Lower limb Prostheses

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Walking depends on the repeated performance by the lower limbs of a sequence of motions that simultaneously advances the body along the desired line of progression while also maintaining a stable weight-bearing posture. Effectiveness depends on free joint mobility and muscle action that is selective in both timing and intensity. Normal function is also optimally conservative of physiologic energy. Pathologic conditions alter the mode and efficiency of walking. The loss of some actions necessitates substitution of others if forward progression and stance stability are to be preserved. Through a detailed knowledge of normal function and the types of gait errors that the various pathologic conditions can introduce, the clinician becomes able to define the significant deficits and plan appropriate corrective measures

Health & Medicine

DEPT OF PMR ,KGMU,lUCKNOW

TYPES OF PROSTHESIS BASED ON
DEFINITIVENESS
PARTIAL FOOT AMPUTATION PROSTHESIS
SYMES AMPUTATION PROSTHESIS
TRANSTIBIAL PROSTHESIS COMPONENTS
KNEE DISARTICULATION PROSTHESIS COMPONENTS
TRANSFEMORAL PROSTHESIS COMPONENTS
HIP DISARTICULATION/HEMI PELIVECTOMY PROSTHESIS 2

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DEPT OF PMR ,KGMU,lUCKNOW

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DEPT OF PMR ,KGMU,lUCKNOW

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Prosthetic management of individuals with upper extremity amputations presents all health professionals, including prosthetists and therapists, with a set of unique challenges. For those wearing an upper extremity prosthesis, the terminal device (TD) of the prosthesis is not covered or obscured by clothing in the same way that a lower extremity prosthesis is “hidden” by pants, socks, and shoes. The person with upper extremity amputation must cope with not only physical appearance changes, but the loss of some of the most complex movement patterns and functional activities of the human body. In addition, upper extremity limb loss deprives the patient of an extensive and valuable system of tactile and proprioceptive inputs that previously provided “feedback” to guide and refine functional movement. Even the simplest tasks related to grasp and release become challenging. The ability to position the prosthetic limb segments in space, as well as the ability to maintain advantageous postures needed to manipulate objects, challenge the medical community to continuously improve the functional and aesthetic outcomes of prostheses for patients in this population.

Upper limb prostheses

Upper limb prostheses

Upper limb prostheses

Pelvic floor disorders include a wide-ranging group of potentially disabling, embarrassing, and often painful conditions that can greatly affect a person’s quality of life. The pelvic floor consists of muscles, fascia, and ligaments that support the pelvic organs and help to provide control for bodily functions. Pathology within the musculoskeletal and neurologic structures of the deep pelvis can lead to the development of pelvic pain, dyspareunia, voiding dysfunction including urinary incontinence or urinary urgency, fecal incontinence (FI), constipation, and pelvic organ prolapse (POP) . Both women and men can develop pelvic floor disorders, although women are at increased risk compared with men because of their unique anatomy and biomechanics. The female pelvis is broader and shallower, requiring greater muscular and ligamentous stiffness to provide support and stability. Women are also more likely to incur injury to the pelvic floor as a result of pregnancy and childbirth. As a result, abnormal biomechanics of the pelvic floor muscles (PFMs) may lead to changes in contraction, relaxation, muscle strength, and myofascial pain. In a 2014 study, the prevalence of symptomatic pelvic floor disorders in the United States was estimated to be approximately 25%. It is important to note that this percentage does not consider women with pelvic pain due to high-tone pelvic floor dysfunction. People with pelvic floor disorders benefit from an interdisciplinary rehabilitation approach to improve function and reduce pain. Physiatrists with experience in acute and chronic pain, neurologic and musculoskeletal conditions, and neurogenic bowel/bladder management are well suited to direct such a patient’s care.In addition to diagnosing and managing the patient’s pelvic floor disorder medically, the physiatrist plays a key role in providing a detailed prescription for physical therapy.

PELVIC FLOOR REHABILITATION

PELVIC FLOOR REHABILITATION

PELVIC FLOOR REHABILITATION

It was estimated that about 40.7 % of the global population was surfing the computers in the year 2012 as compared to 2006 of only 26.2%. [1] Marshall et al study reveal that on average, six out of 10 employees used a chair at work and the number was expected to grow.[2] Many researchers report that working 5.41 hours sitting at desk and 7 hour sleeping at night had a great impact on the physical and mental health.[2] Sitting on a chair is one of the most common positions adopted by humans. children and adults spend approx. 55% of their working hours or 7.7 hours/day in sitting postures.[2] The ergonomic fit workstations have become a standard practice in various developed countries

Ergonomic modification for a person with a desk job

Ergonomic modification for a person with a desk job

Ergonomic modification for a person with a desk job

Charcot Restraint Orthotic Walker

Charcot Restraint Orthotic Walker

Charcot Restraint Orthotic Walker

Reciprocating Gait Orthosis

Reciprocating Gait Orthosis

Reciprocating Gait Orthosis

Floor reaction Ankle foot orthosis or Gravity reaction ankle foot orthosis

Floor reaction Ankle foot orthosis or Gravity reaction ankle foot orthosis

Floor reaction Ankle foot orthosis or Gravity reaction ankle foot orthosis

Posterior leaf spring orthosis

Posterior leaf spring orthosis

Posterior leaf spring orthosis

Total contact cast is rigid or semi-rigid molded cast which extends from the patient’s foot to just below the knee, maintaining contact with the entire plantar surface of the foot and lower leg and immobilizing surrounding joints and soft tissue while allowing the patient to remain ambulatory. Considered as gold standard of offloading techniques Started in early 1930s as a treatment modality for post hansens neuropathic ulcer Effective , Rapid and ambulatory

Total contact cast

Total contact cast

Total contact cast

BOTOX dosage in Lower Limb Spasticity.pptx

BOTOX dosage in Lower Limb Spasticity.pptx

BOTOX dosage in Lower Limb Spasticity.pptx

What do you want for your child’s current life and future? The goals should answer this critical question. Without goals, a life care plan will have a lot of details but no direction. Rely on your trusted experts and your family to help you develop the goals to give your child the best life possible. The life care plan for a child with cerebral palsy has several purposes and is essential for several reasons. The main reason to have a care plan is to have something that acts as a roadmap for your child’s best life. Get Matched with a Leading Cerebral Palsy Attorney in Your Area GET HELP NOW It includes everything you need to give them the best life, from a complete diagnosis and evaluation of their condition, limitations, and abilities, to an assessment of how much care will cost over a lifetime. The primary purpose of having goals as part of the life care plan is to fuel the efforts you and your care team are making to give your child a great life and enable them to live their best life. Goals may be short-term and health-related, such as changing the diet to make sure your child has no nutritional deficits. They may also be long-term, like achieving living independence or finding a job. Experts Help You Develop Goals Your child’s care plan will include a diagnosis, evaluation, and the establishment of a care team. The team of specialists, caregivers, and supportive family and friends will help you decide on the goals for your child. Once you have those goals lined up—and these will change and adapt over time—you can start making a plan for achieving them, the actual roadmap for your child’s care. Developing goals will seem overwhelming, especially when the only goal you can think about is a healthy child. Rely on the expertise of your care team. People such as educational experts, neurologists, nutritionists, and therapists can help you understand what is possible for your child and their future and will guide you as you create the goals. Goal Categories As you develop your care plan and start to think about the goals you have for your child, it can help to break them down into categories. Your child’s condition is complex, and organizing it in this way makes a complicated situation a little easier to understand. Managing the primary disability. Cerebral palsy is complicated, but the first goal you should consider is how to manage the prime condition. This is an overreaching kind of objective and one that your neurologist and pediatrician can help you develop. Managing complications. Cerebral palsy often comes along with co-existing conditions like seizure disorders and cognitive impairment. Setting goals for managing these is the next important step. Improving mobility. Mobility is a significant issue for most children with cerebral palsy.[2] Some will be severely impaired and unable to walk. In contrast, others may have more minor disabilities. Goals that address how well your child moves are essential for making them comfortable

Goals in rehabilitaion of cerebral palsy child

Goals in rehabilitaion of cerebral palsy child

Goals in rehabilitaion of cerebral palsy child

Hand dominance is the preferential use of one hand over the other for motor tasks. 90% of people are right-hand dominant, and the majority of injuries (acute and cumulative trauma) occur to the dominant limb, creating a double-impact injury whereby a person is left in a functional state of single-handedness and must rely on the less dexterous, non-dominant hand. When loss of dominant hand function is permanent, a forced shift of dominance is termed injury-induced hand dominance transfer There are innate differences in dexterity influenced by hand dominance. Although most activities are accomplished bimanually, the dominant hand acts as the more dexterous, main executor while the non-dominant hand acts as supporter. In the context of rehabilitation, permanent loss of dexterity in dominant hand is more devastating because dexterity skill previously endowed to dominant hand must be transferred to non-dominant hand Persons with unilateral dexterity loss of the dominant limb have two challenges they are forced to complete two handed tasks with one hand. the remaining limb, which primarily functioned as the supporting limb, must assume dexterity responsibilities of the dominant limb. Hand dominance is therefore a critical factor related to rehabilitation addressing dexterity of persons with upper limb injuries. Persons with unilateral dexterity loss of the dominant limb have two challenges they are forced to complete two handed tasks with one hand. the remaining limb, which primarily functioned as the supporting limb, must assume dexterity responsibilities of the dominant limb. Hand dominance is therefore a critical factor related to rehabilitation addressing dexterity of persons with upper limb injuries. Persons with unilateral dexterity loss of the dominant limb have two challenges they are forced to complete two handed tasks with one hand. the remaining limb, which primarily functioned as the supporting limb, must assume dexterity responsibilities of the dominant limb. Hand dominance is therefore a critical factor related to rehabilitation addressing dexterity of persons with upper limb injuries. Leading cause of upper limb amputations is trauma occurring in males ages 15-25 years, Most of traumatic amputation happen on dominant limb vascular complications of diseases. No limb prefernces cancer/tumors (common cause of more proximal amputations such as a shoulder disarticulation or forequarter amputation)

Rehabilitation of dominant upper limb amputation

Rehabilitation of dominant upper limb amputation

Rehabilitation of dominant upper limb amputation

Amputation is the most ancient of all surgical procedures. Neolithic man is known to have survived amputation as evidenced from the skeletons with amputated stumps and from the knives and saws made of stone used at that time. Even the murals of La Tene and the drawings on the Peruvian pottery depict human figures with amputated stumps. In the olden times, amputations were practiced not only for disease but also as a punishment for criminals and as rituals to appease Gods or even in the practice of Black Magic. It is considered that the first account of amputation as a purposeful medical procedure is found in the Hippocratic Treatise and it was concerned with amputation for vascular gangrene. Indications for amputations vary according to availability of skill, facilities and line of treatment adopted. Many limb cancers are treated by amputations, but in some advanced centers limb preservation surgeries are done. A severely traumatized limb where the circulation is good may be amputated if the facilities for reconstruction are not available. Although the designs and the usability of the prostheses continue to advance, a well performed amputation is necessary for optimum results. when the blood supply of a limb is irreparably destroyed or when the limb is so severely damaged that reasonable reconstruction is impossible, amputation of the limb is indicated. In injuries of limbs, if three or more out of the five components (blood vessels, nerves, skin, muscles and bones) are badly damaged, amputation can be considered . The amputation can be early, intermediate or late depending on the timing after injury as will be discussed later in type of amputation. Thermal burns, frostbite or electrical burns are other injuries that may require amputation. Residual short stump can have excellent function.1 In the past, amputation through specific levels was necessary for proper fitting of prosthesis. The accepted ideal stump lengths are 23–28 cm from greater trochanter in above-knee amputations, 13 cm from the tibial articular surface in below-knee amputations, 10 cm above elbow in amputations through arm, and 17 cm from olecranon in forearm amputations. With modern prosthetic fitting techniques, a prosthesis can be fitted to any well-healed nontender stump. Determining the level of amputation requires an understanding of the trade-offs between increased function with more distal level of amputation and a decreased complication rate with a more proximal level of amputation.

Principles Of Amputation

Principles Of Amputation

Principles Of Amputation

Knee osteoarthritis (OA), also known as degenerative joint disease, is typically the result of wear and tear and progressive loss of articular cartilage. It is most common in the elderly. Knee osteoarthritis can be divided into two types, primary and secondary. Primary osteoarthritis is articular degeneration without any apparent underlying reason. Secondary osteoarthritis is the consequence of either an abnormal concentration of force across the joint as with post-traumatic causes or abnormal articular cartilage, such as rheumatoid arthritis (RA). Osteoarthritis is typically a progressive disease that may eventually lead to disability. The intensity of the clinical symptoms may vary for each individual. However, they typically become more severe, more frequent, and more debilitating over time. The rate of progression also varies for each individual. Common clinical symptoms include knee pain that is gradual in onset and worse with activity, knee stiffness and swelling, pain after prolonged sitting or resting, and pain that worsens over time. Treatment for knee osteoarthritis begins with conservative methods and progresses to surgical treatment options when conservative treatment fails. While medications can help slow the progression of RA and other inflammatory conditions, no proven disease-modifying agents for the treatment of knee osteoarthritis currently exist.

Osteoarthritis – Knee

Osteoarthritis – Knee

Osteoarthritis – Knee

Spasticity is a common motor control disorder frequently encountered in the spectrum of the upper motor neuron (UMN) syndrome. It can result in pain, fatigue, joint restrictions, functional impairments, and skin breakdown that may negatively affect many domains of life by causing social avoidance and diminished life satisfaction . Spasticity was originally defined as a velocity dependent increase in tonic stretch reflexes or muscle tone with exaggerated tendon jerks resulting from increased excitability of the stretch reflex . This definition has been criticized for being too narrow and inadequately depicting the clinical sequelae. In 2005, a European Thematic Network to Develop Standardized Measures of Spasticity (the SPASM consortium) suggested broadening the definition to reflect a more clinical entity . They defined spasticity as “disordered sensory-motor control, resulting from an upper motor neuron lesion, presenting as intermittent or sustained involuntary activation of muscles.

Pathophysiology of Spasticity

Pathophysiology of Spasticity

Pathophysiology of Spasticity

ithin the fi eld of physiology, there are a number of fundamental principles. Some of these key principles are (a) homeostasis, (b) the linkage between gene expression and physiology, and (c) structure–function relationships. It is this latter principle that forms the foundation of the current chapter. The concept of structure–function relationships extends across the organism-to-molecule spectrum. At the organism level, one can think about a number of examples. For instance, the structural relationship between the glenoid fossa and the head of the humerus gives the shoulder six degrees of motion—a motion that is uncommon among other joints. At the molecular level, one can think about the structure of myosin heavy chains (MHCs) and how this translates into certain functional properties like the force–velocity relationship. The discipline of exercise physiology really represents a subdiscipline or an extension of the fi eld of physiology; and, as such, the fundamental principles are essentially the same except that they are examined typically under conditions where physical activity has been altered. In this context, a great deal of interest has been given to understanding the effects of both activity and inactivity on the structural and functional properties of skeletal muscle during the past 30 to 35 years. Of any cell/tissue type, skeletal muscle certainly exhibits some of the clearest structure–function relationships. Given this perspective, one of the key objectives of this chapter is to provide a backdrop for some of the more detailed discussions that follow in successive chapters. The current chapter is organized into three distinct sections. The fi rst section provides an overview of some of the key structural properties of skeletal muscle (macroscopic to molecular anatomy). The second part of the chapter addresses the linkage between structure and function and the topic of skeletal muscle plasticity as infl uenced by altered physical activity. The fi nal section of this chapter examines issues of muscle plasticity from a comparative perspective and introduces the concept of symmorphosis, a concept related to the optimality of design

physiology of muscle contraction and basics of exercise

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nsaids and opiods in pmr

nsaids and opiods in pmr

nsaids and opiods in pmr

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PHYSICAL Modalities of pain ( except heat and cold).PPT

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Upper limb prostheses

Upper limb prostheses

Upper limb prostheses

PELVIC FLOOR REHABILITATION

PELVIC FLOOR REHABILITATION

PELVIC FLOOR REHABILITATION

Ergonomic modification for a person with a desk job

Ergonomic modification for a person with a desk job

Ergonomic modification for a person with a desk job

Charcot Restraint Orthotic Walker

Charcot Restraint Orthotic Walker

Charcot Restraint Orthotic Walker

Reciprocating Gait Orthosis

Reciprocating Gait Orthosis

Reciprocating Gait Orthosis

Floor reaction Ankle foot orthosis or Gravity reaction ankle foot orthosis

Floor reaction Ankle foot orthosis or Gravity reaction ankle foot orthosis

Floor reaction Ankle foot orthosis or Gravity reaction ankle foot orthosis

Posterior leaf spring orthosis

Posterior leaf spring orthosis

Posterior leaf spring orthosis

Total contact cast

Total contact cast

Total contact cast

BOTOX dosage in Lower Limb Spasticity.pptx

BOTOX dosage in Lower Limb Spasticity.pptx

BOTOX dosage in Lower Limb Spasticity.pptx

Goals in rehabilitaion of cerebral palsy child

Goals in rehabilitaion of cerebral palsy child

Goals in rehabilitaion of cerebral palsy child

Rehabilitation of dominant upper limb amputation

Rehabilitation of dominant upper limb amputation

Rehabilitation of dominant upper limb amputation

Principles Of Amputation

Principles Of Amputation

Principles Of Amputation

Osteoarthritis – Knee

Osteoarthritis – Knee

Osteoarthritis – Knee

Pathophysiology of Spasticity

Pathophysiology of Spasticity

Pathophysiology of Spasticity

physiology of muscle contraction and basics of exercise

physiology of muscle contraction and basics of exercise

physiology of muscle contraction and basics of exercise

neuroantomy of bladder

neuroantomy of bladder

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nsaids and opiods in pmr

nsaids and opiods in pmr

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PHYSICAL Modalities of pain ( except heat and cold).PPT

PHYSICAL Modalities of pain ( except heat and cold).PPT

PHYSICAL Modalities of pain ( except heat and cold).PPT

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Step into the captivating realm of cardiovascular physiology as Dr. Faiza, an esteemed Assistant Professor of Physiology, unravels the intricacies of recording an electrocardiogram (ECG). In this illuminating lecture, students are guided through the fundamental principles of ECG interpretation, from lead systems and electrode placement to the analysis of waves, segments, and intervals. Beginning with an exploration of the twelve-lead system, Dr. Faiza elucidates the significance of bipolar limb leads (I, II, III), unipolar limb leads (aVR, aVL, aVF), and unipolar chest leads (V1-V6). Through mnemonic aids and clinical anecdotes, students gain a comprehensive understanding of lead placement techniques, enabling them to navigate the complexities of ECG recording with confidence and precision. As the lecture unfolds, Dr. Faiza delves into the nuances of ECG interpretation, empowering students to correlate ECG findings with electrophysiological events in the cardiac cycle. With a focus on waveform morphology and rhythm analysis, students learn to determine heart rate, rhythm, and axis deviation, deciphering the electrocardiographic manifestations of various cardiac pathologies and physiological states. Moreover, the lecture explores the normal waves, segments, and intervals of an ECG, providing students with a detailed roadmap for interpreting these essential components. From the P wave to the T wave, students gain insight into the voltage, duration, and clinical significance of each waveform, equipping them with the skills to identify aberrations and anomalies in ECG tracings. Enriched with clinical pearls and practical tips, this lecture serves as a cornerstone for students embarking on their journey into cardiovascular medicine. By demystifying the art of ECG interpretation, Dr. Faiza empowers students to harness the power of this diagnostic tool in clinical practice, fostering a deeper appreciation for the intricate interplay between electrical activity and cardiac function.

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Lower limb Prostheses

1. DEPT OF PMR ,KGMU,lUCKNOW

2. TYPES OF PROSTHESIS BASED ON DEFINITIVENESS PARTIAL FOOT AMPUTATION PROSTHESIS SYMES AMPUTATION PROSTHESIS TRANSTIBIAL PROSTHESIS COMPONENTS KNEE DISARTICULATION PROSTHESIS COMPONENTS TRANSFEMORAL PROSTHESIS COMPONENTS HIP DISARTICULATION/HEMI PELIVECTOMY PROSTHESIS 2

10. 10 DEPT OF PMR ,KGMU,lUCKNOW

12. 12 DEPT OF PMR ,KGMU,lUCKNOW

19. 19 DEPT OF PMR ,KGMU,lUCKNOW

33. 33 DEPT OF PMR ,KGMU,lUCKNOW

35. 35 Jaipur Foot SACH Foot

36. 36 2500 RS 200 RS

Editor's Notes

Small toes doesn’t give much biomechanical advantage