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What are some criteria for adult prosthetics?
- condition of limb
- ROM in proximal jt
- non-tender slump
- desire to wear prosthesis <- most important
- fairly good general health
- well healed stump
- free of metastatic CA
What type of prosthesis is used very early in the rehab procedure when youre making modifications?
What are some classifications of a preparatory/tempory prosthesis?
- cosmetically unfinished
- sound biomechanics
- less costly
- help in assessment of prosthetic candidancy/feasibility/indications for a permanent prosthesis
- promote shape for permanent prosthesis
What type of prosthesis is cosmetically finished, comfortable, and has adequate function?
What are some characteristics of a foot-ankle assembly?
- general contour of wearers foot
- absorb shock at heel contact
- simulates MTP hyperext in latter part of stance
- may provide slight motion in the frontal and transverse plane
What are rotators?
- component that is placed above the prosthetic foot to absorb shock in the transverse plane (inv/ever)
- not in all prosthetics
- protects wearer from chafing
- most often used with single axis feet anf by very active wearers with transfemoral amputations
What restores the length and shape of a prosthetic and is adjacent to the foot-ankle assembly (or rotators)?
- transmits the wearers body weight from the socket to the foot
What are the 2 types of shanks?
What type of shank is central aluminum, or rigid plastic pylon covered with foam?
- rubber and a sturdy stocking
What are the advantages of an endoskeletal shank?
- more life like
- permits changes in angulation of the prosthesis which increases comfort and eas of gait
What type of shank is usually made of wood or plastic and presents a rigid exterior?
- shaped to simulate the contour of the lg
What are the advantages of an exoskeletal shank?
- very durable
- impervious to liquids and most abrasives
What are the disadvantages to an exosketal shank?
- less life-like
- does not provide for change in angulations of the prosthesis
What is the recepticle for which the amputated limb fits into?
- designed to contact all portions of the residual limb for maximum load distribution
- allows for venous blood circulation
- provides tactile feedback
What do sockets have for sensitive/tolerant areas?
reliefs and build ups
What are the characteristics of an unlined socket?
- good for wearer whos limbs have no stabilzed yet
- wear uses socks or a sheath for a soft interface
- a pad can be placed in the bottom to cushion the distal end of the limb
What are the characteristics of a lined socket?
- usually resilient polyethylen foam liner
- cushions the limb
- facilitates alteration of socket size by adding material to the outside of the liner
*when a pt is up to 15ply of sock, the socket should be altered or replaced
What are the 4 most common transtibial suspension types?
- supracondylar cuff suspension
- neoprene/rubber sleve
- neoprene/rubber with screw
What type of suspension is a cuff (leather strap) that encircles the thigh immediately above the femoral epicondyles?
- supracondylar cuff
- user can easily adjust the snugness
What are the advantages of a supracondylar cuff?
- allows normal knee motion
- easy to don and doff
- relatively inexpensive
- durable and easy to replace
good for house ambulation pts
What are the disadvantages of a supracondylar cuff?
- does not eliminate pistoning (sliding up and down with amb)
- no mediolateral knee stability (not good for bad knees)
- may interfere with circulation of distal thigh in obese clients (bad for circulatory problems)
- may cause pinching in distal thigh when sitting
What are the characteristics of a neoprene/rubber sleeve?
- sleve covers the proximal socket and distal thigh
- provides excellent suspension
- streamlines the users silhouette in sitting
- requires 2 strong hands to don
- cannot be used with a thigh that has excessive subcutaneous tissue
What are the advantages of a neoprene/rubber sleeve?
- better suspension than all other types except suction
- no circumferential constriction
good for younger/more active pts
What are the disadvantages of a neoprene/rubber sleeve?
- increased perspiration and heat
- no mediolateral stability
- not as durable as a cuff
- more expensive than a cuff
What are the characteristics of a neoprene/rubber with a screw/pin (shuttle lock)?
- silicone sheath with special hardware
- provides secure suspension
- sheath clings to pts skin during gait
What type of suspension has the medial and lateral walls extend above the femoral epicondyles?
- increases medial/lateral stability
- more difficult to fabricate (more expensive)
- less readily adjustable
What are the advantages of a supracondylar/suprapatellar suspension?
- improves cosmesis
- no circumferential constrictions
- aids in mediolateral stability
- better suspension for short residual limbs
good for jacked up knees
What are the disadvatages of a supracondylar/suprapatellar suspension?
- enclosed patella can limit kneeling
- difficult to suspend over heavy thighs
What are the advantages of a waste belt?
- provides auxillary suspension
- some weight bearing on iliac crests
What are the disadvantages of a waist belt?
- may be uncomfortable, esp for the obese
- uneven suspension and swing
- fork strap does not resist knee ext
- more difficult to don
What are the advantages of suction?
- reduces pistoning
- minimizes shear forces on residual limb
- does not limit knee flexion
good for younger/active pts
What are the disadvantages of suction?
- may be difficult to don
- increased perspiration and heat
- most expensive of all suspensions
What are the 3 types of transfemoral suspensions?
- total suction
- partial suction
- no suction
What type of suction has the internal socket pressure less than the external?
What are the advantages of total suction?
- gives max control of the prosthesis
- allows full freedom of hip motion
- good proprioceptive feedback through intimate fit
What are the disadvantages of total suction?
- socket must fit very snuggly-difficult to get a good fit
- cannot accommodate changes in limb volume well
- suction can be lost through perspiration
- potential for skin shear and abrasions
- potential for skin irritation in a closed medium
- requires good balance and coordination for donning
What type of suction does the user wear a sock, and must use silesian bandage/belt or pelvic belt/band to aid in the suspension?
- partial socket
- internal socket pressure is less than external
What are the advantages to the partial suction pelvic band?
- easy to don
- provides rotational control
- provides mediolateral pelvic stability
What are the disadvantages of the partial suction pelvic band?
- adds weight to the prosthesis
- usually not very comfortable
What are the advantages to the partial suction silesian belt/bandage? (sling around the waist)
- lightweight additional suspension
- provides some rotational control
What are the disadvantages to the partial suction silesian belt/bandage? (sling around the waist)
- difficult to keep clean, unless detachable
- can irritate waist
With what type of suction is a silicone liner or neoprene sleeve used? total elastic suspension
What are the advantages to no suction suspension?
- provides excellent suspension
- adjusts to the size of the individual
- generally comfortable
- adds less weight than pelvic belt
- provides for rotational control
What are the disadvantages to no suction suspension?
- retains body heat which can lead to skin irritation and discomfort
- wears out easily
- difficult to keep clean