2. Definition
• Any artificial substitute for lost part of the
body
prosthesis
External
Upper &lower
limb
Internal
Joints
replacement
3. Ideal lower limb prosthesis
• Provide proper posture ,balance ,stability
• Comfort in ambulation & activities of daily
living including vocation
• Functionally & cosmetically acceptable
4. Parameters considered before proper
prescription
• Level of amputation
• Stump size
• Type of stump –end bearing & side bearing or
total contact
1. End bearing –better stability &balance but
cosmetically poor specially in female e.g. knee &
ankle disarticulation
2. Side bearing –rest all
5.
6. Preprosthetic preparation
• Process of stump maturation takes 6-8 weeks
a) Measuring the circumference of stump at different
level & comparing with the previous one
b) Displacement of water technique
• During this periods
a) Maintain stump hygiene
b) Stump strapping & exercise
c) Sensory training
d) Quadriceps strengthen exercise
7. Fabrication of prosthesis
• Positive mould by wrap casting method & use
of laser alignment system
• Modification of mould
• Fabrication of soft insert
• Development of HDPE/PP total contact socket
by vaccum moulding technique
• Fitting of socket in jaipur foot
8. Components of B/K prosthesis
– Suspension –provide proper attachment to
proximal part of stump(supracondylar
cuff,sleeve,suction)
10. Shank/shin piece
Exoskeleton Endoskeleton
Made up of wood hollow inside along with
plastic resin
Made up of PVC or metal
Provide max strength Foam covering provides natural apperance
Less expensive Rubber covering deteriorates
Unnatural appearance &texture
11. Ankle foot assembly
Non articulated Articulated
no separation between foot &ankle Core &rubber blocks of jaipur foot replaced
with small bone like tarsal etc
SACH FOOT
JAIPUR FOOT
Articulated Single axis Articulated Multiple axis
Wooden foot joined to ankle block by
metal both with transverse axis
Wooden foot piece joined to ankle block
by cable &rubber blocks
PF is controlled by post.rubber bumper
&DF is controlled by anterior firm rubber
PF &DF possible with moderate inversion
&eversion
Weight –multiple>single>non articulated
12.
13. SACH
– Made up of wooden keel (centrally located)
surrounded by rubber
– Proximally attached with wooden piece with bolt
in side e.g .no joints
– Few layers rubber sheet of varying degree of
hardness
– Foot provides slight inversion-eversion & PF-DF by
compression of heel
– Require shoe wear, shape is like shoe
– Provides heel to toe gait
14.
15.
16. Jaipur foot
– Wooden keel was modified with 2 wooden blocks
– Blocks are used in palace of tarsal &metatarsal
bone with sponge rubber in between
– Sponge was used to work as talus & calcaneum
&acted as joint between wooden blocks
– provide movement in all directions
– Small piece of hard rubber were used to prepare
toe
– Does not require foot wear ,shape is like natural
foot
17. First version jaipur foot Second version
Wooden block of forefoot & hard rubber of
toe area was replaced by sponge rubber
Natural foot appearance
Allow squatting &sitting on ground
Flexibility in terms of pronation-supination
Works well on rural uneven roads, muddy
farming
18.
19. Above knee prosthesis
• Suspension ,socket ,knee joint ,shank , AF
assembly
• Suspension- To hold the prosthesis in proper position
during all possible movements
•
suction Silesian belt Pelvic band Shoulder suspender
One way valve
permits air to exit
from socket
Most commonly
used
Used for short A/K
stump
Few selected case
Socket is total
contact
For ideal knee
stump
Give more stability
Snugging fit with
valve
20.
21. Socket-part of prosthesis which
remains in contact with stump
Quadrilateral socket Total contact
Commonly used for AK prosthesis Stump is in complete contact with socket
Weight is borne on ischial tuberosity
&gluteal group of muscle
Weight is borne on ischial tuberosity
Provide better sensory feedback
,confidence in prosthetic use
22. Knee joint assembly
– Provide stability & controlled movement for
ambulation
Constant friction Constant friction with
friction lock
Hydraulic (more
resistive)
Same amount of
friction during swing
phase
Should be given when
stump have poor
musculature &balance
Pneumatic (less
resistive )
23. Friction mechanism of knee
– During knee extension hydraulic unit locks the foot in
DF
– Hydraulic smoothening produce well controlled
bending of knee without excessive amplitude eg. at 20
degree of knee flexion foot is raised
– Foot is raised around 15 degree to avoid irregularities
of ground
– Hydraulic smoothing is set in proportion to walking
pace of amputee eg. gradual deceleration till
complete extension so stump would not injured
during sudden knee extension
24.
25. Upper limb prosthesis
• Consists of
a) Socket
b) Suspension system
c) Arm section &elbow mechanism
d) FA section
e) Wrist unit
f) Hand
g) Terminal device
h) Power transmission system
26. Type of prosthesis
• Body powered prosthesis
a) relies on a system of cable or harness to control the
limbs
b) Operate & control the prosthetic arm using other part
of body like shoulder ,chest or elbow
• Myoelectric prosthesis
27. Socket & arm section
• Socket is the part of prosthesis which remain
in contact with stump
• In case of thin stump a double walled socket
used, this helps in rotation of prosthesis to
some extent
28. Suspension system
– To hold the prosthesis in proper position during all
possible movements
– Figure of 8 –single amputees, posterior aspect of
opposite axillary loop gives origin to operating
cord
– Figure of 8 with metallic ring-b/l amputees
29.
30. Elbow mechanism
• It is a hinge joining the arm & FA with facility
of locking the elbow at various degree of
flexion
Old manual locking New automatic locking system
Lock was to be operated with other
hand
Operated by downward &upward
shoulder movements ,locking
position comes alternatively
Flexion was performed by pulling the
operating cord
31. Wrist unit
Quick gripping system Spring ball type Locking system
Hand or terminal devices
can be fixed
Type of catch to adjust the
position of hand 0r
terminal devices
Hand can be locked in any
position of supination-
pronation
32. Terminal devices
– Most important component of UL prosthesis
– Provides most required function, prehension &
ability of grasp an object
– Most preferred devices now days is voluntary
opening hook
33. Power transmission system
• Leather/nylon cords or bowden’s cable are
being used in transmitting tension force
generated by the movement of shoulder or
other parts of body to operate the terminal
devices
34. Source of energy
– The arm amputees have 3 source of energy that
can be converted into linear power for operation
of prosthesis without aid of other hand
– These are shoulder shrug, shoulder elevation &
stump
Pneumatic Electric prosthesis
Energy is provided by small
size ,high pressure cylinder
placed in wrist unit
Electric energy used to
operate electric motor in wrist
unit
Switching system is operated
by shoulder shrug or stump
movements
35. Myoelectric prosthesis/bionic hand
• Sensor is located in socket at a palace which
correspond with max electrical potential activity at
myoneural junction
• Electric motor in hand or wrist
• Desired movements
