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PROSTHETICS AND
ORTHOTICS
INTRODUCTION
PROSTHESIS: IT’S A DEVICE DESIGNED TO
REPLACE A MISSING PART OF THE BODY OR
TO MAKE A PART OF THE BODY WORK
...
• SPECIFICATIONS FOR IDEAL
PROSTHESIS/ORTHOTICS:
1. FUNCTION:
a) MEET USERS NEED
b) SIMPLE
c) EASILY LEARNED
d) DEPENDABLE...
3.COSMESIS:
LOOKS ,SMELLS,SOUNDS NORMAL
EASILY CLEANED
STAIN RESISTANT
4.FABRICATION:
FAST,MODULAR
READILY & WIDELY A...
5.ECONOMICS:
AFFORDABLE
COST EFFECTIVE.
MATERIAL USED:
1)METALS:STEEL,ALUMINIUM,ALLOYS OF
TITANIUM
2)PLASTICS:THERMOPLASTICS &
THERMOSETTING PLASTICS
3)WOOD
...
1)METALS:
 A)STEEL:USED IN – PROSTHETIC &
ORTHOTIC JOINTS,METAL
BANDS,CUFFS,SPRINGS,BEARINGS.

 B)ALUMINIUM: UPPER
EXT...
2)PLASTICS:
CAN BE MADE INTO COMPLEX
ANATOMIC SHAPES
A)THERMOPLASTICS: LOW TEMPERATURE
THERMOPLASTICS:UPPER LIMB ORTHOTIC...
WOOD:MAPLE & HICKORY-PROSTHETIC
FOOT ,BASEWOOD,WILLOW,LINDEN FOR
PROSTHETIC KNEES & SHINS
LEATHER:
VEG.TANNED COWHIDE- ...
FABRIC:WOOL,
COTTON,SILK(NAT),SYNTHETIC-
NYLON,OLEFIN,POLYESTER,RAYON,VINYL
PROSTHESIS:USED FOR-WAIST
BELTS,STRAPS,HARNE...
IMPORTANT CHARACTERISTICS OF P & O
MATERIALS :
1)STRENGHT
2)DURABILITY
3)DENSITY
4)CORROSION RESISTANCE
5)EASE OF FABRICA...
PROSTHETICS
• 1. UPPER LIMB:
THE SHOULDER PROVIDES THE
CENTRE OF RADIUS OF THE FUNCTIONAL
SPHERE OF UPPER LIMB,THE ELBOW A...
• AFTER AMPUTATION PROSTHETIC FITTING
SHOULD BE DONE AS SOON AS POSSIBLE,EVEN
BEFORE COMPLETE WOUND HEALING HAS
OCCURRED.
...
WHEN RESIDUAL FOREARM IS SO SHORT:
SUPRACONDYLAR SUSPENSION (MUNSTER
SOCKET) AND STEP UP HINGES CAN BE USED
TO AUGMENT FU...
WHEN THE LEVER ARM CAPACITY OF THE
PROXIMAL TRANSHUMERAL OR SHOULDER
DISARTICULATION AMPUTATIONS,LTD
FUNCTION IS ACHIEVED...
LOWER LIMB PROSTHETICS:
1.PROSTHETIC KNEES:
USED IN TRANSFEMORAL &
KNEE DISARTICULATION PROSTHESES AND
CHOSEN BASED ON P...
ANTERIOR:FLEXION IS EASY,CONTROL
DIFFICULT
SO, ONLY THE POLYCENTRIC KNEE TAKES
ADVANTAGE- HAS A VARIABLE CENTRE OF
ROTAT...
1.POLYCENTRIC KNEE:
HAS A MOVING INSTANT
CENTRE OF ROTATION,ITS RECOMMENDED
FOR :
a)PATIENTS WITH TRANSFEMORAL
AMPUTATION...
2.STANCE PHASE
CONTROL(SAFE/WT.ACTIVATED):
FUNCTIONS LIKE A
CONSTANT –FRICTION KNEE DURING THE
SWING PHASE ,FREEZES WHEN ...
3.FLUID CONTROL KNEE:
1. ALLOWS ADJUSTEMENT OF
CADENCE RESPONSE BY CHANGING RESISTANCE TO
KNEE FLEXION – PISTON MECHANISM...
4.CONSTANT FRICTION KNEE:
DAMPEN KNEE SWING
VIA SCREW/RUBBER PAD THAT APPLIES
FRICTION TO THE KNEE BOLT.
USED ON UNEVEN ...
5.VARIABLE FRICTION KNEE(CADENCE
CONTROL):
ALLOWS RESISTANCE TO
KNEE FLEXION TO INCREASE – KNEE
EXTENDS BY EMPLOYING A NU...
6.MANUAL LOCKING KNEE:
CONSISTS OF CFK
HINGE WITH A POSITIVE LOCK IN EXTENSION
THAT CAN BE UNLOCKED TO ALLOW
FUNCTION SIM...
PROSTHETIC SHANKS:
 STRUCTURAL LINK B/W TWO PROSTHETIC
COMPONENTS
 2 VARITIES –a) endoskeletal
b)exoskeletal
 SUSPENSION SYSTEMS:
MAINLY VIA SOCKET DESIGN
& SUSPENSION SLEEVES
 SOCKETS ARE DESIGNED :FUNCTON
CONTROL& EVEN- PRESS. ...
B)TRANSFEMORAL SUSPENSION:
 VACCUUM SUSPENSION IS COMMONLY
USED.
STABLE BODY WT. IS NEEDED
C)TRANSFEMORAL SOCKETS:
 QU...
D)TRANSTIBIAL SOCKETS:
PATELLAR TENDON
BEARING LOADS ALL AREAS OF RESIDUAL
LIMB THAT ARE WT.
TOLERANT(PAT.TENDON,MEDIAL T...
PROSTHETIC FEET:
CLASSIFIED INTO FIVE CLASSES:
1)SINGLE AXIS FOOT
2)SACH FOOT
3)SAFE FOOT
4)MULTIP AXIAL FOOT
5)DYNAMIC ...
1)SINGLE AXIS FOOT:
BASED ON ANKLE HINGE-DOSIFLEXION &
PLANTARFLEXION
LTS:POOR DURABILITY & COSMESIS,NO
LATERAL MOVEMEN...
C)NO MOVING COMPONENT
d)MIN MAINTAINENCE
e)GOOD SHOCK ABSORPTION
DISAVANTAGES:
a)LTD PLANTAR FLEXION & DORSIFLEXION
A...
3)SAFE FOOT(STATIONARY ATTACHMENT
FLEXIBLE ENDOSKELETAL):
PERMITS TRIPLANAR MOVT.& EASY ROLL-OVER
LIGHT WEIGHT-OLDER PE...
B)REDUCES TORQUE ON RESIDUAL LIMB
C)ADJUSTABILITY
DISADVANTAGES:
A)INCREASED WT
B)INCREASED MAINTAINENCE
C)DECREASED...
5)FLEXIBLE KEEL DYNAMIC – RESPONSE FEET:
INDICATED FOR PEOPLE – GAIT PATTERNS
GENERATE ENOUGH ENERGY
ELASTIC KEEL STRUC...
 ORTHOSES:
 STATIC/DYNAMIC/COMBINED
 NAMED ACCORDING TO THE JOINTS THEY
CONTROL & METHODS
 THE FOLLOWING ARE USED:
A)S...
 B)FOOT ORTHOSES:
 THEY ARE USED TO:
1)ALIGN & SUPPORT
2)PREVENT,CORRECT/ACCOMODATED
DEFORMITIES
3)IMPROVE FOOT FUNCTION...
C)A.F.O:
MOST COMMONLY USED TO CTRL ANKLE JOINT
GOALS:ABSORPTION OF GROUND REACTION
FORCES,PROTECTION OF FUSION
SITES,P...
E)H.K.A.F.O:
PROVIDES HIP & PELVIC STABILITY
RARELY USED
USED IN CHILDREN WITH UPPER LUMBAR
MYELOMENINGOCELE
F)ELBOW ...
G)W.H.O:
USED FOR POSTOP CARE AFTER
INJURY/RECONSTRUCTIVE SURGERY
STATIC/DYNAMIC
OPPONENS SPLINT-PREPOSITIONING THUMB
...
H)FRACTURE BRACES:
TREATMENT OF ISOLATED # TIBIA & FIBULA
PRE-FABRICATED:ANKLE#,ANKLE
SPRAIN,HAND INJURIES
I)PEDIATRIC...
J)SPINE:
1)CERVICAL SPINE:
NUMEROUS ORTHOSES ARE USED TO
IMMOBILISE SPINE
COLLARS,HALO VEST
2)THORACOLUMBAR:
STABILI...
Prosthesis and orthotics
Prosthesis and orthotics
Prosthesis and orthotics
Prosthesis and orthotics
Prosthesis and orthotics
Prosthesis and orthotics
Prosthesis and orthotics
Prosthesis and orthotics
Prosthesis and orthotics
Prosthesis and orthotics
Prosthesis and orthotics
Prosthesis and orthotics
Prosthesis and orthotics
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Prosthesis and orthotics

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Prosthesis and orthotics

  1. 1. PROSTHETICS AND ORTHOTICS
  2. 2. INTRODUCTION PROSTHESIS: IT’S A DEVICE DESIGNED TO REPLACE A MISSING PART OF THE BODY OR TO MAKE A PART OF THE BODY WORK BETTER. ORTHOSES: IT’S A DEVICE THAT SUPPORTS OR CORRECTS THE FUNCTION OF A LIMB OR THE TORSO
  3. 3. • SPECIFICATIONS FOR IDEAL PROSTHESIS/ORTHOTICS: 1. FUNCTION: a) MEET USERS NEED b) SIMPLE c) EASILY LEARNED d) DEPENDABLE 2.COMFORT: a) FITS WELL b) EASY TO PUT ON AND TAKE OFF c) LIGHT WEIGHT d) ADJUSTABLE.
  4. 4. 3.COSMESIS: LOOKS ,SMELLS,SOUNDS NORMAL EASILY CLEANED STAIN RESISTANT 4.FABRICATION: FAST,MODULAR READILY & WIDELY AVAILABLE
  5. 5. 5.ECONOMICS: AFFORDABLE COST EFFECTIVE.
  6. 6. MATERIAL USED: 1)METALS:STEEL,ALUMINIUM,ALLOYS OF TITANIUM 2)PLASTICS:THERMOPLASTICS & THERMOSETTING PLASTICS 3)WOOD 4)LEATHER 5)RUBBER 6)FABRIC
  7. 7. 1)METALS:  A)STEEL:USED IN – PROSTHETIC & ORTHOTIC JOINTS,METAL BANDS,CUFFS,SPRINGS,BEARINGS.   B)ALUMINIUM: UPPER EXTERIMITIES,PEDIATRIC,WHERE WT IS A MAJOR CONCERN  C)TITANIUM:HIGH COST
  8. 8. 2)PLASTICS: CAN BE MADE INTO COMPLEX ANATOMIC SHAPES A)THERMOPLASTICS: LOW TEMPERATURE THERMOPLASTICS:UPPER LIMB ORTHOTICS & TEMPORARY USE(# BRACE).HIGH TEMPERATURE PLASTICS B)THERMOSETTING:
  9. 9. WOOD:MAPLE & HICKORY-PROSTHETIC FOOT ,BASEWOOD,WILLOW,LINDEN FOR PROSTHETIC KNEES & SHINS LEATHER: VEG.TANNED COWHIDE- SUSPENSION STAPS,WAIST BELTS,SOCKET LINERS ,COVERINGS FOR ORTHOSES & PROSTHESES
  10. 10. FABRIC:WOOL, COTTON,SILK(NAT),SYNTHETIC- NYLON,OLEFIN,POLYESTER,RAYON,VINYL PROSTHESIS:USED FOR-WAIST BELTS,STRAPS,HARNESS,SOCKS WHICH KEEP SKIN DRY,CUSHIONING ORTOSES:CORSETS;BELTS,STOCKINGS RUBBER: SEALS IN HYDRAULIC & PNEUMATIC MECHANISMS –HEELS,BUMPERS IN PROSTHETIC FEET & SPECIAL FOOTWEAR
  11. 11. IMPORTANT CHARACTERISTICS OF P & O MATERIALS : 1)STRENGHT 2)DURABILITY 3)DENSITY 4)CORROSION RESISTANCE 5)EASE OF FABRICATION 6)COST & AVAILABILITY
  12. 12. PROSTHETICS • 1. UPPER LIMB: THE SHOULDER PROVIDES THE CENTRE OF RADIUS OF THE FUNCTIONAL SPHERE OF UPPER LIMB,THE ELBOW ACTS A CALIPER TO POSITION THE HAND. • MULTIPLE JOINT-SEGMENT ACTIVITIES ARE USUALLY DONE SIMULTANEOSLY,WHERE AS UPPER LIMB PROSTHESES PERFORM THESE TASKS SEQUENTIALLY,THUS LIMB SALVAGING IS MORE CRITICAL FOR UPPERLIMB.
  13. 13. • AFTER AMPUTATION PROSTHETIC FITTING SHOULD BE DONE AS SOON AS POSSIBLE,EVEN BEFORE COMPLETE WOUND HEALING HAS OCCURRED. • MYOELECTRIC PROSTHESES PROVIDE GOOD COSMESIS & ARE USED FOR SEDENTARY WORK. • BODYPOWERED PROSTHESIS ARE USED FOR HEAVY LABOUR.
  14. 14. WHEN RESIDUAL FOREARM IS SO SHORT: SUPRACONDYLAR SUSPENSION (MUNSTER SOCKET) AND STEP UP HINGES CAN BE USED TO AUGMENT FUNCTION. THE BEST FUNCTION WITH LEAST WEIGHT AT LOWEST COST IS PROVIDED BY HYBRID PROSTHETIC SYSTEMS –MYOELECTRIC+BODY POWERED+BODY DRIVEN.
  15. 15. WHEN THE LEVER ARM CAPACITY OF THE PROXIMAL TRANSHUMERAL OR SHOULDER DISARTICULATION AMPUTATIONS,LTD FUNCTION IS ACHIEVED – MANUAL UNIVERSAL SHOULDER JOINT POSITIONED BY THE OPPOSITE HAND,COMBINED WITH LIGHT WEIGHT HYBRID PROSTHETIC COMPONENTS.
  16. 16. LOWER LIMB PROSTHETICS: 1.PROSTHETIC KNEES: USED IN TRANSFEMORAL & KNEE DISARTICULATION PROSTHESES AND CHOSEN BASED ON PATIENT NEEDS,THEY PROVIDE CONTROLLED KNEE MOTION. ALIGNMENT STABILITY(POSITION OF PR. KNEE IN RELATION TO PATIENTS LINE OF WEIGHT BEARING:  POSTERIOR:STANCE CONTROL ;MAKES FLEXION DIFFICULT.
  17. 17. ANTERIOR:FLEXION IS EASY,CONTROL DIFFICULT SO, ONLY THE POLYCENTRIC KNEE TAKES ADVANTAGE- HAS A VARIABLE CENTRE OF ROTATION. SIX TYPES:B 1.POLYCENTRIC(4- BAR LINKAGE) 2.STANCE PHASE CONTROL 3.FLUID CONTROL 4.CONSTANT FRICTION 5.MANUAL LOCKING KNEE
  18. 18. 1.POLYCENTRIC KNEE: HAS A MOVING INSTANT CENTRE OF ROTATION,ITS RECOMMENDED FOR : a)PATIENTS WITH TRANSFEMORAL AMPUTATIONS b)PATIENTS WITH KNEE DISARTICULATIONS c)B/L AMPUTEES
  19. 19. 2.STANCE PHASE CONTROL(SAFE/WT.ACTIVATED): FUNCTIONS LIKE A CONSTANT –FRICTION KNEE DURING THE SWING PHASE ,FREEZES WHEN WT. IS APPLIED TO THE LIMB.ITS USED IN OLD PATIENTS,HIGH LEVEL AMPUTEES / USE ON UNEVEN TERRAIN
  20. 20. 3.FLUID CONTROL KNEE: 1. ALLOWS ADJUSTEMENT OF CADENCE RESPONSE BY CHANGING RESISTANCE TO KNEE FLEXION – PISTON MECHANISM.IT PREVENTS EXCESSIVE FLEXION & IS EXTENDED EARLIER IN THE GAIT CYCLE – FLUID GATE  USED-ACTIVE PATIENTS ;GREATER UTILITY & VARIABILITY @ EXPENSE OF MORE WEIGHT.
  21. 21. 4.CONSTANT FRICTION KNEE: DAMPEN KNEE SWING VIA SCREW/RUBBER PAD THAT APPLIES FRICTION TO THE KNEE BOLT. USED ON UNEVEN TERRAIN MOST COMMON KNEE USED IN CHILDHOOD PROSTHETICS DISADVANTAGE: ALLOWS ONLY SINGLE –SPEED WALKING & RELIES ON ALIGNMENT FOR STANCE PHASE
  22. 22. 5.VARIABLE FRICTION KNEE(CADENCE CONTROL): ALLOWS RESISTANCE TO KNEE FLEXION TO INCREASE – KNEE EXTENDS BY EMPLOYING A NUMBER OF STAGGERED FRICTION PADS.  ALLOWS WALKING @ DIFFERENT SPEEDS  NOT DURABLE,NOT AVAILABLE IN ENDOSKELETON
  23. 23. 6.MANUAL LOCKING KNEE: CONSISTS OF CFK HINGE WITH A POSITIVE LOCK IN EXTENSION THAT CAN BE UNLOCKED TO ALLOW FUNCTION SIMILAR TO CFK  LTD INDICATIONS:WEAK UNSTABLE PATIENTS,BEGINNERS,BLIND AMPUTEES
  24. 24. PROSTHETIC SHANKS:  STRUCTURAL LINK B/W TWO PROSTHETIC COMPONENTS  2 VARITIES –a) endoskeletal b)exoskeletal
  25. 25.  SUSPENSION SYSTEMS: MAINLY VIA SOCKET DESIGN & SUSPENSION SLEEVES  SOCKETS ARE DESIGNED :FUNCTON CONTROL& EVEN- PRESS. DISTRIBUTION ON AMP. STUMP A)TRANSTIBIAL SUSPENSION:  GEL- LINER SUSPENSION SYSTEMS WITH LOCKING PIN IS PREFERED.ALLOWS UNRESTICTED KNEE FLEXION  PROSTHETIC SLEEVES  SUPRACONDYLAR SUSPENSION(RESID.LIMB<5 CM)  SUPRACONDYLAR-SUPRAPATELLAR SUSPENSION
  26. 26. B)TRANSFEMORAL SUSPENSION:  VACCUUM SUSPENSION IS COMMONLY USED. STABLE BODY WT. IS NEEDED C)TRANSFEMORAL SOCKETS:  QUADILATERAL SOCKETS ARE USED,DIFFICULT TO KEEP FEMUR IN ADDUCTION  ISCHIAL CONTAINMENT SOCKETS – COMFORTABLE  ALLOWS 10°ADDUCTION & 5°FLEXION
  27. 27. D)TRANSTIBIAL SOCKETS: PATELLAR TENDON BEARING LOADS ALL AREAS OF RESIDUAL LIMB THAT ARE WT. TOLERANT(PAT.TENDON,MEDIAL TIB, FLARE,GASTROCNEMIUS,FIB SHAFT)
  28. 28. PROSTHETIC FEET: CLASSIFIED INTO FIVE CLASSES: 1)SINGLE AXIS FOOT 2)SACH FOOT 3)SAFE FOOT 4)MULTIP AXIAL FOOT 5)DYNAMIC RESPONSE FEET
  29. 29. 1)SINGLE AXIS FOOT: BASED ON ANKLE HINGE-DOSIFLEXION & PLANTARFLEXION LTS:POOR DURABILITY & COSMESIS,NO LATERAL MOVEMENT 2)SACHS FOOT(SOLID ANKLE CUSHIONED HEEL): • ADVANTAGES: a)MODERATE WEIGHT b)DURABILITY
  30. 30. C)NO MOVING COMPONENT d)MIN MAINTAINENCE e)GOOD SHOCK ABSORPTION DISAVANTAGES: a)LTD PLANTAR FLEXION & DORSIFLEXION ADJUSTABILITY b) HEEL CUSHION DETERIORATES OVERTIME C) MAY LOOSE ELASTICITY d)POOR SHOCK ABSORPTION FOR HIGH – OUTPUT ACTIVITIES
  31. 31. 3)SAFE FOOT(STATIONARY ATTACHMENT FLEXIBLE ENDOSKELETAL): PERMITS TRIPLANAR MOVT.& EASY ROLL-OVER LIGHT WEIGHT-OLDER PEOPLE 4)MULTIAXIAL FOOT: PROVIDE MORE ANKLE MOTION ENDOSKELETAL & EXOSKELETAL PROSTHESES ADVANTAGES:  A)ALLOWS MOTION IN ALL PLANES
  32. 32. B)REDUCES TORQUE ON RESIDUAL LIMB C)ADJUSTABILITY DISADVANTAGES: A)INCREASED WT B)INCREASED MAINTAINENCE C)DECREASED COSMESIS LESS STABILTY ON SMOOTH SURFACES
  33. 33. 5)FLEXIBLE KEEL DYNAMIC – RESPONSE FEET: INDICATED FOR PEOPLE – GAIT PATTERNS GENERATE ENOUGH ENERGY ELASTIC KEEL STRUCTURES- ABSORB ENERGY DURING MIDSTANCE & TERMINAL STANCE,RELEASE IT DURING PRESWING & INITIAL SWING DURABILITY OF MATERIAL IS NOT TESTED
  34. 34.  ORTHOSES:  STATIC/DYNAMIC/COMBINED  NAMED ACCORDING TO THE JOINTS THEY CONTROL & METHODS  THE FOLLOWING ARE USED: A)SHOES-DIABETIC SHOES:XTRA DEPTH,SACH HEELS:PARALYTIC FOOT,ROCKER SOLE:METATARSALGIA,HALLUX RIGIDUS & FOREFOOT PROBLEMS
  35. 35.  B)FOOT ORTHOSES:  THEY ARE USED TO: 1)ALIGN & SUPPORT 2)PREVENT,CORRECT/ACCOMODATED DEFORMITIES 3)IMPROVE FOOT FUNCTION  3 TYPES:RIGID,SOFT,SEMIRIGID  RIGID:FLEXIBLE DEFORMITIES  SOFT:FIXED DEFORMITIES
  36. 36. C)A.F.O: MOST COMMONLY USED TO CTRL ANKLE JOINT GOALS:ABSORPTION OF GROUND REACTION FORCES,PROTECTION OF FUSION SITES,PROTECTION OF MIDFOOT D)K.A.F.O: EXTENDS :UPPER THIGH – FOOT CONTROL UNSTABLE /PARALYSED KNEE JOINT PROVIDES MEDIOLATERAL STABILITY
  37. 37. E)H.K.A.F.O: PROVIDES HIP & PELVIC STABILITY RARELY USED USED IN CHILDREN WITH UPPER LUMBAR MYELOMENINGOCELE F)ELBOW ORTHOSES: HINGE ELBOW ORTHOSES-LIGAMENT INSTABILITIES DYNAMIC SPRING LOADED ORTHOSES- FLEXION/EXTENSION CONTRACTURE
  38. 38. G)W.H.O: USED FOR POSTOP CARE AFTER INJURY/RECONSTRUCTIVE SURGERY STATIC/DYNAMIC OPPONENS SPLINT-PREPOSITIONING THUMB LOWER CERVICAL QUADRIPLEGICS LT.FACTORS:WT & CUMBERSOMNESS
  39. 39. H)FRACTURE BRACES: TREATMENT OF ISOLATED # TIBIA & FIBULA PRE-FABRICATED:ANKLE#,ANKLE SPRAIN,HAND INJURIES I)PEDIATRIC ORTHOSES:  THE PAVLIK HARNESS – TREATMENT OF DEVELOPMENTAL DISLOCATION OF HIP USED IN PERTHES DISEASE
  40. 40. J)SPINE: 1)CERVICAL SPINE: NUMEROUS ORTHOSES ARE USED TO IMMOBILISE SPINE COLLARS,HALO VEST 2)THORACOLUMBAR: STABILISATION OF MECHANICAL BACKPAIN – INCREASING BODY CAVITY PRESSURE

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