lowerlimb prosthesis


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  • Suspension achieved without straps med lat stability provided
  • Suspension achieved without straps med lat stability provided
  • lowerlimb prosthesis

    2. 2. Orthosis Externally applied mechanical devices support weakened injured, paralyzed, diseased part “ supplimentation Prosthesis Device to replace part of the limb or missing limb “substitute” Prosthetist a person skilled in prosthetics and its application. Prosthetics: a rehabilitation science includes theory and practice of design, production of prosthesis and application
    3. 3. Aim of prosthesis fitting • to substitute for a lost part and to restore lost function. • In the lower extremity prosthesis must permit comfortable ambulation minimal expenditure of energy. • Reduction of energy requirement depends on minimizing the shift of the center of gravity of the body during gait by a well-fitted socket and proper alignment. But for upper limb: It is difficult to get the function as it is not possible to replace the “Normal Hand” center of gravity of the body during gait wheel does not deviate from straight line-hence extreme efficient Normal human locomotion >2”deviation of CG both horizontally and vertically hence also efficient
    4. 4. Power source of prosthesis Body powered amputation stump & other limbs . Externally powered electric or battery More distal the amputation more the functional ability ( more natural limb control the prosthesis). used in the upper limb prosthesis more.
    5. 5. Level of amputation and prosthesis Toe disarticulation: toe filling rubber,foam,wool as spacer to prevent hyperextension of boot at toe break. Transmetatarsal amputation: boot with long steel shank, metatarsal pad and stiff insole. Lisfranc's amputation: boot filled with stiff insole Chopart's amputation: 1.syme's model prosthesis 2. high collar shoe with toe filler
    6. 6. Syme's amputation: syme's prosthesis Syme's prosthesis should have end bearing pad for shock absorption. Types 1.full end bearing i.e. Conventional prosthesis: Has leather socket and wooden foot piece Most pts are unable tom bear long time standing and distance walking 2.CANADIAN SYME'S PROSTHESIS: more distal end bearing and less proximal PTB weight bearing Medial window is given to pull bulbous end to the socket. Also provides suspension over malleoli
    7. 7. SYME'S PROSTHESIS 3. closed expandable syme's prosthesis: more PTB bearing and less end bearing Prescribed for modified syme's amputation where the lower end is less bulbous and there is no need for any window Advantages: better cosmesis and better suspension
    8. 8. -Socket -Suspension system -Extension joints (knee assembly) -Shank/pylon -Terminal device (usually includes foot and Ankle )
    9. 9. Suction& Mechl close fitting
    10. 10. 1. End bearing – End of the stump bears the weight 1. Total Contact socket – load is distributed to entire stump – supports all the distal tissues within the closed system – As there is total contact proprioception will be good. – give good sensory feed back. – good control of stump – acts as a circulatory pump – . During stance phase , positive pressure encourages venous return; – during swing phase ,negative pressure encourages distal blood flow. Socket WT bearing – 2 types
    11. 11. Total Contact socket – Used for most older patients – Offers “partial suction” – Suspended by pelvic belt and hip joint that is attached to socket – A selsian bandage suspension preferred over pelvic belt as the latter often interferes with sitting
    12. 12. suspension system -for attaching socket to body. can be done by a)belt ,straps or cuff b)others – by suction prosthesis – by Mechanical close fitting or silicon sock helps to maintain airtight seal Silesian bandage Hip joint,pelvicband waist belt
    13. 13. suspension system-Soft belts • Used as primary or auxiliary suspention • Traditional form is silesian belt – Simple – disadvantage • hygiene if it is non removable • Discomfort due to constrictive effect • Total elastic suspension (TES) – New ,made ofelasticneoprene lined with smooth Nylon – Belt fits around proximal 8” of prosthesis • Hip joint with pelvic band or belt – Provides rotational stability – significant mediolateral pelvic stability – Essential when abductors are week and amputees are obese Silesian bandage Hip joint,pelvicband waist belt
    14. 14. • held on by suction and close anatomical fit • most suitable for above knee. • eliminates the hip joint and pelvis belt or shoulder harness; • permits free rotator motion about the hip • and eliminates piston action of the stump in the socket , permitting greater toe clearance and smoother gait. • No stump sock needed. • closely fitted • create negative pressure during the swing phase • and positive pressure that expels air through a flap valve during the stance phase. • The tight fit is applied at the upper two and half or three inches and along the anterior wall of the socket, the reminder stump hangs free. • A groove in the anteromedial wall accommodates the adductor tendons. Suction socket prosthesis
    15. 15. Suction socket prosthesis • Indicated for amputees for smooth residual limb contours • Volume fluctuants such as weight gain and fluid retention – contraindications Disadvantages • Difficulty in obtaining press fit • Ocassional lossof suction in sitting position • No medium for absorbing perspiration • Requirement of volume and weight stability
    16. 16. 1. Axis system 2. Friction mechanism 3. stabilizers-
    17. 17. • Axis system Single axis …. – Axis of prosthetic knee is same as that of weighty bearing axis – Flexion easier, But stance phase control difficult Posterior off set axis… – Axis of prosthetic knee is posterior – Flexion difficult, stance phase control easier Polycentric…. – variable center of rotation –advantage in both phases
    18. 18. • Friction mechanism Constant friction – Hinge to dampen knee swing – Allows single speed walking – Most used in children – Not used for older or weaker Variable friction-cadence control – Staggerd friction pads – More friction at extreme ranges, – Less friction at mid swing – Allows walkig at more speed ,but not durale Medium friction Oil (hydraulic) friction Air (pneumatic)friction Allows best gait pattern –best for active patients-expensive Medium friction (hydraulic) friction Constant friction
    19. 19. “ Intelligent prosthesis (IP)” Programmed to each individual user during walking to achieve the smoothest, most energy- saving pattern. Reacts to speed changes Intelligence does not extend to understanding environmental considerations Ex. stairs, ramps or uneven terrain. •utilizes electronic sensors •detect rate and range of shank •Provides instant friction adjustments to changes in gait pattern ‘C-LEG’ Friction mechanism
    20. 20. • Stabilizers Manual locking knee left locked in extension, unlocked whole sitting to permit flexion Used in weak ,unstable patients primarily Stabilizers Manual locking
    21. 21. 1. Endoskeleton “Modular prosthesis” 2,Exo skeleton:
    22. 22. Endoskeleton: “centrally located tubular structure • made of prefabricated. Made of carbon fibers • the load bearing structure • The socket used over it • Adjustments can be easily made • These are called “Modular prosthesis” • Exo skeleton: -conventional artificial limbs outer visible “skin” like -Inner hollow structures. -made of aluminum ,plastic -adjustments are difficult -accurate measurement should be there in the beginning it self.
    23. 23. • Providing contact between to the ground the foot provides shock absorption and stability during stance • influences gait biomechanics by its shape and stiffness. This is because the trajectory of the centre of pressure (COP) and the angle of the ground reaction forces is determined by the shape and stiffness of the foot and needs to match the subjects build in order to produce a normal gait pattern. • The main problem found in current feet is durability, endurance ranging from 16–32 months [ • These results are for adults and will probably be worse for children due to higher activity levels and scale effects.
    24. 24. articulated Non articulated
    25. 25. Non articulated Ex:1)sach Foot (solid Ankle cushion Heal) 2)Madras foot -modified sach –Post TA like look -sponge between heel&ground 3)Jaipur foot 4) dynamic -new -spring in kee l-energy stored and released Articulated SINGLE AXIS MULTI AXIS
    26. 26. SACH Foot (solid Ankle cushion Heal) Some movementt in all directions Useful when not used for heavy duty Women/children Not suitable for indian amputies barefoot/squating cannot
    27. 27. Jaipur foot • Mcr&vulcanised rubber • Looks natural • Bare foot walking/squating possible/crossleg/rough use • 3level movmt • Inv/eversion possible – hence can walk on uneven area • Cheap-durable-water resistant
    28. 28. Single axis ankle and wood foot • Heavy duty activities, rapid plantar flexion at heal strike
    29. 29. Commonly used varieties of prosthesis AK prosthesis preferred design quadrilateral socket –pelvic belt – Suction prosthesis BK prosthesis Patellar tendon bearing Mechanical Fit or with bar suspension system
    30. 30. Commonly used varieties of prosthesis AK prosthesis quadrilateral socket –medwall high,latwall flat10 deg adduction med inclination pelvic belt Suction prosthesis BK prosthesis Patellar tendan bearing 60%pt 40% condyles,post wall Med flare oftibiaalso wt bearing Mechanical Fit or with bar suspension system
    31. 31. Slide the CROW into position, ensuring that the heel is fully seated within the CROW The heel needs to be back all the way and in contact with the bottom of the footplate. Check by looking along the sides and the back where it is separated above the heel.
    32. 32. Apply the front section of the device, making sure it's sides overlap the back section
    33. 33. Apply the instep strap on the front of the ankle Fasten all remaining straps
    34. 34. Skin should be checked for redness that does not go away after approximately 15 minutes. Slight redness is common over the instep and under the ball of the foot.