Poly Ghosh

SPT (P & O)

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Checkout (evaluation)
 Checkout may be defined as a systematic
examination of the patient with the Prosthesis as a
biomechanical entity.
 The checkout procedure provides for the systematic
evaluation of the Prosthesis. The purpose of checkout
is to ascertain that the Prosthesis is satisfactory and
to call attention to any modifications or adjustments
that may be required.

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Initial checkout
 Initial checkout is accomplished before the initiation of
training. It is generally performed with the appliance in the
unfinished state so that minor improvements may be
introduced at minimum cost. It is important for two reasons-
 1. to provide assurance that the prescription has been followed
precisely. 2. to evaluate the biomechanical adequacy of the
device.
 if the prosthesis is found satisfactory at Initial checkout,
prosthetic training is started.

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Is the prescription according to the need?
Is the cosmetic satisfactory?
Is the function satisfactory?

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Final checkout
 Final checkout is done after completion of prostheic training.
 It assures the clinic that the patient is not in immediate need of
any further prosthetic, medical, or surgical attention.
 In Final checkout, the biomechanical adequacy is reviewed,
and evaluation is made of the extent and effectiveness of the
patient`s use of the prosthesis, as well as his physical and
psychological status.
 A checkout consists of a series of tests to be performed and
questions to be answered.

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Below elbow
Prosthesis

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Test 1. Forearm rotation
Objective : To determine if prosthesis restricts the
rotation more than necessary.
Standard: Active rotation with the prosthesis on
should be at least half that obtained without the
prosthesis.
Faults : -Socket too tight
-Improper trimline
-Inadequate length of hinges

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Test 2. forearm flexion
Objective: To determine if the prosthesis restricts
forearm flexion.
Standard: Active flexion with the prosthesis on should
be as great as active flexion without the prosthesis or -
100
Faults: - Improper trimline
- Poor alignment of hinges

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Test 3. control system
efficiency
Objective : To determine if control system requires the
amputee to exert a greater force to operate the TD
than necessary.
Calculation: Force at TD / Force at hanger × 100
Standard: Control system efficiency should be at least
70%
Faults : -Improper location of retainers
-Sharp bends
-Frayed cables

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Test for control-system efficiency

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Test 4. td operation at 900
forearm flexion
Objective: To determine if amputee can actively
operate the TD.
Standard: The wearer should be able to obtain full
range of terminal-device operation actively.
Faults: -Long housing
-Improper harness or cable adjustment
-Control motion limitations

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Test 5. TD operation at mouth
& peroneum
Objective: To determine if amputee can actively
operate the TD.
Calulation: TD opening or closing at mouth or perineum ×
100 max. manual opening or closing
Standard: The wearer should be able to obtain at
least 70% of full range of terminal device
operation actively at the mouth and
perineum.
Faults: -Long housing
-Improper harness or cable adjustment
-Control motion limitations

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Test 6. tension stability
Objective: To determine if prosthesis & harness is
stable under tensile load.
Standard: The prosthesis should not slip more than 1in. in
relation to the stump, and no part of the prosthesis or
harness should fail when a 50-lb. distal load is applied.
Faults: -Poor harness stitching
-Weak leather components
-Improper socket fit

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TEST 7. Fit & COMFORT
Objective: To determine if prosthesis is comfortable
under load.
Standard: The amputee should feel no undue
discomfort or pain.Upon removing the stump
should be free of abrasions, discoloration,
irritation or press. signs
Faults: -Rough trimline
-Projecting rivets
-Tightness
-Tender areas on stump

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Test 1. rom of stump with
prosthesis on (ae)
Objective: To determine if the prosthesis restricts
range of stump motion.
Standard: The amputee should be able to satisfy the
following minimum requirements while wearing the
prosthesis:
flexion - 900
extension - 300
abduction - 900

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Test 2. mechanical range of
forearm flexion
Objective: To determine if the forearm section is
restricted in motion.
Standard: The mechanical forearm flexion should
not be less than 1350 .
Faults: -Improper trim of forearm section
-Elbow unit incorrectly adjusted

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Test 3. Active range of
forearm flextion
Objective: To determine if the amputee can flex the
forearm fully.
Standard: The amputee should be able to flex actively
to 1350 of forearm flexion, no more than 100
of which should be due to initial flexion.
Faults: -Poor harness adjustment
-Housing too long
-Control motion limitations

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Test 4. Humeral Flexion Required to Flex
Forearm (ae)
Objective: To determine if the amputee must exert a
greater amount of humeral flexion to flex the
forearm than necessary.
Standard: Humeral flexion required to flex the
prosthetic forearm fully should not exceed 450
Faults: -Poor harness adjustment

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Test 5. force to flex forearm
Objective: To determine if the amputee must exert a
greater force to flex the forearm than necessary.
Standard: The force required to start flexion of the
forearm from 900 should not exceed 10 lb.
Faults: -Incorrect length or placement of lever loop
-Improper cable alignment

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Test 6. control system
efficiency
Objective : To determine if control system requires the
amputee to exert a greater force to operate the TD
than necessary.
Calculation: Force at TD / Force at hanger × 100
Standard: Control system efficiency should be at least
50%
Faults : -Improper location of retainers
-Sharp bends
-Frayed cables

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Test 7. td operation at 900
forearm flexion
Objective: To determine if amputee can actively
operate the TD.
Standard: The wearer should be able to obtain full
range of terminal-device operation actively.
Faults: -Long housing
-Improper harness or cable adjustment
-Control motion limitations

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Test 8. TD operation at mouth
& perineum
Objective: To determine if amputee can actively
operate the TD.
Calulation: TD opening or closing at mouth or peroneum ×
100 max. manual opening or closing
Standard: The wearer should be able to obtain at
least 50% of full range of terminal
device operation actively at the mouth and
perineum.
Faults: -Long housing
-Improper harness or cable adjustment
-Control motion limitations

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Test 9. stability of socket
against torque (AE)
Objective: To determine if the socket is too loose on
stump or if the turn table is too loose.
Standard: The amputee should be able to resist both
lateral and medial pulls of 2 lb. located 12in
from the elbow center, and the
turntable should not turn with this force.

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Test 10. tension stability
Objective: To determine if prosthesis & harness is
stable under tensile load.
Standard: The prosthesis should not slip more than 1in. in
relation to the stump, and no part of the prosthesis or
harness should fail when a 50-lb. distal load is applied.
Faults: -Poor harness stitching
-Weak leather components
-Improper socket fit

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TEST 11. Fit & COMFORT
Objective: To determine if prosthesis is comfortable
under load.
Standard: The amputee should feel no undue
discomfort or pain when the prosthesis is
forced onto the stump. Upon removing the
stump should be free of abrasions,
discoloration, irritation or press. signs
Faults: -Rough trimline
-Projecting rivets
-Tightness
-Tender areas on stump

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Technical inspection
A. Terminal device & Wrist unit
Does the terminal device function properly in all
respect?
If a cosmetic glove is used, is it undamaged, properly
color matched,& pulled completely onto hand?
If a wrist flexion unit is used , can the amputee operate
it?
If a MLR wrist unit is used ,is the operating button on
the anterior medial aspect of the wrist unit?
If a manual friction wrist unit is used, can the amputee
rotate the terminal device without loosening it unduly?

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B. Cable assembly systems
If a hook is to be interchanged with a hand, is the hook-
to-cable adapter the correct length & do the ball &
socket connections work properly?
Is nylon cable liner installed in the cable housing?
Is the control cable & housing free from sharp bends
which decrease efficiency & cause rapid cable wear?
Are the cable & housing arranged so they do not touch
the amputee skin?
BE
Is the cable housing the proper length between distal
and proximal retainers? ( if it is too long the housing
will bulge out in a large loop; if it is too short, it may
limit flexion or otherwise catch on the hinge & damage
the system.)

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AE – S
Is the forearm lever loop heavy enough to
withstand buckling during use?
Does the fore arm lever loop pivot on the screw
attaching it to the forearm section, & does it grip
the cable housing tightly enough to prevent
slipping?
Does the elbow lock control cable directly from the
access hole through the guide loop to the delto -
pectoral triangle?

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Elbow unit
 Does the elbow unit operate properly & smoothly without pinching
flesh or causing discomfort?
 Is the fore arm set in 10 to 15 deg of initial flexion?
 Can the amputee swing his arms in walking and elevate the
prosthesis 60 deg without the elbow locking involuntarily?
Harness
 Is the axilla loop small enough to keep the cross of the figure 8
harness well below the 7th cervical vertebra and slightly to the
unamputated side?
 Is the control attachment strap below mid-scapular level and does
it remain low enough to give adequate cable travel?
 Is the axilla loop padded or covered and is it comfortable to the
amputee?
 If there are harness straps in addition to the standard model can
they be justified?
 Does the front support strap pass along the deltopectoral line?
 Is the elastic front suspensor of adequate length and properly
located?
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General workmanship
 Is the prosthesis the correct length?
 Have all trimmed edges, rough spots,
unimpregnated or uncured areas been sealed?
 Are all rivets set with no sharp edges? Are all
screws tight?
 Is the arm color satisfactory and consistent?
 Are all soldered joints strong and neat?
 Are the cut edges on the cable housing field
smooth?
 Are all strap ends sealed to prevent fraying?
 Is the interior of the socket absolutely smooth?
 Is the cuff made of good quality leather, lined, neat,
and completely coated with nylon solution?
 Does the cuff fit snugly without gapping during
forearm flexion and terminal device operation?
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