Check-out procedure (PP Lower Limb Prosthesis) Polypropylene Technology International Committee of the Red Cross

TT & TF EVALUATION GUIDELINE Socket fitting  Does the socket fit well, being neither too small nor too large?  Is the patient's stump free from abrasions and discoloration?  Is the patient's stump well supported by the proper weight bearing areas?  Are the bony and tendon areas relieved from pressure?  Is there a distal contact if possible?  Is there absence of major gapping with the socket?  Can the patient sit comfortably with the knee flexed 90 degrees?

TT & TF EVALUATION GUIDELINE Socket design  Does the shape of the socket correspond to known concepts (PTB, Quad, etc)?  Are medial, lateral, anterior and posterior walls of adequate height and shape?

TT & TF EVALUATION GUIDELINE Static Alignment (Patient Standing with Feet Approximately cm apart)  Is the prosthesis of correct length?  Is the foot flat on the floor medio-laterally?  Is the foot flat on the floor antero-posteriorly  Is the knee stable?

TT & TF EVALUATION GUIDELINE Dynamic Alignment  Is the toe-out set to match the sound side?  Is the knee stable medio-laterally? (TT)  Is the knee stable? (TF)  Is there a smooth transition from heel-strike to toe-off?  Is the suspension preventing the prosthesis from pistonning?  Is the suspension secure with attachment points in correct locations?  Is there absence of severe gait deviations that are in need of correction? Is the toe-out set to match the sound side? Is the knee stable medio-laterally? (TT) Is the knee stable? (TF) Is there a smooth transition from heel-strike to toe- off? Is the suspension preventing the prosthesis from pistonning? Is the suspension secure with attachment points in correct locations? Is there absence of severe gait deviations that are in need of correction? Describe: Is the toe-out set to match the sound side? Is the knee stable medio-laterally? (TT) Is the knee stable? (TF) Is there a smooth transition from heel-strike to toe-off? Is the suspension preventing the prosthesis from pistonning? Is the suspension secure with attachment points in correct locations? Is there absence of severe gait deviations that are in need of correction? Describe: Is the toe-out set to match the sound side? Is the knee stable medio-laterally? (TT) Is the knee stable? (TF) Is there a smooth transition from heel- strike to toe-off? Is the suspension preventing the prosthesis from pistonning? Is the suspension secure with attachment points in correct locations? Is there absence of severe gait deviations that are in need of correction? Describe:  Describe:

TT & TF EVALUATION GUIDELINE Quality of Workmanship  Is the construction of the liner adequate? (TT)  Is the socket draping adequate?  Is the welding strong and durable?  Are the riveting strong and without protrusions inside the socket?  Are the straps well constructed and durable?  Is the cosmetic acceptable? Is the toe-out set to match the sound side? Is the knee stable medio-laterally? (TT) Is the knee stable? (TF) Is there a smooth transition from heel-strike to toe- off? Is the suspension preventing the prosthesis from pistonning? Is the suspension secure with attachment points in correct locations? Is there absence of severe gait deviations that are in need of correction? Describe: Is the toe-out set to match the sound side? Is the knee stable medio-laterally? (TT) Is the knee stable? (TF) Is there a smooth transition from heel-strike to toe-off? Is the suspension preventing the prosthesis from pistonning? Is the suspension secure with attachment points in correct locations? Is there absence of severe gait deviations that are in need of correction? Describe: Is the toe-out set to match the sound side? Is the knee stable medio-laterally? (TT) Is the knee stable? (TF) Is there a smooth transition from heel- strike to toe-off? Is the suspension preventing the prosthesis from pistonning? Is the suspension secure with attachment points in correct locations? Is there absence of severe gait deviations that are in need of correction? Describe:

TT & TF EVALUATION GUIDELINE Quality of Information Given to Patient by CPO  Does the patient know how to reduce and prevent oedema?  Does the patient know how and when to adjust the fit of the socket with socks?  Does the patient know for which problems he should visit the center?  Does the patient know when he should consult a doctor? Is the toe-out set to match the sound side? Is the knee stable medio-laterally? (TT) Is the knee stable? (TF) Is there a smooth transition from heel-strike to toe- off? Is the suspension preventing the prosthesis from pistonning? Is the suspension secure with attachment points in correct locations? Is there absence of severe gait deviations that are in need of correction? Describe: Is the toe-out set to match the sound side? Is the knee stable medio-laterally? (TT) Is the knee stable? (TF) Is there a smooth transition from heel-strike to toe-off? Is the suspension preventing the prosthesis from pistonning? Is the suspension secure with attachment points in correct locations? Is there absence of severe gait deviations that are in need of correction? Describe: Is the toe-out set to match the sound side? Is the knee stable medio-laterally? (TT) Is the knee stable? (TF) Is there a smooth transition from heel- strike to toe-off? Is the suspension preventing the prosthesis from pistonning? Is the suspension secure with attachment points in correct locations? Is there absence of severe gait deviations that are in need of correction? Describe:

TT & TF EVALUATION GUIDELINE Does the Patient Know How to Take Care of His Prosthesis?  Does the patient know that he should wear clean socks everyday and why?  Does the patient know how to clean his prosthesis and why? Is the toe-out set to match the sound side? Is the knee stable medio-laterally? (TT) Is the knee stable? (TF) Is there a smooth transition from heel-strike to toe- off? Is the suspension preventing the prosthesis from pistonning? Is the suspension secure with attachment points in correct locations? Is there absence of severe gait deviations that are in need of correction? Describe: Is the toe-out set to match the sound side? Is the knee stable medio-laterally? (TT) Is the knee stable? (TF) Is there a smooth transition from heel-strike to toe-off? Is the suspension preventing the prosthesis from pistonning? Is the suspension secure with attachment points in correct locations? Is there absence of severe gait deviations that are in need of correction? Describe: Is the toe-out set to match the sound side? Is the knee stable medio-laterally? (TT) Is the knee stable? (TF) Is there a smooth transition from heel- strike to toe-off? Is the suspension preventing the prosthesis from pistonning? Is the suspension secure with attachment points in correct locations? Is there absence of severe gait deviations that are in need of correction? Describe: