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49 Cards in this Set
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- Back
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What is an (AFO) ankle foot orthosis? |
•The AFO is composed of a foundation, ankle control, foot control, and a superstructure. • Most AFOs are prescribed to control ankle motion by limiting plantarflexion and/or dorsiflexion, or by assisting motion. |
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•Build ups- (also called bulges) contact pressure- tolerant tisssues |
Build-ups are convexities in the socket over areas contacting pressure-tolerant tissues, such as the belly of the gastrocnemius; patellar lig; proximomedial Tibia, corresponding to the Pes anserinus & the tibial & fibulae shaft. |
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Solid AFO- limiting all foot & ankle motion. Trim-lines are Anterior to the malleoli. •Able-bodied adults fitted with solid ankle AFOs descended stairs more slowly than when walking without orthoses. The solid ankle orthosis may be divided transversely at the ankle. •An alternative to the plastic solid ankle AFO is a metal joint that resists both plantarflexion and dorsiflexion, known as a limited motion joint |
Hinged AFO- 2 section hinged. •It permits slight sagittal motion, facilitating progression to the foot-flat position in early stance. The joint at the hinge may be a plastic overlap or a flexible plastic rod. A versatile option is a pair of metal hinges that can be adjusted to alter the excursion of ankle motion. Hinge AFOs reduced frontal plane motion during ramp decent exhibited by subjects who have subtalar osteoarthritis |
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(CAD-CAM)Computer-aided design/ Computer-aided manufacture. Involves an electronic sensor, which transmit a detailed map of the limb to a computerized program consisting of socket shapes variations; the prosthetist selects the appropriate shapes, which is transmitted to an electronic carver that creates the model over which the plastic is shaped. |
Cuff variants- the modern transtibial prosthesis originated w/ a supracondylar cuff. The cuff may be a leather, flexible plastic or fabric webbing strap. It encircles the thigh immediately above the femoral condyles & permits the user to adjust the snugness of suspension easily. Alternatives to the cuff includes a rubber sleeve, a tubular component that covers the proximal socket & distal thigh. |
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Endoskeletal shank (modular shank)- consist of a central aluminum or rigid plastic tube (called a pylon) usually covered w/ a foam or rubber & a sturdy stocking or similar finish. With its cover, the endoskeletal shank is more natural in appearance than the shiny exoskeletal shank. In addition, the pylon has a mechanisms that permits making slight adjustment of the alignment of the prosthesis, this may contribute to comfort & ease of walking. |
Exoskeletal shank(crustacean)- is typically made of rigid plastic (older version are made of wood). The rigid exterior is shaped to stimulate the contour of the anatomical leg. Although the shank is usually finished w/ plastic tinted to match the wearer’s skin color, some individuals opt for a multicolor shank. The exoskeletal shank is very durable & with the plastic finish, is impervious to liquids. B/c they are less lifelike & do not permit changes in alignment of the prosthesis, exoskeletal shanks are less frequently prescribed. |
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Ischial Containment Socket (contoured adducted trochanter controlled alignment method) - alternative design type that walls cover the ischial tuberosity & part of the ischiopubic, ramus to augment socket stability. To increase frontal plane stability & minimize bull between the thigh, the mediolateral width of the socket is narrow than that of the quadrilateral socket. The anterior wall is lower than the quadrilateral socket, whereas the lateral wall covers the greater trochanter. WB occurs on the sides & bottom of the amputated limb. |
Slight socket flexion is desirable for the following reason: (1) to facilitate contraction of the hip extensors, (2) to reduce lumbar lordosis & (3) to provide a zone through which the thigh may be extended to permit the wearer to take steps of approximately equal length. |
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Quadrilateral socket- the socket features a horizontal posterior shelf for the ischial tuberosity & gluteal musculature, a Medial brim at the same level as the post. shelf, and anterior wall 2.5 to 3 in (6-8 Cm) higher to apply a post. direction force to the thigh to retain the ischial tuberosity on its own shelf, & a lateral wall the same height as the anterior wall to aid in Medial lateral Stabilization. |
Concave reliefs are (1) anteromedial, for the pressure sensitive adductor Longus tendon & obturator N; (2)posteromedial, for the sensitive hamstrings tendon & sciatic N; (3)Posterolateral, to permit the glut Maximus to contact & bulge w/o being crowed & (4) anterolateral, to allow adequate room for the rectus femoris. The ant. wall has convexity, Scarpa’s bulge, to maximize pressure distribution in the vicinity of the femoral (Scarpa’s) triangle. |
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Socks- All individual w/ LE amputations, except those wear a trans femoral prosthesis suspended by total suction or those using a shear requires a supply of clean socks of appropriate material size & shape. |
Fabric socks are woven in various thickness referred to as ply, designating the # of threads knitted together. Cotton socks absorb perspiration readily & are the least allergenic; they are made in 2-3 & 5 ply, the last being the thickest. Wool socks provide good cushioning, woven in 3-5 & 6 ply they are expensive & must be laundered carefully. Orlon/Lycra socks are manufactured in 2&3 ply thickness. They can be washed easily w/o shrinking. This synthetic fabric combination affords considerable, resilience but does not absorb much prespiration |
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Sheaths- A nylon sheath creates a smooth surface over the skin, thereby reducing the risk of chafing, especially in the hot weather & among those w/ much scarring. Because nylon does not absorb sweat, liquid passes through the weave to be absorb by an putter sock of cotton or wool. |
Silicone, urethane & other synthetic sheaths provide excellent shock absorption & abrasion Resistance, they also can aid in suspending the socket on the patient’s limb, & are designed to be worn next to the skin. They are however more expensive than fabric socks or sheaths Socks & sheaths should be long enough to terminate above the most proximal part of socket. |
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Liners- Silicone gel suspension liners are another form of socket residual limb interface. These liners cushion the residual limb as well as function as a primary or secondary suspension system. |
Some include a nylon outer cover, with liner thickness tapering distally, and may be indication for particularly active users & those w/ fragile or sensitive residual limbs. They are available in locking,custom & seal in designs. |
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Multiple axis Feet- These components move slightly in all planes to aid in the wearer in maintaining maximum contact w/ the walking surface, even the surface slopes or has slight irregularities. |
A recent version of the multiple axis foot is the propionate foot, which includes electronic sensors to detect when the wearer need DF, it also provides greater ankle excursion than other foot ankle asssemblies & reduces pressure on the amputation limb. Multiple axis feet are heavier & less durable than single axis or non-articulated feet. |
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Single-Axis Feet: the most common example of an articulated foot. A rear bumper absorbs shock & controls plantar flexion excursion; it is easy for the prosthetist to substitute a firmer or softer bumper, depending on the force that the pt applies in early stance. |
A heavy or very active client requires a firm bumper, whereas a frail individual needs a bumper that is soft enough to permit the foot to plantar flex w/ minimal loading. The single axis foot does. Not allow medial lateral or transverse motion, some ppl prefer the simplicity of control |
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Patellar tendon bearing (PTB) socket- although the original name for the modern transtibial socket was the PTB socket, the socket is designed to contact all portions of the amputated limb for maximum distribution of load, as well as to assist venous blood circulation & provide maximum tactile feedback. |
The PTB socket features a prominent indentation over the patellar ligament, sometimes known as the patellar tendon. |
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Reliefs(also called channels)- concavities in the socket over areas contracting sensitive structures, such as bony prominences, reliefs are located over fibulae heads,tibial crest,tibial condyles, & ant. Distal Tibia. |
The posterior brim is shaped to provide adequate room for the medial & lateral hamstrings tendons, so that the pt is comfortable when sitting |
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Rotators- component placed above the prosthetic foot to absorb shear stress in the transverse plane. A shock absorber reduce vertical impact. These components protect the user from skin chafing, which would otherwise occur if the socket were permitted to slide against the skin. |
Rotators & shock absorbers are most often used w/ single axis feet & very big active individuals, especially those with transfemoral amputation. A rotator w/ or w/o a shock absorber may be contained within a prosthetic foot suck as a certerus |
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SACH Foot (Solid Ankle Cushion Heel)- the longitudinal portion is a wooden or metal keel, which terminates at a point corresponding to the metatarsophalageal joints. The keel is covered w/ rubber; the post. portion is resilient, to absorb shock & permit plantarflexion in early stance. Anteriorly, the junction of the keel & the rubber toe section allows the foot to hyperextend in late stance. |
The SACH foot is manufactured in a wide range of sizes to accommodate infants, adolescents & adults. It is available w/ heel cushions of varying degrees of compressibility for those who strike the heel w/ different amount of forces. SACH deer can be ordered in several plantarfelxion angles to fit shoes w/ diverse heel heights. The heel cushion allows very small amount of medial lateral transverse motion. |
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Shrinkers- Shrinkers are socks like garments knitted of heavy, rubber reinforced cotton, they are conical In shape & come in variety of sizes. It is difficult to use a shrinker in the postoperative period because the process of donning May put unnecessary stress on the unhealed incision. |
Shrinkers are best used after healing has taken place and the sutures have been removed. |
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Shuttle lock- sleeve that includes a distal pin to create a shuttle lock |
The user inserts the sheathed limb into the prosthesis, guiding the attached pin into a receptacle, also called a shuttle lock, in the socket. During swing phase, the pin mechanisms prevents the prosthesis from slipping. |
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Suction suspension (types)- Suction refers to the difference between pressure inside & outside the socket. W/ suction suspension, internal socket pressure is less than external pressure; consequently, atmospheric pressure causes the socket to remain on the thigh. A 1-way air release valve located at the bottom of the socket enables residual air to be expelled. |
Total suction- maximum control of prosthesis, w/o any encumbering Axillary suspension can be achieved only when the socket brim fits snugly. Some ppl add a transfemoral suspension sleeve |
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Partial suction- a socket that is slightly loose may provide partial suction suspension combined w/ auxiliary suspension; the socket has a valve. The pt wears one or more socks or a synthetic liner. B/c air enters the space between the sock fibers, auxiliary suspension is needed, either a fabric Silesian belt or a rigid plastic or metal hip joint & pelvic band. |
Back (Definition) |
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Suspension- Is how the prosthesis is held on to an amputee’s residual limb |
During the swing phase of walking or whenever the wearer is not standing on the prosthesis, such as when climbing stairs or jumping, the prosthesis requires some form of suspension to hold it in place. |
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Supracondylar suspension- the Medial & Lateral walls extend above the Femoral condyles. Some SC suspension design include a plastic wedge on the Medial wall. |
When donning the prosthesis, the client removes the wedge, places the amputation limb in the socket, and then places the wedge between the socket and the Medial condyle to retain the prosthesis on the limb. The SC suspension increases Medial-Lateral stability of the prosthesis, present a pleasing contour at the knee & eliminates the need to engage a buckle or hook and loop closure in a cuff |
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Thoracolumbosacral Orthosis- also called the Taylor brace, TLS flexion, Extension (TLS FE) orthosis consist of a pelvic band, post uprights terminating at midscapular lvl, an abdominal front corset & axillary straps. The orthosis reduce flexion by 3 point system |
TLSO reduce segmental & gross Spinal movements, limits trunk motion in the frontal,Sagittal & transverse plane providing maximum support. |
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What are the major cause for lower extremity amputation? |
•1st cause: Peripheral vascular disease (PVD) & Diabetes •2nd cause: trauma •3rd cause: Tumor |
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Venous wounds •Inadequate venous system function •Wounds are irregular shape & shallow •Located just proximal to the Medial malleolus •Pain is mild to moderate & elevating the leg (decrease) pain |
•Skin is flakey & dry but temperature is normal •Edema is Increase. |
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Arterial Wounds- •occurs secondary to ischemia; poor oxygenated blood circulation •Ulcers seen on toes, lower 3rd leg &/or lateral malleolus |
•Edges are smooth deep, punched out, well defined •Skin is pale, shiny, taunt, & thin, hair loss evident •Severe pain,Elevating legs (Increase) pain •Pedal pulse (decrease) or absent |
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Neuropathic Ulcer(foot,diabetes) • Are associated w/ diabetes due to lack of sensation & excessive plantar surface pressure |
•Most commonly seen on the bottom of the feet •Poor wound healing capabilities |
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Arterial vs Venous leg Ulcers Arterial (Lateral Ankle) •Toes & feet,Shin. •Ulcer deep, pale. •Skin is shiny, hairless, pallor in elevation, cool temperature. •Mild or absent edema. •Intermittent, severe, resting pain. •Decrease or absent pulses |
Venous (Medial Ankle) •Usually around the Ankle. •Ulcer superficial, pink, beefy red, irregular edges. •Skin leathery, brown, purple discoloration, stasis dermatitis present. •Significant edema. •Aching, mild pain. •Pulses usually normal |
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Healing process •Infection is the greatest concern •Takes 14days or 2weeks for a wound to heal |
-Wounds contaminates from injury, infected foot ulcers are at greater risk of infection -Smokers have a 2.5% higher rate of infection & re amputation than non smokers |
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Postural Dressing: Soft Dressing: gauze, cotton padding & elastic bandages or shrinker(not used until sutures have healed). Advantages:inexpensive,light weight. Disadvantages: poor edema control, can slip off, Semi-Ridge Dressing(Luna Dressing)(not common): most often used. Gauze that has zinc oxide, glycerin & calamine. Huge disadvantage is that it can loosen. Advantage: better edema control than soft D. |
Rigid Dressing: Plaster of Paris. Immediate post operative prosthesis (IPOP). Removable rigid Dressing (RRD) can be removed daily to inspect the limb. Advantage: improves wound healing & reduces edema & pain. Disadvantage: may cause pressure ulcers, more expensive; with IPOP can’t inspect incision. |
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Purpose of surgical Dressing: Residual limb shaping •Indications for use of compression devices (elastic wraps & shrinkers) 1. Edema Control. 2. Shaping. 3. Contracture prevention. 4. Reduction of an “adductor roll” in AKA. 5. Desensitization |
6. Long stretching. 7. Elastic wrap, ace band. 8. Short stretching |
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What de synthesize phantom pain? |
•Massage & ice For 15min |
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How to not fall? |
Ankle, knee & taking a step. |
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Phantom limb sensation: will be encountered by the majority of amputees. Described as the sensation of the limb this is no longer present. Tingling, Burning, Itching,Numbness or pressure. Most frequently felt at the distal aspect but can be felt in the whole extremity. Pt’s must understand these are NORMAL sensations & should not be interfere w/ prosthetic training |
Phantom limb pain: is a generalized, noxious sensation in the absent limb that is severe enough to interfere w/ prosthesis fitting, daily life function & function. Can be debilitating. Occurs in only a small # of pt’s. |
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PTB socket- for Transtibial amputations Reliefs in the socket are Concave & located over sensitive (bony) structures Buildups are Convex over pressure tolerant areas (Gastroc, patella tendon) •Socket is triangular in shape |
Quadrilateral Socket- for Transfemoral (above knee amputation) •Reliefs: Ant/Medial- for add Longus tendon. Post/Med- Hamstring tendon & Sciatic Nerve(injuries cause PF/DF). Post/Lateral- Gluteus Maximus, Ant/Lat for Rectus Femoris •Build ups: Ant wall to maximize pressure- Lateral for Sartorius & Medial for add long. **The weight bearing in this socket is primarily on the ischium & gluteal musculature |
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Socks & Variants •Socks come in varying thickness called ply •Cotton socks (readily absorb perspiration) •Wool socks ( good cushion) •Orlon/Lycra Socks (resilient & easily washed) |
Supracondylar Cuff: •Strap encircling the thigh above the Femoral condyle •pt can easily adjust the snugness of the suspension |
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Most of the weight bearing in the Quadrilateral socket is on ischial tuberosities & Gluteus Maximus on the posterior shelf |
Ischial containment- Medial wall of the socket actually cups inside ischium. This prevents socket from shifting laterally during stance phase of gait |
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Types of suspension in the Transfemoral prosthesis -Total Suction provides max control & fits snugly w/o the use of auxiliary suspension |
-Partial suction fits slightly looser & is combined w/ auxiliary suspension 1 or more socks or liners are worn w/ this type of suspension -No suction if there is no valve & just a distal hole, there is no suction. Pelvic band & several socks are worn |
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Viewing deviation/compensations from behind: •Abducted gait pattern, circumducted gait pattern, lateral trunk bending & whips rotation of the foot on heel contact |
View these from the side: •Foward Trunk shift, Increase lordosis,uneven heel rise, abrupt knee extension, vaulting, hip hike, unequal step length |
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Orthosis defined: as an external appliance worn to restrict or assist motion or transfer load from one area to another |
Types of orthosis: FO, AFO,KAFO,HKFO, THKFO |
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Foot Orthosis •Enhances function & relieving pain by: •Transferring weight bearing stresses to pressure tolerant areas •Protecting painful areas from contact w/ shoes •Correcting alignment of a flexible segment or accommodating a fixed deformity |
Types of Orthotics: Internal Modifications: •Internal Heel wedges- Medial Heel wedge & Lateral Heel wedge |
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External Modifications: Rocker bar, Metatarsal bars, Lateral Heel wedge |
(AFO) Ankle- provide ankle foot stability. Improvements in energy efficiency and safety are also important outcomes. AFOs are prescribed for foot drop, poor knee control (especially hyperextension), minimal to moderate spasticity, and poor somatosensation. H |
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Knee Ankle Foot Orthosis : Drop locks keep knees straight when walking |
Hip knee ankle foot orthosis |
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External Modifications: Rocker bar, Metatarsal bars, Lateral Heel wedge |
(AFO) Ankle- provide ankle foot stability. Improvements in energy efficiency and safety are also important outcomes. AFOs are prescribed for foot drop, poor knee control (especially hyperextension), minimal to moderate spasticity, and poor somatosensation. H |
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External Modifications: Rocker bar, Metatarsal bars, Lateral Heel wedge |
(AFO) Ankle- provide ankle foot stability. Improvements in energy efficiency and safety are also important outcomes. AFOs are prescribed for foot drop, poor knee control (especially hyperextension), minimal to moderate spasticity, and poor somatosensation. |
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Orthotic prescriptions: •AFO: pts w/ peripheral neuropathy, Peroneal, lesions & or hemiplegia. •Posterior leaf Spring AFO - used for pt who have the inability to DF -But not appropiate for pts w/ severe spasticity |
•Solid or Spinal AFO- for pts w/ Sagittal & Medial/Lateral instability •KAFO- used for pts to allow compensation for Entire LE paralysis |
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Orthotic gait analysis •It is important to recognized both orthotic & anatomical causes of common gait deviations |
Refer to table 30.1 pages 1349-51 |
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Trunk Orthosis : •Are used to support the trunk & assist in controlling spinal motion •Corset Orthosis: used to reduce pain & increased intra-abdominal pressure decreasing stress on posterior spinal muscles |
•Rigid Orthosis: use a 3 pint system to control motion |
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Trunk orthoses cont. •Boston brave (a TLSO), comes up beneath the underarms. It appears to be effective for mid-back & Lower curves •Milwaukee brave is also still used •Worn for 23hrs a day |
Scoliosis Orthosis: scoliosis brave is usually worn under clothing & is one method used to try to improve the exaggerated curvature of the spine as seen in scoliosis |
