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Unit 15 > TFA socket and alignment > Flashcards

TFA socket and alignment Flashcards

1
Q

objective of all prosthetic sockets is what three things?

A

Provide stability

Maintain suspension

Interface with the residual limb

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2
Q

Knee disarticulation what is the benefit?

A

the femoral condyles act as a wt. bearing surface that is meant to be wt. bearing in the body!

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3
Q

Quad socket is narrow in what dimension?

A

AP

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4
Q

ischial wt. bearing shelf is what socket

A

quad

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5
Q

What kind of contact does the quad socket have?

A

total contact: there are areas of wt. relief and built up areas based on pressure sensitive and tolerant areas

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6
Q

height of the medial wall in quad socket? (2 things to think about)

A

equal posterior wall

contains the ADD tissue

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7
Q

How the the posterior wall slope in a quad socket? Why?

A

Slopes anteriorly to provide a surface for the hip extensors to push on in order to control the knee

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8
Q

Where does the lateral wall of the quad socket extend to?

A

the greater trochanter

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9
Q

What is the highest wall of the quad socket

A

lateral wall, goes up to greater trochanter

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10
Q

What degrees of ABD or ADD is the lateral wall of the quad socket in? why?

A

10 degrees of ADD to put the ABD at a mechanical advantage

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11
Q

Anterior wall of quad socket in comparison to posterior wall

A

2 inches higher

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12
Q

Where is there pressure anteriorly in a quad socket?

A

scarpas bulge: femoral triangle to push pt onto ischia seat and prevent rotation of the socket

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13
Q

Scarpas bulge pushes on what? for what purpose?

A

femoral triangle to push pt onto ischial seat and prevent rotation of socket

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14
Q

IC what dimension is narrow

A

ML

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15
Q

Is quad or IC better for a more active individual?

A

IC

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16
Q

Two goals of IC

A

contain muscle groups and create stability

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17
Q

Where is the butt bone in an IC socket?

A

the ischium is contained! The posterior wall is higher

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18
Q

Is the posterior wall higher in quad or IC?

A

IC: IT is actually inside the socket

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19
Q

Posterior wall sloping for IC?

A

same as quad socket, anterior sloping to give hip extensors something to extend against

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20
Q

Medial wall of IC encloses what?

A

public rampus

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21
Q

In a IC socket the medial wall provides _______ to lateral wall

A

counter pressure: squeezes the femur creating stability

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22
Q

True or false: you should be able to feel the greater trochanter in IC socket

A

no! the lateral wall should be above it

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23
Q

IC socket is 10-15 degrees of what in the frontal plane? for what purpose

A

10-15 degrees of ADD

This puts the TFL and lateral hamstrings on stretch leading to mechanical advantage for them

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24
Q

Does IC have scarpas bulge?

A

yes but normally its not as prominent.

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25
Q

What kind of patient coulds use a sub-ischial socket?

A

“long and strong” a very strong individual. This socket wouldn’t contain the ischium or greater troch.

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26
Q

In quad socket what is the purpose of the medial wall?

A

contain ADD tissue

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27
Q

What does someone have to prove to be put in a sub-ischial socket?

A

they are very strong in ADD tissue

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28
Q

Hi-Fi socket general picture

A

cut outs of hard material that lock into the bones, there are large areas of sot tissue relief

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29
Q

Silesian band attaches how

A

near trochanter, wraps around waist and anchors onto iliac crests

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30
Q

Advantages of silesian band suspension?

A

cheap
easy to fabricate
easy to don

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31
Q

Disadvantage of silesian band?

A

not great at its job

larger habitus won’t be able to lock onto iliac crests and therefore won’t work

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32
Q

One major advantage of pelvic band and external hip joint suspension?

A

if someone has very weak hip joint helps ABD control due to the stability it gives you

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33
Q

3 disadvantages of pelvic band and external hip joint suspension?

A

Heavy
Hard to don
Can cause rotations

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34
Q

Appropriate population for silesian band?

A

obviously iliac crests

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35
Q

Appropriate population for pelvic band and external hip joint suspension

A

really weak hip

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36
Q

Suspenders are used in what event/population (3 things)

A

last resort when silesian or pelvic band are not appropriate

not a candidate for suction

Short TFA or hemipelvectomy

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37
Q

TESS belts two advantages

A

abdominal surgery

back up suspension

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38
Q

TESS bests two disadvantages

A

minimal suspension (so used more as back up)

poor control of rotation

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39
Q

Population for TESS belts?

A

very active population for back up suspension use rather than primary

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40
Q

Traditional suction works by what means?

A

negative pressure

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41
Q

How do you don traditional suction?

A

skin goes right into the socket and then you bleed the air through the valve at distal end.

42
Q

Advantages of this kind of suspension include
intimate fit
lots of degrees of motion
comfort
minimal pistoning
use of musculature to keep it on, the pt doesn’t have to use their own

A

Traditional suction

43
Q

Disadvantages of traditional suction

A

hard to don

not adaptable to girth fluctuations

44
Q

difference btwn partial suction and traditional and the advantage to this

A

prosthetic sock used

Better adaptable to changes in volume

45
Q

How to don 3S

A

totally inside out, roll it onto the limb and then lock in with either a pin or lanyard to the socket

46
Q

how to don seal in liner

A

moisten outer part of liner with alcohol water mixture to slide in, force air out of one way valve

47
Q

What two thing are advantages to 3S suspension that traditional suction does not have?

A

Allows for volume fluctuation

Easy to don

48
Q

Disadvantages to 3S suspension

A

skin reactions
care and maintenance
careful of air-pocket
improper donning

49
Q

rather than sliding down into their socket what can people do

A

step into their socket

50
Q

What is a good method to get traditional suction socket on. three ways

A

Pull in method w/pull sock

Stand up into it

Bleeding the air/pump

51
Q

if you have a 3S liner, socket and sock, what order do you put them on

A

Liner against skin

Sock if necessary

Socket

52
Q

What is the primary goal of prosthetic knees? Secondary/

A

primary: knee stability
secondary: knee mobility

53
Q

in general stance phase control means what?

swing phase control?

A

stance phase control: controls or limits knee flexion while wt. bearing

swing phase control: limits or assists flexion or extension

54
Q

Name the three methods of achieving knee stability in stance phase

A

1) muscular action: mostly hip extensors
2) alignment wt. line anterior to jt axis
3) mechanical device: locked friction, hyraulic cylinder

55
Q

Talk about where the weight line and axis of the knee should be for stability (say it both ways)

A

Knee axis should be posterior to weight line

Weight line should be anterior to knee axis

56
Q

Swing control is achieved through what 5 things

A

movement of residual limb and pelvis

gravity

momentum

Mechanical extension assist

mechanical adjustment for limiting or assisting with flexion or extension

57
Q

Name the 7 categories of knee joints from most basic to most advanced

A

1) manual lock
2) constant friction
3) wt. activated/stance control
4) polycentric
5) gas/fluid control
6) micro-processor
7) power knee

58
Q

Manual lock knee

Jt. axis:
Stance control:
Swing control:

A

Jt. axis: single
Stance control: max mechanical
Swing control: max mechanical

59
Q

patient popultation for manual lock knee

A

weak pt, limited ambulator, no control of knee

60
Q

How does the patient ambulate with the most basic knee

A

most basic knee = manual lock therefore they walk with the locked knee with abnormal gait pattern, prosthesis is shorter for clearance reasons

61
Q

Constant friction knee
where out of the 7 is it?

Jt. axis:
Stance control:
Swing control:

A

2nd

Jt. axis: single

Stance control:

  • muscular control
  • alignment

Swing control:

  • friction to limit flexion and extension
  • extension assist possible
62
Q

indications for constant friction knee

A

long time user resistant to change

limited access to follow up

good muscular control

63
Q

disadvantages for constant friction knee

A

fixed cadence

unstable especially on uneven surfaces

64
Q

Number 3/7 knee joint

A

weight activated/stance control

65
Q

Number 2/7 knee joint

A

constant friction

66
Q

Weight activated stance control

Jt. axis:
Stance control:
Swing control:

A

jt axis: single

Stance control:
- moderate mechanical

Swing control:

  • friction
  • can add extension assistance
67
Q

indications for weight activated stance control

A

weaker pt with some inability to control the knee

68
Q

Major disadvantage to wt activated stance control

A

knee flexion inhibited in pre-swing: they have to fully unweight it to allow it to bend

69
Q

Polycentric knee

Jt. axis:
Stance control:
Swing control:

A 
jt axis: multiple
Stance control:
- moderate alignment
- muscular control
Swing control: 
- extension assit or hydraulic add ons
70
Q

indications for polycentric knee

A

knee disarticulation

Short residual limb, weak hip extensors (requiring greater stability and not a higher level knee)

But active: high K2 and K3

71
Q

What is the single most important thing to take away about the polycentric knee

A

As the knee bends, the axis of rotations moves posteriorly and superior/proximally, just like a real knee joint.

72
Q

In polycentric knee the center or rotation displacing posteriorly increases the _____ moment increasing or decreasing stability

A

In polycentric knee the center or rotation displacing posteriorly increases the external EXTENSION moment therefore INCREASING stability

73
Q

4/7 kind of knee

A

polycentric

74
Q

5/7 kind of knee

A

fluid controlled

75
Q

Fluid controlled (5)

Jt. axis:
Stance control:
Swing control:

A 
Jt. axis: single
Stance control:
- mechanical position of piston 
- muscular 
Swing control:  
- mechanical with flexion and/or extension resistance
76
Q

what is the first knee of the 7 can someone run reciprocally in

A

fluid controlled (5)

77
Q

Caveat of fluid controlled reciprocal units

A

cadence is not responsive, they can run but only at one speed

78
Q

6/7 kind of knee

A

microprocessor

79
Q

Microprocessor explain detecting knee motion

Cadence adjustable?

A

Detects knee motion via pressure and motion sensing

true adjustable cadence

80
Q

Indications for microprocessor (6)

A

active ambulator

Variable cadence

Descent of stiars/inclines

81
Q

7th kind of knee

A

power knee

82
Q

what kind of knee(s) can you reciprocally ascend steps?

A

only power knee (7/7)

83
Q

indications for power knee

A

unilateral TFA

moderate/active

low weight

84
Q

what allows individuals to corss legs, change shoes, sit in car

A

knee rotator

85
Q

what does a ferrier coupler do

A

easily take out knee to be able to swap feet easily

86
Q

name the 4 translational changes to TFA you could make

A

socket inset or outset

knee and foot forward or backward

87
Q

name the 8 angular changes to TFA you could make

A

Foot: DF, PF, Inversion, Eversion

Socket: flex, extend, ABD, ADD

88
Q

name the 2 rotational changes to FA you could make

A

toe in or out

knee IR, ER

89
Q

if you flex the TF socket what are you doing at the hip

A

flex the socket, flex the hip

90
Q

bench alignment should always take into account what?

How?
why?

A

contractures

flexion plate

you cant just flex the socket because this will put the wt. line behind the axis making the knee want to buckle

91
Q

normal TFA alignment in the sagittal plane

Ankle:
Socket
Weight line ____ to knee

A

normal TFA alignment in the sagittal plane

Ankle: neutral

Socket: flexed 5-10 degrees (allows hip extensors to be mechanically advantageous)

Weight line: ANTERIOR to knee FOR STABILITY

92
Q

Normal TFA alignment in the frontal plane

Socket:
Foot: to produce _____

A

Socket: slight ADD so ABD are at mechanical advantage

Foot: slight inset to produce slight VARUS moment at knee during gait like normal person

93
Q

what needs to be accommodated for in the angle of the socket?

A

hip flexion contractures

94
Q

if someone has a hip flexion contracture of 7 degrees what should their socket be set in in this plane

A

normal (10 degrees degrees) + contracture (7 degrees) =17 degrees flexion

95
Q

what should you do before gait assessment?

A

check if prosthesis is aligned properly

96
Q

distal end pain, pain on IT’s may tell you what about the fit of the socket?

A

they’re in too far

97
Q

what signs may tell you someone is not in their socket enough

A

tibial pain, IT too high, circumduction of leg

98
Q

three big picture things to look at first with gait analysis

A

speed
pattern
midline orientation

99
Q

is a new user more likely to have narrow BOS or wider?

A

wider for more stability

100
Q

Shorter step length when

Shorter stance time when

with new prosthetic user

A

shorter step length on intact side

shorter stance time on involved side

likely step to

101
Q

gait training the order of importance of 4 things

A

fit/comfort of socket

stance phase deviations

swing phase deviations/timing

symmetry

102
Q

when you see deviation what are you trying to decide

A

patient?
device?
both?

Unit 15 (10 decks)

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