Week 6 Flashcards
What are the principles to being fitting a person for a prosthetic?
- Wound closure
- Tolerant to force couple pressures
- Circumference reduction
- Sound side weight bearing ability
What are the components of preparing a person for their first prosthesis?
• Don’t deny based on current presentation • Set goals of independence without a prosthesis • Primary factors that can be overcome with PT • Contracture reduction (esp with a transfemoral)
What are the primary factors that can be overcome with PT when preparing a person for their first prosthesis?
- Contractures
- Sound side weakness
- UE weakness
- Excess weight
What are the components of contracture reduction when preparing a person for their first prosthesis?
• Progresses slowly • Measure and give pt a goal • Passive stretching • Active stretching when ambulating with a prosthesis • >25 degrees not advised to fit
When you have a patient whose current presentation is not ideal for a prosthetic, what do you do?
Set measureable performance goals. Ex:
• Independent use of walker for a stated distance (100’)
• Must incorporate good
mechanics in preparation for the prosthesis
What is the progression for assisted prosthesis use?
- Contact guard/min assist
- SBA , stand by assist
- Supervision
What are the characteristics of modified independent prosthesis use?
- Takes longer
- Use of ass. device
What kind of prosthesis can be helpful for transfers in a patient that has being decided to be a non candidate for a prosthesis?
Trans-tibial limbs
What kind of prosthesis can be helpful for household ambulation in a patient that has being decided to be a non candidate for a prosthesis?
Trans-femoral.
• Use a locking knee
• May free up their hands for certain activities
What are the goals for the 1st PT session of a person with a prosthetic?
Goal 1 - Don’t compromise your PT session with poor fitting limbs that cause you more problems Goal 2 - Solve issues within your scope without the prosthetist
What are the parts of a trans-tibial limb and what is their function?
• Socket - Weight support • Inner Liner - Protect skin, absorb shock • Suspension - Secures prosthesis to limb • Foot/ankle - Transfers weight to the ground
What are the weight bearing regions that needs to be evaluated in a trans-tibial limb, before putting the prosthesis on a patient?
- Patella tendon
- Medial tibial flare
- Pre-Tibial musculature
- Gastroc muscle belly
- Fibular shaft
How is the trans-tibial/femoral limb inner liner worn?
- Invert inside out and roll onto limb
- Adheres to the skin
- Protection against shear
- Shock absorbing
- Conforming
- Airtight
What are the characteristics of the suction suspension
sleeve, used in a trans-tibial limb?
Attached to the prosthetic socket, and is rolled on to the thigh. It makes an airtight seal on the skin, that does a great job of reducing movement between the residual limb and the prosthesis
What are the characteristics of the pin lock suspension, used in a trans-tibial limb?
Popular for ease of use and having less surface coverage of the skin. The liner is rolled on to the skin, with a pin attached at the end of the liner. When the patient dons the prosthesis, the pin will lock at the distal end of the segment, keeping the prosthesis stable on the limb, as long as the liner adheres properly to the skin. A release button is pushed to disengage the pin and allow the prosthesis to be removed.
What are the characteristics of the elevated vacuum suspension, used in a trans-tibial limb?
Requires sleeve and electric or mechanical pump. Used to provide maximum suspension capabilities. A suspension sleeve is used to provide an airtight environment, and a pump is integrated into the prosthesis to keep a constant draw on the limb
Why are socks worn over the liner, before putting the prosthesis on?
To adjust the tightness and support of the residual limb within the socket
What will a patient report when too few socks are used in a prosthesis?
Pt reports distal patella and end pressure. And will carry excess weight at the distal end of the limb
What will a patient report when excess socks are used in a prosthesis?
Pt reports pressure at tibial tubercle. And won’t get fully into the socket
What are the possible causes for a patient to feel distal end pressure?
• Excess contact
• Distal gapping and lack of
contact
• Do a distal contact test
What are the type of movements a prothetic foot/ankle can have?
- Torque absorbing
- Shock absorbing
- Plantar/dorsiflexion
- Inversion/eversion
If a patient complains of pain when you first help then don the prosthesis, what are the things to do before calling the prosthetist?
• Take leg off and put on again • When in gait does it hurt? - On heel, midfoot, or toe? • Can you duplicate the pain with the leg off? • Are there pressure areas on the limb you can relate to gait?
What are the components of a trans-femoral limb?
- Socket
- Interface
- Knee
- Suspension
- Foot/ankle
For a trans-femoral limb, how much flexion of prosthetic socket is needed?
Match the pt flexion +5
What are the weight bearing regions that needs to be evaluated in a trans-femoral limb, before putting the prosthesis on a patient?
• Ischial tuberosity - Healthy skin coverage • Quadriceps and hamstrings • Lateral shaft of femur • Tolerance to Circumferential tightness
What are the characteristics of the lanyard suspension, used in a trans-femoral limb?
• Roll on the liner
• Feed the string or Velcro
through the hole in the end of socket
• May be used in temporary limbs
What are the characteristics of the sealing liner suspension, used in a trans-femoral limb?
- Invert and roll on the limb
- Alcohol lubricate the ring and socket
- Works on a suction principle
- For higher activity
What are the characteristics of the skin suction suspension, used in a trans-femoral limb?
• Socket is made a % smaller that the limb • Airtight seal holds the leg on • Pull the limb into the socket and screw in the valve • Ensure there is full contact • Tolerant skin (no adherances, invaginated scar, inelastic tissue)
How do we establish full distal contact in a trans-femoral prosthesis?
• View and palpate distal limb through the valve hole • Note the lanyard length that exits the socket (if it applies) • Check Pelvis for length equality. Leg will appear high if not fully donned
How do we establish correct rotational position of socket in a trans-femoral prosthesis?
• Adductor longus should be in anterior medial corner • Ischial tuberosity - Have pt flex forward at the hip - Palpate IT and have the pt extend back into the socket - IT matches the seat on the socket
How do we establish a comfortable medial brim in a trans-femoral prosthesis?
• Pubic ramus free of pressure
• Adductor tissue contained
with no tissue roll present
How do we check the anterior brim in a trans-femoral prosthesis?
• No tissue rolls outside of socket • No anterior adductor longus impingement • Ample ASIS clearance when sitting and bending forward
How do we check the lateral brim in a trans-femoral prosthesis?
• No gapping, especially
when shifting weight laterally
• Trochanter is free of pressure
How do we check the posterior-medial brim in a trans-femoral prosthesis?
- Ischial tuberosity containment/support
* Gluteal musculature support and loading
What are the things to observe in a patient with a prosthesis in the sagittal plane?
- Tibial progression
* Knee stability
What are the things to observe in a patient with a prosthesis in the frontal (coronal) plane?
- Varus/valgus knee
- Pelvic shift
- Trunk lean
What are the gait deviations causes that are correctable by the PT?
Heel height, sock ply, donning technique, limb edema
What are the gait deviations causes that are correctable only by the prosthetist?
Alignment, socket pain, knee adjustments and software programming
What are some non-prosthetic causes of gait deviations?
• Limits in ROM and strength • Muscular asymmetries - Common in transfemoral • Co-morbidities • Fear of falling • Previously developed gait habits
What are the prosthetic causes of rapid knee flexion in loading response?
- Prosthetic heel too firm
- Socket set too far anterior over the foot
- Socket is excessively flexed (>7 degrees)
What are the patient causes of rapid knee flexion in loading response?
• Quadriceps weakness • Heel of shoe too high (patient has changed shoes) • Patient has changed to a higher heel
What are the prosthetic causes of rapid knee extension in loading response?
- Heel is too soft
- Socket set too far posterior over the foot
- Foot is excessively plantarflexed
What are the patient causes of rapid knee extension in loading response?
- Weak quadriceps
- Habit
- Patient changed to lower heel
What are the prosthetic causes of rapid excessive toe out in loading response?
Prosthetic foot was aligned in excessive external rotation
What are the patient causes of rapid excessive toe out in loading response?
External hip rotation (from weak internal rotators)
What are the prosthetic causes of valgus moment at the knee out in midstance?
• Foot excessively outset • Excess valgus angulation in alignment • Fibular head pain • Looseness in socket fitting
What are the patient causes of valgus moment at the knee out in midstance?
• Short residual limb
• Ligament laxity with coronal
instability
• Wide base of support
What are the prosthetic causes of varus moment at the knee out in midstance?
- Foot excessively inset
- Excessive varus angulation in alignment
- Looseness in socket fitting
What are the patient causes of varus moment at the knee out in midstance?
- Short residual limb
* Ligament laxity with coronal instability
What are the prosthetic causes of lateral bending of trunk in midstance?
• Foot excessively outset leading to a wide base of support • Prosthesis too short • Socket aligned in hip abduction • Distal lateral femur pain
What are the patient causes of lateral bending of trunk in midstance?
• Weak hip abductors or abductor contracture • Very short residual limb • Inability to weight-bear • Fear or habit
What are the prosthetic causes of an abducted gait in midstance?
• Pubic ramus pressure - Medial brim too high • Prosthesis too long • Improper relief for distal femur on lateral wall • Foot excessively outset
What are the patient causes of an abducted gait in midstance?
- Hip joint abduction contracture
- Weak gluteus medius
- Fear or habit
What are the prosthetic causes of an exaggerated lordosis in terminal stance?
Insufficient socket flexion built into limb
What are the patient causes of an exaggerated lordosis in terminal stance?
- Hip flexion contracture
- Weak hip extensors
- Weak abdominal muscles
What are the prosthetic causes of a rapid knee flexion (Pelvic Drop Off ) in terminal stance?
• Socket is too far anterior over the foot • Excessive knee flexion in socket • Foot too dorsiflexed • Foot is too soft
What are the patient causes of a rapid knee flexion (Pelvic Drop Off ) in terminal stance?
• Patient has changed to a
higher heel
What are the prosthetic causes of a circumduction in swing phase?
• Prosthesis too long
- More likely to cause abducted gait
• Knee is too stable and difficult to flex (alignment or friction)
What are the patient causes of a circumduction in swing phase?
- Abductor tightness
* Knee control insecurity
What are the prosthetic causes of a vaulting in swing phase?
• Prosthesis too long
- Verify in static evaluation, dual limb support
• Too much knee stability and won’t swing freely
• Plantarflexed foot
• Inadequate suspension
- Prosthesis “lengthens” in swing
What are the patient causes of a vaulting in swing phase?
- Fear of dragging the toe and falling
* Very Common HABIT!
What are the prosthetic causes of excessive heel rise in swing phase?
Insufficient resistance to knee flexion
What are the patient causes of excessive heel rise in swing phase?
Flexing hip too aggressively
What are the causes of knee/foot whip in swing in swing phase?
- Prosthesis was donned in rotation
* Knee is incorrectly rotated
What is the remedy of knee/foot whip in swing in swing phase?
• Re-donn limb in correct rotation • Check landmarks • Have prosthetist adjust knee rotation
What are the prosthetic causes of terminal impact in swing phase?
- Insufficient extension resistance
* Mechanical extension assist too strong
What are the patient causes of terminal impact in swing phase?
- Too strong hip flexion
* Patient may practice hip extension to speed knee extension
