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Prosthetics Final > Trans-Fem Prosthetics > Flashcards

Trans-Fem Prosthetics Flashcards

1
Q

What does axial load through amputated side rely on?

A
  • body weight distribution through remaining anatomy
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2
Q

What does coronal plane stability rely on

A
  • socket fit and alignment
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3
Q

What does swing phase control of the prosthetic knee rely on?

A

hip ROM/musculature

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4
Q

what does stance phase control of the prosthetic knee rely on?

A

hip ROM/musculature and manipulation of body weight

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5
Q

3 Types of TF socket Designs

A
  • Quadrilateral
  • Ischial Containment
  • Sub0Ischial
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6
Q

Quadrilateral (Quad) Socket

A
  • Ischial weight bearing
  • Rectangular shape, tight AP
  • Scarpa’s triangle
  • Accommodates functioning muscles
  • Total contact
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7
Q

What is the issue with a quad socket?

A

lack of proximal/medial stabilizing force

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8
Q

Ischial Containment

A
  • boney weight bearing
  • femur stabilization
  • controls transverse forces, triangular
  • has coronal stability unlike quad
  • Ischial weight-bearing + containment on medial side
  • Total Contact
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9
Q

What muscles does ischial containment accommodate

A

hamstrings
adductor longus

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10
Q

advantages of ischial containment

A
  • enhanced stability
  • improved confort
  • less soft tissue distortion/injury
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11
Q

disadvantages of ischial containment

A
  • a lot of variance in design
  • may be challenging to fit well
  • possible ROM restriction
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12
Q

Sub-ischial brim

A
  • hydrostatic loading (controls varus moment through suction or vacuum)
  • improved hip ROM
  • sitting comfort
  • not having ischial containment has a lot of advantages (scissor legs/touching toes)
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13
Q

What should you consider with TF suspension

A
  • additional weight
  • transverse forces
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14
Q

Lanyard

A
  • use for someone with balance issues
  • works well for sock ply- good for someone who is changing volume
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15
Q

Suction - skin fit

A
  • put bare residual limb into socket
  • at bottom, open the valve and pull nylon bag through to create hydrostatic load
  • good for very short residual limb
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16
Q

suction - seal in liner

A
  • most TF will have this liner
  • a lot more soft tissue so seal can just absorb into it
  • a lot of athletes
  • more proximal seal
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17
Q

vacuum

A
  • seal in liner with vacuum
  • liner and suspension sleeve with vacuum
  • seal between outside of liner and inside of socket
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18
Q

TES Belt

A
  • total elastic suspension
  • mostly auxiliary
  • good for peds/congenital limb anomalies
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19
Q

Silesian belt

A
  • non elastic
  • rotation control
  • may be stand alone
  • made out of seat belt material
  • prevents unwanted transverse deviations in the socket
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20
Q

Hip joint and pelvic band

A
  • coronal stability
  • rotation control
  • Someone who has laxity at the hip
  • Previous use
  • Very short/almost hip disarticulation level
  • Very rigid hip joint
  • Involves side is contoured leather
  • Prevents dropping away laterally/Trendelenburg type
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21
Q

Suspenders

A
  • non elastic
  • correction tension to allow flex/ext
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22
Q

what purpose does a knee serve

A
  • Enable sitting
  • Swing phase clearance
  • Efficiency
  • Safety with resistance
  • Accommodate to various postures
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23
Q

how to achieve stability

A
  • Voluntary control
  • Alignment
  • Knee design- mechanics
  • Resistance/friction
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24
Q

To what extent can the patient contribute to stability?

A
  • hip strength (extensors)
  • residual limb length (lever arm)
  • balance, body weight manipulation
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25
Q

TKA Line

A
  • line from troch to ankle
  • identifies knee inherent stability from an alignment perspective
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26
Q

3 knee alignments

A
  • Trigger alignment: directly through the knee
  • Overly stable: slightly ant - sitting on end (ext) stop - “safe” alignment
  • Post (unsafe): nothing to rest on - going to bend the way it want to
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27
Q

Prosthetic knee- friction

A

to primarily control knee during swing phase
- flexion: limit heel rise
- extension: prevent terminal impact

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28
Q

two types of friction

A

mechanical
fluid

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29
Q

Mechanical Friction

A
  • K1/K2
  • Constant force
  • 1 speed ambulators
  • Several designs
  • Light weight
  • Low maintenance
    ** medicare only covers friction knees for K1/K2 (will not pay for fluid knee for K2)
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30
Q

Fluid Friction

A
  • K3/K4
  • Hydraulic or pneumatic
  • Supports variable cadence
  • Controlled in a variety of ways * More expensive
  • Adds weight
  • ramps up resistance to the force you are putting on it
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31
Q

Extension assist

A
  • Limits heel rise to make the knee ext faster (knee responds quicker)
  • Helps achieve full knee extension
  • Safety for new users
  • Adjustable
  • Add a terminal impact, they should feel when it is fully extended to know when it is safe
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32
Q

single axis knee

A
  • less moving parts and simple
  • lower fabrication cost
  • less stable at heel strike
  • one axis to absorb forces applied
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33
Q

polycentric knee

A
  • inherent stability at heel strike
  • easy to initiate swing phase
  • often heavier
  • increased maintenance
  • instantaneous knee center
  • indicated for long residual limbs
  • K2 is mechanical friction
  • K3/4 if fluid friction
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34
Q

manual lock knee

A
  • K1 or K2
  • optional lever release on socket
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35
Q

single axis knee

A

constant friction (k2) or fluid control (K3)

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36
Q

multiaxial knee

A
  • additional stability through geometry
  • slide/glide articulation at knee
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37
Q

microprocessor knee

A
  • sensors to predict action
  • stumble recovery
  • real time knee adjustments
  • allows for step over step
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38
Q

TF Biomechanics - Coronal Plane Goals

A
  • ML stability of the pelvis @ midstance
  • Conserve energy by minimizing lateral displacement of CoG
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39
Q

TF Biomechanics - Sagittal Plane Goals

A
  • Provide AP stability of the knee joint during stance,
    smooth advancement.
  • Step length symmetry.
40
Q

Coronal Plane - ML stability of the pelvis during midstance

A
  • Slight varus moment of the socket
  • Minimal socket gapping due to boney lock or other means of stabilization
  • No trunk compensations
41
Q

coronal plane - varus moment factors

A
  • Prosthetic alignment
  • Limb length, soft tissue structure
  • Socket fit
42
Q

More coronal plane stuff

A
  • Foot should start beneath the
    ischium, should produce a varus moment at the hip
  • Pelvis drops to unsupported side
  • Hip abductors fire
  • Femur ABducts
43
Q

Coronal Plane Socket Design

A
  • Adduction angle: Femoral/pelvic angle is assessed
  • Lateral wall: Maintains femoral angle
  • Medial wall height: Counterforce, boney lock
  • ML dimension
  • Hip joint and waist belt: If unable to ABduct
44
Q

Alignment in coronal plane

A
  • Inset foot = increased varus moment
  • Outset foot =decreased varus moment
45
Q

Sagital Plane priority

A
  • AP stability of the knee joint during stance
  • alignment
  • voluntary control
  • knee selection
  • foot selection
46
Q

softer feet

A

the softer the feet the easier it is to control the hip

47
Q

sagittal plane alignment

A
  • TKA reference line maintains GRF ANTERIOR to the knee joint
48
Q

sagittal plane - component selection

A
  • knee
  • foot (single axis foot, heel stiffness)
49
Q

sagittal plane - step length symmetry

A
  • Often a prosthetic socket is pre-flexed
  • 3-5 degrees beyond Thomas test measure
50
Q

Step length Requirements

A
  • 3 deg lordosis
  • 5 deg femoral ext
  • 7 deg knee flexion (stance flexion)
  • = 15 degrees
51
Q

more step length stuff

A
  • Knee must be fully extended to stand on prosthesis.
  • 3-10 deg lordosis
  • 5-12 deg femoral ext
  • 1st step with sound leg
  • Accommodation vs therapeutic alignment.
52
Q

Prosthetic cause of gait deviations

A
  • Identify alignment or design aspects of the prosthesis
    that can cause or contribute to the deviation.
  • Determine what adjustments or modifications to the
    prosthesis can be made to correct the deviation
53
Q

amputee cause of gait deviations

A
  • Identify habits, activities or conditions that the patient
    is doing that can cause or contribute to the deviation.
54
Q

therapy goals

A
  • Determine what therapy or gait training intervention
    can be provided to assist the patient to correct or
    address the deviation.
55
Q

medial whip - prosthetic cause

A
  • External rotation of the knee
  • Tight socket
  • Incorrect foot rotation
56
Q

medial whip - amputee cause

A
  • Gait habit
  • Socket not put on properly
  • External rotation of hip at toe off/hip flexion
57
Q

medial whip - therapy goals

A
  • Encourage proper donning
  • Strengthen internal hip rotators and hip extensors
  • Modify activity that may increase external rotation
58
Q

lateral whip - prosthetic cause

A
  • Internal rotation of the knee
  • Loose socket
59
Q

lateral whip - amputee cause

A
  • Gait habit
  • Socket not put on properly
  • Internal rotation of hip at toe off/hip flexion
  • Tight adductors, int. rotators, flexors
60
Q

lateral whip - therapy goals

A
  • Encourage proper donning
  • Strengthen external hip rotators
  • Stretch hip flexors and adductors
  • Modify activities that increase internal rotation of hip
61
Q

Abducted Gait - Prosthetic Cause

A
  • Prosthesis too long
  • Medial wall too high
  • Insufficient femoral stability in socket
62
Q

abducted gait - amputee cause

A
  • Abduction contracture
  • Pt insecure and wants wide base
63
Q

abducted gait - therapy goals

A
  • Stretch abductors
  • Strengthen core, residual limb and sound leg
  • increase proprioception
64
Q

Circumducted Gait - Prosthetic Cause

A
  • Long prosthesis
  • Excessive knee friction/stability
65
Q

Circumducted Gait - Amputee Cause

A
  • Lack of confidence in flexing knee
  • Abduction contracture
  • Weak hip flexors
  • Habit, using entire hip and pelvis to initiate gait
66
Q

Circumducted Gait - Therapy Goals

A
  • Stretch abductors
  • Strengthen hip flexors
  • Gait training
67
Q

Vaulting - Prosthetic Cause

A
  • Long prosthesis (or heavy)
  • Poor suspension
  • Excessive plantar flexion of foot
  • Excessive knee resistance or stability
  • Inadequate knee extension assist
68
Q

Vaulting - Amputee Cause

A
  • Gait habit, fear of catching toe
  • Weak or improper initiation of hip flexors on residual limb
69
Q

Vaulting - Therapy Goals

A
  • Strengthen hip flexors
  • Work on timing and symmetrical pelvic rotation
  • ADL training
70
Q

Heel Rise - Prosthetic Cause

A
  • Inadequate extension aid
  • Insufficient knee friction
71
Q

Heel Rise - Amputee Cause

A
  • Excessive use of hip flexors to initiate swing phase, overpowering knee unit
72
Q

Heel Rise - Therapy Goals

A
  • Work on coordination and encourage symmetrical motion of the femurs
  • Work on timing of flexor firing
73
Q

Knee Instability - Prosthetic Cause

A
  • Excessive dorsiflexion
  • Knee aligned in unstable position…TKA
  • poor socket flexion or foot alignment
  • Incorrect knee settings
74
Q

Knee Instability - Amputee Cause

A
  • Weak hip extensors
  • Hip flexion contracture
75
Q

Knee Instability - Therapy Goals

A
  • Strengthen hip extensors
  • Stretch hip flexors
76
Q

Uneven Timing - Prosthetic Cause

A
  • Socket Pain
  • Weak extension aid
  • Unstable knee*
  • Leg length discrepancy
  • Poor suspension
77
Q

Uneven timing - amputee cause

A
  • Patient insecurity*
  • Weak hip muscles
  • Poor balance
78
Q

Uneven Timing - Therapy Goals

A
  • Strengthen hip flexors and extensors
  • Improve balance and proprioception during ADL
79
Q

Lateral Trunk Bend - Prosthetic Cause

A
  • Foot too far outset
  • High medial wall
  • Aligned in abduction
80
Q

Lateral Trunk Bend - Amputee Cause

A
  • Inadequate balance
  • Short residual limb (or weak GM)
  • Habit
81
Q

Lateral Trunk Bend - Therapy Goals

A
  • Improve balance
  • Strengthen core
  • Activity modification and
    retraining during ADL
82
Q

Toe Drag - Prosthetic Cause

A
  • Long prosthesis
  • Excessive plantar flexion
  • Excessive knee friction
83
Q

Toe Drag - Amputee Cause

A
  • Weak hip extensors
  • Weak hip abductors on sound side
  • Poor posture
  • Poor gait habits
84
Q

Toe Drag - Therapy Goals

A
  • Strengthen hip extensors and hip abductors
  • Encourage pelvic motion to initiate enough knee flexion for swing phase
85
Q

Wide Gait - Prosthetic Cause

A
  • Prosthesis too long*
  • Medial wall too high*
  • Insufficient femoral stability
86
Q

Wide Gait - Amputee Cause

A
  • Abduction contracture
  • Poor gait habit, patient insecure and desires wide
    base in belief it will increase stability
87
Q

Wide Gait - Therapy Goals

A
  • Stretch abductors
  • Strengthen core, residual limb and sound leg
88
Q

Internal Foot Rotation - Prosthetic Cause

A
  • Internal knee rotation
  • Internal foot rotation
  • Excessive quad pressure
89
Q

Internal Foot Rotation - Amputee Cause

A
  • Improperly donning socket
  • Flexed at the hip during gait, typically with walker or
    crutches, looking down at ground
90
Q

Internal Foot Rotation - Therapy Goals

A
  • Work on donning correctly
  • More upright position during ambulation
91
Q

External Foot Rotation - Prosthetic Cause

A
  • External knee rotation
  • External foot rotation
  • Socket design
  • Tight adductor channel in socket
92
Q

External Foot Rotation - Amputee Cause

A
  • improperly donning socket
93
Q

external foot rotation - therapy goals

A

work on donning correctly

94
Q

Skilled therapy should be a combination of :

A
  • Strengthening
  • ADL analysis, modification and retraining
  • Proprioception activities
  • Balance activities
  • Donning and doffing for consistent alignment
  • Decrease fear/increase confidence resulting
    from lack of sensory input in prosthesis
95
Q

I dont feel like we need to know osseointegration but idk maybe im wrong

A

Prosthetics Final (5 decks)

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