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Suspension System for Transfemoral Prosthesis

The document discusses various suspension systems used for transfemoral prostheses. It defines suspension systems as how the prosthesis is held to the residual limb. Eight different suspension systems are described in detail, including their advantages and disadvantages. The key systems discussed are cuffs/straps/belts, lanyards, self-suspending sockets, external sleeves, pin/lock, suction without liners, suction with liners, and vacuum-assisted suspension. Vacuum-assisted suspension creates a constant negative pressure for better suspension during volume changes but is more expensive due to mechanical components.

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Suspension Systems of Transfemoral Prosthesis BY- ROHAN GUPTA MPO 1ST YEAR, 3RD BATCH, PDUNIPPD 1 Rohan Gupta MPO 1st Year, 3rd Batch
What are Suspension Systems ? The System by which the prosthesis is held to the limb is referred as Suspension. When the prosthesis is suspended perfectly and there is no relative motion between the socket and the limb. Motion occurs because of a faulty or inadequate suspension system. 2 Rohan Gupta MPO 1st Year, 3rd Batch
Importance of Suspension Systems ! • This is a crucial factor in the design of a prosthesis. • The suspension is how the socket kept on the residual limb preventing it to fall off when the leg is lifted up or moved during gait. • Good suspension will improve the energy transfer, enhance the control of the prosthesis, and decrease any discomfort or abrasions. • When suspension is poor the leg will feel heavy and may lead to skin breakdown. 3 Rohan Gupta MPO 1st Year, 3rd Batch
Factor for Prescription of Suspension depends on ? • For suspension prescription the patient will need to be thoroughly assessed not just with regard to the residuum shape and length, but also their overall strength, hand dexterity, eye sight and balance in standing. 4 Rohan Gupta MPO 1st Year, 3rd Batch
1. Cuffs, Straps and Belts • Also called Auxillary suspension. • This is the original way of keeping the socket on and prevent it from falling off during the swing phase. Even though this and “old” way of suspension it is still used today as it is an inexpensive, simple, reliable and durable way of suspension. • This can vary from a simple soft strap/cuff to a very rigid band around the pelvis. 5 Rohan Gupta MPO 1st Year, 3rd Batch
Advantages of Cuffs, Straps and Belts • Belts or straps can be used as a primary suspension method if other methods fail or are not appropriate. • It can also be used as a secondary option for when negative pressure or suction is used. • It is also indicated for an individual with a short residuum, who have changing volume of their residuum, this keeps the socket on even if the socket fit is loser at the end of the day or poor hip abductor strength. 6 Rohan Gupta MPO 1st Year, 3rd Batch
Dis-advantages of Cuffs, Straps and Belts • It is warm. • Pressure around the pelvis area. • Needs good hand dexterity and strength. • Moves when sitting. • Uncomfortable. • Provides minimal suspension. • Can cause bruising or chafing. 7 Rohan Gupta MPO 1st Year, 3rd Batch
8 Rohan Gupta MPO 1st Year, 3rd Batch
2. Lanyard • This is when a cord or strapped is attached to lower end of the liner. • As the individual inserts the residuum with the liner on the cord/strap will go through a small hole in the bottom of the socket. • The cord is then pulled tight, to draw the residuum into the socket. The lanyard is then attached with a mechanism on the outside of the prosthesis to keep it secure. • Used for transfemoral suspension. 9 Rohan Gupta MPO 1st Year, 3rd Batch
Advantages of Lanyard • Easy to don (put on) the prosthesis in a seated position, especially for someone with poor eyesight or balance. • It provides a secure suspension and decreases socket rotation. • Inexpensive. • Simple. • Reliable. 10 Rohan Gupta MPO 1st Year, 3rd Batch
Dis-advantage of Lanyard • Needs some hand dexterity and strength. • A liner is needed for suspension. 11 Rohan Gupta MPO 1st Year, 3rd Batch
12 Rohan Gupta MPO 1st Year, 3rd Batch
3. Self Suspending Socket • This is when the suspension is created by the socket brim (top part) on the residuum. • The brim part is made to extend and narrow over the joint (example over the knee joint) in order to create a grasp or hold over the joint. 13 Rohan Gupta MPO 1st Year, 3rd Batch
14 Rohan Gupta MPO 1st Year, 3rd Batch
4. External Sleeve • A sleeve that fits snugly over the socket and then extends onto the individual’s thigh is used to seal in the air in the socket and in that way create a suspension. • Sleeves are made from different materials including neoprene, silicone or copolymer gel. 15 Rohan Gupta MPO 1st Year, 3rd Batch
Advantages of External Sleeve • Pistoning (movement of the residuum inside the socket) is reduced with an airtight seal. • Sleeves are flexible and usually allows the knee to bend (if the sleeve has a ribbed or wave design over the knee joint) and it is cosmetic as it covers the top edge of the socket. • It is a reliable form of suspension and relatively inexpensive. 16 Rohan Gupta MPO 1st Year, 3rd Batch
Dis-advantages of External Sleeve • Sleeves without a ribbed or wave design can cause abrasion over the patella. • If applied incorrectly the person can get a skin irritation where the sleeve touches the skin. • Needs hand dexterity and strength. • The sleeve’s effectiveness is reduced with wear and tear, a hole in the sleeve can lead to a loss of suction. 17 Rohan Gupta MPO 1st Year, 3rd Batch
18 Rohan Gupta MPO 1st Year, 3rd Batch
5. Pin and Lock • A silicon or gel liner with a pin at the bottom of the liner is used on the residual limb. • When the limb is placed into the socket the pin has to go into a locking mechanism at the bottom of the socket. • This mechanism will lock the pin in place, creating a secure suspension in the socket. • A release mechanism can be pressed to unlock the pin. 19 Rohan Gupta MPO 1st Year, 3rd Batch
Advantages of Pin and Lock • Provide a positive mechanical lock with auditory feedback for the user when the pin engages. • Relatively easy donning and doffing and can be done in a sitting position. • More forgiving with volume fluctuations. 20 Rohan Gupta MPO 1st Year, 3rd Batch
Dis-advantages of Pin and Lock • Due to the pulling down action of the pin on the liner an elongation effect can happen at the bottom of the residuum and cause skin breakdown, but newer liners are reinforced with a matrix to avoid this from happening. • Wear and tear on liners. • When the pin is misaligned or the liner is donned incorrectly the locking mechanism will not be engaged, this might be difficult for someone not having the ability to bend down or with poor eyesight. 21 Rohan Gupta MPO 1st Year, 3rd Batch
22 Rohan Gupta MPO 1st Year, 3rd Batch
6. Suction without a liner • The socket is made with an expulsion valve that will let the air out to create a seal once the residuum is in and the valve is closed. • The suction is created between the bare skin and the inside of the socket. • To achieve this, the individual will have to pull the residuum into the socket using a piece of material, a special sock, cord or webbing. • By opening or pushing on the suction valve the air will return, breaking the seal and thereby releasing the residuum to remove the prosthesis. 23 Rohan Gupta MPO 1st Year, 3rd Batch
Advantages of Suction without a liner • With an accurate fit the suspension will be very good. • Less expensive than options with liners • 24 Rohan Gupta MPO 1st Year, 3rd Batch
Dis-advantages of Suction without a liner • When the socket is donned poorly the suction will not hold and there will be poor suspension. • It is an old way of suspension. • Donning can be complex for some individuals as it requires hand strength and dexterity as well as balance in standing. • Not secure suspension with volume fluctuations or if there is a failure with the valve. 25 Rohan Gupta MPO 1st Year, 3rd Batch
26 Rohan Gupta MPO 1st Year, 3rd Batch
7. Suction with a liner • A liner that is donned on the residuum is used to create suction instead of the skin suction described above. • These liners are usually made of silicone or gel, to create a seal with the inside of the socket the liner can have silicone rings/ribs or a membrane. • The air can escape through the valve as the socket is donned and will keep the suction once the valve is closed. • Some sockets have a one-way valve. 27 Rohan Gupta MPO 1st Year, 3rd Batch
• By opening or pushing on the suction valve the air will return, breaking the seal and thereby releasing the residuum to remove the prosthesis. • Lubricant or an alcohol solution on the seal will help the liner to slide in and to create a seal. • When using suction with a liner an external sleeve is not necessary, unless there are severe volume fluctuations. • he liner is usually covered with material to help it last longer. 28 Rohan Gupta MPO 1st Year, 3rd Batch
Advantages of Suction with a liner • Even pressure throughout the socket. • Secure fit. • Donning in a seated position is possible. • Used to stabilize excess residual tissue. • Good suspension even with small volume fluctuations. • Liner and socket donning does not have to be as precise to secure suspension but may cause rotation in the socket. 29 Rohan Gupta MPO 1st Year, 3rd Batch
Dis-advantages of Suction with a liner • Relatively expensive. • Wear and tear on liners. • Poor suspension with significant volume fluctuations. • Good hand strength and dexterity needed. • Lubricant is needed for donning. 30 Rohan Gupta MPO 1st Year, 3rd Batch
31 Rohan Gupta MPO 1st Year, 3rd Batch
8. Vacuum-Assisted Suspension • Also known as Negative Pressure, Elevated Vacuum or Dynamic Vacuum. • Suction suspension is created with direct contact between the liner (or with the membranes on the liner) and the socket wall. • With this system a mechanism/pump sucks the air out between the liner and the socket creating a negative pressure that is the same across the entire surface. • To seal off the system an external sleeve or seal is used at the top of the socket. 32 Rohan Gupta MPO 1st Year, 3rd Batch
Advantages of Vacuum-Assisted Suspension • The mechanism creates a constant negative pressure and allows for better suspension when there is volume fluctuation. • Less pistoning and rotation occur within the socket. 33 Rohan Gupta MPO 1st Year, 3rd Batch
Dis-advantages of Vacuum-Assisted Suspension • More expensive. • Mechanical components that can break. • Adds weight to the prosthesis. 34 Rohan Gupta MPO 1st Year, 3rd Batch
35 Rohan Gupta MPO 1st Year, 3rd Batch
9. Elevated Vaccum - Advantages • Very firm suspension providing excellent security and improved proprioception. • Elevated vacuum tends to assist in maintaining more constant limb volume, thereby decreasing the need to add additional socks. • Elevated vacuum assists with wound healing by improving circulation through the residual limb. • Provides good distal comfort for bony and sensitive distal ends; as long as the socket fits properly with good volume and length matching. Rohan Gupta MPO 1st Year, 3rd Batch 36
Rohan Gupta MPO 1st Year, 3rd Batch 37
10. Osseo integration • This procedure can be done on patients with a short above knee amputation. • An implant is placed within the remaining femur bone. • When it is healed and the bone attached to the implant an osseointegrated prosthesis can be directly attached to the implant in the bone. • No need for a socket or liner. 38 Rohan Gupta MPO 1st Year, 3rd Batch
Advantages of Osseo integration • Physiological weight-bearing, better mobility because the socket is not restricting. • Easy donning and doffing. • Osseoperceptive sensory feedback that allows for more precise control over the prosthesis. 39 Rohan Gupta MPO 1st Year, 3rd Batch
Dis-advantages of Osseo integration • Cost of surgery and specific components for the prosthesis. • Risk of infection and other complications such as delayed wound healing or bodily fluid leakage from the implant. • Extensive rehabilitation is needed. • With some implants, no weight bearing is allowed for 6 months. 40 Rohan Gupta MPO 1st Year, 3rd Batch
41 Rohan Gupta MPO 1st Year, 3rd Batch
THANK YOU 42 Rohan Gupta MPO 1st Year, 3rd Batch