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Unit 15 > TTA and foot components > Flashcards

TTA and foot components Flashcards

1
Q

what does osteomyoplastic TTA allow?

A

WB on distal end

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2
Q

Name the 5 places that are pressure tolerant

A 
Patella Tendon
Gastroc/soleus muscle belly
Pretibial muscles/DF muscle belly
Popliteal Fossa
Shaft of the Fibula
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3
Q

Name the 7 places that are pressure sensitive

A 
Tibial Crest and Tubercle
Fibular head and distal end
Patella 
Hamstring tendons
Peroneal n.
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4
Q

What would a total surface bearing socket look like

A

un-rectified socket w/o contours.

You always need to wear these with a liner cause obviously our legs aren’t shaped like this.

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5
Q

Pros of total surface bearing sockets

A

Decrease pistoning

Lower peak pressure in socket

Decrease need for other suspension

Increase ROM at the knee joint due to low walls

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6
Q

Cons of total surface bearing sockets

A

Complicated to don

Perspiration in the system

Anticipate volume changes at initial prosthetic limb and this does not accomidate for that, therefore not appropriate for initial prosthetic limb.

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7
Q

Bent knee prosthetic is designed for who

A

TTA with flexion contracture >50 degrees

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8
Q

Symes socket will have what unique feature

A

window so the malleoli can get in the socket and then the window can be closed for ease of donning

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9
Q

Explain where the anterior wall of the socket should be

A

bisect the patella, 1.5 inches from the PTB, should be bearing weight onto their patella.

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10
Q

Explain where the posterior wall of the socket should be?

A

In line or slightly higher than the PTB when viewed from the back

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11
Q

What happens when the posterior wall is too low?

A

not enough pressure on the patella bar, you’ll slip off or weight bear too much on the distal end

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12
Q

Medial aspect of the posterior wall is wider and lower due to what?

A

two hamstring tendons

You also have a popliteal push (this is a safe wt. bearing area) to direct body wt. onto PTB

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13
Q

Where do the medial lateral trim lines generally go for these sockets?

A

femoral condyles: resist rotations and give stability in this plane. They’re slightly higher than the anterior wall to do this.

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14
Q

Bench alignment starting point should be where?

is this before or after walking?

A

90 degrees with respect to the ground

BEFORE walking

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15
Q

What should the alignment of the prosthetic always be looked at with?

A

shoe on the prosthetic foot!

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16
Q

Ankle should be in what position in the sagittal plane on a prosthetic

A

neutral postition (make sure a shoe is on)

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17
Q

What degree of motion should the socket be in the sagittal plane

A

5-10 degrees of flexion (which would be putting the quad in a mechanically advantageous position on stretch; flexing the knee a little bit)

This also allows a larger surface area for wt. bearing

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18
Q

Wt. line should be ____ to the ankle attachment and GRF

A

anterior. This is how our body naturally works. makes it easier to push off but not too far forward.

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19
Q

Alignment of the socket in the frontal plane.

Foot should be ____ to the _____ from the ______. This creates a ______ force

A

foot should be MEDIAL to the MIDPOINT of the SOCKET.

This creates a varus force at the knee during gait.

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20
Q

Knee flexion contractures must be what in the socket?

A

accommodated!

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21
Q

According to Chris (so who knows) what is the most critical part of the prosthesis?

A

the suspension. Because poor suspension leads to pistoning.

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22
Q

Three evils of prosthetics

A

bacteria
peak pressure
shear forces

All are equally problematic

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23
Q

What is the goal of suspension?

A

to control shear forces within the socket

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24
Q

What are the three kinds of anatomical suspension?

A

shape of the socket, belt straps, thigh corset

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25
Q

thigh corset _____ and _____

A

unloads 30-40% and SUSPENDS

This is good for someone with a really short residual limb, unstable knee or fragile skin

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26
Q

What are the three major categories of suspensions?

A

anatomic, suction, vacuume suspension

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27
Q

4 major steps to don 3S?

A

fully deflect the liner

Distal end cups the distal limb (make sure there are no air pockets)

Roll the liner up the leg

Make sure the pin is straight to properly engage the shuttle mechanism

28
Q

4 major steps to don suction liner

A

fully deflect liner

Distal end on distal end

Roll up the liner

instead of pin (like 3S pt will step down into the socket to force the air up and then roll u the outer sleeve to complete the seal

29
Q

how do you discuss sock management

A

ply NOT the number of socks

30
Q

If the top wall of the socket is on the distal end of the patella do you have too little or too few ply on?

A

too few. its slipping too high

Could also see pain in distal tibia when WB, abnormal thrusting or pistoning during swing

31
Q

if the top wall of the socket is on the shin bone do you have too little or too much ply

A

too much ply

Could also see no distal end contact

32
Q

What are other ways (other than where the anterior wall of the socket is) to tell if the ply is correct

A

iliac crests

patient report of where the most pressure is, the most should be at the patella tendon

33
Q

What is the largest risk factor related to skin care

A

change in residual volume: shear or compressive forces

34
Q

What is the biggest thing to not tell someone about sock managment

A

it has nothing to do with feet being cold

35
Q

Gel liners
2 pros
1 con

A

decrease peak pressures, and friction reduction

Increased infections

36
Q

Generally do you want the limb moist or dry

A

dryyyyyyy

37
Q

daily care for liners

weekly?

A

mild soap and water, rinse and dry well

weekly alcohol

38
Q

Warranty on liners?

A

25 month/pair

39
Q

If you have two liners how to do wear them?

A

alternate every other day to increase the life of the liner

40
Q

pylon connects what to what

A

socket to foot

41
Q

what is the keel

A

central portion/main structure of prosthetic foot

42
Q

Limited ambulators would use what kind of prosthetic foot?

A

SACH: solid ankle cushioned heel

These have no jt. movement, just the pin going into it. increase in energy to use

posterior bumper designed to take body weight and provide shock absorption but does this minimally

43
Q

Single axis allows what motion? How much

A

PF 15 degrees (generally we need 20)

DF 5-7 (generally we need 10)

44
Q

Posterior bumper in single axis controls what motion?

A

PF

45
Q

Anterior bumper in single axis controls what motion/

A

DF

46
Q

Why is single axis more commonly seen in TFA.

A

TTA have quads to be able to control knee during loading and create a bit of shock absorption.

47
Q

Multiaxial allows what motion?

A

DF and PF

Inversion and Eversion

48
Q

What is multiaxial good for that the ones prior to it are not?

A

uneven terrain: good for higher ambulator someone who wants to walk outside etc.

49
Q

What is the function of the elastic Keel?

Who is it good for?

A

smooth rollover therefore it is easier to ambulate.

Good for elderly, light, non aggressive ambulators

There is limited push off. bc they can never get into DF

50
Q

Function of dynamic response.

dynamic response are energy _____

A

active push off: as you load the foot it provides some push back

Dynamic response is ENERGY STORING

51
Q

Who is the dynamic response good for?

A

a very active individual

52
Q

Microprocessor feet do what to the terrain you’re walking on

A

actively adjust to it

But they’re heavy, need maintenance

53
Q

What are hybrid limbs good for?

A

excellent performance on multip surfaces

But they’re heavy so not great for runners

54
Q

Energy return of SACH?

A

39% the best are the dynamic responses and those only go up to 89%. Our human foot gives an energy return of 246%

55
Q

How does the bionic foot function?

A

two motors and springs

Allows for smooth inclines and declines, user is able to change speeds quickly

56
Q

Define “K”

A

medicare classification of patients POTENTIAL function

57
Q

Define K0

A

no potential for transfers or ambulation

58
Q

Define K1

A

potential household ambulator, including transfers

59
Q

Define K2

A

potential limited community ambulator. Think of a grandparent

60
Q

Define K3

A

Community ambulator that can VARY THEIR CADENCE.This is like every single one of us jogging or being active etc

61
Q

Define K4

A

EXCEEDS normal ambulation skills, this is sport specific (flipper, olymp[ic runner etc, insurance s not covering this)

62
Q

who pays for components?

A

CMS: centers for medicare and medicaid services

63
Q

What did CMS fail to do?

A

implement standardized and objective process to determine potential functional level (K) but the defined the K levels

64
Q

Name what kind of prosthetic would be used for which K

K0
K1
K2
K3
K4
A 
K0 = none
K1 = SACH
K2: flexible keel (easy to anterior shift for low energy cost) and multi axis 
K3: energy storing feet 
K4: all feet/specialized level
65
Q

what is the 3 point scoring for the Amp Pro and Amp NoPro?

Strong correlation with what?

A

0: inability to perform
1: minimal level of achievement or assistance
2: task completed independently

Strong correlation with 6MWT

66
Q

AMPPRO scores are higher or lower than AMP noPRO scores for the same K levl?

A

Higher, they have an advantage bc they’re using prosthetic.

67
Q

inverted pendulum model is important for what?

A

preservation of the intact limb

Unit 15 (10 decks)

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