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Management of Special Populations > Transfemoral Prosthetics > Flashcards

Transfemoral Prosthetics Flashcards

1
Q

Do higher levels of amputation have a higher/lower risk of contractures

A
  • Higher risk of contractures
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2
Q

How to stretch the hips flexors n prone

A
  • Like on your stomach with your legs out straight
  • Slowly troop yourself up on your elbows
  • Hold for ≥10sec then lower slowly
  • Repeat 3-5 times and perform 1-2x daily
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3
Q

Benefits of a knee disarticulation

A
  • Bulbous distal end nachos prosthetic suspension
  • Normal ADD angle of the LEE is Moree likely to be preserved
  • Long lever arm of the femur facilitates control of the prosthetic knee
  • Proximal component of a WBing joint, the distal femur tolerates bend-bearing pressures with the socket
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4
Q

What are the trade-offs of a knee disarticulation

A
  • Knee center o prosthetic side is lower than sound side which affects gait kinematics & cosmesis when sitting
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5
Q

Pressure tolerant areas for a Transfemoral amputation

A
  • Ischial tuberosity: keeps residual limb from migrating distally inn socket
  • Femoral triangle: keeps pelvis from translating anterior/posterior
  • Lateral shaft of the femur: provides lateral stability (frontal plane) during gait & helps maintain femoral ADD
  • Soft tissue circumferences: compression & proximal distraction offer hydrostatic support that offloads the ischial tuberosity
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6
Q

Describe the different socket styles

A
  • Quadrilateral: more narrow anterior/posterioir, flat self for ischial tuberosity & glutes
  • Ischial containment: wider anterior/posterior (accommodate muscle contraction), more narrow medial/lateral to maintain femoral ADD
  • Marlo Anatomical: lower trim lines posteriorly (more comfortable for sitting)
  • Subischial: more comfortable, greater hip mobility, must be tight circumferentially
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7
Q

Describe prosthetic sockets and proper angle of ADD of the femur

A
  • Prosthetic socket cannot provide enough lateral pressure to change the position of the femur
  • Proper anatomical ADD is achieved only through specific surgical techniques
  • An intimately contoured socket in optimal alignment enhances an individual’s gait, decrease energy expenditure, increases socket comfort, & improves overall function
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8
Q

Describe the position of the ischial tuberosity inn ischial containment socket

A
  • Inside the socket
  • Contained on the medial surface of the socket brim
  • Pivot point to keep the pelvis from migrating laterally resulting in lateral trunk lean
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9
Q

What are the trade-offs of a flexible socket design

A
  • Somewhat less durable
  • More bulky to wear
  • More expensive to produce than rigid sockets
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10
Q

What are the benefits of a flexible socket design

A
  • Vacuum formed
  • Encased in a rigid frame which provides support during WBing & helps to maintain socket shape
  • Accommodates to change in muscle shape during contraction & can easily by modified after initial fabrication
  • More comfortable to wear especially in sitting
  • Useful if suction suspension is desired
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11
Q

Force couples during loading response

A
  • Anterior/proximal
  • Posterior/distal
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12
Q

Force couples during terminal stance

A
  • Anterior/distal
  • Posterior/proximal
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13
Q

Force couples during mid-stance

A
  • Medial/proximal
  • Lateral/distal
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14
Q

Criteria to begin fitting

A
  • Wound closure
  • Tolerant to force couple pressures
  • Circumference reduction
  • Sound side weight bearing ability
  • Evaluate WBing regions
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15
Q

Describe contracture reduction to begin fitting for prosthetic

A
  • Progresses slowly
  • Measure & give patient a goal
  • Passive stretching
  • Active stretching when ambulating with a prothesis
  • Over 25º not advised to fit
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16
Q

Prosthetic features that affect energy expenditure

A
  • Weight of the prosthesis
  • Socket fit
  • Alignment of the prosthesis
  • Functional characteristics of the prosthetic components
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17
Q

The energy cost of gait __________ significantly as the length of the residual limb _____________

A
  • Increases, decreases
  • Less efficient in terms of energy expended over distance (per meter)
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18
Q

3 variables that influence knee stability during stance

A
  • Individual’s ability to voluntarily control the knee using muscular power (hip extensors)
  • Alignment of the knee unit with respect to the weight line (trochanter knee ankle line)
  • Inherent mechanical stability of the knee unit
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19
Q

Prosthetic alignment considerations

A
  • Confirm flexion of prosthetic socket: match the patient flexion +5
  • Check height (IT to floor)
  • Foot level in the shoe
  • Knee stability
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20
Q

What can cause an unaccommodated hip flexion contracture

A
  • AK prosthetic socket not aligned to match patient measurements
  • Most commonly results in lordosis form insufficient socket flexion
  • Patient may also stand with the knee flexed
21
Q

Shoes with different heel heights affect knee stability in what ways

A
  • Most prosthetic feet are designed for a standard 3/4 inch heel
  • Decreasing the heel height results in an extension moment creating an excessively stable knee
  • Increasing the heel height results in a flexion moment creating instability of the prosthetic knee
22
Q

Describe pelvic stability during gait with a prosthetic

A
  • The femur without its distal attachment at the knee is susceptible to lateral displacement within the socket during WBing
  • The displacement can make it difficult to maintain a horizontal pelvis & results win an apparent Trendelenburg sign & compensatory gait deviations
  • Pelvis stability is especially problematic for those with short residual limbs
23
Q

What intrinsic (patient) factors can cause lateral trunk bending towards the prosthetic side

A
  • Decreased balance
  • Short residual limb = shorter lever arm for pelvis to stabilize
  • Weak ABD (Glute Medius)
  • Painful residual limb
24
Q

What extrinsic (prosthetic) factors can cause lateral trunk bending towards the prosthetic side

A
  • Socket/lateral wall not ADD enough
  • Socket/medial wall too high = pinch of soft tissue so lateral bend to avoid pressure on the pubic ramus
  • Prosthesis too short = mid-stance hip drop
25
Q

Describe the correct way to don the prosthesis

A
  • It must have full distal contact
  • View & palpate distal limb through the valve hole
  • Note the lanyard length that exits the socket
  • Check pelvis for length equality: leg will appear high if not donned correctly
  • Ensure correct rotational position of socket
26
Q

How too ensure correct rotational position of socket

A
  • Adductor longus should be in anterior medial corner
  • Ischial tuberosity: have pt flex forward at the hip & palpate IT and see that ti matches the seat on the socket
27
Q

What muscles are needed to prevent lateral trunk bend during mid-stance in the coronal plane

A
  • Hip abductor strength & femoral adduction in socket is needed
28
Q

What can cause an unstable knee (AK)

A
  • Hip flexion not accommodated in the socket position over the knee
  • Knee center too far anterior
  • Heel too high
  • Prosthesis too long
29
Q

What are the more common types of transfemoral suspension

A
  • Traditional pull in suction
  • Roll on liners: pink lock, lanyard, one-way valve suction (seal inn liner)
  • Elevated vacuum
30
Q

What are the less common types of transfemoral suspension

A
  • Silesiian belt suspension
  • Total elastic suspension belt
  • Pelvic belt and hip joint
31
Q

Describe a traditional suction socket

A
  • Uses negative air pressure, skin to socket contact, & muscle tension to hold the socket onto the limb
  • Intimate fit is essential
  • High shearing forces associated with donning a suction socket
  • Inappropriate for patients with recent amputation who will continue to lose limb volume or those with Hx oof fluctuating edema or unstable weight
32
Q

Describe an elevated vacuum suspension

A
  • Lower trim lines in comparison to other transfemoral socket designs leading to increased pt comfort & ROM
  • By utilizing elevated negative pressure around the distal 2/3 of the residual limb, the socket no longer requires compression of the proximal residual limb to provide WBing & stabilization
33
Q

Who designed a hydraulic prosthetic knee for veterans with amputations after the war

A
  • Henschke Mauch
34
Q

List the prosthetic knee types

A
  • Manual locking knee
  • Single axis knee
  • Weight activated stance control knee
  • Polycetric knee
  • Hydraulic knee
  • Microprocessor knee
  • Power knee
  • Sport specific knees
35
Q

Describe a single axis knee

A
  • Most economical, durable, & lightest option available
  • Pt must use heir own muscle power to keep them stable when standing
  • To compensate the knee often incorporates a constant friction control & a manual lock
  • Friction keeps the leg from swinging forward too quickly as it swings through to the next step
36
Q

Describe a state control knee

A
  • Very stable & often prescribed for a first prosthesis
  • If weighted the knee will not bend until the weight is displaced
  • Functions as a constant friction knee during leg swing but held in extension when weighted
  • If initial contact is made when the knee is not fully extended the braking mechanism provides additional mechanical stability to knee the knee from rapidly buckling
37
Q

Describe a hydraulic knee

A
  • Cadence responsive, fwd progression of the prosthetic shin changes as gait speed changes
  • Provides the closest thing to normal knee function for active amputees
  • Although they provide smoother gait they are heavier, require more maintenance, & a higher initial cost
38
Q

What happens if the patient takes too big of a step

A
  • Ground reaction force will go posterior to the knee causing a flexion moment leading to knee buckling at initial contact
39
Q

How do you counter-act the knee flexion moment without quads?

A
  • Use hip extension
40
Q

How is mid-stance affected by going up or down a ramp?

A
  • While going up a hill you tend to lean forward meaning the hip extensors are working more but it makes it harder for them to flex the knee
41
Q

Describe medial and lateral whips

A
  • Name for the direction the heel goes
  • Medial whip: heel is faced radially and the knee is face out laterally
42
Q

Evidence for hydraulic knees when using swing control

A
  • Leads to increased confront & improved walking speed in a active pts
  • Leads t improved gait symmetry & speed
  • Reduces stride time & improves the symmetry of swing phase duration
  • Indicated for active walkers, permitting increased walking comfort, speed, & symmetry
43
Q

Evidence of microprocessor knees (MPK)

A
  • Decrease O2 rate at self selected speed
  • Reduce energy requirements of walking
  • Increased walking speed on uneven terrain
  • Improved gait pattern during stair descent
  • Decreased number of subject reported stumbles & falls
  • Reduced wear & tear of the contralateral limb
44
Q

Describe the microprocessor knee and K2 functional level

A
  • Amount limited community ambulatory, MPK use may significantly reduce uncontrolled falls by up to 80%
  • Persons with a lower functional level might also benefit from using a prosthesis featuring an MPK
45
Q

Parameters that are NOT primary indications in prosthetic knee joint selection

A
  • Daily step counts
  • Temporal and spatial gait symmetry
  • Self reported general health
  • Total costs of prosthetic rehabilitation
46
Q

How to educate amputees on how to negotiate ramps and hills

A
  • Instruct pt to lean back when going downhill to align with the ground reaction force at initial contact/loading response & ‘ride’ the friction of the knee mechanism down the hill
  • Instruct pt to lean forward into the hill bc the only muscles available to pull them uphill are the hip extensors which have a better mechanical advantage in a flexed posture (fwd lean creates extension moment at knee making it difficult to unlock which is achieved through loading the prosthesis through terminal stance once toe load is achieved
47
Q

Foot selection for stability

A
  • A foot that can reach flat foot quickly is preferable bc it enhances stance phase knee stability
  • Reaching foot flat quickly is especially important for individuals who have a short residual limb or weak hip extensors
48
Q

Foot selection for active individuals

A
  • Energy storing capabilities of these prosthetic feet at push-off promote rapid advancement of the shin section during swing phase. This enhances the ability of the individual who is using a transfemoral prosthesis to walk at faster speeds.
  • Most of these feet are much lighter in weight than the articulating feet.
49
Q

Benefits of a hip disarticulation

A
  • More advanced options such as the Ottobock Helix system
  • Provides dynamic stability & triplanes motion control
  • Makes it easier to extend the leg & clear the toe during gait

Management of Special Populations (13 decks)

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