LE Prosthetics - 2 - Assessment

Question 1

Functional testing

Answer 1

Prosthetist can’t do it to get reimbursed, so they have to have someone else do it
PTs!

Question 2

How do we do functional testing

Answer 2

Amputee mobility predictor!

Question 3

Amputee mobility predictor - what is it

Answer 3

21 tests for assessing particular level of function in a patient
made by Gailey

Question 4

Amputee mobility predictor! - what does it take

Answer 4

Simple equipment

Stopwatch, 12 inch ruler, 4 in box, 2 chairs

Question 5

Amputee mobility predictor - scoring

Answer 5

K levels

Question 6

Amputee mobility predictor! - K0

Answer 6

Regardless of prosthesis you give them, they will not walk

Question 7

Amputee mobility predictor - K1

Answer 7

transfer prosthesis

value of it - safety - could be the difference that allows them to be more independent and allow them to be home

Question 8

Amputee mobility predictor! K2

Answer 8

Single speed ambulator
So no matter what, is always going the same speed
Can usually only traverse low level barriers in community

Question 9

Amputee mobility predictor! K3

Answer 9

Multispeed ambulator (they can change their speed)
No barriers - unlimited community ambulator

Question 10

Amputee mobility predictor! K4

Answer 10

High activity like sports

Other than peds, most of us do not function at K4 level

Question 11

Expectations

Answer 11

Setting expectations
Know what each participant expects - need to understand what they want to do with their prosthesis
What are they motivated to accomplish

Question 12

K1 what kind of knee

Answer 12

Manual locking

Gives stability

Question 13

K2 - what kind of knee

Answer 13

Manual locking
Weight activated control
Pneumatic knee systems
Polycentric4 or 7 Bar linkage systems

Question 14

K3 and K4 - what kind of knee

Answer 14

Polycentric4 or 7 Bar linkage systems

Hydraulic control

Question 15

3 views of prosthetic gait - planes

Answer 15

Sagittal is the most common that prosthetists talk about

Frontal would be next (looking at varus/valgus forces)

Question 16

CAUSE

Answer 16

Component
Alignment
User
Socket
Education

Question 17

CAUSE - component

Answer 17

any piece of the hardware that is causing the issue

Question 18

CAUSE - alignment

Answer 18

something off with the alignment - maybe too much rotation

When they measure alignment, the manufacturer tells them where the alignment should go

Question 19

CAUSE - User

Answer 19

maybe they have something to cause the dysfunction (maybe tight hip ER)

Question 20

CAUSE - socket

Answer 20

if socket does not fit properly

Varicose hyperplasia - pt not making contact distally so get suction - cancer risk!

Question 21

CAUSE - education

Answer 21

person wearing it
PT
prosthetist

Question 22

The challenge - cluitmans

Answer 22

Any prosthesis necessitates a good suspension in swing phase and adequate pressure distribution in the stance phase

Question 23

The challenge - johannesson

Answer 23

Amputees are exposed to a high degree of load at all times

Difference is that the structures (skin) that are exposed to the loads are not originally intended for this purpose

Question 24

Diabetic skin tissue overview - Distal end blistering

Answer 24

usually caused by void or space in distal aspect

Question 25

Diabetic skin tissue overview - Irritation following removal

Answer 25

mineral build up | could be related to perspiration - crystalize and cause itchiness

Question 26

Intersurface selection - residual limb length - suspension option - SHORT

Answer 26

``` Upper 1/3 Locking suspension - Volume instability - Security Cushion/sleeve - Simplicity ```

Question 27

Intersurface selection - residual limb length - suspension option - MEDIUM

Answer 27

``` middle 1/3 Locking suspension - Volume instability - Security Seal in suspension - ease of use and ROM - low build height Cushion/sleeve - Simplicity ```

Question 28

Iceross liner selection - the issue

Answer 28

``` Poor suspension Inc shear Inc peak pressure Discomfort Tissue damage ```

Question 29

Iceross liner selection - the soluation

Answer 29

``` Rolling it on (invert it first) Reduce pistoning Absorb shear Dissipate peak pressure Protect skin envelope Stabilize soft tissue ```

Question 30

Shore value/Durometer is what

Answer 30

Measure of hardness

Question 31

Iceross liner durometer/design

Answer 31

``` Dermo Comfort Synergy Sport Transfemoral Original ```

Question 32

Iceross liner durometer/design - comfort is

Answer 32

30

Question 33

Iceross liner durometer/design - dermo

Answer 33

25 (softest)

Question 34

Iceross liner durometer/design - synergy

Answer 34

40/25 soft on inside, hard on outside good for active person

Question 35

Iceross liner durometer/design - sport

Answer 35

get more proprioception and feedback from it | 50/25

Question 36

Iceross liner durometer/design - transfemoral

Answer 36

High durometer 50 we have a lot of soft tissue so don't need as much padding

Question 37

Iceross liner durometer/design - original

Answer 37

60

Question 38

Iceross liner durometer/design - indicated for diabetic amputees

Answer 38

Synergy (40/25) Comfort (30) Dermo (25)

Question 39

Iceross liner selection - thickness

Answer 39

3 MM | 6 MM

Question 40

Iceross liner selection - thickness - 3 MM

Answer 40

``` Distal protection Tapered to grade pressure Thin around knee Reduced pressure on thigh Designed for protection and performance ```

Question 41

Iceross liner selection - thickness - 6 MM

Answer 41

Distal protection Enhanced proximal protection Designed for ultimate tissue protection

Question 42

Iceross liner selection - sizing technique

Answer 42

Measure 4cm from distal end Measure circumference Select Iceross as measured (if btw sizes, downsize with seal in liner)

Question 43

Iceross liner selection - suspension options

Answer 43

Locking Cushion (use sleeve on outside) Seal in (leave on inside of socket)

Question 44

Iceross liner selection - Suspension options: Locking

Answer 44

Matrix - prevents tissue stretching Size specific umbrella to prevent compression Overall prevents movement up and down btw the prosthesis

Question 45

Socket design - total surface bearing- describe

Answer 45

``` Vlume match (residual limb to socket) Distribution of load over max area Control of soft tissue position Minimize pressure peaks Minimal movement of bone/socket Forces normal to surface (less shear) Optimized with pressure casting ```

Question 46

Socket design - total surface bearing - axial/dynamic forces

Answer 46

Socket shaping Pre-compression of soft tissue Adaptation of liner thickness

Question 47

Socket design - total surface bearing- rotational forces

Answer 47

Shear absorbed by the liner | Contact area with socket wall

Question 48

Socket design issues

Answer 48

Reliefs and air pockets | Posterior wall trimmed too low

Question 49

Volume related issues

Answer 49

Undersized (M/L instability) Even/Correct Oversized (fibula head and distal tibial pressure)

Question 50

CadCam imaging

Answer 50

Computerized image of residual limb Modifications and socket adjustments made on computer Digital image created and stored in database Data transferred to produce exact socket

Question 51

Prosthetic feet - recommendation

Answer 51

prescribed according to activities the pt has the potential to achieve

Question 52

Prosthetic foot serves the purose of

Answer 52

connecting the prosthesis to the ground

Question 53

Classification of prosthetic foot - single axis

Answer 53

``` Foot with a hinge to it Allows PF and DF Rapid foot flat Provides knee stability Primarily rx for transfemoral amputees ```

Question 54

Classification of prosthetic foot - multiple axis

Answer 54

Allows foot to accommodate terrain | Inv/ev

Question 55

Classification of prosthetic foot - SACH

Answer 55

``` Solid ankle cushioned heel Low maitenence Low cost Adjusted heel heigh The ultimate in durabiity ```

Question 56

Classification of prosthetic foot - Elastic keel

Answer 56

allows for compliance

Question 57

Classification of prosthetic foot - Dynamic response

Answer 57

Energy storage at heel strike Spring in heel compresses and as they come foward it will decrompress and help with push off Energy storage in loading response

Question 58

Bench alignment - sagittal plane

Answer 58

Sagittal plane Socket flex 5-10 deg Mark ntersection of post and middle third of foot Alignment reference line should fall at junction of the posterior and middle third of the foot length

Question 59

Bench alignment - coronal plane

Answer 59

Coronal plane Socket add 5 degrees Bisect socket

Question 60

Static alignment

Answer 60

knee in neutral flex/ext full WB Assess coronal balance pelvic stability

Question 61

Shoes

Answer 61

Consider stability, safety of remaining foot, don and doff, consistent heel height, cosmesis Make sure same heel to toe ratio for shoes worn

Question 62

Dynamic alignment checklist

Answer 62

``` Height level Smooth trans to stance Swing smooth Proper heel/toe lever Proper stiffness in heel Limited shift in socket Vertical pylon Body symm Arm swing ```

Question 63

Transfemoral levels

Answer 63

Knee disarticulation - adductors still intact, long residual limb BUT knee center lower than other side Long AK - still long residual but now 70% of add gone so less stability Short AK - still functional but see a lot of Trend Hip disarticulation - works like bench so can still be functional (usually CA) Hemipelvectomy (Not functional, usually CA)

Question 64

Transfemoral - Preparation for fitting

Answer 64

``` Wrapping limb Distal to proximal No gaps Above the hip Requires multiple applications Shrinker socks ```

Question 65

Socket design - transfemoral

Answer 65

Quad | Narrow medial lateral (ischial containment)

Question 66

Socket design - transfemoral - ischial component

Answer 66

Comes up on medial side of ischial tub creating a bony lock | Typically less comfortable

Question 67

Socket design - transfemoral - quadrilateral

Answer 67

they sit on ischial tub like sitting on bench

Question 68

Transfemoral - Bench alignment

Answer 68

Socket rotation External foot rotation TKA - Trochanter knee ankle Tend to have more flexion contractures

Question 69

Transfemoral - Bench alignment - TKA

Answer 69

Trochanter knee ankle Stationary alignment line to identify relative alignment between the center of the socket weight line, the rotation point of the knee and the functional rotation point of the ankle/foot

Question 70

Transfemoral - Static alignment

Answer 70

Stationary alignment to establish: - height - foot rotation - socket position: flexion/ext, ad/abd, AP position, ML position

Question 71

Transfemoral - Dynamic alignment

Answer 71

Allows for minute adjustments to the prosthesis Customizes alignment of prosthesis to the pt needs Ensures max activity and stability resulting in achieving the highest possible outcome

Question 72

Transfemoral - Alignment - purpose

Answer 72

The goal is to align the prosthesis so that the amputee uses the minimum amount of alignment stability or involuntary knee control necessary to optimize voluntary control Critical balance between mobility and stability to a achieve a safe and efficient gait