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Orthodics > Lower Extremity Prosthetics > Flashcards

Lower Extremity Prosthetics Flashcards

1
Q

Reasons for LE Prosthetics:

A

Disease 70% vascular related
Trauma 22%
Congenital birth defects 4%
Tumors 4%

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2
Q

Check Socket or Diagnostic Socket

A

A transparent socket used to aid in assessing prosthetic fit.

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3
Q

Definitive Prosthesis

A

A prosthesis that is intended for long term usage, comfort, fit, cosmetic appeal and durability. Usually fit once the residual limb stabilizes.

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4
Q

Pistoning

A

refers to the residual limb moving up and down within the socket while walking

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5
Q

Preparatory Prosthesis

A

Initial prosthesis that may or may not include definitive components. It is intended for temporary use to allow the patient to begin therapy for gait training. It is expected that it will need to be replaced within 3-9 months due to changes in the residual limb

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6
Q

Socket liner

A

soft interface used between the hard socket and residual limb. These can be made of various types of gel, socks or soft foams

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7
Q

Suspension Sleeve

A

an elastic tube made of varying materials that is first pulled over the outside of the prosthesis and then rolled up onto the thigh once the prosthesis is put on

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8
Q

C-Leg

A

The Otto Bock C-Leg features a swing and stance phase control system that senses weight bearing and positioning to provide the knee’s microprocessor information about the amputee’s gait, thus promoting smoother ambulation. The outer shell houses a hydraulic cylinder, microchip, and rechargeable battery

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9
Q

energy storing foot

A

A prosthetic foot designed with a flexible heel. The heel stores energy when weight is
applied to it and releases this energy when weight is transferred to the other foot

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10
Q

Ischial containment socket

A

In some amputation cases, usually those of the HP or HD, this socket is used to
support the ischium

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11
Q

multiaxis foot

A

The multi-rotational axis allows for inversion and eversion of the foot, and it is effective for walking on uneven surfaces.

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12
Q

pylon

A

A rigid structure, usually tubular, between the socket or knee unit and the foot that provides a weight bearing, shock-absorbing support shaft for the prosthesis

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13
Q

suction socket

A

Mainly for use by AK level amputees, this socket is designed to provide suspension by means of negative pressure vacuuming. This is achieved by forcing air out of the socket through a one-way valve when donning and using the prosthesis. In order for this type of socket to work properly, the soft tissues of the residual limb must precisely fit the contours of the socket. Suction sockets work very well for those whose residual limbs maintain a constant shape and size

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14
Q

Apply post-operative protector:

A

0-4 weeks

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15
Q

Incision fully healed; cast for prosthesis

A

5-9 weeks

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16
Q

Sutures removed; limb shaping

A

3-5 weeks

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17
Q

Pre-prosthetic training period from presurgery to temporary device

A

0-2 weeks (could start before)

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18
Q

Ongoing therapy and prosthetic adjustments

A

4 months-6/7 months

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19
Q

Receive permanent prosthesis

A

6/7 months-1 year

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20
Q

Primary post-operative concerns:

A 
Protection of residual limb
Compression-reduce post surgical edema
Maintenance of ROM
Pain Management- Pain vs Phantom pain/sensation 
Maintain Strength and cardiac reserves
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21
Q

Types of protection for residual limb:

A

simple splint
post operative cast
removable post operative cast
weight-bearing post operative device

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22
Q

Post-op evaluation

A 
History
Living situation
Support network 
Work
Goals
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23
Q

Tubular Gauze

A

Used for bulbous, sensitive limbs
double layering of material
same advantages and disadvantages as ace wrapping
uniform compression

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24
Q

Prosthetic Shrinker

A

Compression sock that is used to help control swelling in the residual limb and help shape the limb in preparation for prosthetic fitting

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25
Q

Prosthetic Socks

A

Socks of varying thicknesses or ply. The higher the ply number, the thicker the sock. They allow a patient to manage small volume changes in limb size and add to the comfort of prosthesis. They can be made of different materials, including wool, silicone and synthetic fibers

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26
Q

Compression garments:

A

ace wrapping
shrinkers
post operative casts

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27
Q

Who are our patients?

A

60% are 45 years or older
85% lose limbs to diabetes or related vascular disease
Multiple chronic health concerns
Deconditioned, Flexion contractures, Overweight

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28
Q

What determines the

prosthetic Rx?

A 
Functional ‘K’ level
Physical Concerns
Vocational and Leisure Activities
Cognitive skills
Home environment / distance from prosthetic center
Insurance Coverage
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29
Q

Physical Concerns of prosthetic Rx?

A

Level of amputation
Disease pathologies
Body weight
Skin integrity

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30
Q

Functional Level 0

A

no ability or potential for weight bearing or transfer

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31
Q

Functional Level 1

A

Ability or potential to transfer and ambulate within the household with an assistive device

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32
Q

Functional level 2

A

Community ambulator with the ability or potential to traverse minor environmental barriers, fixed cadence

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33
Q

Functional Level 3

A

Community ambulator with the ability or potential to traverse all environmental barriers with a variable cadence

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34
Q

Functional Level 4

A

ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete

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35
Q

Physical Concerns

A 
Amputation length
Weight restrictions on components
Vocational and Leisure Activities
Skin Integrity 
Peripheral Neuropathy/ hand strength
Disease pathologies
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36
Q

Socket design

A

Muscle contouring

Total contact

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37
Q

Socket interface

A

Socks

Gel liners

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38
Q

Suspension

A

Sleeve
Suction
Pin locks
Belts

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39
Q

Principals of

Socket Design

A

Contour, relief and support for functioning muscles
Stabilize Skeletal Structure
Position Muscles to optimize strength
Minimize applied pressures to neurovascular structures
Distribute forces within socket over the entire limb

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40
Q

Trans-tibial Socket design and Interface

A

Patellar Tendon Bearing (PTB)

Total Surface Bearing (TSB)

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41
Q

Where is weight bearing concentrated in PTB?

A

patellar tendon
medial tibial flare
gastrocnemius

42
Q

PTB complaints:

A

excessive pressure in popliteal fossa or patella tendon

Older style of Prosthetic sockets developed in 1959 after WWII

43
Q

Total Surface Bearing (TSB)

A

Pressure distributed over entire limb surface.
The entire surface ofthe residual-limb is in total contact with socket while every unit area isunder compression to its proportionate tolerable level

44
Q

Hydrostatic Design Sockets

A

considered TSB
Bearing design but they utilized compression chambers to achieve a uniform fit.
Fluid in chambers utilized Pascal law of fluids that apply pressure uniformly in all directions.
Also uses a silicone suction suspension sleeve

45
Q

Socks

A

maintain socket fit

46
Q

Nylon Sheaths:

A

help wick perspiration from skin

47
Q

Gel Liners

A

provide protection against shear and pressure and can be integrated into suspension. Key component of TSB sockets. High friction inner and low friction outer allows decrease skin shear

48
Q

Types of gel liners

A

Silicone elastomers, silicone gels, urethanes

49
Q

Transtibial Suspension

A 
Cuff / Waist belt / Joints & Lacer
PTB SC/SP
Sleeve – many variations
Locking liners/seal in
Active suction
50
Q

Sleeve Suspension

A

Older style of prosthesis suspension but a versatile
Neoprene, Latex, Gel lined sleeve that fits over the top of the prosthesis
Not durable
Create negative pressure seal
Work w/other suspension methods

51
Q

Three suspensory forces attributed to the sleeve are

A
  1. negative pressure created during the swing phase,
  2. friction between the residual limb and the socket, and
  3. longitudinal tension in the sleeve
52
Q

Sleeve suspension advantages

A

Simple and effective means of suspension.
Helps minimize socket pistoning.
Does not create proximal constriction.

53
Q

Sleeve suspension disadvantages

A

Provides no added knee stability.
Suspension is greatly decreased if the sleeve is punctured.
Perspiration may build up under the sleeve and create skin irritation or hygiene problems.
Must be replaced regularly.
Sleeves may restrict full knee flexion and require good hand function to don and doff.

54
Q

Elevated vacuum systems try to

A

reduce pistoning, perspiration and provide better linkage between user and prosthesis.

55
Q

Benefits of Elevated Vacuum Systems:

A

Better pistoning
Better cirulation
Soft tissue hydrated

56
Q

Trans-femoral socket design

A

Quadrilateral
Ischial Containment
M.A.S.

57
Q

Quadrilateral Socket

A

Wide M-L / narrow A-P
Weight bearing through ischium and Gluteal muscles
Can be used effectively by healthy, muscular individuals

58
Q

Ischial Containment

A

Narrow M-L dimension
Ischium and ramus contained within socket
Maintains natural femoral adduction
Increased medial lateral stability during ambulation

59
Q

Muscle Contouring

A

built-in relief for concentrated pressure points
an aggressive, more intimate fit of the pelvis bone
improved M-L control
increased A-P stability
reduced socket rotation on the
Controls alignment of Femur
anatomically correct channels to encourage muscle contraction during gait
ability to increase muscle tone in residual limb

60
Q

MAS Socket: Marlo Anatomical Socket Medial Ramus Ischial Containment

A

Narrow M-L Anatomical Socket Shape
Good M-L control due to boney lock
Increased Range of Motion throughout gait cycle
Increased sitting Comfort

61
Q

Double Wall Socket for Transfemoral

A

Socket within a socket
transfemoral prosthesis that fits intimatelyand provides increased control and security
largerrange of motion

62
Q

Trans-femoral Suspension Belts:

A

Silesian
Elastic Removable
Waist belt with pelvic band and hip joint

63
Q

Trans-femoral Suspension Suction:

A

Incorporated into socket

Incorporated into liners

64
Q

Trans-femoral belt suspension:

A

May be used as primary or auxiliary form of suspension

Rotational stability / mediolateral pelvic stability may be enhanced with the addition of hip joint

65
Q

Advantages of belt suspension

A

Can be simply applied
Rotational control for shorter limb length
Positive point of attachment over contra-lateral pelvic crest

66
Q

Disadvantage of belt suspension:

A

Can cause skin irritation
Silesian Belt can not be removed for laundering
Removable belts are bulky and retain body heat

67
Q

Trans-femoral suction suspension:

A

Air expulsion valve facilitates suspension by negative air pressure applied with sock or other pull on device
applied with lotion or other lubricant

68
Q

Disadvantages of Trans-femoral suction suspension

A

Must Have stable limb volumes
Less effective on limbs with irregular contours or scars
Short residual limbs may require secondary suspension
Perspiration can be a problem

69
Q

Advantages of Trans-femoral suction suspension

A

Increased Proprioception

Less vertical displacement of prosthesis during ambulation

70
Q

Disadvantages of suction liners:

A

Can cause fleshy limbs to elongate during swing
Lock mechanisms add additional length to socket
Liners need meticulous hygiene to avoid odors and skin irritation

71
Q

Advantage of suction liner:

A

Easy donning

Can be adjusted for volume fluctuations

72
Q

Flexible
Socket and Frame
Construction

A

Improved comfort at brim
Ability to modify for volume fluctuation
Cut outs in frame allow for increased sitting comfort, as well as active muscle contraction during gait

73
Q

Function of Prosthetic Knees

A

Provide Security against collapse when prosthesis is loaded
Provide shock absorption at heel strike
Flex during preswing and swing phase to advance prosthesis
Slow down extension during terminal swing to prevent damage to knee joint

74
Q

Functional level 1 choices of Prosthetic knees:

A

locking knee
single axis friction
safety-knee-stance; activated breaking mechanism

75
Q

Manual Lock

A

Functional Level 1 – 2
Transfer prosthesis or limited walking on level surfaces
Simple design, provides a non-flexing knee while standing/ambulating
Patient must unlock knee manually to sit
If patient falls, the knee will not collapse under them
“knee of last resort”

76
Q

Friction Knee

A

Functional level 1 - 2
Transfer prosthesis or limited walking on level surfaces
Simple design, functionally acts like a simple door hinge.
Friction setting allows for only one walking speed
Friction plates wear and will require regular maintenance and replacement

77
Q

Single Axis

A

Less moving parts and simple design
Lower fabrication costs
Less stable at heel strike
One axis to absorb gait stress

78
Q

Polycentric

A 
Inherent stability at heel strike
Easy to initiate swing phase
Tend to be heavier
Increased maintenance
Greater inherent mechanical stability resulting in greater stance stability
Good choice for short residual limbs
79
Q

Stance Control Knee

A

Functional Level 1-2-3
Provides added stability during a missteps or uneven surfaces
Breaking mechanism locks the knee during stance phase
Most popular knee fit in USA
Light weight
Break will wear and knee will fail without proper adjustment and maintenance
Locks’ in up to 20 degrees of flexion
Best suited to geriatric or individuals with weak hip extensors

80
Q

Fluid and Pneumatic Swing Control

A

Extension and flexion resistance controlled for more efficient gait
Eliminates terminal impact
Heavier
More expense
Some models include stance flexion
Hydraulic can be used to descend stairs step over step
Can be either single axis or polycentric linkage

81
Q

Hydraulic Swing Phase Knee

A

Functional level 3-4
Hydraulic mechanism provides resistance to flexion/extension during swing phase
Provides variable cadence; ability to change walking speeds without hesitation
Tend to be heavier due to hydraulic fluids in cylinder
Require regular maintenance

82
Q

Microprocessor Swing

A

Functional Level 3-4
Provides resistance to flexion/extension during swing phase
Enables variable cadence; ability to change walking speeds without hesitation
Added expense due to computer technology
Maintenance is essential

83
Q

Microprocessor Swing/Stance

A

Functional Level 3-4
Some level 2 requiring added stability
On board computer analysis gait 50 times per second and performs continuous hydraulic adjustments to ensure stability, security and efficiency in swing and stance.
Provides microprocessor hydraulic controlled stance and swing phase function
Stance stability is engaged and disengaged as necessary
Provides maximum cadence response over a wide range of functional applications

84
Q

Microprocessor Knee

A

Utilize microprocessor controls to adjust resistances according to ‘real time analysis’ of gait
‘Stumble Recovery’
Typically involved authorization process
Expensive initial cost and repairs

85
Q

Power Knee

A

Motor powered to simulate knee function without relearned motor strategies using alternative muscle groups. The knee mechanically replaces the knee function.

86
Q

Specialized Adaptors/Knee

A

water knee
positional rotators
quick disconnects

87
Q

Functional Level 1 feet:

A

single axis foot

SACH foot

88
Q

Single axis foot

A

provides plantar –flexion moment at heel strike improving stability

89
Q

SACH

A

Solid Ankle Cushion Heel foot

SACH foot is simple design, low cost lowest function

90
Q

Functional Level 2 feet:

A

multi-axial foot

flexible keel foot

91
Q

Multi-axial foot

A

provides plantar and dorsi-flexion as well as inversion, eversion and rotation, reducing shear forces on limb and greater stability on uneven surfaces

92
Q

Flexible Keel foot-

A

SAFE Foot internal flexible keel permits tri-planar movement with an easy roll over

93
Q

Functional Level 3 feet:

A

no restrictions

94
Q

Dynamic response/energy storing feet

A

absorbs energy” during mid and terminal stance
“releases energy” at toe off
More energy efficient gait
Can incorporate pylon for increased reaction
Can incorporate inversion/eversion
Lightweight and durable
Body Mass and activity sensitive

95
Q

Multi-axial dynamic response feet

A

Provides Multi axial compliance to uneven ground
Dynamic response at toe off for more dynamic walkers
Classified as “Energy Storing”
Split toe allows for inversion eversion

96
Q

Specialty Feet

A 
micro-processor controlled ankle (adjusts plantar and dorsiflexion)
adjustable heel height
special uses (running, swimming)
97
Q

Vertical Shock and Torque Absorbers Advantages

A

Reduce impact at heel strike

Reduce rotational shear forces within socket

98
Q

Vertical Shock and Torque Absorbers Disadvantages:

A

Increased weight
Increased maintenance and cost
Clearance an issue for long residual limbs

99
Q

Syme limbs prosthetic characteristics:

A

Light enough to wear comfortably
Ability to supply the equivalent of foot and ankle function
Lengthening of the limb to adjust for loss of the talus and calcaneous
Distribution of the high forces developed in the ankle area
Provision of rotary stability about the long axis
Provision of shock absorption
Suspension during swing phase
Readily donned without requiring multiple non-cosmetic, difficult fasteners
Adjustability to relieve pressure along a sensitive scar line
Cosmesis

100
Q

SAFE foot:

A

stationary-ankle-flexible-endoskeletal
makes it easier for the amputee to walk over uneven terrain
Foot has the same action as the SACH plus the ability for the sole to conform to slightly irregular surfaces (mild inversion eversion compontent of motion)

Orthodics (16 decks)

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