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Prosthetics&Orthotics > L6: Stairs, Transfers, then Peds+Special Considerations > Flashcards

L6: Stairs, Transfers, then Peds+Special Considerations Flashcards

1
Q

Stair Negotiation:

TTAs

What is the most IMPORTANT COMPONENT

A

ANKLE

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2
Q

Stair Negotiation: TTAs

LTG:

A
  • Efficient, reciprocal pattern (AD, handrail)
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3
Q

Stair Negotiation: TTAs

What should the process of stair negotiation look like/Most important component

A
  • Ankle is most important component
    • When Descending→ foot close to edge OR over edge== facilitates knee flexion
      • PT can help control knee flex
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4
Q

Stair Negotiation: TTAs

IF Non-Reciprocal

Pattern ?

A

UP w/ the GOOD→ “intact limb”

DOWN w/ the BAD→ “prosth side”

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5
Q

Stair Negotiation: TTAs

If anxious or do NOT have knee flex ROM….

A

Teach to go up/down sideways holding handrail

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6
Q

Stair Negotiation: TTAs

If not SAFE….

A

Doff prosth and either use ADs: Crutches, cane, 2 handrails (B/L UE A), or bump up

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7
Q

Stair Negotiation: TFAs

Most important component?

A

KNEE

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8
Q

Most important component of stair negotiation for TTAs

A

Ankle

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9
Q

Most important component in stair negotiation for TFAs:

A

Knee

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10
Q

Stair Negotiation: TFAs

Pattern taught depends almost ENTIRELY on what?

2:

A

Knee component

Control of knee

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11
Q

Stair Negotiation: TFAs

Pattern taught depends on knee component and control of knee

Microprocessor knees/some hydraulic and pneumatic knees

A

Efficient, reciprocal pattern is REALISTIC LTG*

Do NOT UNDERtrain them!!!

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12
Q

Stair Negotiation: TFAs

Pattern taught depends on knee component and control of knee

Wt. Activated or Safety (total knees) dependent on:

A

Length of RL

Strength

Balance, cognition, etc.

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13
Q

Stair Negotiation: TFAs

Pattern taught depends on knee component and control of knee

W/ Single-axis OR low-resistance knees

A

Typ lock knee and teach non-reciprocal or sideways

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14
Q

Stair Negotiation: TFAs

Stairs

More tidbits…

A
  • When descending foot close to edge OR over edge to facilitate knee flex: may cause anxiety
    • Two hands on rails, shorter step in //bars, step overs
    • PT can help control knee flex
    • Teach pt to “ride” C-legs ecc. resistance
      • work WITH it
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15
Q

Stair Negotiation: TFAs

Alternatives to Reciprocal

A
  • If non recip→ Usually UP w/ GOOD, DOWN w/ BAD
    • Good→ intact limb
    • Bad→ prosth side
  • If anxious or do not have knee flex ROM→ up/down sideways holding rail
  • If not SAFE→ doff prosth and use ADs, or bump up
    • PROBLEM: leaves pt w/out prosth.
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16
Q

Stair negotiation

A

See video slide 6****

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17
Q

Ramp Negotiation:

TTAs w/ SACH or SAFE feet…

Explain

A

Difficulties w/ standard incline grades

Accommodate @ knee, hip, trunk

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18
Q

Ramp Negotiation:

TTAs w/ Mobile feet

i.e. Single Axis w/ large ROM, Multi-axis, Dynamic Response, Microprocessor

A

Min. diffs w/ ascend/descend ramps

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19
Q

Ramp Negotiation:

Describe step length

A
  • Typ Longer step w/ prosth.
  • Shorter step w/ uninvolved due to lack of DF
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20
Q

Ramp Negotiation:

IND/safety w/ TFAs largely dependent on ______ and ________

A

Knee and Ankle component

*NOTE: newer gen knees/feet have MIN. diffs w/ ramps

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21
Q

Ramp Negotiation:

Little knee control and immobile ankle/foot complexes will NOT have ability to amb w/out obv compensations which may also compromise safety

What should you do?

A

Teach sideways w/ prosth side ALWAYS low

PT guards/supervises from BELOW

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22
Q

Ramp negotiation

Where does PT guard?

A

Guard from Below

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23
Q

C-leg: Downhill/Ecc control

A

Video slide 9

24
Q

Sit ←→ Stand Transfers

How can you OVERPOWER or facilitate use of the Prosth side?

A

Reach and stand

Elevate UNinvolved side

Prosth. LE slightly posterior

25
Sit ←→ Stand Transfers ## Footnote **Regardless of lvl of amputee:** **Goal?**
Become IND w/ EQUAL LE use
26
Sit ←→ Stand Transfers ## Footnote **TFAs should be able to flex hip to 90degs** **T/F???**
TRUE!!!!!!!!!!
27
Sit ←→ Stand Transfers ## Footnote **Technique taught depends on:** **4:**
1. **Strength** of hip/knee EXTs 2. **Length** of RL 3. **Control** of knee 4. **Ht** of surface
28
Falling and Floor to Sit Transfers What is **KEY?**
PREVENTION!!!
29
Falling and Floor to Sit Transfers ## Footnote **Teach HOW to fall:**
* Whenever possible→ **Fall forward OR to in-tact side** * Once on ground **advise them NOT to try and stand right away** * Get bearings and ensure no other injuries * **Remove prosth.** * Bump or crawl to LOW surface and use UEs to get to sit * Wait for help
30
Falling and Floor to Sit Transfers ## Footnote **To stand back up:**
* Place **sound leg directly under trunk and use UEs either on that LE OR on chair/other surf.** * Reqs **strength/balance**
31
Special considerations: **Children** ## Footnote **Some stats**
* 58.5% congenital deforms are UEs * **Fitting timetable for UE usually @ 6mos** * **8 mos for LEs** * **Gradeschool children req new prosth every 12-18mos** * **Teens every 18-24mos**
32
Special Considerations: **Children** ## Footnote **Fittings**
* For **LE infants→** SACH foot initially * as child becomes more active, **dynamic resp feet prescribed**
33
Special Considerations: **Children** ## Footnote **Children w/ TFA:**
Whenever possible **fit w/ friction control knee (hydraulic) w/ an _extension assist_ to assimilate gait pattern of child**
34
Special Considerations: **Children**
* Diff w/ fitting as rapid leg changes and meeting functional goals during **growth/development** * More agile w/ stronger skin and less skin breakdown vs adults * Considerable walking proficiency earlier in rehab * **Adaptive neuro. mapping from birth accommodates for loss of limbs**
35
Special Considerations: **Children** ## Footnote **Proximal Focal Femoral Deficiency (PFFD)** **What is this?**
Femur and Pelvis malformed @ birth \***NOTE:** Depending on **length of residuum→ may be approached as _hip disartic_ OR _TFA_→** If foot and ankle present, may be **Van Ness candidate**
36
Special Considerations: **Children** ## Footnote **Van Ness Procedure aka**
Longitudinal deficiency of femur \***Turn tibia posteriorly**
37
Special Considerations: **Children** ## Footnote **Van Ness Procedure (Rotationplasty)** **Explain it**
* Foot and ankle **rotated and becomes the knee** * **DF becomes Knee Flexion, PF→ knee ext** * **=better control of prosth.** * **usually bw 5-12yo** **See video slide 17\*\*\***
38
Van Ness aka Rotationplasty Pics
see pics
39
Special Considerations: **B/L amps** ## Footnote **Result from**
Trauma→ MVA, electrocution, land mines, bombs
40
Special Considerations: **B/L Amps** ## Footnote **Critical to what?**
Critical to **preserve @ least one anatomical knee joint** which **sig incs chances for practical amb.** **-Schuling et al. 1994**
41
Special Considerations: **B/L Amps** ## Footnote **These B/L amps usually do very well w/ prosth training**
B/L TTA \*less energy cost to walk vs **U/L TFA**
42
Special Considerations: **B/L Amps** ## Footnote **Functional Capacity**
* Incd energy expend.→ need lt. wt. prosth design * Decd sensory feedback→ decd balance * May need 2 canes/LFST to inc BOS and push-off
43
Special Considerations: **B/L Amps** ## Footnote **B/L TTA**
* Usually **same ankle/foot comps both sides** * **SACH foot** offers **most predictable standing balance** * Usually **single-axis or multi-axis feet** chosen bc of **balance** * Consistency of ea step is **crucial** bc **no “good foot”**
44
Special Considerations: **B/L Amps** ## Footnote **B/L TFA**
* **Posture/Balance** sig. compromised * **wider BOS during stand/gait** due to PROX. fit * usually **solid ankle used** * MANY B/L TFA use AD * **Many B/L TFA choose WC as primary source of mobility**
45
Special Considerations: **B/L Amps** ## Footnote **B/L TFA**
* Incd **WB forces thru both LEs→** Reqs soft flexible **IRC containment socket** to reduce skin breakdown
46
Special Considerations: **B/L Amps** ## Footnote **B/L TFA** **“Stubbies”**
Sockets attached to specialized rocker platforms early in gait training * LESS energy and balance reqs * Gradual lengthening of prosth. until norm ht is managed
47
B/L amps
TTA on one side, TFA on other
48
Special Considerations: **Hip Disarticulation/Hemipelvectomy→ half pelvis removed** ## Footnote **How many jts to control now?**
Three
49
Special Considerations: **Hip Disarticulation/Hemipelvectomy→ half pelvis removed** ## Footnote **3 joints to control: what is crucial?**
Trunk/Core strength
50
Special Considerations: **Hip Disarticulation/Hemipelvectomy→ half pelvis removed** Explain prosth joints used
* Usually **solid ankle designs→** more joints to control, want **stable ankle** * Typ **hydraulic and pneumatic knees for more active pts** * **Microprocessor knees** used more freq now
51
Special Considerations: **Hip Disarticulation/Hemipelvectomy→ half pelvis removed** ## Footnote **Talk about hip**
* Usually **free motion hip** w/ **flexible carbon fiber thigh “strut”** that functions as **leaf spring** * improves **limb shortening for Sw** * **\*\*\*SEE VIDEO IN CANVAS!!!!!!!**
52
Special Considerations: **Hip Disarticulation/Hemipelvectomy→ half pelvis removed**
SEE PICS
53
Special Considerations: **Hip Disarticulation/Hemipelvectomy→ half pelvis removed** ## Footnote **STATS**
* **200% more effort to walk vs unimpaired walking** * **High prosth. rejection rates** bc gait is slow and energy consuming * **usually resort to single limb gait w/ AD to inc speed/dec effort** **\*Also need 2nd person just to Don**
54
REVIEW VIDEOS!!!!
SEE SLIDE 32
55
GOAL WRITING FOR AMPUTEES
SEE SLIDE 33 TO PRACTICE \*remember **function AND go back in lectures to understand what STGs and LTGs should _Focus On_!!!!!**

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