UE Flashcards
All of the following are indications for single pivot hinges EXCEPT?
Allows for minimal pronation and supination.
If a force of 9 lbs. is necessary to open the hook fingers at the terminal device and 13 lbs. is required at the hanger. The control system efficiency would be?
69%
A client is operating a standard body-powered prosthesis and notices the TD opens when he pronates the TD. This is most likely caused by?
Cable too short.
In order to allow for pronation and supination, a prosthesis must be designed to?
exclude the humeral epicondyles.
A trans-radial prosthesis using single pivot hinges is assessed as meeting the recognized standards if it has no more than _______ degrees less elbow flexion range than normal?
10 degrees
3,6, and 7 hooks all have what feature(s) in common?
voluntary opening.
When fitting a bilateral, short, trans-radial patient who has limited elbow flexion range of motion bilaterally, the most appropriate prosthesis design would incorporate?
geared step-up hinges.
The wrist units which allow for flexion to be available to patients are mostly indicated for?
bilateral transradial levels
One advantage of a voluntary closing terminal device is?
it allows for graded prehension.
In order for the transradial patient to operate a terminal device, which combination of body control motions are utilized?
Biscapular abduction and humeral flexion.
A trans-radial patient will feel pressure on his limb when lifting an object with his prosthesis on the?
proximal ulna and distal radius.
The main difference between the 5XA and the 555 terminal device is?
shape; # 5 is canted, 555 lyre shaped
The main function of the inverted “Y” strap in a standard figure of eight trans-radial harness is?
distribute forces to humeral cuff from axial loads.
The amount of cable travel necessary to fully open a 5XA terminal device is?
2 inches
If the cross point of a figure of eight harness is positioned too superior, what effect will that have on the controll attachment strap(CAS)?
The CAS will be too superior on the scapula.
Dual control fair-lead?
proximal housing at the elbow, distal housing, anterior side one cable, lateral side the other cable.
Why must transhumeral amputation levels have intimate socket fittings?
The more proximal the less excursion used (excursion > length and ROM.
4.5” of cable to move the TD and the elbow?
it takes more excursion the more proximal the amputation.
Elbow flexion attachment?
- upper limb amputees have strength by the shoulder joint rarely have to move the EFA more distal
- the lever arm( short residual limb) more distal the heavier the components, placement has an effect on the prosthesis function
- MORE PROXIMAL = MORE FORCE & LESS EXCURSION (used for shorter limb length, FA is longer, heavier TD)
- MORE DISTAL = LESS FORCE & MORE EXCURSION (ROM & distance, easier to lift the elbow).
The starting point of the EFA?
- 25 mm anterior to the elbow axis; 30 mm distal to the elbow axis; 12 mm cable house extending beyond elbow; 3rd hole distal
- Short limb move proximal base plate: 1. PROXIMAL, CAS moves SUPERIOR, less body motion, LESS EXCURSION
- PROXIMAL, CAS moves SUPERIOR, less body motion, LESS EXCURSION.
Proximal Base Plate?
can never be placed more distal than the cut end of the humerus.
- Longer limb move proximal base plate?
- POSTERIOR & DISTAL,GAIN excursion -> lose force, cable is closer to the elbow axis, CAS moves more INFERIOR creates more ROM
24.Proximal base plate?
- The more LATERAL & PROXIMAL move the cable anterior to the elbow it is easier to lift the arm (GAIN more force lose excursion)
DISADVANTAGE CAS is more SUPERIOR on the scapula less ROM
How can we improve the opening of the elbow to make it greater opening?
We can move the proximal base plate more distal; move the strap more inferior which allows more body movement which then requires less excursion to move the elbow. Or we can move the elbow attachment more proximal.
Elbow lock motions?
shoulder abduction; shoulder extension, shoulder depression
Spring assist at the elbow?
will help bring the forearm up; also if there are heavy TD components which allows more body movement which then requires less excursion to move the elbow. Or we can move the elbow attachment more proximal.
Dual ring harness?
lowers the position of the control attachment strap and the axilla loop larger has more room; good for any amputee
What is the minimum amount of shoulder flexion is needed for a standard body powered prosthesis?
45 degrees
Procedure for elbow disarticulation: where do we need loading what side do we pad?
Above the MEDIAL condyle so that we can doff the cast
Coronal alignment: transhumeral prosthesis?
Evaluate anterior alignment attitude of socket on shoulder > medial portion of the turntable must fall 25mm or 1 inch (width of a yard stick) away from the widest point of the body.
To assist an individual who is having difficulty flexing his transhumeral prosthesis through the entire range of 135° because it is requiring an excessive amount of force you would?
move the base plate on the humeral section more laterally,move the EFA further distally.
The main advantage of using the three quarter socket (Sauter) modification is?
allows greater elbow flexion ROM.
A person using a standard body-powered TH prosthesis is having difficulty getting full opening of the TD at the mouth. Identify one adjustment you would make to get increased opening?
add a cross back strap, move the proximal base plate posterior & distal b’c the CAS moves inferior gives more body motion
One reason you may choose to pre-extend a forearm in fabrication is to?
improve the hanging angle for cosmetic reasons.
If a patient requires greater than 45 degrees of shoulder flexion to flex the prosthetic elbow of a TH prosthesis, this is indicative of?
a control attachment strap that is loose.
A TH patient is having difficulty achieving full opening of the TD at the mouth?
the EFA is too distal
the base plate is too proximal,the control attachment strap is too superior.
Standard Sewn Figure of eight
Best anchor strap for the patient
inferior to C7 toward the sound side
CAS inferior 3rd of the scapula
Lateral suspension strap at the apex of the shoulder anterior to the acromion
Ring type figure of 8 harness?
Benefits: lays flatter on the back, the straps are adjustable
Disadvantages: ring allows it to pivot which can lead to less excursion
comes with a ½ elastic strap that can be positioned at all different places on the harness
connect the lat and ant suspension strap so that they become one with the use of this elastic strap. Use a buckle to attach.
Chest Strap with Shoulder Saddle?
heavy duty harness for lifting over the shoulder
CAS is posterior
does not capture much excursion like the fig of 8
ADD a strap like the cross back strap to hold the it more inferior
CAS is high and lateral on the shoulder, less excursion
can make the saddle longer to adjust
NOT good for short limb
Cross Back Strap:
kyphotic posture or where you are trying to keep the CAS harness more inferior
easy donning
only use on the figure of 8 harness and made of elastic.
Z- strap Modification:
one continuous strap
alternate to figure 8 harness
advantage > non elastic captures more excursion
disadvantage > donning, use for shorter limb amputees
keeps the harness from moving inferior
Hessing Loop?
can be used in transradial level, wider, broader, more rigid pad to relieve axilla pressure spreads the loading over the chestwall cut out for the lats made of all types of materials
Lateral “Y” Strap?
deltoid region (cutout over the shoulder)
alteration to the lateral strap
split it and attach to the anterior and posterior wings of the scapula
45.Lateral “Y” Strap?
use with a patient with a longer limb (increase the ROM)
use on shorter limb
Expanded crosspoint strap & dual ring: good alternative for standard fig 8, the CAS more inferior capture more excursion . Lowering the CAS and it makes the axilla loop larger, less pressure.
- How do you improve ROM for the very short transradial amputee?:
SAUDER modification cut out the olecranon;allows for more flexion; high trimlines will hinder ROM
Bilateral individuals has an endoskeletal extension screwed into the base unit at the end of the socket,wrist unit to allow the flexion takes place at the socket (forearm)and not at the TD
preflexion,geared step-up,sliding step-up S.A.L.H > stump activating locking hinge
polycentric
2.When using multiple action hinges, what are the options available for cabling and harnessing?
Bowden Single Control.
- geared step-up hinges?
- Siding step-up hinge: socket does not stick out as much with elbow flexion, better for cosmesis, bilateral transradial with short residual limb and limited ROM
50.Split housing Fair Lead (can use all hinges EXCEPT for SALH) reduce the force on the forearm: S.A.L.H: extremely short (less than 1.5”) residual limb,
bilateral, limited ROM and strength, flexion and extension of the armlock the elbow when flexed/extends and does not raise the forearm, housing is split so when flex the shoulder it brings the forearm up and flex the limb that locks/unlocks the elbow
2:1 ratio, 1 elbow felxion 2 of forearm flexion, twice as much force to lift the arm, bilateral transradial with short residual limb and limited ROM (last resort to use) takes twice as much effort on a short residual limb we can use split housing if we wanted to use this hinge.
50.Split housing Fair Lead (can use all hinges EXCEPT for SALH) reduce the force on the forearm?
S.A.L.H: extremely short (less than 1.5”) residual limb,
bilateral, limited ROM and strength, flexion and extension of the armlock the elbow when flexed/extends and does not raise the forearm, housing is split so when flex the shoulder it brings the forearm up and flex the limb that locks/unlocks the elbow
Which hook design has symmetrical shaped fingers?
Sierra Two-Load
Which wrist unit is best suited for bilateral transradial amputations?
Sierra wrist flexion unit
Prehension Patterns:
- cylindrical
- tip
- hook or snap
- palmar
- spherical grasp
- lateral
Voluntary-opening hooks?
Each number and letter denotes the size, shape, or type of hook. The “5” series hooks are the standard adult size with canted fingers
CANTED?
the slanted configuration of the hook fingertips which facilitates visual feedback during fine motor tasks.
The letter “X” indicates?
the assertion of notrile rubber finger linings to improve friction and grasp, especially on metal objects like doorknobs.
The letter “A” indicates?
57.The letter “A” indicates: Alluminum alloy which reduces the weight of a steel hook by 50% and is satisfactory for all but the most rugged of users.
TRANSHUMERAL?
aluminum alloy hooks are preferred b’c of the ease of elbow flexion facilitated by reduced terminal weight compared to steel devices.
The series “8” hooks are?
slightly smaller and intended for women or teens.
The series “10” and “12: are?
used for children and infants.
The series “7”?
work hook characteristic; has a large opening between the two fingers.
The “555” hook?
alluminum alloy hook with more rugged solid fingers in the same lyre shape; the “555-SS” offers the same design in stainless steel. (Most commonly used for bilateral amputees on the non-dominant side to provide and alternative prehension pattern that is optimized for cylindrical objects.
Voluntary-Closing Hooks?
open at rest, body motion and effort to close the TD, operating force based on the users needs.
Wrist units?
allow interchange of Tds, permit pre-positioning of the TD (pronation/supination) or (flexion/extension), can be friction, locking or both
Carlye Method?
A way to measure for a bilateral amputee for a prosthesis
Lateral epicondyle to the thumb tip : height x .21
Acromion to lateral epicondyle : height x .19
Where does the figure of 8 harness fit?
Inverted “Y” strap, Anterior and inferior to the clavicle 25 mm, through the deltopectoral groove. Posterior Inferior to C7 and slightly towards the sound side.
Wrist disarticulations?
maintain pronation/supination.
Which of the following is needed for a second retainer?
This pertains to a very short residual transhumeral limb. A proximal base plate retainer- where is the initial placement; decrease excursion as possible you would need to add an additional retainer ( but then the efficiency would be diminished)
Which of the following will make the TD (terminal device) open prematurely?
At the transradial level the control attachment strap is too tight. Transhumeral - 290 mm forearm is an 11 inch forearm and 290 mm is the magic number- if it was longer it would cause a force problem.
NU supracondylar design TR?
ML critical measurement
cast at 45 degrees static
lower anterior trimlines
NU supracondylar?
Indications: unilaterals, TR, long limb, medium duty, myoelectric
Contraindications: long limb with pro/supination, heavy duty user, short to very short TR
What are the three metals hooks come in?
Steel, aluminum, titanium.
