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64 Cards in this Set
- Front
- Back
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Transfemoral Considerations
Cause of Amputation Chronology Biomechanics: Length/ROM Patient Issues Funding Issues Geographic Location |
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Transfemoral Considerations
Cause of Amputation: 1. Peripheral Vascular Disease -Diabetes -Infection -Gangrene 2. Trauma 3. Congenital 4. Tumor |
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Transfemoral Considerations
Chronology: Date of amputation RL Condition Post Op? Intermediate 3-6 mos ___ ~6mos |
Definitive
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Transfemoral Considerations
Biomechanics: ROM Length Surface Area ___ Condition/Surgical techniques |
residual limb
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Transfemoral Considerations
Patient Issues: General ___ Desire, Ability Activities |
Physical Condition
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Medicare K-levels
___- Does not have ability or potential to ambulate safely with or without assistance and a prosthesis does not enhance their quality of life or mobility. |
K0
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Medicare K-levels
___- Has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator. |
K1
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Medicare K-levels
___- Has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stair or uneven surfaces. Typical of limited community ambulator. |
K2
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Medicare K-levels
___- Has the ability or potential to ambulate with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activities that demands prosthetic utilization beyond simple locomotion. |
K3
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Medicare K-levels
___- Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete. |
K4
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Prescription Factors
___ mediates knee and foot componentry Knee Selection Foot Selection |
K-Level
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Prescription Factors
Other design criteria: Exoskeletal vs. Endoskeletal ___ Design Suspension |
Socket
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Complete Transfemoral Rx
Socket design & material Suspension Knee Foot ___/Torque Absorber |
Rotator
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Socket Designs
PLUG FIT QUAD SOCKET Ischial Containment |
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___ socket
Total contact Wider in the ___ dimension than AP Originally made in just thermo-setting laminates |
Quadrilateral
ML |
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Posterior ___
Flat, slants anteriorly to provide initial flexion of 15 degrees Contoured for hamstrings |
Posterior Wall
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Posterior ___
Horizontal parallel to floor Ischial seat |
Posterior Brim
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Medial ___
Relief channel located anteriomedial for adductor longus tendon High to prevent adductor roll Prevents medial movement of limb in socket |
Medial Wall
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Medial ___
Same height as posterior brim or slightly lower Socket should not press on pubic ramus |
Medial Brim
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___ Wall
2.5 inches higher than the medial wall (even higher for shorter limbs) Provides counter pressure for posterior wall Scarpa’s bulge—maintains ischial tuberosity on the ischial seat by providing counter pressure against posterior wall (Scarpa’s triangle=sartorius, inguinal ligament, adductor longus) |
Anterior
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___ Wall
Higher than anterior wall Inclines medially as it goes distally Set in 10 degrees of adduction |
Lateral
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Icelandic Swedish new York (ISNY) or Scandinavian Flexible Socket (SFS)
Same design as ___ Has a flexible socket with a rigid retainer |
quadrilateral
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___ (NSNA)
ML diameter is less than the AP Ischial tuberosity sits within the socket Lateral wall is higher than greater trochanter Lateral wall is set in 10-15 degrees of adduction Usually made with thermosetting laminate hard socket, but may be soft socket with rigid retainer |
Normal Shape Normal Alignment
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___ Design – Normal Shape Normal Alignment
Also known as ischial containment, CAT CAM (Contoured adducted trochanteric-controlled alignment method), and now Sabolich socket Some contain both Ischium and ramus therefore creating a “boney lock” with the femur. Closer to anatomical design Requires test sockets and very good understanding of the theory and fitting principles |
Socket
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___-CAM
Has a flexible socket with a rigid retainer |
CAT-CAM
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___
“Containment” of the residual limb High fit for rotational stability and side to side control Flexible material for the socket—comfortable High strength, light weight frame |
Sabolich
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___
Suction Partial Suction -Worn with a type of auxiliary suspension such as a Silesian band or belt Silesian band or belt -A webbing belt used as auxiliary suspension Total Elastic Suspension (TES Belts) -Another type of auxiliary suspension -Sometimes called a neoprene belt Pelvic Band with Hip Joint |
Suspension
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Suspension continued
Pin Suspension (roll-on silicone liner pin suspension –shuttlecock with lanyard ) Roll on “Seal In”liner Roll on liner and Coyote Summit Lock Osseointegration |
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Suction
___ suspension if possible Provides greatest feedback-no sock is worn Many suction designs Difficult to don Not indicated for individuals with -fluctuating volume -heart conditions -balance problems |
Best primary
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___ Belt or Band
Simple Made of cotton/Dacron webbing Relatively low profile Controls rotation well Auxiliary suspension Used with partial suction-Patient wears a sock |
Silesian
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___ (TES Belt)
Very simple to use Somewhat bulky Moderate rotational control Prosthesis may “telescope” Auxiliary suspension-used with suction, roll on silicone suction, or partial suction |
Total Elastic Suspension
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___ with Hip Joint
Bulky Very stable in M/L and Rotational control Indicated for -Weak hip abductors -Short femur |
Pelvic Band
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Roll-on Silicone Liner with shuttlecock and lanyard
Liners now being used for transfemoral applications. Used with patients who have difficulty donning a traditional suction suspension Extra guidance needed to get pin in shuttle Lanyard used to solve this problem Hand dexterity is a must Makes socket longer than normal |
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___ In Liner
Provides a suction socket Easier to don than traditional true suction Relatively new and have had good results |
Roll-on Seal In Liner
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Roll-on Liner with ___
Relatively new Prevents rotation in the socket Easy to apply Works like a ski boot lock |
Roll-on Liner with Coyote Summit Suspension
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___integration
Advantages: Less feeling of weight More control of prosthesis No perspiration, pain from socket Easy don and doff |
Osseointegration
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Osseointegration
Disadvantages: ___ required -First-fixture threaded into skeleton-wound closed and wait for bone to grow into the threads (6 months) -Second-re-expose implanted fixture, attach abutment, gradually load limb-another 6 months Long rehab period Deep infection risk If occurs=bone loss, need to re-amputee at higher level |
2 surgeries
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Structure Design Criteria
____skeletal Traditional “Hard Finish” Fabrication Method Durability / Heavy Duty Use Limited Componentry Non-Adjustable |
Exoskeletal
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Structure Design Criteria
___skeletal Vast Componentry Options Post Fabrication Adjustability Light Weight More “Anatomical” / Soft / Cosmetic |
Endoskeletal
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Knees
Primary Design Selection ___ Single Axis Polycentric |
Axis
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Knees
Primary Design Selection ___ Mediated by K-level -Constant Friction -Fluid Resistance |
Swing Resistance
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Knees
Primary Design Selection Other Features Extension Assist Stance Control Computer Controlled Rotator Torque Absorber |
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Knees
___ Axis: Simple Low Maintenance Limb Length Considerations |
Single Axis
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Knees
Axis ___ Multiple “centers of rotation” Provides added stability Indicated for anyone especially long limbs |
Polycentric
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Knees
Swing Resistance ___ Single speed ambulators (K1 or K2) |
Constant Friction
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Knees
Swing Resistance ___ Hydraulic oil or air (pneumatic) Variable speed ambulators (K3 or K4) -Resistance against flexion increases as forces increase --Increase V -> increase cadence -> increase resistance --This slows the swing rate which allows the foot to advance more quickly (increased cadence) |
Fluid Resistance
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Knees
___ Assists extension at terminal swing |
Extension Assist
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Knees
___ Locked Friction “Brake” Mechanical Hydraulic |
Stance Control
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Single Axis Constant Friction Knee With Stance Control (Not a SAFETY Knee)
Uses a ___ friction brake Restricts more flexion when wt put on in 15 –20 degrees of flexion For K1 or K 2 To 220 lbs. Comes in Child size |
weight-activated
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___ Knee
Polycentric CF –constant friction Mechanical Stance Control To 225lbs Comes in child size See video |
Total Knee
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Otto Bock 3R60
___ Hydraulic Swing Phase Control To 225lbs Otto Bock 3R65 Pediatric hydraulic unit |
Polycentric
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Henschke-Mauch Stance and Swing Control (SNS)
Provides increasing resistance to flexion as knee flexes more & more to prevent falling In swing, as knee is flexed more than 20 degrees, the foot is lifted and the knee extends |
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Computer-controlled Hydraulic Units
___ by Otto Bock Intelligent knee by Endolite Controls resistance to flexion & extension Does not provide active flexion/extension |
C-Leg
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Located Proximal to Knee Joint Allow Pt. To Sit With Leg Crossed |
Rotator
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___ Absorber
May Be Specific Unit on Shank or Integral With Foot Absorbs Torque and Thereby Decreases Shear at Residuum / Socket Interface |
Torque Absorber
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Feet
TT / TF Utilize Same Feet May See Increased Use of ___ Axis Foot |
Single
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Transfemoral Considerations
Funding -Functional Levels of Ambulation K0 - non ambulator (No prosthetic coverage) K1 - household ambulator (SACH, Constant Friction Knee) K2 - limited community ambulator (Flexible Keel Foot, Constant Friction Knee) K3 - unlimited community ambulator (Dynamic.Response Foot, Fluid Friction Knee) K4 - high activity (Dynamic Response Foot, Fluid Friction Knee) |
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___ Prosthesis Design
Advantages: ___ RL Self suspending Long lever arm Less surgically traumatic Disadvantages: Component limitations Cosmetic concerns |
Knee Disarticulation Prosthesis Design
End bearing |
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Transfemoral Biomechanics
Must provide for ML stability of pelvis during mid-stance on prosthetic side -Lateral wall of socket ___ |
adducted
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Transfemoral Biomechanics
Provide AP stability of prosthetic knee between heel contact and heel off -Socket aligned in ___ approximately 5-10 degrees -Knee joint posterior to TKA line |
flexion
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TKA LINE
Socket ___ of knee Knee posterior to trochanter and ankle if drop a plumb line |
forward
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___ Prosthesis
Patients can walk unassisted but with noticeable deviations Suspension by socket that encompasses the waist Requires a lot of gait training in order to learn the proper method of hip, knee and ankle control |
HD Endoskeletal Prosthesis
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Bilateral Amputees
Limbs shorter so easier to control Begin training with ___ |
stubbies
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CASE STUDY
35 yo, M, 225#, 5’11” DOA: 8-10-90, COA: MVC Right, TF, mid length Gen. Phys. Cond: Good Limb and skin: good Occupation: commercial actor Activity Level: Moderate Sports: Swimming & Channel surfing |
Prescription recommendation
Socket: total contact Ischial Containment - Good weight distribution and anatomical weight bearing Structural design - Endoskeletal for adjustability Suspension: Suction - Best for control of prosthesis Knee - Polycentric, Hydraulic Foot - dynamic response/multi axial |
