Pre-Gait Activities Flashcards
1
Q
What is involved in prosthetic training
A
- Pre-prosthetic training and preparation
- Care of prosthetic componentes and residual limb
- Donning/doffing of prostheses
- Assessment of prosthetic fit
- Pre-gait activities and training
- Gait training/assessment and environmental negotiation
- Gait dysfunction/patterns
- Outcome measurement
2
Q
What is involved with prosthetic preparation
A
- Protect incision/residual limb integrity
- Regular skin checks
- Shaping of the residual limb
- Scar mobilization
3
Q
What are the components of a prostheses that requires care
A
- Linear/nylon sheath
- Socks
- Prosthesis itself
4
Q
4 steps of component care
A
- Hand wash with mild soap and water
- Rotate daily and allow to dry overnight
- Remove any debris
- Check for uneven areas/holes and replace when worn
5
Q
Describe prosthetic socks
A
- Different thicknesses/ ply
- Most common is 1, 3, and 5 ply
- You have to add them together to get the total ply
- Goal is to wear the least number of socks to get the correct ply.
- Educate the patient to always carry multiple socks and they will need to adjust ply during the day.
6
Q
Prosthetic donning
A
- Safest if performed initially in sitting
- Most patients will need to stand to get all the way down into the socket but want to don most things in seated
- Start with liner -> don correct number of socks for a snug fit but able to drop all the way into the prosthetic
- Don thickest sock first progressing to thinnest — its easier to adjust ply later
7
Q
Trans-tibial donning
A
- Angle of prosthesis with knee flexed to 30-45 deg
- Align patella with patellar cut out
- Gently push down on knee or slide down into socket to engage suspension method (shuttle lock, suction, vacuum)
- Stand and weight shift to slide down to final resting position
8
Q
Trans-femoral donning
A
- Don in sitting if possible
- Slide into socket as far as possible
- Attach socket to limb via suspension mechanism (suction, vacuum, strap)
- Stand to lock into prosthesis/get to final resting position — requires good dynamic balance
- Lock knee in standing prior to weight shifting.
9
Q
How do you assess a transtibial prosthetic fit
A
- Assess in standing
1. Patella lined up with cut out
2. Supracondylar ridges over femoral condyles
3. Patellar tendon just above patellar bar
4. Tight fit between socket and residual limb
5. Not bottoming out
10
Q
How do you assess transfemoral prosthetic fit
A
- Assess in standing
1. Bend forward to assess ischial tuberosity
2. Abduct prosthesis to palpate public ramus.
11
Q
What are other prosthetic fitting observations
A
- Pelvic alignment — want symmetry of iliac crests and ASIS
- TF socket — flex, add, wall height
- TT socket — IR/ER, valgus/varum, supracondylar trims
- Feet — prosthetic foot flat on floor, slight toe out, PF/DF
12
Q
Steps for doffing prosthesis
A
- Performed in sitting
- Disengage locking/suspension mechanism
- Slide off prosthesis
- Take off socks/sleeve
- Skin inspection (can use handheld mirror)
13
Q
General skin inspection tips
A
- Total surface bearing and transfemoral = look for general redness and reports of discomfort, should not be over areas of bone prominences
- Note amount of sweating or any rashes
- Redness should dissipate within 20-30 minutes
- Educate patient on expected areas of redness
- Put compression method back on or rewrap
14
Q
Transtibial pressure tolerance areas
A
- Patellar tendon
- Supracondylar areas
- Tibial flares
- Hamstring muscle/posterior residual limb
15
Q
Transtibial pressure INtolerance areas
A
- Femoral condyles
- Patella
- Tibial tub
- Tibial crest
- Fibular head
- Anterior/distal ends of tibia and fibula/incision line