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8 Prosthetics

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8 views

8 Prosthetics

Uploaded by

mimf4347
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Guilan university of medical sciences

Orthotics & Prosthetics


By
Dr Kamran Ezzati PT, PhD
Associate Professor

Dr Ezzati,PT,PhD, Associate professor 1


Dr Ezzati,PT,PhD, Associate professor 2
Dr Ezzati,PT,PhD, Associate professor 3
 The amputation limb fits into a plastic receptacle called the socket
 The prosthetic socket is the device that joins the residual
limb (stump) to the prosthesis

 Modern transtibial socket: patellar-tendon-bearing


(PTB) socket,

 Is designed to contact all portions of the amputated limb for


maximum distribution of load, as well as to assist venous
blood circulation and provide maximum tactile feedback.

Dr Ezzati,PT,PhD, Associate professor 4


Dr Ezzati,PT,PhD, Associate professor 5
 Reliefs, concavities in the socket over areas contacting
sensitive structures, such as bony prominences; reliefs are
located over the fibular head, tibial crest, tibial condyles, and
anterior–distal tibia.

 Build-ups are convexities in the socket over areas contacting


pressure-tolerant tissues, such as the belly of the
gastrocnemius; patellar ligament; proximomedial tibia,
corresponding to the pes anserinus; and the tibial and fibular
shafts

Dr Ezzati,PT,PhD, Associate professor 6


Dr Ezzati,PT,PhD, Associate professor 7
 During the swing phase of walking, or whenever the wearer is not
standing on the prosthesis, such as when climbing stairs or jumping, the
prosthesis requires some form of suspension to hold it in place.

 The cuff may be a leather, flexible plastic, or fabric-webbing strap

Dr Ezzati,PT,PhD, Associate professor 8


 The modern transtibial prosthesis originated with a
supracondylar cuff

Dr Ezzati,PT,PhD, Associate professor 9


 Very secure suspension is achieved with the use of a silicone sheath
with a distal metal pin

Dr Ezzati,PT,PhD, Associate professor 10


 Vacuum-assisted suspension is another
alternative mode of suspension.

Dr Ezzati,PT,PhD, Associate professor 11


 The socket walls may be extended proximally to suspend the prosthesis.
 supracondylar (SC) suspension

Dr Ezzati,PT,PhD, Associate professor 12


 Supracondylar suspension

1. increases medial–lateral stability of the prosthesis,
2. presents a pleasing contour at the knee,
3. eliminates the need to engage a buckle or hook-and-loop
closure on a cuff.

Dr Ezzati,PT,PhD, Associate professor 13


 Suprapatellar (SC/SP) suspension: features an anterior wall that
terminates above the patella.

Dr Ezzati,PT,PhD, Associate professor 14


 Some individuals with very
sensitive skin may benefit
from thigh corset suspension

 Prolonged use of a thigh corset


produces pressure
atrophy of the thigh

Dr Ezzati,PT,PhD, Associate professor 15


 Amputation between the femoral condyles and greater
trochanter

 If the amputation is proximal to the greater trochanter, the


patient cannot retain or control a transfemoral prosthesis and
is therefore a candidate for a hip disarticulation prosthesis.

Dr Ezzati,PT,PhD, Associate professor 16


 The transfemoral prosthesis consists of:

(1) foot-ankle assembly;


(2) shank;
(3) knee unit;
(4) socket;
(5) suspension device.

Dr Ezzati,PT,PhD, Associate professor 17


 SACH foot is often prescribed

 Single-axis foot is more frequently used for transfemoral than for


transtibial prostheses

Dr Ezzati,PT,PhD, Associate professor 18


 Bend the knee when sitting or kneeling and, in most instances, also
permits knee flexion during walking.

(1) Axis;
(2) Friction mechanism;
(3) Extension aid;
(4) Mechanical stabilizer.

Dr Ezzati,PT,PhD, Associate professor 19


 Single-axis hinge and polycentric linkage

Dr Ezzati,PT,PhD, Associate professor 20


 Pivoting bars and provide greater stability to the knee

 Provides mechanical swing control that allows a single optimal


walking speed.

Dr Ezzati,PT,PhD, Associate professor 21


 Modify the pendulum action of the leg to reduce the
asymmetry between the motions of the sound and prosthetic
limbs

 Provides mechanical swing control that allows a single optimal


walking speed.

Dr Ezzati,PT,PhD, Associate professor 22


Dr Ezzati,PT,PhD, Associate professor 23
 external extension aid, consisting of elastic webbing in front
of the knee axis: The elastic stretches when the knee flexes in
early swing and recoils to extend the knee in late swing

 Provides mechanical swing control that allows a single optimal


walking speed.

Dr Ezzati,PT,PhD, Associate professor 24


 The internal extension aid: elastic strap or coiled spring within
the knee unit.

 Unlike the external aid, the internal type keeps the knee
flexed when the individual sits.

Dr Ezzati,PT,PhD, Associate professor 25


 Assists the user to ascend
stairs step-over-step as well as
to rise from a chair.

Dr Ezzati,PT,PhD, Associate professor 26


 1. Manual Lock: The simplest
mechanical stabilizer is a manual
lock

 When engaged, the manual lock prevents


knee flexion.

Dr Ezzati,PT,PhD, Associate professor 27


 Friction Brake:

- Provides very high friction during early stance as the wearer


bears weight on the prosthesis, resisting the tendency of the
knee to flex

Dr Ezzati,PT,PhD, Associate professor 28


 Quadrilateral Socket: The basic transfemoral socket shape

Dr Ezzati,PT,PhD, Associate professor 29


 Ischial Containment Socket: contoured adducted trochanter-controlled
alignment method

Dr Ezzati,PT,PhD, Associate professor 30


 Its walls cover the ischial tuberosity
and part of the ischiopubic ramus
to augment socket stability.

Dr Ezzati,PT,PhD, Associate professor 31


 Weight-bearing occurs on the sides and bottom of the
amputated limb

 Slight socket flexion is desirable:


(1) to facilitate contraction of the hip extensors;
(2) to reduce lumbar lordosis;
(3) to provide a zone through which the thigh may be extended to permit
the wearer to take steps of approximately equal length.

Dr Ezzati,PT,PhD, Associate professor 32


 Soft flexible socket (plastic and
silicone materials) placed in a carbon
graphic frame

Dr Ezzati,PT,PhD, Associate professor 33


 Individuals with knee or hip disarticulation wear prostheses
that include the same distal components as prostheses lower
limbs amputations.

 The major distinction, therefore, is in the proximal portion of


the prostheses.

Dr Ezzati,PT,PhD, Associate professor 34


 When amputation is at or distal to the femoral condyles, the patient
should have excellent prosthetic control because

(1) thigh leverage is maximum;


(2) most of the body weight can be borne through the distal end of the femur;
(3) the broad condyles provide rotational stability.

 The problem presented by knee disarticulation is primarily cosmetic.

Dr Ezzati,PT,PhD, Associate professor 35


 Amputation above the greater trochanter (very short
transfemoral),

 The modern prosthesis: Canadian Hip Disarticulation


Prosthesis.

Dr Ezzati,PT,PhD, Associate professor 36


Dr Ezzati,PT,PhD, Associate professor 37
Dr Ezzati,PT,PhD, Associate professor 38
THANKS

Dr Ezzati,PT,PhD, Associate professor 39

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