Fergus Jepson @ MRF Childhood Amputee Day - Pushing the Boundaries

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Advancements in prosthetics

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Fergus Jepson @ MRF Childhood Amputee Day - Pushing the Boundaries

  1. 1. Dr Fergus Jepson MB ChB MRCSEd DORT FRCP Consultant in Amputee Rehabilitation Specialist Mobility Rehabilitation Centre Preston
  2. 2. Introduction  Developments in prosthetics?  What can you expect from your centre?  Are children treated differently from adults?
  3. 3. But before…  Let’s discuss how to classify different prosthetics
  4. 4. Sockets and suspension  Interface between the body and prosthesis  Below knee amputation  Anatomical  Cuff  Supracondylar  Suction  Locking liner  Above knee  (TES) Belt  Suction  liner
  5. 5. Socket – weight bearing  Below knee amputation  Patella Tendon Bearing  End bearing  Paratibials  Above knee amputation  Ischial tuberosity  Tuber bearing  Tuber containment  +/- end bearing  Bio-designs socket
  6. 6. Knee units  Free or locked  Simplest is the SAKL – Semi Automatic Knee Lock  Locks straight automatically  Safest and most reliable  HOKL – Hand Operated Knee Lock  Ability of patient to choose when knee is locked  Option of safety in certain situations – weather etc  Free knee  Always free
  7. 7. Knee components  Free knee continued  Unicentric  Polycentric  Micro-processor controlled  Pneumatic  Hydraulic  Power
  8. 8. Ankle/foot  300+ prosthetic ankles on the market  Uniplanar  SACH foot  Multiflex  Adjustable heel  Energy return  carbon fibre foot spring  Blades  Hydraulic foot  Powered ankles  (few on the NHS)
  9. 9. Accessory components  Shock absorbers  Rotation  Dynamic ankle  Beach activity limbs  Sports limbs
  10. 10. Cosmesis  Standard definition  High definition
  11. 11. Upper limb  Cosmetic  Standard definition  High definition  Functional  Mechanical  Body powered  Split hook  Mechanical hand  Myoelectric hand
  12. 12. Weight category : 40+kg = adult
  13. 13. Developments in Prosthetics  Microprocessor controlled knee joints  C-leg, Genium, Orion, Plie
  14. 14. Developments in Prosthetics  Microprocessor controlled hands
  15. 15. Developments in Prosthetics  Powered joints - Knees and ankles
  16. 16. Areas of other development  Non – microprocessor controlled knees  Very Good Knee – fluidic controlled adaptive knee
  17. 17. Areas of other development  Haudraulic ankle joint  Echelon foot first: now Echelon VT, Kinterra, Motion control
  18. 18. Sports prosthesis  Running feet  Dedicated running limbs  Hybrid limbs
  19. 19. Sports prosthesis  Swimming legs  Dedicated swimming legs  Dedicated feet for swimming  Other sports  Rock climbing  Ski feet
  20. 20. What can you expect from your centre?  Each centre will have a limb prescription policy  Many centres will have dedicated paediatric limb prescription policies  Currently (and historically) each centre has a different arrangement with their Specialist commissioner (representing the PCTs for which they served)  Led to different management
  21. 21. What’s coming…  Changes by the current government will mean  National commissioning  National tariff  National standards  Your choice to go to which ever centre you choose  But they should all be the same! As yet we do not know what that standard will be or how the tariff will be applied.
  22. 22. Paediatric Limb prescription policy at the SMRC  2 activity limbs  Primary limb  For every day use  Secondary limb  Can be a replacement for everyday use or a dedicated sports limb e.g. running  Water activity limb  For showers, swimming, beach, pool  Others – exceptional circumstances  e.g. high definition limbs
  23. 23. How does this differ from adult prescription policy?  Adult prescribing is very dependent on activity levels  We felt at the SMRC that children should have the right to run and engage in sports as much as they want to  There are no hybrid limbs for children until they can access adult limb sizes
  24. 24. What is also important for multiple limb loss through meningitis?  Strong communication between  Special seating  Occupational therapy  Physiotherapy  Rehabilitation  Plastics / surgical specialities  Primary care
  25. 25. Summary  Knowledge of what’s out there is very important  Discussing with your rehabilitation consultant and prosthetist how can your mobility be improved because prosthetics have improved  Trial children with adult components as soon as their shoe size and weight category allow
  26. 26. The Sky is the limit! Thanks for listening Fergus.Jepson@lthtr.nhs.uk www.littlelegs.org.uk

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