Prosthetics

 Replacement to lost body part

MC Amputation
Congenital Acquired
UE (L) Terminal Trans radial (R) Transradial d/t Trauma -> PVD
LE Absence of Fibula (Tibial Bowing) Transtibial (BKA) – PVD -> Trauma

Pre-Prosthetic Considerations
Considerations UE BK AK
Size 3-4” 5-7” >10”
Posterior
Middle Middle
Flap Burges
Fishmouth Fishmouth
(Gastrocs)
Any
Shape Cy Co
Best: Cy
Skin 100% Sensation, dry, pliable
Nerves Retracted (cutting nerve under tension); prevent neuroma formation
Bones Rounded: check for bony overgrowth (pedia)
Muscles Stabilized, MMT 4-5/5, (-) Contractures
Blood Vessels (-) edema, (-) hematoma
You know the size of all your stumps
its 3-4, 5-7, gree-eat than 10!
How ‘bout the flast, that cover up,
‘upper above middle yan, below burgess naman
Song Any ang shape pag kay UE but
“You don’t know Your the best is cylindrica-al!
Beautiful”
SKIN has 100 sensation, dry and pliable
NERVES are retracted, bones rounded, check for overgrowth
MUSCLE are stabilized, Gr 4-5 walang tikop
BLOOD VESSELS No-o-o edema o buong dugo-o-o; bawal may dugong buo!
Cy: cylindrical; Co: conical
Choke Syndrome: brownish-yellow skin d/t tight bandaging

Muscle Procedures
1. Myodesis – muscle connected to bone
2. Tenodesis – most physiologic; tendon connected to bone
3. Myoplasty – muscle connected to muscle
4. Myofascial Closure – muscle connected to fascia

Typically all is done together

UE Prosthesis

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Components
1. Terminal Device – hand
2. Wrist Unit – handles the wrist movements
3. Control Devices – make terminal device move
4. Elbow unit
5. Socket – cradle of the stump
6. Suspension – connects prosthesis to the rest of the body part

I. Terminal Device
 Hand or hook
 PBEQ: “What is the MC prehension of your Terminal Device? A – 3 Jaw Chuck
a. Passive Cosmetic/Hands
b. Electric Powered (Batteries motor units)
c. Body powered (contraction of a muscle) usually deltoids
d. Cable Driven – obsolete
 PBEQ: “What is the most common and most functional terminal device?” A. Voluntary OFening
 Most Physiologic: Closing

II. Wrist Unit

 Function:
o A quick disconnect
o Friction control: used for a more controlled movement
o Spring Assisted: ↑ flexion & extension of the wrist

III. Control Devices

 Makes terminal devices move
o Bowden: 1 casing
o Fair Lead: 2 casings (More complex)

IV. Elbow Unit

 5-135° elbow flexion
a. Mechanical: hinged-type
b. Electric Powered
c. Myoelectric (contractions)
o Digital: (+) on/off controls
o Proportional: ↑ contraction = ↑ speed of movement

V. Socket
a. Standard: fitted to size
b. Müenster: very short Below Elbow Amp.
c. 3-Walled Socket: preferred for infants; provides very low pressure; inner, middle, outer walls

VI. Suspension
 Suction: most effective
o Uses (-) atmospheric P°; preferred for younger
o One-way valve
 Figure of 8: Most common
 Figure of 9: One strap connected to bowden device
 Condylar: encloses humeral condyles; ↑ stability
 Lanyard: cord socket-outer socket

Pediatric Readiness
 UE: 3 – 6 mos.
 LE: 8 – 10 mos.
 Active T.D: 2 y.o
 Active E.U: 2 – 3 y.o

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 Functional Hand: 3 y.o

 Active KJ: 3 – 4 y.o
 Awwh!!!!

Pediatric Check-Out
UE LE
0-5 y/o Annually
5-12 y/o at 18 months Bi-annully
12-21 y/o every 3-4 years
 Normal Lifespan: 3 y/o (depends on wear and tear)
 Golden Period of Prosthetic Fitting: 1 mo or 30 days

Lower Extremity Prosthesis

I. Below Knee
1A. Foot Ankle Assembly: Non-Articulated
1. (-) mechanical ankle joint
2. FAA connected to shank
3. Lighter & quieter
4. Active
5. Simpler Designs
6. Keel: weight supporting structure inside the prosthetic foot

Types of Non-Articulated FAA

1. SACH (Solid Ankle Cushion Heel)
a. Most Common
b. Cushion Heel: absorbs shock
i. Stiff: DF --> Knee flexion
ii. Soft: PF --> Knee extension
c. Toe Break: MTP Joints
2. SAFE (Stationary Attachment Flexible Endoskeleton)
a. SA: rigid bolt blod
b. FE: movable keel
c. Modified SAFE: SAFE Lite (lighter)
3. STEN (Stored Energy)
a. Has 3 pieces of wooden keel and 2 pieces of rubber plugs
b. Heavier than SACH
4. Quantum: spring module (keel)
a.
5. Seattle: “C-shaped” Delrin Keel
a. Seattle – “C”
b. Acts like a cantilever
c. Modified: Seattle Lite
6. Carbon Copy II
a. Has 2 carbon plates
b. Long (Walk)
c. Short (Run)
d. Light Weight
7. Flex-Walk
a. Foot made of Carbon Graphite
8. Flex-Foot
a. Same with flex walk
b. Foot continues to be the shaft

Non-Articulated FAA Codes

Heavy: SAFE STreet in SEATTLE are heavy (SAFE, STEN, SEATTLE)
Lightweight: CAR QUo WALK FOOT kaya lightweight (Carbon Copy II, Quantum, Flex Walk, Flex Foot)

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M-L Motion: SACH SAFE CARBON QUd WALK M-L Motion (SACH, SAFE, Carbon Copy II, Quantum, Flex Walk)
1B. Foot Ankle Assembly: Articulated
1. (+) Mechanical Ankle Joint
2. Px with sit-stand transfer difficulty
3. Heavier & noisy
4. Complex in Design

Parts
1. Axis
a. Single: DF (5), PF (15) inherent stability
b. Multi: DF, PF, Inv, Ev, slight rot
c. Polycentric: Sports

II. Shank
a. Exoskeletal – normal leg, hollow inside; aka Crustacean type
b. Endoskeletal – aka central support, modular, pylon; More common

III. Socket
1. Patellar Tendon Bearing (PTB)
a. Most Common
b. PBEQ: Pressure Sensitive vs Pressure Tolerant

Pressure Sensitive Pressure Tolerant

AT PT
Depressions Built-ups/Bulges
provide relief
No Redness

2. Hard (Thermoplastic)
a. Given to px with Heavy Perspiration
b. Px must have good/mature tissue covering
3. ISNY (Icelandish Swedish New York)
a. Good Ventilation
b. Thin to dissipate heat
c. Translucent (plastic)

IV. Suspension
1. Cuff: Most Common
2. SC (Supra-Condylar)
a. Encloses femoral condyles
b. Better Stability
c. High Med & Lat Walls
d. More Cosmetic
3. SC-SP (Supracondylar-Suprapatellar) Suspension
a. High Med.Lat.Ant. Walls
b. Greater stability
c. Very Short Below Knee Amp.

II. Above Knee

Energy Expenditure
 1 below: 10-40%
 2 below: 41%
 1 Above: 65%
 1 Above, 1 below: 75%
 2 above: 110%
 Crutches: 60%

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 W/C: 9%

I. Knee Assembly
a. Axis
a. Single: F, E
b. Multi/Polycentric: F, E, IR, ER
i. (+) Screwhome mechanism
ii. For Sports/active px
b. Friction
a. Constant
i. Sliding
ii. Friction remains constant all throughout gait
iii. ↑ speed
b. Variable
i. Sliding
ii. ↑ friction during acceleration and deceleration
iii. Prevents terminal swing impact
c. Fluid Control
i. More expensive; provides cadence dependent motion
ii. Pneumatic: air
iii. Hydraulic: oil
c. Extension Aid/Extension Stop
a. Extension Aid: aids knee extension, for px with weak quads
b. Extension Stop/Bumper/Resistance: for px with G. Recurvatum
d. Locking Mechanism
a. Manual
b. Weight Activated:
i. Locks at 20°-30° extension
ii. Elderly
e. Socket
a. Quadrilateral Sockets
i. Has wider Medial-Lateral structure
ii. Weight bearing: ischial Tuberosity
iii. Walls
1. Posterior Wall (WB Part)
a. G.Max rests on Posterior Wall
2. Anterior and Lateral Walls are higher 2.5-3” higher
3. Medial Wall accommodates for the adductor muscles
4. Lateral Wall prepositioned in adduction to give greater leverage for the Abductors: 7°
iv. Stability (Elderly)
v. Most Commonly Used
b. Ischial Containment
i. WB: Ascending ischio-pubic ramus
ii. For Mobility
iii. For young/athletic
f. Suspension
a. Suction
i. MC
ii. Difficult to wear
iii. Painful for elderly
b. Partial Suction with Auxiliary Suspension
c. Silesian Bandage
i. Provides rotatory control
d. Pelvic Bandage/Corset
i. Last Option
ii. Very unstable

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iii. (+) Heavy perspiration

iv. Can promote atrophy
v. Heavy in weight

Below Knee Gait Deviation

1. HS --> FF --> MS
A. Increased Knee Flexion
a. Increased DF
b. Excessively STIFF Cushion Heel
c. Increase Anterior Displacement of Socket
d. Flexion Contracture: 20° + 15-20° = 35-40°
B. Decreased Knee Flexion
a. Increased PF
b. Soft Cushion Heel
c. Increase Posterior Socket
d. Quadriceps Weakness: eccentric contraction
e. Anterodistal discomfort
f. Habit: knees kept in extension
2. MS Only
A. Lateral Thrusting Position
a. ↑ Medial Displacement of Foot
b. Abd Socket
3. HO --> TO
A. Early Flexion (weight nearer toe break)
a. ↑ Anterior Socket
b. ↑ Posterior Toe Break
c. ↑ DF
d. ↑ Soft DF Bumper
B. Late Flexion
a. ↑ posterior socket
b. ↑ anterior toe break
c. ↑ PF
d. ↑ Hard DF Bumper

Above Knee Gait Deviation

1. Lateral Trunk Bending (Trendelenburg)
a. Weak Hip Abd
b. Abd Contracture
c. Abd Socket
d. ↓ support for Lateral Wall
e. Pain discomfort
f. Short Prosthesis
2. Wide Walking Base/Abducted Gait
a. Pain on crotch area
b. Contracted hip abductors
c. Prosthesis too long
d. Shank aligned in VALGUS
e. Socket is abducted
f. Insecurity
3. Circumduction
a. Insecurity/fear
b. ↑ friction/↑ tight extensor aid
c. ↓ suspension
d. Too small socket
e. ↑ PF

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f. Long prosthesis
4. Vaulting
a. ↓ friction (↑mov’t)
b. Long prosthesis + all of circumduction
5. Swing Phase Whips
a. At & just after TO
b. Heel
i. Medial: Knee ER
ii. Lateral: Knee IR
c. Causes
i. Improper alignment (Knee)
ii. Weak/Flabby Muscle (Suction)
iii. Too Small Socket
6. Foot Rotation @ HS
a. Too stiff cushion Heel
b. ER (lateral)
7. Foot Slap
a. PF Stop, Too soft
8. Uneven Heel Rise
a. ↑/Excessive
i. ↓ friction
ii. ↓ tension (Extension aid)
iii. Forceful hip flexion
b. ↓ Heel Rise
i. ↑ friction
ii. Too tight (extension aid)
iii. Insecure
iv. Manual lock
9. Terminal Impact
a. Causes
i. ↓ friction at terminal unit
ii. Too tight
iii. Fear of buckling
iv. Absent extension bumper
10. Uneven Step Length
a. Pain/insecurity
b. Hip flexion contracture
c. ↓ friction
11. Exaggerated Lordosis
a. Hip flexion contracture
b. ↓ socket flexion (initial flexion: 5°)
c. ↓support for anterior wall
d. Weak hip extensors
e. Weak abdominal mm

Below Knee Pressure Sensitive Areas

 Anterior Tibia
 Anterior Tibial Crest
 Fibular Head & neck
 Peroneal N.

Above Knee Pressure Sensitive Areas (All other areas not listed are tolerant areas)
 Pubic Symphysis
 Perineal A.
 Distolateral end of the femur

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