Prosthetics Components Worksheet PDF

Prosthetics Components Worksheet ================================ {#section.HeadingNumberTitle} Socks, Liners, and Sockets -------------------------- 1. What is the order of donning when you have gel liner, liner-liner, and socks? What is the first layer that should be applied to the sk...

Prosthetics Components Worksheet ================================ {#section.HeadingNumberTitle} Socks, Liners, and Sockets -------------------------- 1. What is the order of donning when you have gel liner, liner-liner, and socks? What is the first layer that should be applied to the skin?  - Donning prosthetics - 1\. Donn the liner-liner if present - This is a small \ - Gel liner that does not act as a suspension is a suction sleeve. 3. What are the two types of transtibial sockets?  4. What are pressure tolerant areas for someone with a transtibial amputation?  - Pressure Tolerant Areas: - Patellar tendon - Pre-tibial areas - Medial tibial flare - Medial shaft of tibia - Anterior compartment - Lateral shaft of fibula - Gastroc belly (Posterior compartment) - Redness may occur at these areas 5. What are pressure sensitive areas for someone with a transtibial amputation?   - Pressure Sensitive Area: - Tibial crest - Distal tibia - Tibial tubercle - Patella - Lateral tibial flare - Distal fibula - Fibular head - Hamstring tendons - Redness should NOT occur in the pressure sensitive areas 6. What is the role of socks?  - Prosthetic socks are incredibly important in order to ensure appropriate fit of sockets.  Socks are used to accommodate changes in volume.   - Socks are the first line of defense in managing fit.  Keep in mind that some prosthetic wearers will need different sock ply at different times based on limb changes throughout the day.  7. What are signs to add socks to a transtibial prosthesis?  a. Adding socks to a transtibial prosthesis can help adjust the fit when the residual limb changes size. Here are signs that indicate socks might be needed: b. Looseness in the Prosthesis: If the prosthetic limb feels loose or shifts when walking, it's a sign that the limb has lost volume, and socks may be needed to fill the space. c. Pistoning: If the residual limb moves up and down inside the socket during walking (pistoning), adding socks can help stabilize the fit. d. Excessive Pressure or Discomfort: If pressure points develop or there is discomfort in specific areas of the residual limb, especially near bony prominences, adding socks can redistribute the load and improve comfort. e. Redness or Skin Breakdown: If redness, irritation, or sores appear at the distal end of the limb, adding socks can prevent further skin damage by improving the socket fit. f. Sagging or Drooping of the Prosthesis: If the prosthesis seems to be sagging or sitting lower than usual, this could indicate that the socket is too large and needs a sock to lift the limb into the correct position. g. Limb Shrinkage Over Time: Limb volume may decrease, especially in the first year after amputation. Adding socks can accommodate this gradual shrinkage. h. Typically, prosthetic socks come in different thicknesses (1-ply, 3-ply, 5-ply) to allow for fine adjustments. Adjusting the sock thickness can be an ongoing part of managing the prosthesis fit. 8. Where might you see redness or unwanted pressure if there are too few socks?  i. Too few socks 1. Short prosthetic limb 2. Sensation of dropping into a hole 3. Excessive pistoning 4. Distal pressure 5. Pressure on distal patella 6. Pressure on distal fibula, fibular head or medial tibial flare 7. Easy donning 9. List 4 benefits of a gel liner  - Advantages - Improved comfort - Decreased shear/impact forces - Effectively aids in suspension - Material \"flows,\" which distributes weight-bearing load - Come in multiple thicknesses - Different thickness AP or proximal-distal 10. What are the pressure sensitive areas of a transfemoral limb?  - Pressure sensitive areas - Greater trochanter - Ischial ramis - ASIS - Adductor tendon - Distal femur - Inguinal fossa - Pubic tubercle - Incision line 11. What are the pressure tolerant areas?  8. Ischial tuberosity 9. Lateral flare of femure 10. Anterior flare of residual limb 11. Posterior flare of residual limb 12. Entire distal end of limb (with total contact socket) 12. What are the socket designs?  i. Quadrilateral socket ii. The quadrilateral socket uses opposing forces to keep the ischial tuberosity on a ledge that is built into the socket, which is the main weight bearing area.  The opposing forces in this socket provide suction suspension through negative pressure and can be complemented by other suspension methods. j. Ischial ramus containment socket iii. Weight bearing in the ischial containment socket is focused primarily through the medial aspect of the ischium and the ischial ramus. The socket encompasses both the ischial tuberosity and the ramus; the specific contour depends on the musculature, soft tissue, and skeletal structure of the amputee. k. Sub-ischial brimless socket iv. Sub-ischial brimless sockets utilize a vacuum suspension system and gel liners to ensure constant contact with the socket to minimize movement, maximize femoral control, while lowering trim lines. 13. What might the patient report if there are too few socks?  - Too few socks - Short prosthetic limb - Sensation of dropping into a hole - Excessive pistoning - Distal pressure - Pressure on distal patella - Pressure on distal fibula, fibular head or medial tibial flare - Easy donning 14. Where might be noted if there are too many socks?  v. Too many socks 13. Feeling of a long prosthetic limb 14. Sensation of hill climbing 15. \"Hammocking" (when socks prevent residual limb from fitting snugly in prosthesis with the residual space resembling a hammock) may cause distal discomfort 16. Pressure on **tibial tubercle** 17. Difficulty donning l. Suspension ---------- 1. What are the advantages of a pin shuttle mechanism?  - Advantages - Secure suspension - No sleeve needed - Audible clicks - Allows for sock adjustment with volume changes 2. What are the disadvantages of passive vacuum with the silicone suction suspension sleeve?  - Disadvantages - Liner plus sleeve creates bulk behind knee; limits flexion - Donning difficulty with hand weakness/neuropathy 3. Where do socks need to be added when using a seal-in liner?  - Socks can only be added proximal to seal (flip down ring and place sock under it) 4. What is the difference between the lanyard and strap systems?  - Lanyard system - In a lanyard system, a strap is attached to the bottom of a liner which is fed through an opening at the bottom of the socket and then attaches to the outside of the socket - Fork strap waist belt - A removable fork strap and prosthetic belt can be applied to a prosthesis suspended with a prosthetic sleeve or liner providing amputees with additional security when jumping or walking through deep mud or snow. 5. What transfemoral suspension systems suspends the prosthesis without wearing a liner?  a. 1\. Suction Suspension (Direct or Skin Fit Suction) i. How it works: The prosthesis is suspended by creating a vacuum seal between the socket and the skin of the residual limb. ii. No liner needed: The residual limb is inserted directly into the socket, and a one-way valve is often used to expel air, creating suction to hold the prosthesis in place. iii. Benefits: Provides a close fit and allows for better proprioception (awareness of limb position). iv. Considerations: Skin contact with the socket may lead to irritation for some users, and the limb volume must be relatively stable for this suspension system to work well. b. 2\. Vacuum-Assisted Suspension (VASS) without a Liner v. How it works: Similar to suction suspension, vacuum-assisted systems use an external vacuum pump to enhance the seal between the residual limb and the socket. vi. No liner needed: The limb is in direct contact with the socket, and the vacuum system actively maintains a consistent level of suction. vii. Benefits: Increased stability and limb control, improved circulation, and reduction in limb volume fluctuations. viii. Considerations: Requires more maintenance and the need for a consistent fit for effective suction. c. 3\. Pelvic Belt and Hip Joint ix. How it works: A belt is worn around the waist, with a hip joint mechanism connected to the socket to help stabilize and suspend the prosthesis. x. No liner needed: This system is external, involving straps and belts rather than a liner. xi. Benefits: Useful for individuals with short or irregular residual limbs, or those who have difficulty achieving suction or vacuum suspension. xii. Considerations: Less comfortable than suction systems and may restrict movement or cause pressure in the pelvic area. d. Each of these systems offers different benefits depending on the individual\'s limb shape, activity level, and personal preferences. Knees ----- 1. Why is a constant friction knee unsafe?  - Disadvantages - Requires voluntary control to remain stable in stance - Single speed ambulation - These are basic knees that bend freely. The amputee must rely on his own muscle control for stability 2. What are the benefits of a manual locking knee?  - Advantages - Maximum stability - The manual locking knee is the most stable knee used in prosthetics. The knee is locked during gait and the patient releases the lock mechanism in order to sit down.  - Decrease hip extension strength in order to stabilize -- do not need other muscular to stabilize 3. What are the advantages of a polycentric knee?  - Advantages - Increase stance stability - Improve sitting cosmesis with change in knee center - Increase toe clearance 4. Who is a candidate for a hydraulic knee? (k-level and needs for mobility)  - K2 and K3 descriptor - **K2 -** Has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. Typical of the limited community ambulator. - **K3** -- The patient has the ability or potential for ambulation (walking) with variable cadence (speed). This is the typical level of the community ambulator who can traverse most environmental barriers and may have vocational, therapeutic, or exercise beyond simple locomotion. 5. What are the disadvantages of microprocessor knees?  - Disadvantages - Cost - Weight - Maintenance - Computerized - Plug in to charge or swap battery every 24-72 hours - Require calibrations - Water proof - May have limited durability under heavy use or heavy loads Feet ---- 1. What does SACH stand for?  2. What are the advantages of a single axis foot?  - Advantages - Allows for plantarflexion and dorsiflexion when weighted - Assists with knee stability and roll over - May be water friendly depending on brand - Allows for inversion and eversion -- multi axis ankle 3. Which features of a foot/ankle are beneficial for uneven terrain?  - Hydroloic ankle is beneficial - Multi-Axis Foot - Although similar to the single-axis foot in terms of weight, durability and cost, the multi-axis foot conforms better to uneven surfaces.  4. Which type of foot provides actual range of motion at the ankle?  a. 1\. Single-Axis Feet i. Functionality: These prosthetic feet have a hinge that allows plantarflexion (downward movement) and dorsiflexion (upward movement) at the ankle. ii. Range of Motion: Provides limited range of motion in the sagittal plane (up and down). iii. Benefits: Helps users adapt to uneven surfaces and improves stability during walking, especially for individuals with limited knee stability. iv. Considerations: The range of motion is typically restricted to just up and down movements, with no side-to-side motion. b. 2\. Multi-Axis Feet v. Functionality: These feet offer movement in multiple planes---sagittal (up and down), frontal (side to side), and transverse (rotational). vi. Range of Motion: Provides a more natural range of motion in multiple directions, allowing for better adaptation to uneven terrain. vii. Benefits: Increases stability on uneven surfaces and provides a more natural walking experience. It can also reduce strain on the residual limb and the knee. viii. Considerations: Multi-axis feet may be heavier and require more maintenance than single-axis feet. c. 3\. Hydraulic and Microprocessor-Controlled Ankles ix. Functionality: These advanced systems use hydraulic mechanisms or microprocessors to control ankle motion. They actively adjust the range of motion in response to walking speed, terrain, and incline. x. Range of Motion: Provides dynamic and adjustable range of motion in the sagittal plane, and in some cases, in multiple planes. xi. Benefits: Allows for smoother transitions and more efficient walking patterns. The microprocessor systems can adapt in real-time to different walking conditions, offering a highly responsive and natural gait. xii. Considerations: These feet are more expensive and require regular maintenance and battery power (for microprocessor models). d. Multi-axis feet and hydraulic or microprocessor-controlled feet are the best options for providing a more complete range of motion, especially for active users or those navigating uneven terrains. 5. When is a hydraulic ankle beneficial? e. Hydraulic ankle feet combine traditional prosthetic feet with the hydraulically-regulated movement of a mechanical ankle, allowing for a more natural "rocking" motion of the ankle and foot during walking f. There are a range of hydraulic ankle feet available, which are generally determined by the characteristics of the foot portion. Basic feet provide appropriate function for more limited walkers, and dynamic feet providing enhanced functionality for more aggressive walkers. g. This foot is commonly used for K-2 and K-3 users.  Some aspects of this type of prosthesis include: xiii. Hydraulic control for plantarflexion or dorsiflexion xiv. Can increase the hydraulic resistance to optimize roll over h. Advantages xv. Negotiate ramps and slope, stairs, sit to stand xvi. Increased foot flat time xvii. Improve roll over xviii. Adapts across a broad range of surfaces and elevations