact side first_, but check BOTH!**
* WC→Bed
* Sit pivot, stand pivot, slide board
* **Front on/Back off**
* **\*B/L amps**
49
What is a MAIN GOAL for post-op amputees?
CONTRACTURE PREVENTION!!!
50
Prevention of Contractures:
## Footnote
**TFAs**
**Most Common and how to Avoid**
* **Common:**
* Hip flex (\>30d=problems) \> hip abd \> hip ERs
* **To avoid:**
* pos pt in **prone** OR
* **supine w/ hip EXT and ADD**
51
Prevention of Contractures:
## Footnote
**TTAs**
**Most Common and how to Avoid**
* **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
ROM/Pos'ing
GET THEM PRONE!!!
53
GEN GUIDELINES FOR PT PROGRAM
## Footnote
**Acute Care**
**Day 1-3**
**\*be familiar→ notice the general goals/themes/flow**
* 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
GEN GUIDELINES FOR PT PROGRAM
## Footnote
**Acute Care**
**Day 3-10**
**MONITOR VITALS CLOSELY DURING THIS STAGE!!!\*\*\***
**\*be familiar→ notice the general goals/themes/flow**
* 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
Phantom Pain/Sensation
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
Phantom Pain/Sensation
* 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
Phantom Pain/Sensation
## Footnote
**Pt tech's to reduce Ph Pain**
* 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
Phantom Pain/Sensation
## Footnote
**PT Techs to reduce pain:**
* Cold pack
* Hot pack
* Estim (derm pattern OR surrounding sx site)
* **Desensitization**
* **Active ex.**
* **INC/DEC prosthetic wearing time**
59
Phantom Pain/Sensation
## Footnote
**PT Techs to reduce pain:**
**3 that Ferraro BOLDED!!!**
* **Desensitization**
* **Active Exercise**
* **Inc/Dec prosthetic wearing time**
* **Early use/wearing time as well**
60
PT Program Amputees:
## Footnote
**Day 10-14**
**\*be familiar→ notice the general goals/themes/flow**
* 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
Post-Op Dressings for Amputees
## Footnote
**Purpose?**
Volume control/shaping of RL
62
Post Op Dressings: Vol Control/Shaping
## Footnote
**Rigid dressings/Immediate Post-Op Prosthesis**
**IPOP**
**explain…**
* Immed post op resembles hard cast→ bivalved for dressing changes
* **may be used to ambulate** (supracondylar suspension)
63
Post Op Dressings: Vol Control/Shaping
## Footnote
**Rigid dressings/Immediate Post-Op Prosthesis**
**IPOP**
**BENEFITS vs Drawbacks**
* **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
Post Op Dressings: Vol Control/Shaping
## Footnote
**Removable Rigid Dressings (RRDs)**
**The “Cap” one**
**explain…**
* “**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
Post Op Dressings: Vol Control/Shaping
## Footnote
**Removable Rigid Dressings (RRDs)**
**The “Cap” one**
**BENNIES vs. DRAWBACKS**
* **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
Post Op Dressings: Vol Control/Shaping
## Footnote
**Semi Rigid Dressings (aka DEC hardness of cast)**
**Types**
Polyethylene vs plaster or fiberglass
67
Post Op Dressings: Vol Control/Shaping
## Footnote
**Semi Rigid Dressings (aka DEC hardness of cast)**
**BENNIES vs. DRAWBACKS**
* **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
Post Op Dressings: Vol Control/Shaping
**Pneumatic Compression:**
**What is it and how much pressure?**
Air cast typ w/ **35-40mmHg air pressure**
69
Post Op Dressings: Vol Control/Shaping
## Footnote
**Pneumatic Compression:**
**BENNIES vs. DRAWBACKS**
* **BENNIES:**
* Easy to don/doff
* **Aggressive shaping RL**
* Protects suture line
* **DRAWBACKS:**
* Uneven compression **compromising shape of RL**
* Hot
* **Limits functional mobility\*\*\***
70
Post Op Dressings: Vol Control/Shaping
## Footnote
**Soft Dressings**
**Types**
* Ace wraps
* Elasticized stockinette/Tubigrip
* Elastic shrinker garments (shrinkers\*\*\*\* YOU KNOW THESE!!!)
71
Post Op Dressings: Vol Control/Shaping
## Footnote
**Soft Dressings**
**BENNIES vs. DRAWBACKS**
* **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
**LEAST aggressive method of vol mgmt/shaping**
Ace Wraps
73
Ace Wrapping Gen Concepts:
* **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
Ace Wrapping Gen Concepts
## Footnote
**Pressure gradient directions and WHY?**
Distal → Proximal
\***drives edema back proximally**
YOU KNOW THIS!!!
75
ACE Wrapping Concepts
## Footnote
**W/ TTAs…direction of wrapping and WHY?**
Posterior → Anterior
\***prevent knee flex contractures**
76
TFA Volume control/shaping
Ace Wrap w/ TFA
see pics
77
Amputees and **HEP**
## Footnote
**How many exercises?**
3-5
78
Amputees and **HEP**
## Footnote
**TFA specific:**
* **Stress** strength hip EXTs + ABDs
* ALLLLL that SL stuff you saw!!!
* **Static stretches** for hip flexors
* prevent contracture!!!
79
Amputees and **HEP**
## Footnote
**TTA specific:**
* **Stress** knee and hip EXT strength
* **Static stretches** for hip and knee flexors
80
Pre-Prosthetic Take Home Message\*\*\*\*
* 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
Desired tensile gradient when ace wrapping for edema control???
Distal → Proximal
\*drives edema proximally
82
TFA HEP
What needs to be **strengthened?**
Hip EXTs and ABDs
83
TFA HEP what needs to be **stretched?**
Hip flexors
84
TTA HEP
What needs to be **strengthened?**
Knee and hip EXTs
85
TTA HEP
What needs to be **stretched?**
Hip/knee flexors
86
Components of Transtibial Prothesis:
4:
1. Socket + Interface
2. Suspension Mechanism
3. Shank (or pylon)
4. Prosthetic foot
87
Components of Transtibial Prothesis:
## Footnote
**Socket + Interface**
* **Socket**
* Where RL is housed (what the limb actually goes into)
* **Interface**
* Anything that goes **bw RL and socket**
* ex. cotton ply (sock)
88
Components of Transtibial Prothesis:
## Footnote
**Suspension Mechanism**
ANY system that **secures** RL comfortably in socket
*keeps it in there snug*
89
Components of Transtibial Prothesis:
**Shank or pylon**
The metal piece\*\*
Component **connecting** **socket** and **foot**
90
Components of Transtibial Prothesis:
All components together
see pics
91
Transtibial Prosthetic Socket **Interfaces:**
**Hard Socket**
**ADV's vs Disadv's**
* **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
Transtibial Prosthetic Socket **Interfaces:**
**Socks**
**aka “Plys”**
**1 ply=thinnest and then they inc from there \*\*\***
**ADV's vs. Disadv's**
* **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
Transtibial Prosthetic Socket **Interfaces:**
## Footnote
**Socks**
**\*NOTE about _Socks!!!_**
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
Shrinkers\*\*\*\*
## Footnote
**For when?**
Used when prosthetic **NOT ON!**
95
Transtibial Prosthetic Socket **Interfaces:**
## Footnote
**SOFT LINER**
**ADV'S vs. Disadv's**
**\*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
Transtibial Prosthetic Socket **Interfaces:**
## Footnote
**Soft Liner**
**\*NOTES**
1. **MOST COMMON socket interface used today**
2. Usually amp. will use **sheath, then approp. ply, then _soft liner_**
97
Transtibial Prosthetic Socket **Interfaces:**
**Roll-on Liners\***
**\*Rubber or polyeurothane**
\***think thing that _lock pin_ hangs off of**
**ADV's vs. Disadv's**
* **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
Transtibial Prosthetic Socket **Interfaces:**
## Footnote
**Roll-on Liners**
**\*NOTE: rxn to liner causing blistering, rash→ dermatitis, bact. infxs, follic. irritation**
**Caused by?**
Caused by change in skin tension @ the **interface** and **alleviated often by some non-water soluble lube**
99
Suspension Systems
## Footnote
**What is it?**
* Anything **holding _prosthetic limb_ onto _anatomical limb_**
100
Suspension Systems
## Footnote
**2 types of _Pre-molded_**
1. Patellar tendon
2. Supracondylar suspension
101
Transtibial Prosthetic **Suspension Systems:**
## Footnote
**Sleeve Suspension**
**Explain it**
* 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
Transtibial Prosthetic **Suspension Systems:**
## Footnote
**Sleeve Suspension**
**\*the one that goes on _outside_**
**ADV's vs. Disadv's**
* **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
Transtibial Prosthetic **Suspension Systems:**
## Footnote
**Supracondylar**
**Explain it**
* 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
Transtibial Prosthetic **Suspension Systems:**
**Supracondylar**
**ADV's vs. Disadv's**
* **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
Transtibial Prosthetic **Suspension Systems:**
## Footnote
**Cuff Suspension**
**Explain it**
* 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
Transtibial Prosthetic **Suspension Systems:**
## Footnote
**Cuff Suspension**
**ADV's vs. Disadv's**
* **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
Transtibial Prosthetic **Suspension Systems:**
## Footnote
**Roll-on Suction w/ Pin-Lock**
**Explain**
* 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
Transtibial Prosthetic **Suspension Systems:**
## Footnote
**Roll-on Suction w/ Pin-Lock**
**ADV's vs. Disadv's**
* **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
REVIEW:
## Footnote
**INTERFACE**
Refers to **material that is in contact w/ skin**
* Hard socket
* Socks
* Soft liner
* Roll on liners
110
REVIEW:
## Footnote
**Suspension**
Refers to the **system that holds prosthesis in place**
* Sleeve
* Supracondylar
* PTB-SC, PTB-SCSP
* Cuff suspension
* Roll on liner w/ pin-lock
111
\*NOTE: Various combos of **interfaces and suspensions** may be used to optimize\_\_\_\_\_\_\_\_\_\_\_
Comfort and function
112
**FIT of the prosthesis can only be assessed WHEN????**
IN STANDING!!!!!!!! \*\*\*\*\*\*
113
**Transtibial _Donning_ Technique**
**Typical Technique + Pics**
* **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
Transtibial Silicone Sleeve w/ Pin
3S
**Donning**
* **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
Pressure **Tolerant** Areas\*\*\*
## Footnote
**2 Primary**
1. Femoral Condyles
2. Patellar Tendon
116
Pressure **Tolerant** Areas
ALL
KNOW THIS!!!!!!
\*Can only assess after WB in prosth.
\*Areas will be **dark red**
* 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
Pressure **INtolerant** Areas
* 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
Wearing schedule
NOTE:
NOTE:
Redness
Pain score
of socks needed
AD Y/N?
