Transcript PROSTHETIC COURSE - Precision Prosthetics

PROSTHETIC COURSE
Bryan Humble CPO/LPO
Precision Prosthetics
AMPUTATION LEVELS
 TRANS
TIBIAL
(BELOW
KNEE)
 TRANS
FEMORAL
(ABOVE KNEE)
 HIP
DISARTICULATION /
HEMIPELVECTOMY
TRANS TIBIAL
(BELOW KNEE)






PHALANGEAL
TRANSMETATARSAL
LIS FRANC
CHOPART
SYMES
TRANSTIBIAL ·SHORT
·MEDIUM
·LONG
TRANS FEMORAL
(ABOVE KNEE)
 KNEE
DISARTICULATION
 TRANS FEMORAL •SHORT
•MEDIUM
•LONG
HIP DISARTICULATION /
HEMIPELVECTOMY
MAJOR COMPONENTS
SUSPENSION
LINER
KNEE
JOINTS
SOCKET
PYLON
FOOT
SUSPENSION
SUCTION
SILICONE
WITH LOCK
SLEEVE
PTB
CUFF
JOINT AND CORSET
BELT
LINERS
 SILICONE
 PELITE
 C-FLEX
 HARD
SOCKET
KNEE JOINTS
 LOCKING
 SINGLE AXIS
 SAFETY
 4-BAR
 HYDRAULIC
 COMPUTER
CONTROLLED
FEET
SACH
SINGLE AXIS
MULTI-AXIS
ENERGY
STORING
(SEATTLE)
DYNAMIC RESPONSE (FLEX
FOOT)
 COMPONENT
SELECTION MUST
MATCH PATIENT AND ACTIVITY
LEVEL. *(K-LEVEL)
INSURANCE
REIMBURSEMENT
 MEDICARE
REIMBURSEMENT
 MEDICAID REIMBURSEMENT
 PRIVATE INSURANCE
 FUNDING SOURCES FOR AMPUTEE
•TEXAS REHAB
•SSD
•UASA (BARR FOUNDATION)
MEDICARE USUALLY ALLOWS ONE PROSTHESIS
PER YEAR IF DOCUMENTED AS MEDICALLY
NECCESARY.
SOCK BALANCING




SOCK BALANCE IS ONE OF THE
MOST IMPORTANT FACTORS IN
SUCCESSFUL PROSTHESIS USE.
1, 2, 3 & 5 PLY SOCKS SUPPLIED
MAINTAIN “SNUG” FIT AT ALL TIMES.
SHORT SOCKS
HYGENE
 STUMPS
SOCKS CHANGED
EVERY DAY
 SILICONE LINER CLEANED &
DISINFECTED EVERY DAY.
SHRINKER USE
MUST BE WORN ANYTIME NOT
IN PROSTHESIS. (USUALLY IN
THE 1ST YEAR OF POST-OP)
 SHRINKERS MAINTAIN VOLUME
CONSISTANCY.

GAIT DEVIATIONS & CAUSES
(TRANSTIBIAL)
1
2
3
HEEL STRIKE TO MIDSTANCE
AT MIDSTANCE
MIDSTANCE TO TOE OFF
HEEL STRIKE TO MIDSTANCE
EXCESSIVE KNEE FLEXION
(CAUSES)
PROSTHETIC
EXCESSIVE D.F.
OR S.F.
 STIFF HEEL
 ANTERIOR SKT.

OTHER

FLEXION
CONTRACTURE
HEEL STRIKE TO MIDSTANCE
ABSENT KNEE FLEXION
(CAUSES)
PROSTHETIC
EXCESSIVE P.F.
 SOFT HEEL
 ANTERO-DISTAL
PAIN

OTHER
WEAK QUADS
 HABIT

AT MIDSTANCE
LATERAL THRUST
(CAUSES)
PROSTHETIC
MEDIAL FOOT
 ABDUCTED SKT.
 SKT. M-L LOOSE

OTHER

LIGAMENTOUS
LAXITY @ KNEE
MIDSTANCE TO TOE OFF
A




EARLY FLEXION
(DROP OFF)
ANT. DISPLACEMENT
SKT.
POST.
DISPLACEMENT OF
KEEL
EX. D.F. OF FOOT
SOFT D.F. BUMPER
B
DELAYED FLEXION

POST DISPLACEMENT
SKT.
ANT DISPLACEMENT
OF KEEL
EX. P.F. OF FOOT
HARD D.F. BUMPER



GAIT DEVIATIONS & CAUSES
(TRANS FEMORAL)
1
2
3
4
5
6
7
8
9
10
11
LATERAL TRUNK BENDING
ABDUCTED GAIT
CIRCUMDUCTION
VAULTING
SWING PHASE WHIPS
FOOT ROTATION @ HEEL STRIKE
FOOT SLAP
UNEVEN HEEL RISE
TERMINAL IMPACT
UNEVEN STEP LENGTH
EXAGERATED LORDOSES
LATERAL TRUNK BENDING
(CAUSES)
PROSTHETIC




ABDUCTED SKT.
LATERAL SKT.
WALL
PAIN D.L. FEMUR
SHORT TFB
OTHER
WEAK HIP
ABDUCTORS
 ABDUCTED
GAIT

ABDUCTED GAIT
(CAUSES)
PROSTHETIC




PAIN IN PERONEAL
AREA
LONG TFP
VALGUS
ALIGNMENT
HIP JT.
MISALIGNED
OTHER


CONTRACTED HIP
ABDUCTORS
PATIENT
INSECURITY COMPENSATES
WITH WIDE GAIT
CIRCUMDUCTION
(CAUSES)
PROSTHETIC

MECHANICAL
•LOCKED KNEE
•TIGHT EXT. ASSIST
•TIGHT KNEE FRICTION
POOR SUSPENSION CAUSES “PISTONING”


SKT. SMALL

EX. PF
OTHER

INSUFFICIENT KNEE
FLEXION (FEAR)
VAULTING
(CAUSES)
PROSTHETIC
 LONG
TFP (LOCK,
SUSP. FRICTION
EX. PF.
 INSUFFICIENT OR
EXCESSIVE KNEE
FRICTION
OTHER
 INSUFFICIENT
KNEE FLEXION
(FEAR)
 HABIT
SWING PHASE WHIPS
(CAUSES)
PROSTHETIC
 KNEE
JOINT
MISALIGNED
 TIGHT OR
IMPROPER SKT.
CONTURE
OTHER
 WEAK
OR
FLABBY
MUCULATURE
FOOT ROTATION
AT HEEL STRIKE
(CAUSES)
PROSTHETIC

HARD PF CUSHION OR PF BUMPER
FOOT SLAP
(CAUSES)
PROSTHETIC

PF BUMPER TOO SOFT
UNEVEN HEEL RISE
(CAUSES)
!EXCESSIVE!
PROSTHETIC
INS. KNEE
FRICTION
 ABSENT OR
LOOSE EXT. AID

OTHER

FORCEFUL HIP
FLEXION BY
PATIENT
UNEVEN HEEL RISE
(CAUSES)
!INSUFFICIENT!
PROSTHETIC
EX. KNEE
FRICTION
 EX. AID TIGHT
 MANUAL LOCK

OTHER

FEAR /
AMPUTEE
WALKS WITH
LITTLE OR NO
KNEE FLEXION
TERMINAL IMPACT
(CAUSES)
PROSTHETIC
INS.
KNEE
FLEXION
TIGHT EX. AID
EXTENSION
BUMPER DEF.
OTHER
AMPUTEE
OF KNEE
BUCKLING
FEAR
UNEVEN STEP LENGTH
(CAUSES)
PROSTHETIC


LACK OF
FRICTION OR
LOOSE EXT. AID
INSUFFICIENT
SKT. FLEXION
OTHER


PAIN /
INSECURITY
HIP FLEXION
CONTRACTURE
EXAGGERATED LORDOSIS
(CAUSES)
PROSTHETIC
 INSUFFICIENT
SKT. FLEXION
 INSUFFICIENT
SUPPORT ANTERIOR SKT.
BRIM
OTHER
 HIP
FLEXION
CONTRACTURE
 WEAK HIP
EXTENSORS
 WEAK
ABDOMINALS