PROSTHETIC COURSE
description
Transcript of PROSTHETIC COURSE
PROSTHETIC COURSE
Bryan Humble CPO/LPOPrecision 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
SUSPENSIONLINERKNEE JOINTSSOCKETPYLONFOOT
SUSPENSION
SUCTION SILICONE WITH LOCK SLEEVE PTB CUFF JOINT AND CORSET BELT
LINERS
SILICONEPELITEC-FLEXHARD SOCKET
KNEE JOINTS
LOCKINGSINGLE AXISSAFETY4-BARHYDRAULICCOMPUTER 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 HEEL STRIKE TO MIDSTANCE2 AT MIDSTANCE3 MIDSTANCE TO TOE OFF
HEEL STRIKE TO MIDSTANCEEXCESSIVE KNEE FLEXION
PROSTHETICPROSTHETIC EXCESSIVE D.F.
OR S.F. STIFF HEEL ANTERIOR SKT.
OTHEROTHER FLEXION
CONTRACTURE
(CAUSES)
HEEL STRIKE TO MIDSTANCEABSENT KNEE FLEXION
PROSTHETICPROSTHETIC EXCESSIVE P.F. SOFT HEEL ANTERO-
DISTAL PAIN
OTHEROTHER WEAK QUADS HABIT
(CAUSES)
AT MIDSTANCELATERAL THRUST
PROSTHETICPROSTHETIC MEDIAL FOOT ABDUCTED
SKT. SKT. M-L LOOSE
OTHEROTHER LIGAMENTOUS
LAXITY @ KNEE
(CAUSES)
MIDSTANCE TO TOE OFF
A EARLY FLEXION EARLY FLEXION (DROP OFF)(DROP OFF)
ANT. DISPLACEMENT SKT.
POST. DISPLACEMENT OF KEEL
EX. D.F. OF FOOT SOFT D.F. BUMPER
B DELAYED DELAYED FLEXIONFLEXION
POST DISPLACEMENT SKT.
ANT DISPLACEMENT OF KEEL
EX. P.F. OF FOOT HARD D.F. BUMPER
GAIT DEVIATIONS & CAUSES(TRANS FEMORAL)
1 LATERAL TRUNK BENDING2 ABDUCTED GAIT3 CIRCUMDUCTION4 VAULTING5 SWING PHASE WHIPS6 FOOT ROTATION @ HEEL STRIKE7 FOOT SLAP8 UNEVEN HEEL RISE9 TERMINAL IMPACT10 UNEVEN STEP LENGTH11 EXAGERATED LORDOSES
LATERAL TRUNK BENDING
PROSTHETICPROSTHETIC ABDUCTED SKT. LATERAL SKT.
WALL PAIN D.L. FEMUR SHORT TFB
OTHEROTHER WEAK HIP
ABDUCTORS ABDUCTED
GAIT
(CAUSES)
ABDUCTED GAIT
PROSTHETICPROSTHETIC PAIN IN PERONEAL
AREA LONG TFP VALGUS
ALIGNMENT HIP JT.
MISALIGNED
OTHEROTHER CONTRACTED HIP
ABDUCTORS PATIENT
INSECURITY - COMPENSATES WITH WIDE GAIT
(CAUSES)
CIRCUMDUCTION
PROSTHETICPROSTHETIC MECHANICAL
OTHEROTHER INSUFFICIENT KNEE
FLEXION (FEAR)
(CAUSES)
•LOCKED KNEE
•TIGHT EXT. ASSIST
•TIGHT KNEE FRICTION
POOR SUSPENSION - CAUSES “PISTONING”
SKT. SMALL
EX. PF
VAULTING
PROSTHETICPROSTHETIC LONG TFP (LOCK,
SUSP. FRICTION EX. PF.
INSUFFICIENT OR EXCESSIVE KNEE FRICTION
OTHEROTHER INSUFFICIENT
KNEE FLEXION (FEAR)
HABIT
(CAUSES)
SWING PHASE WHIPS
PROSTHETICPROSTHETIC KNEE JOINT
MISALIGNED TIGHT OR
IMPROPER SKT. CONTURE
OTHEROTHER WEAK OR
FLABBY MUCULATURE
(CAUSES)
FOOT ROTATION AT HEEL STRIKE
PROSTHETICPROSTHETIC HARD PF CUSHION OR PF BUMPER
(CAUSES)
FOOT SLAP
PROSTHETICPROSTHETICPF BUMPER TOO SOFT
(CAUSES)
UNEVEN HEEL RISE
PROSTHETICPROSTHETIC INS. KNEE
FRICTION ABSENT OR
LOOSE EXT. AID
OTHEROTHER FORCEFUL HIP
FLEXION BY PATIENT
(CAUSES)
!EXCESSIVE!!EXCESSIVE!
UNEVEN HEEL RISE
PROSTHETICPROSTHETIC EX. KNEE
FRICTION EX. AID TIGHT MANUAL LOCK
OTHEROTHER FEAR /
AMPUTEE WALKS WITH LITTLE OR NO KNEE FLEXION
(CAUSES)
!INSUFFICIENT!!INSUFFICIENT!
TERMINAL IMPACT
PROSTHETICPROSTHETIC INS. KNEE
FLEXIONTIGHT EX. AIDEXTENSION
BUMPER DEF.
OTHEROTHERAMPUTEE FEAR
OF KNEE BUCKLING
(CAUSES)
UNEVEN STEP LENGTH
PROSTHETICPROSTHETIC LACK OF
FRICTION OR LOOSE EXT. AID
INSUFFICIENT SKT. FLEXION
OTHEROTHER PAIN /
INSECURITY HIP FLEXION
CONTRACTURE
(CAUSES)
EXAGGERATED LORDOSIS
PROSTHETICPROSTHETIC INSUFFICIENT
SKT. FLEXION INSUFFICIENT
SUPPORT - ANTERIOR SKT. BRIM
OTHEROTHER HIP FLEXION
CONTRACTURE WEAK HIP
EXTENSORS WEAK
ABDOMINALS
(CAUSES)