Prosthetics Flashcards
What is a prosthesis?
- Is a device or artifical substitute designed to replace as much as possible the function or appearance of a missing limb or body part
What’s the aim of prosthetic rehabilitation ?
- Enable the patient to achieve maximum functional independence with the prosthesis taking into account the patients premorbid abilities, lifestyle expectations
For a successful outcome what are the dependent factors?
Patient factors-
- premorbid levels activity
- ability to learn new skills
- pathology of contralateral limb
- static and dynamic level
- sufficient trunk control
- other comorbidities
Prothesis factors
- comfortable
- easy don (on) and doff (off)
- appropriate components
- lightweight, durable, realiable
- cosmetically pleasing
Teamwork
- appropriate communication between surgeon and rehab team.
- Surgeon operate with prostheis on mind
Who are upper amputations more common in?
- Young men- secondary to trauma
Who are lower limb amputations common in?
- Older population
- secondary to medical disease - PVD, DM
For trash ossseous amputations what criteria should be born in mind for the ideal stump?
- Scar should be well healed and mobile away form subcutaneous edges
- Skin should be sensate as possible
- Stump should be cyclindricial or conical shape at closure
- excessives tissue distal to bone secretion should be avoided
- Traumatised tissue shouldn’t be retained
- Myoplastic techniques- suturing muscle to periosteum should be attempted although myodesis maybe used in transfemoral
- Nerves sectioned cleanly under gentle tension and allowed to retract prevent neuroma formation
- Bone ends should be Bevelled or contoured
- Non absorbable sutures must be avoided
What is the optimism level of a prosthesis ?
- This achieved to allow limb fitting,common error stump left too long.
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Transradial forearm - optimal junction proximal 2/3rds and distal third of forearm.
- Shortest 3cm below insertion of biceps brachii. Longest 5cm above wrist joint to allow spacer for wrist rotatory prosthesis
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Transhumeral - optimum middle third if humerus,
- shortest 4cm below ant axillary fold,
- longest 10 cm above olecranon to alow spaces for elbow mechanism.
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Tansfemoral- optimium middle third of thigh
- shortest 8cm below pubis,
- longest 15cm above medial joint line
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Trans-tibial- optimium 8cm for 1m height
- , shortest 7.5 below knee joint,
- longest level at which a myodesis carried out.
What are the advantages of a dis articulation amputation ?
- The amputation retains the WB surface
- The Bulbous shape assists suspension of the prosthesis
What are the disadvantages of a disarticulation amputation?
- Amputation can compromise the choice and or fitting of prosthesis
- The prosthesis can appear bulky-
- exception- symes amputation for CONGENTIAL absence of fibula with associated leg shortening. The shortening of the leg allows the bulb of the stump to be masked within the shaping of the external calf prosthesis
How are prosthesis classified ?
- By level of amputation - e.g. transfemoral
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By structure
- ** exoskeletal**= where the strength of the prosthesis is in the rigid external structure and all parts are fitted to it
- Endoskeletal- modular where individual components are linked by internal struts and the whole assembly is covered with soft external cosmesis
- By Function- cosmetic vs functional
What are the common elements of a prosthesis ?
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Socket/ interface
- connection between the residual limb and the prosthesis
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Suspension mechanism- attaches the prosthesis to the residium ( belts, wedges, straps or suction )
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standard suction
- form fitting or semi rigid socket which residium is fitted
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elastomeric suction
- silicone/gel based sleeve that slips onto residium, which is then inserted into socket
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standard suction
- Struts/tubes (pylon) -intervening structure that restore limb length and attach the socket to the terminal device
- Articulating joints- replace missing joint function
- Terminal device- most distal part of the prosthesis ( in the ll= foot)
What does the socket do?
- Protects the residual stump
- transmits the forces necessary for standing and ambulation
- Made by computer assisted technology or moulding of residium
- May need to be adjusted as volume of residium changes
What are the 2 types of suspension mechanism?
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Standard suction
- form fitting or semi rigid socket into which residium is fitted
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Elastomeric suction
- silicone or gel based sleeve that slips onto the residium which is then inserted into the socket.
- Combined with a proximal external sleeve and distal valve-> airtight seal that stabilizes the prosthesis
What is the terminal device in a lower limb prosthesis cf a upper limb prosthesis?
what are the different types?
- LL= foot
- UL= Hand, Hook, gripper
- either passive ( less function but greater cosmesis)
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active ( more function less cosmesis)
- powered by cables attached to harness**= body powered device **
- action potentials from muscle contraction in the residum-= myoelectric device
- voluntary opening -if lie closed at rest
- voluntary closing- if lie open at rest
What are the 5 different types of grip ?
- Precision - pad thumb to index finger- pinching
- Tripod- pad of thumb to index and middle finger
- Lateral- thumb to lateral aspect of index finger
- Hook power- small joints of finger flexed and thumb extended
- Spherical - tips of fingers and thumb are flexed to open doorknob