Prosthetic Phase (1) Flashcards
how do we determine K level
objective measures and outcome measures
scores of K level
range of scores across K-levels overlap
overlaping scores –> K level
mean scores do not overlap
range overlap makes determination difficult
allows for more flexibility
K1
slow walker
K2
intermediate walker
K3
fast walker
K4
fast walker and athletic activity
K1 and K2
stance control (single axis) and polycenturic knees
Foot: SACH or low level dynamic feet
K3 and K4
hydraulic and micropressor knees
higher energy storing dynamic feet
what are independent of K level
socket suspension and interface
bilateral
prosthetic check out
static
dynamic
static –> prosthetic check out
prosthesis
donning
check w/ pt sitting
check w/ pt standing
check doffing/inspection
prosthesis –> static
check prosthetic prescription
donning –> static
does the prosthesis fit
check insert/socks/interface
check ability to don
check insert/socks/interface –> donning –> static
measured in ply (cotton 2 ply/wool 3-5 ply)
insert 15 ply
check w/ pt sitting –> static
pressures
TT –> posterior, liner, knee flexion, RL
TF –> easy flexion, amount of flexion
check w/ pt standing –> static
pain/sensations
tissue rolls
foot position (shoe contact)
knee stability (TT/TF)
pistoning
leg length
suspension
total contact
checking doffing/inspection –> static
ability to doff
skin inspection = redness in appropriate areas
dynamic check out
gait eval
stair climbing
training v. problem
training v. problem –> dynamic
do they need more training
is this a problem
prosthetic rehab
prosthetic adjustment
RL
sound side
endurance
ADL
begin with –> prosthetic adjustment –> prosthetic rehab
1/2 hour to 1 hour per day
prosthetic adjustment –> prosthetic rehab
AM/PM
check RL skin before and after
gradual increase WBing
increase to 2-3 hours a day
progress until weaking prosthesis all day
RL–> prosthetic rehab
advanced rehab
exercises w/ prosthesis on and off
ADL –> prosthetic rehab
rising from floor, transfers, ramps
characteristics of gait for individuals w/ limb loss
asymmetrical
decreased self-selected walking speed (SSW)
increased energy consumption
what happens to SSW w/ limb loss
choice is slower
still most efficient but higher energy
able bodied SSW
120-140 cm/s
TT SSW
70-120 cm/s
TF SSW
60-80 cm/s
what step length is longer
prosthetic step length is longer than sound limb
prosthetic side –> step length
less time in stance = more in swing
less weight on prosthetic limb
sound side –> step length
more time in stance = less in swing
more weight on sound limb
divisions of gait
gait initiation –> quiet walking –> gait termination
initiation of gait
the phase when we go from static standing to starting to walk
what is the most problematic phase of gait
initiation
regardless of which foot is used (sound or prosthetic)
how long does initiation take
longer than able bodied
part of the cause is decreased walking speed
other issues with gait –> TT & TF
decreased shock absorption at HS
decreased propulsion at PO
other issues w/ gait –> TF
decreased knee control (flexion) @ HS
decreased propulsion at PO
decreased knee control during swing
increased muscle activity around the hip
TT compensations –> gait
increased hip and knee movement and force (muscle activity)
TF compensations –> gait
increased hip movements and force (muscle activity)
effects on sound limb
increase stress
trauma and degenerative changes
general considerations for prosthetic gait
more available movement in prosthetic joint –> more control needed
must consider mobility v. stability (always compromise)
safety first = most important consideration
