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Which type of socket design for transtibial amputation?
- Evenly distributes forces across residual limb
- Some hypersensitive areas cannot tolerate the even pressure
Total surface bearing (hydrostatic)
Which type of socket design for transfemoral amputation
- ML diameter is less than AP
- Lateral wall is higher than greater trochanter
- more stable, but higher trim lines
- may enhance muscle function by providing more room for muscle contraction in AP dimension
Ischial containment
What are the 2 types of shank?
1. Exoskeleton
2. Endoskeleton
Which type of socket design for transtibial amputation?
- Loading on patellar tendon, tibial flares, femoral condyle
- Relief areas for hamstrings and fibular head
Patellar tendon bearing
Which type of shank:
- Internally supported by an internal pylon
- Interchangeable
- Post fabrication adjustment
- Covering options
Endoskeleton
Which type of suspension system for transfemoral amputation:
- Best primary suspension if possible
- Difficult to don and adjust for volume changes
- Not indicated for individuals with fluctuating volume or heart conditions
- Some have air expulsion valve in socket to create negative pressure environment
Suction
Which type of shank:
- strong enough to support body weight
- heavy and inflexible
- very little adaptability
- very durable
- will last longer than pylon structures
Exoskeleton
Which type of suspension system for transfemoral amputation:
- Don the liner with lanyard attachment then feed lanyard through socket
- Don prosthesis
- Secure lanyard to itself
- Simple
- Requires good hand strength
Lanyard/strap
Which prosthetic allows for the patient to walk forward downhill?
Microprocessor knee
What are the 2 types of socket designs for transfemoral amputation?
1. Ischial containment
2. Quadrilateral
- Responds to forces felt when walking
- controls resistance to flexion and extension
- common devices: C-leg ottobock, intelligent knee by endolite, rheo knee
Microprocessor knee
Which type of socket design for transfemoral amputation
- Total contact
- ML diameter is more than AP
- Ischial seat
- Easier to don/doff
- Decreased trim lines, but less stability and have to have good balance
Quadrilateral
Which K levels:
Abilities: prosthesis will not enhance quality of life or mobility potential; does not walk or transfer
Knee: N/A
Foot/ankle system: N/A
K0
Goal: mimic biomechanical characteristics of a human foot/ankle
- SACH
- Flexible heel
- Multiaxial
- Dynamic response (energy return)
Foot systems
Single axis
- Simple, low maintenance
- Single speed
Polycentric
- Multiple centers of rotation
- Provides added stability during stance
Hydraulic or pneumatic - K3 or K4
- Permits swing phase that more closely stimulates normal gait
- Increased weight, higher maintenance
Knee componentry
What are the 3 ways that K levels are determined?
1. Prior level of function = where did they come from
2. Current level of function = objective data
3. Perceived future level of function = where they want to be
Which K levels:
Abilities: variable cadence; unlimited community ambulator; prosthetic use beyond simple locomotion
Knee: hydraulic; microprocessor
Foot/ankle system: dynamic response, multiaxial, microprocessor
K3
Which K levels:
Abilities: exceeds basic ambulation skills; high impact, stress, or energy levels; child, athlete
Knee: any system
Foot/ankle: any system, blades
K4
What are the 2 socket designs for transtibial amputations?
1. Patellar tendon bearing
2. Total surface bearing (hydrostatic)
Which K levels:
Abilities: transfers, ambulates on level surfaces, fixed cadence, household ambulator
Knee: single axis
Foot/ankle system: SACH, single axis
K1
Which K levels:
Abilities: traverse low level environmental barriers; limited community ambulator
Knee: poly centric
Foot/ankle: flexible keel, multi axial
K2
Definition: cadence x step length
Gait speed
Definition: number of steps per minute
Cadence
Cognitive requirements: problem solving, sequencing, identifying issues regarding prosthetic fit, self management of residual limb
- Evidence of dementia, decreased verbal or immediate memory, decreased learning capacity, and decreased attention were all associated with poor prosthesis-related outcomes
Cognition and use of prosthetic device