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cj orthotics & prosthetics > Transtibial Prosthesis > Flashcards

Transtibial Prosthesis Flashcards

1
Q

4 Key Components to Transtibial Prosthesis

A

Prothetic Foot

Shank

Socket

Suspension

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2
Q

Transtibial Shank - EXOskeleton

A
  • prior to vietnam war
  • lamniate that formed outside dimensions
  • stong enough to support body weight
  • heave and inflexible
  • very little adaptability
  • very durable
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3
Q

Transtibial Shank - ENDOskeleton

A
  • internally supported by an internal pylon/pipe
  • interchangability
  • post fabrication adjustable
  • strength - very durable
  • light weight
  • covering options
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4
Q

Transtibial Shank - Pylons

A
  • narrow vertical support connecting the socket to the ankle/foot assembly (shank)
  • shock and torque absorption pylons can be added for additional responsiveness, stress, shear and torque reduction
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5
Q

Socket Design: PTB WB force Distribution

A
  • developed 1950s
  • most commonly prescribed
  • WB areas
    • through PT and post popliteal tisues
    • fibular shaft
    • tibial shaft
    • tibial flares
    • fem condyles
  • Protect:
    • fibular head
    • peroneal nerve
    • anterior distal tibia
    • HS tendons
    • tibial crest,
    • ant tibial tubercle
    • distal fibula
    • patella
    • adductor tub
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6
Q

PTB Socket Advantages and Disadvantages

A
  • Exert forces in all directions equally
  • advantages
    • evenly distrib. forces across RL - max WB
    • liner offeres good shear and friction reduction
    • enhancement comfort
  • Disadvantages
    • skin irritations
    • some hypersensitive areas cannot tolerate the even pressure
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7
Q

Socket Interface b/t Residual Limb and Socket Design

A

Hard Socket = Thin Sock

Soft Socket = Foam “pelite” liner

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8
Q

Hard Socket Interfaces

A
  • Rigid plastic interface
  • direct contact b/t socket and residual limb
  • shearing/friction are minimized
  • enhanced cosmesis
  • easy to cleen
  • durable = easy to replace thin sock
  • requires increased skill of prosthesis
  • difficult to adjust/modify
  • may not be appropriate for fragile skin
  • MATURE LIMBS ONLY
  • minimize bulk
  • reportedly cooler
  • 3 goals
    • help cushion - good fit
    • accomodate volume change
    • wick moisture
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9
Q

Soft Liner Interface

Foam Pelite Liner

A

Advantage:

  • adds cushion
  • easily modifiable
  • suspension can be incorporated

Disadvantage:

  • adds bulk
  • increases friction
  • insulative properties
  • skill required for donning/doffing
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10
Q

Soft Interface

Custom Liners

A
  • indicated for uniquely shaped and/or scarred limbs
  • were the first silicone liners available
  • advantages
    • reduced friction and shear
    • suspension mechanisms may be included
  • disadvantages
    • expensive and hot at first
    • potential for skin problems - humidity and friction
    • add bulk
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11
Q

Soft Interface

Off the Shelf Liners

A
  • most manufacturers now have their own line
  • advantages:
    • reduce friction and shear
    • suspension may be included
    • different thickness and styles
    • silicone, mineral oil gels, even with aloe
    • customizable
  • disadvantage
    • may be hot
    • add bulk
    • potential for skin problems
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12
Q

Suspension - Cuff Strap

A

advantages:

  • simple and effective means of suspension
  • suspends over the condyles
  • attachment points approximate knee center
  • leather or leather and elastic

disadvantages

  • does not provide AP or ML stability
  • may impede circulation and knee flexion >90
  • not very cosmetic
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13
Q

Suspension

Waist Belt and Fork Strap Suspension

A

Advantages

  • removes all suspension burden from the limb
  • elastic anterior strap - accomodate extra length in knee flexion during end stage of stance and assists with knee extension during swing
  • usually added as an auxillary suspension
  • often used for high lvel athletes

Disadvantages

  • hot
  • allows for piston action
  • bulky
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14
Q

Suspension - PTB Supracondylar

A

Advantages:

  • often dont need another suspension
  • added ML stability
  • some recurvatum control
  • increased socket surface lowers pressure overall
  • one piece design

Disadvantages:

  • higher trim lines
  • requires dexeterity to don/doff
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15
Q

Suspension

Locking Pin

A

-pin is incorporated into the distal end of the gel liner and must be guided into the shuttle at the distal end of the socket

Advantage:

  • pistoning reduced
  • secure suspension

Disadvantage:

  • suspension forces concentrated distally
  • mechanical complications
  • flexion limitations
  • some feel milking action at and of residual limb
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16
Q

Suspension

Suction(most common now)

A

-consists of one way valve into the socket that allows air to escape in conjunction with a gel suspension sleeve that seals the top of the socket preventing air from coming in

Advantage:

  • best suspension available
  • improved cosmesis
  • suspension not concentrated on the RL

Disadvantage:

  • durability
  • knee flexion limitations
  • heat
  • skin irritations
17
Q

Suspension

Sleeve

A

Advantage:

  • improved cosmesis
  • suspension is not concentrated on the RL
  • OFTEN USED AS AN AUXILLARY SUSPENSION

Disadvantage:

  • durability
  • knee flexion limitations
  • heat
  • skin irritations
18
Q

Biomechanics of PTB

A
  • maximize weight bearing capacity of RL (use flexion in interface (5-8 deg)
  • alignment - maintain ML stability at midstance on prosthetic side (initial contact inset 1/4 in)
  • encourage knee flexion throughout stance on prosthetic side (initial foot placement 1 1/2 in post to midpoint of socket at med tib plataue)
19
Q

Normal Expectations

A
  • patient should be comfortable walking
  • base of support 2-4 in between heel centers
  • knee flexion approximately 10-15 deg after initial contact
  • foot moves smoothly into loading response
  • socket should not gap at lateral brim, no increased pressure at medial brim
20
Q

Terminology

Heel Lever Arm

A

Distance from end of prosthetic heel to midpoint of shoe

-Provides support from intital contact to midstance to allow smooth descent of the prosthetic foot and controlled knee flexion

21
Q

Terminology

Toe Lever Arm

A

Distance from midpoint of shoe to toe

  • provides support from midstance to terminal stance
  • allows patient to roll over the foot in a smooth manner
22
Q

Terminology

Lever Arms

A

Altering the position of the foot DF or PF or positioning the foot anterior or posterior to the socket alters the toe and heel lever arms

cj orthotics & prosthetics (10 decks)

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