Prosthetic Training Flashcards
When would a PT typically order a definitive prosthesis for a person post amputation
when the person is proficient with a preparatory prosthesis
Prosthetic timeline
- specific timeframe varies from facility to facility
- prepartory prosthesis usually 4-6 months post healing
- training: DON/Doff procedure, gait train, progression AD and surface
- definitive prosthesis (12-18 months post surgery - when serial girth measurements/stable with socks indicates stable volume
education during prosthetic training
- care of prosthesis, socks, and residual limb
- use lotion sparingly - apply at night
- use sunscreen on residual limb when exposed to sun
- may need antiperspirant appled at night
- protect the remaining limb
- DO NOT apply lotion between toes or around open wounds
Wearing schedule: skin checks
- successful prosthesis use requires skin adapation
- skin needs to develop ability to sustain weight-bearing in area not inherently desgined for weight-bearing
- most individuals with vascular dysfunction have a degree of sensory impairement
- transtibial: skin check is VERY important as they are more likely to have effects of neuropathy still
What is the recommended wearing schedule when getting adjusted to a prosthetic
- wear for 2 hrs on, 2 hrs off and up to 20 minutes weight bearing each hour
- 2-2-20 rule
Pressure tolerant areas
- patellar tendon ligament primary WB surface
- pretibial muscle mass
- lateral surface of fibula
- inferior surface of medal tibial condyle
- popliteal fossa
- pressure sensitive areas are over body landmarks
pressure sensitive areas
- patella
- tibial tubercle
- tibial crest
- anterodistal end of tibia
- head of fibula
- hamstring tendon
Socket fit
transtibial prosthesis
- redness from patella tendon bar on skin of resdiual limb after WB - reference used to determine if socket fits properly
- if mark is too high = pt is too deep = more socks needed
- if mark is too low = pt is not deep enough in socket = remove socks
Socket fit
transfemoral prosthesis
- pt usually complains of groin pressure if too deep in socket
- check iliac crest heights
Basic transtibial prosthetic checkout
whenever patient stands or ambulates
complaints of discomfort in socket
- generalized discomfort = continue
- localized discomfort = remove prosthesis, check for excess pressure in pressure sensitive areas
is prosthesis correct length - check iliac crest
- is piston action minimal
- hike leg up and down and observe
- can result in skin probelms
- makes limb too long during swing
is A-P alignment satisfactory
- no excess knee flexion or extension when standing/ambulating
- heel on floor at midstance
Is M-L alignment satisfactory
- no excess knee valgus or varus
- foot flat on floor
after ambulation/WB: remove prosthesis and socks
- is pressure in pressure tolerant areas
Basic transfemoral
prosthetic checkout
complains of discomfort in residual limb when WB
- generalized = continue
- local = remove and check for excessive pressure
is socket in proper rotational position on residual limb
- knee slightly ER and foot slightly toed out
- if not loosen suspension and ER socket on residual limb
is prosthesis correct length
- check iliac crest height
Is A-P alignment correct
- prosthetic knee should be stable
Is M-L alignment correct
- foot flat on floor at midstance (not on medial or lateral border)
Is piston action minimal
after ambulation/WB remove prosthesis check for areas of excessive pressure on skin
Gait training challenges
transtibial vs transfemoral
Transtibial
- easy to teach to walk
- difficulty to keep skin in tact
transfemoral
- challenge to teach to walk safely and well
- skin NOT the issue
What should be the first priority for initial gait training with prosthesis
find center>weight shift control>stance control on prosthetic side.>step with prosthetic foot
Finding center
- new amputee usually feels like they are leaning toward prosthetic side when COM is centered
- stand with UE support
- mirror in front
- find equal WB on BLE
- progression: lift one hand, lift both hands, look away from mirror - try to maintain centered position
Weight shift control
- dynamic control
- weight shift toward non-prosthetic leg
- then weight shift toward prosthetic leg
- move hips side to side “hula hoop”
- pay attention to sensory input related to where weight is on foot
