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ASSIGNMENT
PROSTHESIS
Given by-
Badal (K19796)
BPT 4th Year
Clinical Rehabilitation (PTL-
404)
Given to-
Dr. Divya
Assistant Professor
Career Point University
Alniya, Kota
INTRODUCTION
 The prosthesis is an artificial substitute for a
missing part of the body.
 The artificial parts that are most commonly
thought of as prostheses are those that replace lost
arms and legs, but bone, artery, and heart valve
replacements are common, and artificial eyes and
teeth are also correctly termed prostheses.
 They are manufactured by a prosthetist and fit on
a custom-made basis onto the patient
PURPOSE OF PROSTHESIS
 The most important purpose of the prosthesis is, to provide function of
the amputated part of the body.
 So that, the amputee can perform their ADLs.
 Can live social life like others.
 Can participate in occupation or sports activity.
 For the lower limb, where the primary function is ambulation,
prostheses have been very successful in functionally replacing the lost
limb.
CONSIDERATIONS WHEN CHOOSING PROSTHESIS
 Level of amputation
 Cause of amputation
 Shape of stump
 Expected function
 Motivation and cognitive function of the patient
 Vocation and hobby of the patient
 Cosmesis
 Financial resources of the patient
CLASSIFICATION
 Prosthetic Construction Design
1. Exoskeletal
2. Endoskeletal
 Based on the material used
1. Wood
2. Plastic
3. Fiber glass
4. Carbon fibre
 On the base of the limb
1. Upper limb prosthesis
2. Lower limb prosthesis
Exoskeletal Prosthesis
 An exoskeletal prosthesis gains its structural strength from the outer laminated
shell, through which the weight of the body is transmitted.
 This shell was usually made of a resin socket, which is quite durable, over a
filler material of wood or foam, and the whole prosthesis is shaped to provide a
cosmetic appearance of the amputated limb.
 The opposite surviving leg is taken for reference for shape length and skin color
Endoskeletal Prosthesis
 This is more modern in design.
 It gains its structural integrity from the inner endoskeleton—a pylon
made of metal or carbon fiber, which is a light internal modular
component to provide weight bearing.
 The cosmetic appearance is provided by shaped foam covers slipped
over the modular components.
 Advantages of this design include the ease of alignment of the
components and their adjustments, and the ability to interchange
components by removing the foam cover.
 The disadvantage of this design is that the foam cover is not very
durable, and needs to be replaced often
COMPONENTS OF A PROSTHESIS
1. Socket made of plastic or resin
2. Body of the prosthesis
3. Harness/suspension system
4. Control system (not relevant to lower limb
prostheses)
5. Terminal device- For the upper limb the
terminal device is the hand and for the leg, it
is the foot
UPPER LIMB PROSTHESIS
 Prosthesis which are used for upper limb functions, are called Upper
limb prosthesis.
 Components-
 Plastic Laminate Socket
 Harness
 Bowden Cable and Control Mechanism
 Elbow Units
 Wrist Units
 Terminal Devices
PLASTIC LAMINATE SOCKET
 The socket is that part of the prosthesis into which the stump is
inserted.
 Intimate and comfortable fit between the socket and the stump
 Double wall framework made of resin, lightweight plastic, or
composite materials. The inner wall conforms to the stump and an
outer wall provides length and contour to the forearm replacement.
 Some sockets are single-walled and contoured to the stump as well as
provide a forearm replacement.
 The wrist unit is fixed onto the distal end of the forearm piece.
HARNESS
 The harness is attached directly to the socket. Its
function is to:
 Provide stable support of the prosthesis.
 To provide attachment for the control cables.
 To help in controlling the terminal device and/or the
elbow unit through the control cables.
 Straps are formed in a figure of ‘8’ pattern, or figure
of ‘9’ pattern, the latter generally used with the
below elbow Muenster prosthesis.
BOWDEN CABLE AND CONTROL MECHANISM
 The control mechanism may be body or externally
powered to activate the terminal device or elbow.
 These movements of the shoulder and the upper part of
the torso are specific and have to be taught to the
patient when he is fitted with the prosthesis.
 The movements are transmitted by the Bowden’s
cable, which attaches to the elbow unit and terminal
device.
 Control mechanisms are not needed for cosmetic
terminal devices.
ELBOW UNITS
 In the treatment of AE (tran-shumeral
amputation), prosthetic elbows providing
reach to the midline of the body, are
available with either external or internal
joints.
 Mechanical elbows have a locking
mechanism that is manually applied.
WRIST UNITS
 The terminal device is connected to the forearm socket by the wrist
unit.
 This unit allows the interchange of cosmetic and functional terminal
devices and rotation for the terminal device.
 The type of prosthetic wrist most commonly used allows passive
pronation and supination. Spring-assisted rotation is available for the
bilateral amputee.
 Quick disconnect wrists permit rapid interchange of different terminal
devices with the wrist unit. In addition, when it is locked, the quick
disconnect wrist provides a secure control for wrist rotation.
TERMINAL DEVICES
 The functional or mechanical hand can be attached to the wrist and is
operated by cable control.
 It consists of a plastic, spring-controlled device with fingers that are
controlled by the control cable of prosthesis.
 The thumb can be placed manually in either of two positions to grasp
small objects or larger ones.
 Only the thumb index and middle finger participate in the pinch;
known as the 3-jaw chuck pinch.
 Terminal devices are classified as:
 Cosmetic hands
 Body-powered hooks and hands
– Voluntary opening (VO)
– Voluntary closing (VC)
 Externally powered hooks and hands.
Myoelectric
– Digital
– Bionic arm
ABOVE ELBOW PROSTHESIS
 The AE prosthesis has an upper arm unit and a below elbow unit,
connected by an elbow joint.
 The upper arm unit has a double-walled socket with a locking elbow
unit.
 Since the above elbow amputee lacks independent elbow flexion and
extension, these are provided mechanically by an elbow joint which is
activated, locked, and unlocked by the cable control system,
 Bowden dual control cable system, because it controls movement of
both elbow and terminal device (hook or hand).
 Prescription of an AE prosthesis should be
done with care, since a unilateral AE
amputee manages several of his ADL
activities with the residual normal limb, and
training in the use of the prosthesis is an
arduous task.
 Hence, very often a unilateral AE amputee
chooses to use a cosmetic hand, without
function.
BELOW ELBOW PROSTHESIS
 The components are the same except that the
elbow unit and the dual control cable are
absent.
 The cable system is used in this case only to
operate the mechanical terminal device and not
the elbow unit because the anatomical elbow is
present.
 Use of the BE prosthesis is more convenient
since the normal elbow joint is present, and
many quick change terminal devices for
bimanual activities can be used, for example, a
screwdriver, sickle, or knife
MYOELECTRIC PROSTHESIS
 A myoelectric prosthesis uses signals or
potentials from muscles through
electromyography, within a person’s stump.
 The signals are picked up by electrodes on the
surface of the skin which activates a battery-
driven motor that operates a prosthetic
component, like the finger.
 Control of the motor regulates the extent or
speed of the prosthesis, such as elbow flexion or
extension, or opening and closing of the fingers
of the terminal device
 Advantages
• Use of natural muscle stimuli.
• More accurate control with less energy expenditure.
• Eliminates the shoulder harness.
• Decreased body movement to control prosthesis.
The myoelectric prosthesis provides more mobility, pinch force, and
cosmetic appearance than body-powered prostheses.
 Disadvantages
• They are very expensive
• In the event of a breakdown, it needs very skilled technical backup to
repair. Also, they need servicing regularly
• Component operation is noisy and slow.
• The energy source is from a battery, which would have to be recharged
regularly.
• Lack of proprioceptive feedback from the harness in body-powered
systems.
• It is heavy.
• It cannot control fine rhythmic and fast movements.
• The cosmetic/protective gloves get dirty very easily
PROSTHESIS FOR THE LOWER EXTREMITY
 Prosthesis which are used in lower extremity, are called Lower limb
Prosthesis.
 Disability limitation is very good for the lower extremity amputee;
inevitably he or she can be assured of an independent gait, whatever
the level of the amputation, because a lot of technological advances
have been made in the field.
SOCKET CONSTRUCTION
 Sockets are individually constructed for each client from a cast of the client’s
residual limb.
 The prosthetist notes the individual characteristics of the residual limb, takes
measurements of both the residual limb and the other normal limb, and makes a
cast of the residual limb with Plaster of Paris.
 Later the mould is filled with plaster of Paris powder and a positive model is
made from the case.
 Sockets may be end-bearing or proximal weight-bearing.
 Examples of proximal weight-bearing prosthesis are the PTB below knee
prosthesis and the ischial weight bearing above knee prosthesis, while examples
of end-bearing prosthesis are the knee disarticulation and Symes prosthesis.
BODY OF THE PROSTHESIS
 The emphasis is on stability, weight-bearing and light weight of the
limb.
 In exoskeletal prostheses, resin, HDPE, and willow wood are used,
while metal alloy pylons are used in endoskeletal prostheses.
THE FOOT
 The prosthetic foot should ideally:
• Perform plantar flexion and dorsiflexion, inversion,
and eversion.
• Simulate muscle activity.
 The prosthetic foot substitutes for muscle action
primarily through stance phase stability and passive
dorsiflexion in the swing phase.
• Absorb shock.
• Provide a stable base of support during the stance
phase of gait.
SYME’S PROSTHESIS
 Syme’s amputation provides a weight-bearing
surface at the distal end, the heel, along the shaft of
the tibia.
 The standard Syme prosthesis is functional but not
very cosmetic because of its thick distal end and
straps. The medial window also reduces the
mechanical strength of the prosthesis. The design is
exoskeletal, but the weight is born distally.
 Types of Syme’s Prosthesis
 Conventional Syme’s Prosthesis
 PTB Syme’s Prosthesis
BELOW KNEE PROSTHESIS
 PTB Socket:
 The prosthesis is sometimes called PTB prosthesis (after the
special socket of the same name.
 The patellar tendon bearing (PTB) socket is the standard
transtibial socket. It is a laminated plastic socket.
 The body weight has to be taken on the patellar tendon, an
area which can stand pressure. A part of the weight is borne
over the condylar flares and the distal end of the residual
limb.
 Areas of relief from pressure include the head of the fibula,
the distal ends of both the tibia and the fibula, and the shin.
 Liners Most:
 PTB prostheses are constructed with a soft liner made of polyethylene
foam or silicone gel that acts as an interface between the residual limb
and the hard socket. The liner absorbs some of the compressive and
shear forces generated during ambulation, thus cushioning and
protecting the stump; however, it may wear out over time, and will
have to be replaced.
 Supracondylar Cuff:
 The Supracondylar cuff is a leather fastening system that holds the
prosthesis in position attaching itself by buckles to the distal thigh.
 It is attached to the proximal part of the socket in the posteromedial
and posterolateral aspects.
 Advantages
 Relatively cheap
 Easy to don and doff.
 Allows normal knee movement
 Durable and easily replaceable.
• Provides auxiliary suspension
 Disadvantages
 No mediolateral knee stability.
 It may interfere with circulation and pinch
the distal thigh in obese clients.
ABOVE KNEE PROSTHESIS
The Quadrilateral Socket: it is named for its four walls that have a
specific function. Distally, the socket is contoured to provide total
contact for the residual limb.
 The Posterior Wall: Most of the weight is borne along the posterior
wall. The ischial tuberosity and some gluteal muscles rest on top of
the wall, which is thicker medially than laterally. Internally, the wall is
contoured for the hamstring muscles, while externally, it is flat to
prevent rolling of the thigh in sitting. The height of the posterior wall
is determined by the position of the ischial tuberosity.
 The Anterior Wall:
 It rises about 5 centimeters above the height
of the posterior wall.
 It is convex laterally to allow space for the
bulk of the rectus femoris muscle.
 The Lateral Wall:
 The lateral wall is as high as the anterior wall.
Inside, the wall inclines medially to set the
residual limb in about 10° of adduction.
 The lateral wall is contoured to distribute
pressure evenly over that side and bear some
of the weight.
 The Medial Wall:
 It is vertical and prevents medial movement
of the residual limb within the socket,
especially during stance.
 A relief channel is built into the corner of the
medial and anterior walls for the adductor
longus tendon.
 The medial wall and the posterior wall are of
the same height.
 Hitching on the pubic ramus, which causes a
lot of irritation, is avoided by lowering the
medial wall
SUSPENSION MECHANISMS
 Silesian Band: The Silesian band is a soft strap of leather that is attached to
the lateral socket wall, encircles the pelvis, and connects with a strap on the
anterior wall.
The Silesian band-aids suspension and provide some control of rotation.
 Pelvic Belt: The pelvic belt provides some mediolateral stability in patients
whose weight fluctuates widely. It is made of metal and leather and encircles
the pelvis.
 There is a hip joint that connects it to the superolateral aspect of the socket.
It is useful for individuals with weakness in the glutei or with hip
disarticulation or very short AK stumps.
KNEE JOINTS
 The knee joint is aligned in the prosthesis with the
client’s knee in extension.
 The best knee mechanism is one that offers adequate
stability in the stance phase, yet requires the least
amount of alignment.
 In some cases, if the knee mechanism does not fully
extend before heel contact, it buckles causing the
prosthetic knee to flex suddenly when weight is applied.
 Knee mechanisms can be classified into:
• Constant friction • Stance control • Polycentric knee
• Manual locking (rare) • Fluid controlled.
PROSTHESES FOR PARTIAL FOOT AND ANKLE
DISARTICULATION
 A moulded shoe insert can be
constructed to provide a firm support
base for the end stance and to distribute
pressure evenly over the foot.
 Shoe fillers of soft foam, cork or cloth
can be used.
 The major problem of single digit, ray,
or partial foot amputations is the loss of
push-off at terminal stance.
PHYSIOTHERAPY
General Goals
• Independence in self-care activities
• Return to the former job or train for a different job.
• Return to hobbies and recreation.
FIRST THERAPY SESSION
First, the patient is guided on:
• When and how to wear it.
• Donning and removing it
• Stump hygiene
• Care of the prosthesis.
Later he is given prosthetic control
training and muscle strengthening
EXERCISES
 Full AROM is maintained in all remaining joints of the limbs to ensure good
control over the prosthesis.
 Strengthening the muscles by varying the amount of resistance, and improves
function.
 Isometric exercises are also given to maintain muscle bulk and ensure that the
limb does not pop out of the socket.
 The above elbow amputee needs to strengthen external rotators and biceps to
prevent the prostheses from slipping or rotating during shoulder flexion and
abduction.
 The same applies to BE amputees where the muscles of supination and
pronation are effective stabilizers.
 In general the muscles to be strengthened are those of:
 Upper limb
• Chest expansion
• Shoulder depression, flexion, extension and abduction
• Elbow flexion and extension.
 Lower Limb:
• Trunk flexion, extension
• Hip flexion, extension, external and internal rotation
• Knee flexion, extension
FUNCTIONAL TRAINING WITH THE PROSTHESIS
 Controls Training:
Patients with an above elbow prosthesis must learn elbow activation as
well as the use of the terminal device with the help of the dual control
cable system.
 Practice in Control Requires:
Coaching the patient in patterns of reach, grasp, and release for objects
that vary in weight, size texture, and configuration.
 Sequence- from “larger and hard objects to smaller and fragile ones.”,
like holding a plate and later holding a pencil.
FUNCTIONAL ACTIVITIES:
 Given below are some activities, which need training with the prosthesis
in unilateral upper extremity amputation:-
 Dining table- ACTIVITY PROSTHESIS SOUND LIMB
Cut Hold fork Cut with knife
Butter bread Stabilize bread Spread butter
Fill glass from tap Hold glass Turn tap on
Peel orange Stabilize orange Peel
Carry tray Hold side of tray with
Terminal device in mid
position,
Hold opposite side of tray
Open carton Stabilize carton Open
Desk skills:
ACTIVITY PROSTHESIS SOUND LIMB
Write Stabilize ruler/paper Write/turn pages
Put letter in envelope Hold paper envelope Open side of envelope. Insert
letter and seal
Draw line with ruler Stabilize ruler Draw line
Use paper clip Hold paper Apply clip
Use phone Hold receiver Dial number
GAIT TRAINING
 Dynamic alignment is performed by a prosthetist to fine-
tune the alignment to the patient’s gait pattern.
 Train to Weight bearing on the prosthesis.
 Taught balance in standing and walking, walking in parallel
bars
 The patient graduates to use of assistive devices, like
axillary crutches or walkers.
 Once the patient has mastered walking on level ground,
training to climb stairs or ramps and gradients or to
negotiate uneven surfaces should begin.
SPORTS AND RECREATION
 Interest in customizing prostheses for sports and
recreation is much more developed recently.
 Modification of terminal devices is being increasingly
done to enable the patient to go back to the occupation of
his choice, or the one he is skilled at.
 The training program of the child amputee must involve
activities natural to the child’s level of development. The
most successful method of teaching a child prosthetic
function is through play.
 Hence incorporate all activities with the prostheses with
games and activities interesting to an inquisitive child
REFERENCES
Textbook_of_Rehabilitation_S_Sunder_3rd_PTMASUD_pdf_·_version_1
(1).pdf
Physical Rehabilitation ( PDFDrive ).pdf
THANKS

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Prosthesis upper limb and lower limb.pptx

  • 1. ASSIGNMENT PROSTHESIS Given by- Badal (K19796) BPT 4th Year Clinical Rehabilitation (PTL- 404) Given to- Dr. Divya Assistant Professor Career Point University Alniya, Kota
  • 2. INTRODUCTION  The prosthesis is an artificial substitute for a missing part of the body.  The artificial parts that are most commonly thought of as prostheses are those that replace lost arms and legs, but bone, artery, and heart valve replacements are common, and artificial eyes and teeth are also correctly termed prostheses.  They are manufactured by a prosthetist and fit on a custom-made basis onto the patient
  • 3. PURPOSE OF PROSTHESIS  The most important purpose of the prosthesis is, to provide function of the amputated part of the body.  So that, the amputee can perform their ADLs.  Can live social life like others.  Can participate in occupation or sports activity.  For the lower limb, where the primary function is ambulation, prostheses have been very successful in functionally replacing the lost limb.
  • 4. CONSIDERATIONS WHEN CHOOSING PROSTHESIS  Level of amputation  Cause of amputation  Shape of stump  Expected function  Motivation and cognitive function of the patient  Vocation and hobby of the patient  Cosmesis  Financial resources of the patient
  • 5. CLASSIFICATION  Prosthetic Construction Design 1. Exoskeletal 2. Endoskeletal  Based on the material used 1. Wood 2. Plastic 3. Fiber glass 4. Carbon fibre  On the base of the limb 1. Upper limb prosthesis 2. Lower limb prosthesis
  • 6. Exoskeletal Prosthesis  An exoskeletal prosthesis gains its structural strength from the outer laminated shell, through which the weight of the body is transmitted.  This shell was usually made of a resin socket, which is quite durable, over a filler material of wood or foam, and the whole prosthesis is shaped to provide a cosmetic appearance of the amputated limb.  The opposite surviving leg is taken for reference for shape length and skin color
  • 7. Endoskeletal Prosthesis  This is more modern in design.  It gains its structural integrity from the inner endoskeleton—a pylon made of metal or carbon fiber, which is a light internal modular component to provide weight bearing.  The cosmetic appearance is provided by shaped foam covers slipped over the modular components.  Advantages of this design include the ease of alignment of the components and their adjustments, and the ability to interchange components by removing the foam cover.  The disadvantage of this design is that the foam cover is not very durable, and needs to be replaced often
  • 8.
  • 9. COMPONENTS OF A PROSTHESIS 1. Socket made of plastic or resin 2. Body of the prosthesis 3. Harness/suspension system 4. Control system (not relevant to lower limb prostheses) 5. Terminal device- For the upper limb the terminal device is the hand and for the leg, it is the foot
  • 10. UPPER LIMB PROSTHESIS  Prosthesis which are used for upper limb functions, are called Upper limb prosthesis.  Components-  Plastic Laminate Socket  Harness  Bowden Cable and Control Mechanism  Elbow Units  Wrist Units  Terminal Devices
  • 11. PLASTIC LAMINATE SOCKET  The socket is that part of the prosthesis into which the stump is inserted.  Intimate and comfortable fit between the socket and the stump  Double wall framework made of resin, lightweight plastic, or composite materials. The inner wall conforms to the stump and an outer wall provides length and contour to the forearm replacement.  Some sockets are single-walled and contoured to the stump as well as provide a forearm replacement.  The wrist unit is fixed onto the distal end of the forearm piece.
  • 12. HARNESS  The harness is attached directly to the socket. Its function is to:  Provide stable support of the prosthesis.  To provide attachment for the control cables.  To help in controlling the terminal device and/or the elbow unit through the control cables.  Straps are formed in a figure of ‘8’ pattern, or figure of ‘9’ pattern, the latter generally used with the below elbow Muenster prosthesis.
  • 13. BOWDEN CABLE AND CONTROL MECHANISM  The control mechanism may be body or externally powered to activate the terminal device or elbow.  These movements of the shoulder and the upper part of the torso are specific and have to be taught to the patient when he is fitted with the prosthesis.  The movements are transmitted by the Bowden’s cable, which attaches to the elbow unit and terminal device.  Control mechanisms are not needed for cosmetic terminal devices.
  • 14. ELBOW UNITS  In the treatment of AE (tran-shumeral amputation), prosthetic elbows providing reach to the midline of the body, are available with either external or internal joints.  Mechanical elbows have a locking mechanism that is manually applied.
  • 15. WRIST UNITS  The terminal device is connected to the forearm socket by the wrist unit.  This unit allows the interchange of cosmetic and functional terminal devices and rotation for the terminal device.  The type of prosthetic wrist most commonly used allows passive pronation and supination. Spring-assisted rotation is available for the bilateral amputee.  Quick disconnect wrists permit rapid interchange of different terminal devices with the wrist unit. In addition, when it is locked, the quick disconnect wrist provides a secure control for wrist rotation.
  • 16. TERMINAL DEVICES  The functional or mechanical hand can be attached to the wrist and is operated by cable control.  It consists of a plastic, spring-controlled device with fingers that are controlled by the control cable of prosthesis.  The thumb can be placed manually in either of two positions to grasp small objects or larger ones.  Only the thumb index and middle finger participate in the pinch; known as the 3-jaw chuck pinch.
  • 17.  Terminal devices are classified as:  Cosmetic hands  Body-powered hooks and hands – Voluntary opening (VO) – Voluntary closing (VC)  Externally powered hooks and hands. Myoelectric – Digital – Bionic arm
  • 18. ABOVE ELBOW PROSTHESIS  The AE prosthesis has an upper arm unit and a below elbow unit, connected by an elbow joint.  The upper arm unit has a double-walled socket with a locking elbow unit.  Since the above elbow amputee lacks independent elbow flexion and extension, these are provided mechanically by an elbow joint which is activated, locked, and unlocked by the cable control system,  Bowden dual control cable system, because it controls movement of both elbow and terminal device (hook or hand).
  • 19.  Prescription of an AE prosthesis should be done with care, since a unilateral AE amputee manages several of his ADL activities with the residual normal limb, and training in the use of the prosthesis is an arduous task.  Hence, very often a unilateral AE amputee chooses to use a cosmetic hand, without function.
  • 20. BELOW ELBOW PROSTHESIS  The components are the same except that the elbow unit and the dual control cable are absent.  The cable system is used in this case only to operate the mechanical terminal device and not the elbow unit because the anatomical elbow is present.  Use of the BE prosthesis is more convenient since the normal elbow joint is present, and many quick change terminal devices for bimanual activities can be used, for example, a screwdriver, sickle, or knife
  • 21. MYOELECTRIC PROSTHESIS  A myoelectric prosthesis uses signals or potentials from muscles through electromyography, within a person’s stump.  The signals are picked up by electrodes on the surface of the skin which activates a battery- driven motor that operates a prosthetic component, like the finger.  Control of the motor regulates the extent or speed of the prosthesis, such as elbow flexion or extension, or opening and closing of the fingers of the terminal device
  • 22.  Advantages • Use of natural muscle stimuli. • More accurate control with less energy expenditure. • Eliminates the shoulder harness. • Decreased body movement to control prosthesis. The myoelectric prosthesis provides more mobility, pinch force, and cosmetic appearance than body-powered prostheses.
  • 23.  Disadvantages • They are very expensive • In the event of a breakdown, it needs very skilled technical backup to repair. Also, they need servicing regularly • Component operation is noisy and slow. • The energy source is from a battery, which would have to be recharged regularly. • Lack of proprioceptive feedback from the harness in body-powered systems. • It is heavy. • It cannot control fine rhythmic and fast movements. • The cosmetic/protective gloves get dirty very easily
  • 24. PROSTHESIS FOR THE LOWER EXTREMITY  Prosthesis which are used in lower extremity, are called Lower limb Prosthesis.  Disability limitation is very good for the lower extremity amputee; inevitably he or she can be assured of an independent gait, whatever the level of the amputation, because a lot of technological advances have been made in the field.
  • 25. SOCKET CONSTRUCTION  Sockets are individually constructed for each client from a cast of the client’s residual limb.  The prosthetist notes the individual characteristics of the residual limb, takes measurements of both the residual limb and the other normal limb, and makes a cast of the residual limb with Plaster of Paris.  Later the mould is filled with plaster of Paris powder and a positive model is made from the case.  Sockets may be end-bearing or proximal weight-bearing.  Examples of proximal weight-bearing prosthesis are the PTB below knee prosthesis and the ischial weight bearing above knee prosthesis, while examples of end-bearing prosthesis are the knee disarticulation and Symes prosthesis.
  • 26. BODY OF THE PROSTHESIS  The emphasis is on stability, weight-bearing and light weight of the limb.  In exoskeletal prostheses, resin, HDPE, and willow wood are used, while metal alloy pylons are used in endoskeletal prostheses.
  • 27. THE FOOT  The prosthetic foot should ideally: • Perform plantar flexion and dorsiflexion, inversion, and eversion. • Simulate muscle activity.  The prosthetic foot substitutes for muscle action primarily through stance phase stability and passive dorsiflexion in the swing phase. • Absorb shock. • Provide a stable base of support during the stance phase of gait.
  • 28. SYME’S PROSTHESIS  Syme’s amputation provides a weight-bearing surface at the distal end, the heel, along the shaft of the tibia.  The standard Syme prosthesis is functional but not very cosmetic because of its thick distal end and straps. The medial window also reduces the mechanical strength of the prosthesis. The design is exoskeletal, but the weight is born distally.  Types of Syme’s Prosthesis  Conventional Syme’s Prosthesis  PTB Syme’s Prosthesis
  • 29. BELOW KNEE PROSTHESIS  PTB Socket:  The prosthesis is sometimes called PTB prosthesis (after the special socket of the same name.  The patellar tendon bearing (PTB) socket is the standard transtibial socket. It is a laminated plastic socket.  The body weight has to be taken on the patellar tendon, an area which can stand pressure. A part of the weight is borne over the condylar flares and the distal end of the residual limb.  Areas of relief from pressure include the head of the fibula, the distal ends of both the tibia and the fibula, and the shin.
  • 30.  Liners Most:  PTB prostheses are constructed with a soft liner made of polyethylene foam or silicone gel that acts as an interface between the residual limb and the hard socket. The liner absorbs some of the compressive and shear forces generated during ambulation, thus cushioning and protecting the stump; however, it may wear out over time, and will have to be replaced.  Supracondylar Cuff:  The Supracondylar cuff is a leather fastening system that holds the prosthesis in position attaching itself by buckles to the distal thigh.  It is attached to the proximal part of the socket in the posteromedial and posterolateral aspects.
  • 31.  Advantages  Relatively cheap  Easy to don and doff.  Allows normal knee movement  Durable and easily replaceable. • Provides auxiliary suspension  Disadvantages  No mediolateral knee stability.  It may interfere with circulation and pinch the distal thigh in obese clients.
  • 32. ABOVE KNEE PROSTHESIS The Quadrilateral Socket: it is named for its four walls that have a specific function. Distally, the socket is contoured to provide total contact for the residual limb.  The Posterior Wall: Most of the weight is borne along the posterior wall. The ischial tuberosity and some gluteal muscles rest on top of the wall, which is thicker medially than laterally. Internally, the wall is contoured for the hamstring muscles, while externally, it is flat to prevent rolling of the thigh in sitting. The height of the posterior wall is determined by the position of the ischial tuberosity.
  • 33.  The Anterior Wall:  It rises about 5 centimeters above the height of the posterior wall.  It is convex laterally to allow space for the bulk of the rectus femoris muscle.  The Lateral Wall:  The lateral wall is as high as the anterior wall. Inside, the wall inclines medially to set the residual limb in about 10° of adduction.  The lateral wall is contoured to distribute pressure evenly over that side and bear some of the weight.
  • 34.  The Medial Wall:  It is vertical and prevents medial movement of the residual limb within the socket, especially during stance.  A relief channel is built into the corner of the medial and anterior walls for the adductor longus tendon.  The medial wall and the posterior wall are of the same height.  Hitching on the pubic ramus, which causes a lot of irritation, is avoided by lowering the medial wall
  • 35. SUSPENSION MECHANISMS  Silesian Band: The Silesian band is a soft strap of leather that is attached to the lateral socket wall, encircles the pelvis, and connects with a strap on the anterior wall. The Silesian band-aids suspension and provide some control of rotation.  Pelvic Belt: The pelvic belt provides some mediolateral stability in patients whose weight fluctuates widely. It is made of metal and leather and encircles the pelvis.  There is a hip joint that connects it to the superolateral aspect of the socket. It is useful for individuals with weakness in the glutei or with hip disarticulation or very short AK stumps.
  • 36. KNEE JOINTS  The knee joint is aligned in the prosthesis with the client’s knee in extension.  The best knee mechanism is one that offers adequate stability in the stance phase, yet requires the least amount of alignment.  In some cases, if the knee mechanism does not fully extend before heel contact, it buckles causing the prosthetic knee to flex suddenly when weight is applied.  Knee mechanisms can be classified into: • Constant friction • Stance control • Polycentric knee • Manual locking (rare) • Fluid controlled.
  • 37. PROSTHESES FOR PARTIAL FOOT AND ANKLE DISARTICULATION  A moulded shoe insert can be constructed to provide a firm support base for the end stance and to distribute pressure evenly over the foot.  Shoe fillers of soft foam, cork or cloth can be used.  The major problem of single digit, ray, or partial foot amputations is the loss of push-off at terminal stance.
  • 38. PHYSIOTHERAPY General Goals • Independence in self-care activities • Return to the former job or train for a different job. • Return to hobbies and recreation.
  • 39. FIRST THERAPY SESSION First, the patient is guided on: • When and how to wear it. • Donning and removing it • Stump hygiene • Care of the prosthesis. Later he is given prosthetic control training and muscle strengthening
  • 40. EXERCISES  Full AROM is maintained in all remaining joints of the limbs to ensure good control over the prosthesis.  Strengthening the muscles by varying the amount of resistance, and improves function.  Isometric exercises are also given to maintain muscle bulk and ensure that the limb does not pop out of the socket.  The above elbow amputee needs to strengthen external rotators and biceps to prevent the prostheses from slipping or rotating during shoulder flexion and abduction.  The same applies to BE amputees where the muscles of supination and pronation are effective stabilizers.
  • 41.  In general the muscles to be strengthened are those of:  Upper limb • Chest expansion • Shoulder depression, flexion, extension and abduction • Elbow flexion and extension.  Lower Limb: • Trunk flexion, extension • Hip flexion, extension, external and internal rotation • Knee flexion, extension
  • 42. FUNCTIONAL TRAINING WITH THE PROSTHESIS  Controls Training: Patients with an above elbow prosthesis must learn elbow activation as well as the use of the terminal device with the help of the dual control cable system.  Practice in Control Requires: Coaching the patient in patterns of reach, grasp, and release for objects that vary in weight, size texture, and configuration.  Sequence- from “larger and hard objects to smaller and fragile ones.”, like holding a plate and later holding a pencil.
  • 43. FUNCTIONAL ACTIVITIES:  Given below are some activities, which need training with the prosthesis in unilateral upper extremity amputation:-  Dining table- ACTIVITY PROSTHESIS SOUND LIMB Cut Hold fork Cut with knife Butter bread Stabilize bread Spread butter Fill glass from tap Hold glass Turn tap on Peel orange Stabilize orange Peel Carry tray Hold side of tray with Terminal device in mid position, Hold opposite side of tray Open carton Stabilize carton Open
  • 44. Desk skills: ACTIVITY PROSTHESIS SOUND LIMB Write Stabilize ruler/paper Write/turn pages Put letter in envelope Hold paper envelope Open side of envelope. Insert letter and seal Draw line with ruler Stabilize ruler Draw line Use paper clip Hold paper Apply clip Use phone Hold receiver Dial number
  • 45. GAIT TRAINING  Dynamic alignment is performed by a prosthetist to fine- tune the alignment to the patient’s gait pattern.  Train to Weight bearing on the prosthesis.  Taught balance in standing and walking, walking in parallel bars  The patient graduates to use of assistive devices, like axillary crutches or walkers.  Once the patient has mastered walking on level ground, training to climb stairs or ramps and gradients or to negotiate uneven surfaces should begin.
  • 46. SPORTS AND RECREATION  Interest in customizing prostheses for sports and recreation is much more developed recently.  Modification of terminal devices is being increasingly done to enable the patient to go back to the occupation of his choice, or the one he is skilled at.  The training program of the child amputee must involve activities natural to the child’s level of development. The most successful method of teaching a child prosthetic function is through play.  Hence incorporate all activities with the prostheses with games and activities interesting to an inquisitive child
  • 47.