Prosthetic CPM Flashcards
Causes if knee instability occures at heel strike to foot flat
Knee center too far anterior to TKA
planter flexion to stiff.
Weak hip extensors.
Causes if Foot slap occurs at heel strike?
Hydracadence gait
plantar bumper to soft (weak) SACH foot
If patient presents with unequal stride lengths
Excessive initial socket flexion
bad gait habit.
Optimum gait AK heel strike to mid stance?
Goals
foot remains on line of progression during plantar flexion
trunk erect 1”-2” head sway towards prothesis.
If there is external rotation of foot?
Cause,
anterior medial brim not flared enough, presses on pubic area
plantar flexion too stiff or ROM limited.
Lateral trunk bending?
Weak abductors short femur insufficient adduction of lateral wall painful lat distal femur pressure foot outset too far prsothesis too short hip pathology.
Optimum gait AK mid stance goals?
Gait base 1”-2” between medial borders of heels
ischium over center of heel
foot remains flat on floor.
Abducted gait?
Excessive crotch pressure– ramus on medial wall, ishcium down in socket
anterior pelvic tilt causes pressure on pubes
prostheis too long
poor gait habit
lateral distal femur pain.
Wide base of gait
Foot outset too far.
Inversion/eversion of foot?
Improper adductions/ abductions of socket loose socket (ML).
Optimum gait AK heel rise?
Goals
center of grravity follows a smooth arc without perceptiable rise or fall of head and troso (Pelvie ride , dropp off)
normal stride length on soude side with excessive lumbar lordosis.
Pelvic rise?
Toe level arm too long
hyrdacadence foot set in excessive plantar flexion
shoe change by amputee-lower heel
foot too tight in shoe.
Drop off
Toe level are too short
hyrdacadence foot in excessive dorsiflexion
long stride on sound side
insufficient initial socket flexion.
Optimim gait AK toe off through acceleration frontal plane goals?
Hip knee and foot swing through on line of progression.
Medial whip
Knee axis in excessive external rotation
socket unstable on stump.
Lateral whip more common than medial?
Knee axis in excessive interal rotation
socket unstable on stump.
Optimum gait AK toe off through accelectation sagittial plane?
Goals
smooth hip and knee flexin with quad like control of knee flexion and heel rise
socket remains secure on stump.
Inadequate knee flexion?
Excess knee damper action.
Excessive heel rise?
Inadequate knee flexion damper action.
Circumduction
Medial brim problems
prosthesis too long
inadequate knee flexion.
Piston action?
Inadequate fit and/or suspension.
Optimum gait AK SWING THROUGH?
Goals
smooth center of gravirty summit of arc equal on both sides accompained by ample toe clearance.
Vaulting on sound foot and/or toe drag of prosthetic foot?
Prosthesis is too long
prosthesis is correct length, not well seated on ischium stump out of socket
prosthetic knee too stiff, does not flex enough
bad gait habit.
Optimum gait AK deceleration?
Goals
smooth noiseless deceleration of swign to full extenison
equal stride length.
Terminal impact?
Improper friction function.
Knee hyper extension?
Incorrect or worn out extension stop.
Unequal stride?
Incorrect initial socket flexion.
Optima gait BK heel contact viewed laterally?
Goals ball of foot not over 1-1.2" from floor knee flexed 5-10 degrees viewed thigh to shank or pylon stride length same as normal need 1/2" heel compression.
Ball of foot dorsiflexed more than 1/2”?
Stride length too long – gait training problem
faulty suspension– does not maintain knee in 5-10 degreees flexion
excessive socket flexion ( first two must be evaluated before socket flexion).
Knee fully extended?
Faulty suspension – does not maintian knee in 5-10 degrees of flexion
heel level are too short
heel cushion too soft.
Unequal stride BK?
Faulty suspension- does not maintain knee in 5-10 degrees of flexion
bad gait habit.
Optimum gait BK heel contact to foot flat viewed laterally?
Goals
knee flexes smoothly and quickly to approximately 25 degrees or same number of degrees as the normal side
residual limb in down in socket, not piston action.
Knee flexes jerkily?
Weak knee musculature.
Excessive knee extension?
Bad gait habit.
Knee “jack knifes” abruptly?
Heel lever arm to long.
Piston action of stump on socket?
Suspension system is incorrect.
Continued anterior distal tibia pressure?
Excessive use of knee extensors
socket posterior brim too low
AP socket too large.
Optimum gait BK mid stance viewed from anterior posterior?
Goals
lateral bending trunk 1” at head
width of gait base up to 2” between medial borders of heel
foot is flat on floor
socket is displaced laterally but not more than 1/2”.
Lateral trunk bending exceeds 1” at head?
Hip pathology
prosthetic foot out set too far laterally
prosthesis too short.
Gait base exceeds 2” wide base of gait?
Bad habit
prosthetic foot outset too far
possible hip abductor pathology
prosthesis 1” or more too long.
Inversion and eversion of foot, walking on lateral or medial border of shoe?
Improper adduction or abduction of socket
loose socket.
Lateral displacement exceeds 1/2”?
Loose socket ML
prosthetic foot excessively inset.
No lateral displacement or any displacement medially?
Prosthetic foot outset too far
pain in peroneal nerve
very short residual limb
knee joint pathology.
Optimum gait BK HEEL RISE VIEWED LATERALLY?
Goal
as amputee passes over the prosthesis, knee flexion increases smoothly to equal that of the normal leg.
Knee goes into extension?
Toe level arm too long.
pressure at the anterior knee reported by the amputee
SACH foot too tight in shoe.
Amputee may also report “unable to go over the toe”?
Amputee changed shoe to lower heel height
bad gait habit
insufficient socket flexion.
Optimum gait BK WEIGHT TRANSFER TO TOE OFF VIEWED LATERALLY?
GOALS
weight is shifted to the sound side without perceptible drop or ride of head and torso accompained by increase in knee flexin on the prosthetic side equal to the sound side.
Drop off?
Toe level to short
foot to posterior
short keel in foot
heel of shoe too high.
Prosthesis drops away from residual limb?
Suspension.
Knee fleses jerkily?
Weak musculature.
Optimum gait BK swing phase viewed laterally?
goals no whip
shank and foot sging through on line of progression
socket remains securely on residual limb
ample tor clearance.
Foot rotates during swing?
Improper placement of suspension studs for cuff suspension.
Piston action bk socket?
Faulty suspension.
Circumduction?
Prosthesis too long.
Drags toe on floor?
prosthesis too long, foot not in dorsiflexion
Three month old congenital transtadial amputee has been refered to you for evaluation, would you recommend fitting at this time ? why? describe in details you recommendation for prosthetic treatment starting with initial fit through the stages as child develops?
No fitting at 3 months, skin in tender and limited until child sits
“fit with sit” usually 6 months with passive opening TD cuff and harness
reasons
Balance improved
to get child used to normal symmetrical length extremities
to simulate bilateral function at normal work distance
to incorporate a prosthesis into body image
to help xhild and parent to accept prosthesis
to reude dependence on tactile sensation on end of limb.
When to use TD, Mitt, Harness, Active harness
Activate terminal device when child puts items in TD– clue that child is ready to use bemanual activited usually 18 monthe to 2 years.
In stance phase, what socket and amputee condition would cause trendelenburg gait?
Prosthetic
Insufficient socket adduction
Loose socket M/L
No skeletal lock
Amputee Short limb Weak hip abductors Hip pathology Distal lateral stump pain
Alignment consideration for bilateral trans femoral?
Outset feet
Make knee as stable as possible
Shorten height of prosthesis.
Unilateral trans femoral amputee has been fit with a definitive prosthesis, she returns one week after delivery with excessive knee flexion occurring at heel strike. Give as many causes as possible for the unstable knee
Insufficient flexion
Unstable alignment
Stiff planter flexion bumper or firm SACH heel cushion.
Why is insufficient flexion a cause of knee instability at heel strike?
A Ak amputee requires 15 degrees of extension, for normal stride length. 10 degrees available in lumbar, therefore, 5 degrees of preflexion is needed to allow normal stride length with sound leg. 5 degrees preflexion, hip extensor on stretch for powerful extension for of knee stability.
What would cause an trans femoral to break suction when he sits?
Anterior brim too high
Loose socket tension
A/p too large.
How would you correct lateral whip?
Externally rotate knee
Correct post-med wall angle that I’d too great
Ask patient to Redon prosthesis.
Figure 8 TR Harness
Name 6 parts and use
Anterior support strap- passes through deltoid pectoral groove, connects to prosthesis by inverted Y strap. Provides stability against downward pull. 18in long
Inverted Y- 8-10 in 1/2 in wide provides stability against downward pull
Control attachment strap - 24 in long, connects to cable system to control TD. Sit low across scapula to allow for better excursion
Axilla loop- anchor for harness, suspension. 3 feet long top end is sewn to NW ring, bottom connects through 4 bar buckle
4 bar buckle wide slot towards ring
NW ring- located below c7 towards sound side, aids in suspension
A 45 year old male, bilateral trans femoral amputee acquired from a traumatic injury, he is 6 months post operative, what would be some consideration before fitting?
Consideration: general health, upper extremities, skin consideration, occupation
First 6 months
Shriners
Stubbies for eval for definitive prosthesis
Total contact, pelvic belt in length is sufficient
Fit with TF prosthesis
Total contact with Silesian belt
Total contact with pelvic suspension
1 knee weight friction locking knee for stability
1 knee non locking for sitting
Single axis feet
Extra points-use endoskeletal when fabricating with ultra lite componentry.
Explain how the single control system works?
Stainless steel cable attach to the cable attachment strap, the cable enters the cable housing at the level of the proximal tricep cuff and the housing runs through the cross bar assembly tab located on the tricep cuff. Is passes close to the elbow joint. And enters the base plate to anchor the cable to the socket. It leaves the cable housing.
Figure 8 TH harness
Name 7 possible options?
Axilla loop- 3 feet long, aids in suspension and anchor for harness! superior end is seen to NW ring, inferior connects through 4 bar buckle
4 bar buckle- use to assemble harness, wide slot towards ring
Anterior control strap- runs through deltoid pectoral groove, and attached to socket anterior just slightly above mechanical elbow. Primary suspenders, prevent external rotation, distal 2/3 made of elastic webbing.
Control attachment strap- 24 in long, connects to cabling system to operative terminal device
NW ring- sits inferior slightly towards sound side to lay low across the scapula for better excursion. Aids in suspension
lateral control strap- primary suspension for TH, prevents external rotation when operation terminal device. Attaches to axilla loop and TH socket just anterior to acromion, and close to proximal trim lines.
Cross back strap (optional)- prevents harness from riding high on shoulders, and eases prosthetic use. Often use in TH because the harness needs to very snug.
What would be a good quality(s) to look for in a prosthetic foot for a TT amputee who is a K2 designated household ambulator that utilizes his prosthesis efficiently during the day but fatigues in the evening and buckles at the knee secondary to quadriceps weakness.
Foot that progresses rapidly into plantar flex ion during loading response.
Heel should have a relatively soft durometer.
A TT patient is seen presenting with a traditional exoskeletal PTB prosthesis with a SACH foot. Patient states that see feels like to prostheses is throwing her knee forward as soon as the heel firmly contacts the ground. She has worn this prosthesis comfortable for two years until one month ago. What is the first clinical action you should tale at this time in the appointment?
Check to see if the patient switched to a shoe with a higher heel height compared to what she used to wear.
The Krukenburg procedure is used at times in developing countries where expensive prosthesis are not attainable. What other patient population would this be potentially used for?
Blind patients with bilateral below elbow amputations.
Failed prosthetic use for bilateral below elbow amputations.
