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PROSTHETIC COURSE Bryan Humble CPO/LPO Precision Prosthetics.

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Presentation on theme: "PROSTHETIC COURSE Bryan Humble CPO/LPO Precision Prosthetics."— Presentation transcript:

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2 PROSTHETIC COURSE Bryan Humble CPO/LPO Precision Prosthetics

3 AMPUTATION LEVELS TRANS TIBIAL (BELOW KNEE) TRANS FEMORAL (ABOVE KNEE) HIP DISARTICULATION / HEMIPELVECTOMY

4 TRANS TIBIAL (BELOW KNEE)  PHALANGEAL  TRANSMETATARSAL  LIS FRANC  CHOPART  SYMES  TRANSTIBIAL ·SHORT ·MEDIUM ·LONG

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6 TRANS FEMORAL (ABOVE KNEE) KNEE DISARTICULATION TRANS FEMORAL SHORT MEDIUM LONG

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8 HIP DISARTICULATION / HEMIPELVECTOMY

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10 MAJOR COMPONENTS  SUSPENSION  LINER  KNEE JOINTS  SOCKET  PYLON  FOOT

11 SUSPENSION  SUCTION  SILICONE WITH LOCK  SLEEVE  PTB CUFF  JOINT AND CORSET  BELT

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13 LINERS SILICONE PELITE C-FLEX HARD SOCKET

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15 KNEE JOINTS  LOCKING  SINGLE AXIS  SAFETY  4-BAR  HYDRAULIC  COMPUTER CONTROLLED

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17 FEET  SACH  SINGLE AXIS  MULTI-AXIS  ENERGY STORING (SEATTLE)  DYNAMIC RESPONSE (FLEX FOOT)

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19 COMPONENT SELECTION MUST MATCH PATIENT AND ACTIVITY LEVEL. *(K-LEVEL)

20 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.

21 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

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23 HYGENE  STUMPS SOCKS CHANGED EVERY DAY  SILICONE LINER CLEANED & DISINFECTED EVERY DAY.

24 SHRINKER USE  MUST BE WORN ANYTIME NOT IN PROSTHESIS. (USUALLY IN THE 1ST YEAR OF POST-OP)  SHRINKERS MAINTAIN VOLUME CONSISTANCY.

25 GAIT DEVIATIONS & CAUSES (TRANSTIBIAL) 1 HEEL STRIKE TO MIDSTANCE 2 AT MIDSTANCE 3 MIDSTANCE TO TOE OFF

26 HEEL STRIKE TO MIDSTANCE EXCESSIVE KNEE FLEXION  PROSTHETIC  EXCESSIVE D.F. OR S.F.  STIFF HEEL  ANTERIOR SKT.  OTHER  FLEXION CONTRACTURE (CAUSES)

27 HEEL STRIKE TO MIDSTANCE ABSENT KNEE FLEXION  PROSTHETIC  EXCESSIVE P.F.  SOFT HEEL  ANTERO-DISTAL PAIN  OTHER  WEAK QUADS  HABIT (CAUSES)

28 AT MIDSTANCE LATERAL THRUST  PROSTHETIC  MEDIAL FOOT  ABDUCTED SKT.  SKT. M-L LOOSE  OTHER  LIGAMENTOUS LAXITY @ KNEE (CAUSES)

29 MIDSTANCE TO TOE OFF A EARLY FLEXION (DROP OFF)  ANT. DISPLACEMENT SKT.  POST. DISPLACEMENT OF KEEL  EX. D.F. OF FOOT  SOFT D.F. BUMPER B DELAYED FLEXION  POST DISPLACEMENT SKT.  ANT DISPLACEMENT OF KEEL  EX. P.F. OF FOOT  HARD D.F. BUMPER

30 GAIT DEVIATIONS & CAUSES (TRANS FEMORAL) 1 LATERAL TRUNK BENDING 2 ABDUCTED GAIT 3 CIRCUMDUCTION 4 VAULTING 5 SWING PHASE WHIPS 6 FOOT ROTATION @ HEEL STRIKE 7 FOOT SLAP 8 UNEVEN HEEL RISE 9 TERMINAL IMPACT 10 UNEVEN STEP LENGTH 11 EXAGERATED LORDOSES

31 LATERAL TRUNK BENDING  PROSTHETIC  ABDUCTED SKT.  LATERAL SKT. WALL  PAIN D.L. FEMUR  SHORT TFB  OTHER  WEAK HIP ABDUCTORS  ABDUCTED GAIT (CAUSES)

32 ABDUCTED GAIT  PROSTHETIC  PAIN IN PERONEAL AREA  LONG TFP  VALGUS ALIGNMENT  HIP JT. MISALIGNED  OTHER  CONTRACTED HIP ABDUCTORS  PATIENT INSECURITY - COMPENSATES WITH WIDE GAIT (CAUSES)

33 CIRCUMDUCTION  PROSTHETIC  MECHANICAL  OTHER  INSUFFICIENT KNEE FLEXION (FEAR) (CAUSES) LOCKED KNEE TIGHT EXT. ASSIST TIGHT KNEE FRICTION  POOR SUSPENSION - CAUSES “PISTONING”  SKT. SMALL  EX. PF

34 VAULTING  PROSTHETIC  LONG TFP (LOCK, SUSP. FRICTION EX. PF.  INSUFFICIENT OR EXCESSIVE KNEE FRICTION  OTHER  INSUFFICIENT KNEE FLEXION (FEAR)  HABIT (CAUSES)

35 SWING PHASE WHIPS  PROSTHETIC  KNEE JOINT MISALIGNED  TIGHT OR IMPROPER SKT. CONTURE  OTHER  WEAK OR FLABBY MUCULATURE (CAUSES)

36 FOOT ROTATION AT HEEL STRIKE  PROSTHETIC  HARD PF CUSHION OR PF BUMPER (CAUSES)

37 FOOT SLAP  PROSTHETIC  PF BUMPER TOO SOFT (CAUSES)

38 UNEVEN HEEL RISE  PROSTHETIC  INS. KNEE FRICTION  ABSENT OR LOOSE EXT. AID  OTHER  FORCEFUL HIP FLEXION BY PATIENT (CAUSES) !EXCESSIVE!

39 UNEVEN HEEL RISE  PROSTHETIC  EX. KNEE FRICTION  EX. AID TIGHT  MANUAL LOCK  OTHER  FEAR / AMPUTEE WALKS WITH LITTLE OR NO KNEE FLEXION (CAUSES) !INSUFFICIENT!

40 TERMINAL IMPACT  PROSTHETIC  INS. KNEE FLEXION  TIGHT EX. AID  EXTENSION BUMPER DEF.  OTHER  AMPUTEE FEAR OF KNEE BUCKLING (CAUSES)

41 UNEVEN STEP LENGTH  PROSTHETIC  LACK OF FRICTION OR LOOSE EXT. AID  INSUFFICIENT SKT. FLEXION  OTHER  PAIN / INSECURITY  HIP FLEXION CONTRACTURE (CAUSES)

42 EXAGGERATED LORDOSIS  PROSTHETIC  INSUFFICIENT SKT. FLEXION  INSUFFICIENT SUPPORT - ANTERIOR SKT. BRIM  OTHER  HIP FLEXION CONTRACTURE  WEAK HIP EXTENSORS  WEAK ABDOMINALS (CAUSES)


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