Prosthetic Sockets, Knees, and Feet Flashcards
Approximately how many new amputations occur every year?
135,000
What percentage of amputations are due to vascular related disease?
70% (85%…who knows)
What percentage of amputations are due to trauma?
22%
What percentage of amputations are due to congenital birth defects?
4%
What percentage of amputations are due to tumors?
4%
When does limb shaping begin?
After sutures are removed somewhere around 2-4 weeks
When does a patient receive a temporary prosthesis which will allow them to begin prosthetic gait training?
5 weeks-4 months
When will a patient typically receive their permanent prosthesis?
Anywhere from 6 months to 1 year post-op
What 7 things are important to instruct your patient not to do post-op in regards to positioning?
- do not hang stump over bed
- do not sit in wheelchair with stump flexed
- do not place pillow under hip or knee
- do not place pillow under back curving spine
- do not lie with knees flexed
- do not place pillow between knees
- do not sit with knees crossed
60% of our patients are __ years or older
45
What 6 things determine the prosthetic prescription?
- Functional ‘K’ level
- Physical Concerns
- Vocational and Leisure Activities
- Cognitive skills
- Home environment
- Insurance Coverage
Describe a level 0 patient
Does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility
Describe a level 1 patient
Has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulatory.
Describe a level 2 patient
Has the ability or potential for ambulation with the ability to traverse low-level environmental barriers such as curbs, stairs, or uneven surfaces. Typical of the limited community ambulatory.
Describe a level 3 patient
Has the ability or potential for ambulation with variable cadence. Typical of the community ambulatory who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion.
Describe a level 4 patient
Has the 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
Are functional level 0 patients typically recommended for prosthetic use?
NO
What are the prosthetic limits for functional level 1 patients?
There are no limits on socket design, however there are limits on suspension choices, and the selection of knees and feet.
Functional level 1 patient prosthetics are for ______ purposes only.
basic ambulation
What are the prosthetic limits for functional level 2 and 3 patients?
There are NO limits on socket design, suspension, or interface
Functional level 2 patient prosthetics are for ______ purposes only.
basic ambulation
The typical transtibial prosthetic costs anywhere from _____ to _____
$7,000-$14,000
The typical tranfemoral prosthetic costs anywhere from _____ to _____
$10,000-$60,000
It is typical that the patient is responsible for __% of the prosthetic cost
20%
In regards to socket design what are 2 essential components?
It must be contour in order to provide relief and support for muscle function and total contact must be maintained
What 2 things can line the socket interface?
socks and gel liners
What are 4 suspension mechanisms for sockets?
- sleeve
- suction
- pin locks
- belts
Despite the fact that patients following Symes amputation have a long lever arm from intact tibia and fibula and full weight bearing on the heel pad, problems still exist. What is the biggest problem?
There is limited space available between the distal portion of the residual limb and the floor.
What type of prosthetic foot is used in nearly all contemporary Syme prostheses? What are its advantages?
Stationary-ankle flexible-endoskeleton (SAFE) foot
It has a flexible anterior keel that allows an easier rollover and reduces the ground reaction forces on both prosthesis and residual limb
What does SACH stand for?
Solid Ankle Cushion Heel
Describe the mobility that is allowed in a SACH foot and the advantages and disadvantages
Provides plantarflexion moment at heel strike which increases stability, however does not allow for inversion/eversion movements
What patient level is a SACH foot appropriate for?
K1
What does SAFE foot stand for?
Stationary Ankle Flexible Endoskeletal
What is the difference between the SACH foot and the SAFE foot?
They both provide stability at heel strike, however the SACH foot has the ability for the sole to conform to slightly irregular surfaces (mild inversion eversion compontent of motion) which makes it easier for the amputee to walk over uneven terrain
What are SAFE feet sometimes referred to as?
“flexible keel” feet
What patient level is a SAFE foot appropriate for?
K1 and K2
In what amputation type is the 2 single axis foot types (SACH and SAFE) beneficial to?
BK amputees with weak quad strength can benefit
What is the differences between functional level K3 feet (Seattle Litefoot, Quantum foot, etc.) and the SACH foot?
They are fabricated from lightweight flexible carbon fiber
What are the 4 advantages of level K3 feet?
- offer increased ankle motion
- reduce energy consumption
- reduce sound side loading
- store and return more energy