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Movement Science 2 > Week 9 Lower Extremity Prosthetics > Flashcards

Week 9 Lower Extremity Prosthetics Flashcards

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1
Q

What is a socket?

A

where the residual limb inserts

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2
Q

What is a Pylon?

A

area below the socket

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3
Q

What is the most common cause for LE amputation?

A

Dysvacular (PVD, DM2)

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4
Q

True/False of persons with diabetes who have lower extremity amputation up to 55% will require amputation of the second leg within 2-3 years.

A

true

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5
Q

True/false nearly 50% of the individuals who have an amputation due to vascular disease will die within 5 years

A

true

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6
Q

Should prosthesis be viewed as a tool/ assistive device

A

yes

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7
Q

What is a K level and how many are there?

A

individual with an amputation functional level
4 levels to describe function

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8
Q

does not have the ability or potential to ambulate or transfer with or without assistance and the prosthesis does not enhance their quality of life or mobility

A

Level 0

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9
Q

Has the ability or potential to use prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator

A

Level 1

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10
Q

Has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. Typical of the limited community ambulator

A

Level 2

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11
Q

Has the ability or potential for ambulation with variable cadence. typical of the community ambulator who has the ability to transverse most environmental barriers and may have vocational, therapeutic or exercise activity that demands prosthetic utilization beyond simple locomotion

A

level 3

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12
Q

Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress, energy levels. Typical of the prosthetic demands of the child active adult or athlete

A

level 4

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13
Q

What are some immediate post op concerns?

A

healing
compression/limb shaping
contraction prevention
prevent scar adhesion
preserve or regain strength and stamina

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14
Q

What doe a rigid removable dressing do?

A

contracture prevention
fall prevention

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15
Q

what does a shrinker do? and when do you fit a patient with one

A

6 weeks post op
control edema
phantom pain/sensation management
compression/limb shaping

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16
Q

What are the 4 LE prostheses levels

A

hip disarticulation
transfemoral
transtibial
trans metatarsal

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17
Q

Gel liner rolled onto residuum
connecting pin at distal end of liner
locking mechanism incorporated into socket

A

Pin locking liner

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18
Q

What level is most common for a pin locking liner

A

Transtibial

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19
Q

Advantages
Disadvantages to a pin locking liner

A

advantage: simple easy to maintain
suspension is seen, felt and heard by patient
ease of donning and doffing
liner protects skin from shear and pressure

Disadvantage: pistoning can occur
distal pulling

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20
Q

gel liner rolled onto residuum
lanyard connected at distal end of liner
lanyard exit port and velcro anchor incorporated into socket

A

lanyard

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21
Q

what is the common level for a lanyard

A

transfemoral

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22
Q

What are advantages/disadvantaged to a lanyard

A

advantages: easy to maintain
suspension is seen and felt by the patient
ease of don doff
patient can forcefully pull limb into the socket
liner protects skin from shear and pressure
helps reduce rotation
disadvantage: pistoling can occur
distal pulling

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23
Q

gel liner rolled onto residuum
knee sleeve extends from socket to thigh section

A

sleeve suspension

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24
Q

what level is the sleeve suspension used at

A

only transtibial

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25
Q

what are some advantages/disadvantages of sleeve suspension

A

advantages: simple, easy to maintain
ease of donning and doffing
liner protects skin from shear and pressure
reduce rotation

disadvantage: multiple layers of material restricts the knee
pistoning can occur

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26
Q

gel liner rolled onto residuum
sealing gaskets on external surface of liner create an airtight seal agains the interior socket wall
one way expulsion valve in socket wall

A

sealing liner

27
Q

What level is the sealing liner used?

A

both transtibial and transfemoral

28
Q

what are the advantages/disadvantages to the sealing liner

A

advantages: liner protects skin from shear and pressure
reduce rotation
reduce pistoning

disadvantage: difficult to don doff
difficult to manage volume fluctuations

29
Q

patients uses a donning sleeve or pull sock to pull the residual limb soft tissue into the socket
one way expulsion valve in socket wall

A

skin fit suction

30
Q

what are the advantages/disadvantages to the skin fit suction

A

advantages: reduced rotation
reduced pistoning

disadvantages: difficult to don and doff
difficult to manage
volume fluctuations
difficult fitting process

31
Q

What level are suction fit used at

A

transfemoral only

32
Q

liner is rolled onto the residuum
pump mechanism actively evacuates air from the socket
maintaining a vacuum environment within the socket
knee sleeve extends from socket to thigh creating an airtight seal

A

elevated vacuum

33
Q

what are the advantages/disadvantages to elevated vacuum

A

advantages: most solid and secure option
solidification of soft tissues
eliminates rotation and pistoning
encourages circulation in limb
reduces or eliminates volume fluctuations

disadvantages: very difficult to don and doff
multiple layers of material restricts knee flexion
more maintenance is required

34
Q

what level is a elevated suction used for

A

transfemoral and transtibial

35
Q

Typical for a K1 who is very limited or only transfering
locking mechanism engages manually or automatically upon full extension
user must manually disengage lock to sit

A

manual lock knees

36
Q

advantages/disadvantages to a manual lock knee

A

advantages: lightweight
low cost
certainty and security of locking mechanism

disadvantage: no transition from stance phase to swing phase
necessitates gait deviations to ambulate

37
Q

Typical for k1-k2 patients
braking mechanism engages automatically under load
brake disengages automatically when unloaded

A

stance brake knees

38
Q

Advantages/ disadvantages to stance brake knees

A

A: light to moderate weight
certainty and security of stance brake
braking mechanism is typically adjustable
less effort needed for patient to control knee in stance
disadvantage: necessitates slight gait deviation to ambulate

39
Q

available for k2-k4 patients
constructed of a series of linkages
design brings the center of rotation proximal and posterior= stability

A

polycentric knees

40
Q

Advantages/disadvantages to polycentric knees

A

advantages: inherent stability
smooth transition from stance to swing
imitates normal knee- better clearance in swing
stance flexion is possible
disadvantages: patient must control knee in stance- glute activation

41
Q

available for k3 - k4 patients
can be single axis or polycentric
hydraulic unit provides resistance in stance phase/swing phase

A

Hydraulic knees

42
Q

advantages/disadvantages hydraulic knees

A

A: good stance phase stability
variation of resistance in stance and swing possible
very smooth gait
stance flexion is possible

D: heavy
increased maintenance

43
Q

available for k3-k4 patients
haydraulic unit provides resistance in stance and swing
hydraulic unit valves are controlled by an onboard programmable processor

A

microprocessor hydraulic knees

44
Q

advantages/disadvantages for microprocessor hydraulic knees

A

a: same as hydraulic knees
less energy and concentration required by patient

d: same as hydraulic knees
increased maintenance
has to be changed
risk of water damage

45
Q

typically for k1-k2 patients
rigid wood or plastic core. foam or rubber exterior
various durometer materials in heel simulate eccentric plantar flexion

A

solid cushion ankle

46
Q

advantage/disadvantage to solid ankle cushion heel

A

A: light weight low maintenance
low cost

D: unresponsive poor compliance

47
Q

Typical for k2-k3 patients
composite or carbon fiber keel
compressible heel
simulated foot articulation, plantarflexion and dorsi
various flexibility categories corresponding to patient weight and activity

A

flexible keel

48
Q

advantages/disadvantages to flexible keel

A

a: light weight
low maintenance
low cost
smoother gait
some are multiaxial

disadvantages: minimal energy return

49
Q

typical for k3- k4 patients
series of composite or carbon fiber keels/blades/struts
simulated foot articulation, plantarflexion and dorsiflexion
various flexibility categories corresponding to patients weight and activity

A

dynamic response

50
Q

advantages/disadvantages to dynamic response

A

advantages: very smooth gait
mulitaxial
energy stored and returned
minor torque and shock absorption

disadvantage: increased weight high cost

51
Q

typically for k3- k4+ patients
series of composite or carbon fiber keels/blades/struts
keels designed to flex under high impact
simulated foot articulation, PF, DF
various flexiability categories corresponding to patient weight and activity

A

vertical shock

52
Q

advantages/disadvantages to vertical shock

A

advantages: max energy return
max torque and shock absorption
max compliance

d: max cost

53
Q

true/false every human is in constant sate of volume fluctuations

A

true

54
Q

true/false socks are used to manage fluid fluctuations during the day

A

true

55
Q

failure to address volume changes can lead to what

A

skin breakdown
pressure on bony prominences
height discrepancy
instability
socket rotation
loss of suspension

56
Q

gait deviation: excessive flexion moment at the knee

A

prosthetic cause: heel to firm
foot too dorsiflexed

patient: knee flexion contracture
weak knee extensors

57
Q

gait deviation: excessive extension moment at the knee

A

prosthetic cause: heel to soft
foot too plantarflexed

58
Q

gait deviation: uneven step length uneven timing

A

pain (socket)

pain (OA)
poor balance
fear

59
Q

gait deviation: lateral trunk bend

A

prosthetic cause:
lack of lateral femoral support
prosthesis too short

Patient:
weak abductors

60
Q

gait deviation: abducted gait

A

prosthetic cause:
prosthesis too long
pressure on socket

Patient: abduction contracture
fear, habit

61
Q

gait deviation: circumduction or vaulting

A

prosthesis:
too long
knee flexion resistance too high

patient:
abduction contracture
fear of toe clearance
habit

62
Q

Gait deviation: knee instability

A

prosthesis: knee too far anterior
heel too firm

Patient cause:
weak hip extensors

63
Q

Gait deviation: lumbar lordosis

A

prostheis:
insufficient socket flexion

patient cause:
hip flexion contracture
weak hip extensors

64
Q

gait deviation: uneven timing

A

prosthesis: pain
knee flexion resistance too low

patient cause: muscle weakness
poor balance fear

Movement Science 2 (10 decks)

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