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Prosthetics and Orthotics - Coggle Diagram

- - - - Pin locker liner:
        gel wrapped around residual limb with pin at the end which locks on to socket:
        
        Advantages:
        easy to maintain
        suspension can be seen and felt
        easy don and off
        liner protects skin from shear
        
        Disadvantage:
        pistoning can occur
        distal pulling can occur
      - Lanyard liner:
        gel rolled on residual
        lanyard connects to end
        Velcro through ports to anchor
        
        Advantage:
        simple and easy to maintain
        suspension seen and felt by patient
        reduces rotation
        easy on off
        
        Disadvantages:
        pistoning can occur
        distal pulling can occur
      - Suction sealing:
        gel liner rolled onto residual limb
        sealing gaskets create airtight seal
        Suction skin fit:
        pull sock with one way valve on socket walll
        
        Advantages:
        reduced rotation
        reduced pistoning
        
        Disadvantages:
        difficult on and off
        difficult to manage volume flux
      - Sleeve suspension:
        gel liner rolled onto residual limb
        knee sleeve extends from socket to thigh
        
        Advantages:
        easy to maintain
        easy on and off
        reduces rotation
        
        Disadvantages:
        multiple layers of material restrict knee
        pistoning can occur
      - Elevated vacuum:
        pump mechanism actively evacuates air from socket
        maintains vacuum within socket
        
        Advantages:
        most solid and secure option
        eliminates rotation and pistoning
        encourages circulation in limb
        reduces or eliminates volume flux
        
        Disadvantage:
        very difficult on off
        multiple layers restrict knee flex
        needs more maintenance
    - - Manual Locking knee:
        1st K1 patients
        pretty much for only transfers
        auto locks at full extension
        must manually disengage
        
        Advantages:
        lightweight
        low cost
        very secure lock
        
        Disadvantages:
        no transition to swing
        Gait deviations
        
        Swing phase control:
        NONE
        constant friction
      - Stance break knee:
        1st K1-2 patients
        The braking mechanism engages automatically under load
        automatic disengagement automatically with unload
        
        Advantages:
        light-mod weight
        certanty and security of stance
        braking mechanism id adjustable
        less effort needed to control
        
        Disadvantage:
        need slight gait deviations
        
        Swing phase control:
        extension assist
        constant friction
        hydraulic control
      - Polycentric knee:
        1st K2-4 patients
        constructed series of linkages
        brings center of rotation
        prox and post stability
        
        Advantages:
        inherent stability
        smooth stance to swing
        imitates normal knee flex
        
        Disadvantages:
        patinet must control knee in stance
        so they need glut activation
        
        Swing phase control:
        hydraulic, but constant friction
      - Hydraulic knee:
        K3-4 patients
        hydraulic unit that provides resistance in stance or swing
        
        Advantages:
        good stance phase stability
        variation of resistance possible
        very smooth gait
        stance flexion possible
        
        Disadvantage:
        heavy
        increased maintenance
        
        Swing phase control:
        Hydraulic
      - Microprocessor Hydraulic knee:
        hydraulic unites that provides resistance in stance or swing
        controlled by programable processor
        
        Advantages:
        same as hydraulic
        less energy and concentration
        
        Disadvantages:
        same as hydraulic
        increased maintenance
        has to be charged
        risk of water damage
    - - Solid ankle cushion heel (SACH):
        FOR K1-2
        flexible wood core with foam
        
        Advantages:
        Lightweight
        low maintenance and cost
        
        Disadvantage:
        unresponsive
        poor compliance
      - Flexible keel:
        for K2-3
        composite carbon keel
        compressible heel
        simulated artic
        various flexibility
        
        Advantage:
        lightweight
        low cost and maintenance
        smoother gait
        can be multiaxial
        
        Disadvantage:
        minimal energy return
      - Dynamic response:
        For K3-4
        series of composite carbon fiber
        simulated foot articulation
        many categories
        
        Advantage:
        very smooth gait
        multi axial
        energy stored and returned
        minor torque and shock absorb
        
        Disadvantages:
        increased weight
        High cost
      - vertical shock:
        for K3-4+
        series of composite or carbon fiber
        high flex under impact
        simulated articulation
        Various flexibility
        
        Advantage:
        max energy return
        max torque and shock absorption
        max compliance
        
        Disadvantage:
        MAX COST
      - Bionics:
        for K3-4
        Electronic motor powers knee and ankle
        can synchronize to knee
        
        Advantage:
        replaces lost muscle function
        
        Disadvantage:
        Max cost
        Bulky
        Max weight
  - - - Day 1 OM:
        10Mwt
        can do: 2mwt
        FGA
      - 4 Commonly seen deviations:
        
        Compensated Trendelenburg
        
        Poor wt shift into prosthesis
        
        Asymetrical step length
        
        poor initiation of gait w pelvis
      - Things to talk about before:
        
        Wear schedule compliance;
        
        SKIN CHECKS:
        ensure frequent skin checks based on wear schedule.
        ensure skin check every 15-30min in new activity
        IF red area on skin persists for >15min then take off, put on shrinker, call care team
        
        Vascular poor stats:
        50% of amp due to vascular disease die within 5y
        55% of DM LE amp require 2nd LE amp within 2-3y
        
        Pregait training
        
        posture alignment
        Alignment Should be the first step!
        will need to be cued on how to get to midline, can usse mirror
        send them home and say put 60% of your wt on prosthetic. requires MANY reps
        
        Engage TA:3rd
        view in sagital plane
        creates more lordosis
        
        Proprioception input:
        use small ball under both sound limb and amp limb one at a time. ensure to ask about the feelin in both so they can relate.
        MANY reps
        
        Unilateral stance control:
        Start on unaffceted side to etablish affected side goal
        manually guide COM more lateral and anterior
        should be able to so 20x with no compensation before getting off parallel bars
        
        Static and dynamic balance(start in parallel bars):
        static- reach, twists, bending
        Dynamic: lateral, reactive, altered BOS, altered surface
        
        Weight shift control (2nd):
        goes in many directions start with lateral and A/P in bars
        Proprioception of that limb now comes from socket limb interface
        
        Gait training:
        goals: proper alignment, most efficient pattern, progress to least restrictive AD
        
        Step lengths
        
        Chop steps- quick steps for community ambulation
        load to bend the knee and then get one foot down
        
        Long steps:
        faster longer steps for crossing streets
        
        Linear training:
        
        lateral training
        
        high knees
        
        mule kick for stumble recovery
        
        Train hurdles:
        assist with proprio and balance
        stepping over hurdle with sound limb to increase socket stability
        
        Sport cord and multidirectional stability.
        sport cords can be used to support weight shift and provide aha moment
        should train in all directions
        
        Stairs:
        step to step then step over step
        TFA - no step over step in ascent
        
        Ramps:
        
        Ascent: forward lean
        weight through toes, shorter step
        
        Descent:
        weight shift posterior and firmly through heel
        
        Uneven terrain-
        compensations- increased visuals, decrease gait speed, shorter step length, increased timing variability
        
        Interventions to increase ability:
        fall prevention
        practice with therapy
        WALK HARD
        
        Gait Deviations:
        
        decreased CL step length
        
        drop off
        
        varus thrust
        
        quad avoidance
        
        abducted gait
        
        lateral shift
        
        lateral and medial whip
        
        vaulting
        
        Hip hiking
        
        Circumduction
        
        Decreased CL step length:- CE- Hip extension
        
        Treat with:
        ROM and strengthening of hip and knee
        SLS stability
        Step overs
        
        Amputee causes:
        hip or knee contracture
        poor strength, stability or confidence on that side
        
        Prosthetic causes:
        pain in prosthesis
        too long
        insufficient socket flexion
        ill fitting socket
        
        Drop off- CE
        controlled knee flexion
        ankle rocker
        Hip extension
        
        Amputee causes:
        
        weak quads
        
        weak hip ext
        
        knee of hip flexion contracture
        
        excessive heel height of shoe
        
        Fixes for drop off:
        quad strengthening
        hip extensor strengthening
        ROM work
        
        Prosthetic Causes of drop off:
        Too much flexion
        Foot too posterior
        Excessive DF
        Heel is too stif
        
        Varus thrust:
        during stance phase there is a lateral shift at the knee
        CE - controlled knee flexion
        pelvic stability
        SEEN IN INITIAL STAGES OF training for TTA
        
        Amputee Causes of varus:
        lack of wt acceptance
        lack of limb stability
        weak hip and LE
        laxity
        
        Amp Fixes for Varust thrust:
        weight acceptance stability
        hip and LE strength
        balance training
        
        Prosthetic causes of Varus thrust
        foot too inset
        too much socket ABDuction
        Lack of M/L control
        
        Quad avoidance:
        knee remains extended
        CE- controlled knee flex
        
        Amp causes of quad avoidance:
        weak quads
        discomfort on stance knee
        
        Amp fixes- quad avoidance:
        quad strengthening
        gait training - mirrors, proprio
        
        Prosthetic causes of Quad avoidance
        Foot too Anterior
        foot to PF
        heel cushion too soft
        insufficient flexion in socket
        
        Abducted gait:
        widened BOS through gait cycle
        usually in TTA and TFA
        CE- hip stability, trailing limb posture
        
        AMP causes of abducted gait:
        lack of confidence
        decreased balance
        weak abductors
        Abduction contracture
        Habit
        
        Amp fixes in abducted gait:
        increase Hip abductor
        Gait weight acceptance training
        provide additional support for ambulation
        
        Prosthetic causes of abducted gait:
        High medial wall
        too long
        ill fitting socket
        Foot too outset
        
        Lateral Proximal shift:
        proximal aspect of the socket shifts laterally and there is lateral gapping of the socket
        CE- pelvic stability
        
        AMP causes of lat prox shift-
        weakness in lateral glutes
        aDDucting prosthesis too much
        
        AMP fixes
        increase hip ABDuctor strength
        gait training
        provide additional support like AD
        
        Prosthetic causes of lateral prox shift:
        Minimal Ischial containment
        Knee/ foot too inset
        oversocked prosthesis
        
        Lateral and Med whip:
        mostly a prosthetic issue, watch them take it off and on, could be related to too much IR (lat) or ER (med) in the prosthetic but almost always user error
        
        The Vault (excessive sound PF during prosthetic swing), hip hike(pelvic shift to clear foot) and circumduction combo
        
        AMP causes:
        decreased confidence in swing phase
        too many socks
        weak hip flexors
        
        AMP Fixes of the 3 :
        Standing motor control to achieve terminal stance
        gait training using mirrors, part task, hip flexion
        
        Prosthetic cause of the combo:
        Prosthesis too long
        prosthesis too stable so it releases too late or has excessive swing
      - 7 pregait priorities:
        
        healing
        
        mobilization
        
        NMR strength
        
        promote symetrica pattern
        
        strengthen residual limb
        
        prevent overuse of sound
        
        improve enddurance
- - - - Harness suspension:
        system of straps and buckles about the shoulder back and chest
        used at all levels
        
        Advantages:
        simple and easy to maintain
        durable
        easy on off
        
        Disadvantages:
        can be uncomfortable
        poor cosmesis
      - Pin lock liner suspension:
        get that wraps over with attchment that locks in to engage mechanical lock
        IDEAL FOR PASSIVE
        good for mid and short length TH, TR
        
        Advantages:
        Comfortable
        cushion bony prominences
        
        Disadvantages:
        kind of difficult to don
        harnessing usually still needed
      - Suction suspension:
        skin tight fit seal to walls
        one way expulsion valve
        
        Advantages:
        interface with myoelectric control
        reduce or eliminate harnessing
        
        Disadvantage:
        difficult to don
        distal end of dislocation
        VERY sensitive to volume flux
      - Anatomical suspension/ self:
        socket that encompasses bony prominences
        
        Advantage:
        integrates with myoelectric control
        reduce or eliminate harness
        
        Disadvantage:
        difficult to don
        reduced ROM
    - - Body power prosthesis:
        individual generates force necessary to cause movement.
        can work with body cable control
        
        movements for force and excursion in Shoulder disarticulation:
        
        Biscap ABD
        
        Scapular elevation
        
        Chest expansion
        
        Movements for force and excursion in Transhumeral/ elbow disarticulation:
        
        GH flex
        
        biscapular ABD
        
        Scapular depression/ ext/ ABD
        
        Body movement for force and excursion in Transradial/ wrist disarticulation:
        
        GH flex
        
        Bicapular add
      - Passive prosthesis: primarily prosthetic (cosmesis): can still be functional
      - Externally powered prosthesis:
        terminal device wrist unit and elbow powered and motorized in user selected function
    - - cable control:
        harness to capture force and excursion
        analogous to break lever or shifter
        can be intergrated with external power
      - Myoelectric control:
        electrodes in socket wall contact skin and capture electrical activity of contraction and convert it to a signal
      - Hybrid control:
        mix of cable and electric