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PROSTHETIC COURSE. Bryan Humble CPO/LPO Precision Prosthetics. AMPUTATION LEVELS. TRANS TIBIAL (BELOW KNEE) TRANS FEMORAL (ABOVE KNEE) HIP DISARTICULATION / HEMIPELVECTOMY. TRANS TIBIAL (BELOW KNEE). PHALANGEAL TRANSMETATARSAL LIS FRANC CHOPART SYMES TRANSTIBIAL. SHORT

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prosthetic course

PROSTHETIC COURSE

Bryan Humble CPO/LPO

Precision Prosthetics

amputation levels
AMPUTATION LEVELS
  • TRANS TIBIAL (BELOW KNEE)
  • TRANS FEMORAL(ABOVE KNEE)
  • HIP DISARTICULATION / HEMIPELVECTOMY
trans tibial below knee
TRANS TIBIAL (BELOW KNEE)
  • PHALANGEAL
  • TRANSMETATARSAL
  • LIS FRANC
  • CHOPART
  • SYMES
  • TRANSTIBIAL
  • SHORT
  • MEDIUM
  • LONG
trans femoral above knee
TRANS FEMORAL(ABOVE KNEE)
  • KNEE DISARTICULATION
  • TRANS FEMORAL
  • SHORT
  • MEDIUM
  • LONG
major components
MAJOR COMPONENTS
  • SUSPENSION
  • LINER
  • KNEE JOINTS
  • SOCKET
  • PYLON
  • FOOT
suspension
SUSPENSION
  • SUCTION
  • SILICONE WITH LOCK
  • SLEEVE
  • PTB CUFF
  • JOINT AND CORSET
  • BELT
liners
LINERS
  • SILICONE
  • PELITE
  • C-FLEX
  • HARD SOCKET
knee joints
KNEE JOINTS
  • LOCKING
  • SINGLE AXIS
  • SAFETY
  • 4-BAR
  • HYDRAULIC
  • COMPUTER CONTROLLED
slide16
FEET
  • SACH
  • SINGLE AXIS
  • MULTI-AXIS
  • ENERGY STORING (SEATTLE)
  • DYNAMIC RESPONSE (FLEX FOOT)
insurance reimbursement
INSURANCE REIMBURSEMENT
  • MEDICARE REIMBURSEMENT
  • MEDICAID REIMBURSEMENT
  • PRIVATE INSURANCE
  • FUNDING SOURCES FOR AMPUTEE
  • TEXAS REHAB
  • SSD
  • UASA (BARR FOUNDATION)
  • MEDICARE USUALLY ALLOWS ONE PROSTHESIS PER YEAR IF DOCUMENTED AS MEDICALLY NECCESARY.
sock balancing
SOCK BALANCING
  • SOCK BALANCE IS ONE OF THE MOST IMPORTANT FACTORS IN SUCCESSFUL PROSTHESIS USE.
  • 1, 2, 3 & 5 PLY SOCKS SUPPLIED
  • MAINTAIN “SNUG” FIT AT ALL TIMES.
  • SHORT SOCKS
hygene
HYGENE
  • STUMPS SOCKS CHANGED EVERY DAY
  • SILICONE LINER CLEANED & DISINFECTED EVERY DAY.
shrinker use
SHRINKER USE
  • MUST BE WORN ANYTIME NOT IN PROSTHESIS. (USUALLY IN THE 1ST YEAR OF POST-OP)
  • SHRINKERS MAINTAIN VOLUME CONSISTANCY.
gait deviations causes transtibial
GAIT DEVIATIONS & CAUSES(TRANSTIBIAL)
  • HEEL STRIKE TO MIDSTANCE
  • AT MIDSTANCE
  • MIDSTANCE TO TOE OFF
heel strike to midstance excessive knee flexion
PROSTHETIC

EXCESSIVE D.F. OR S.F.

STIFF HEEL

ANTERIOR SKT.

OTHER

FLEXION CONTRACTURE

HEEL STRIKE TO MIDSTANCEEXCESSIVE KNEE FLEXION

(CAUSES)

heel strike to midstance absent knee flexion
PROSTHETIC

EXCESSIVE P.F.

SOFT HEEL

ANTERO-DISTAL PAIN

OTHER

WEAK QUADS

HABIT

HEEL STRIKE TO MIDSTANCEABSENT KNEE FLEXION

(CAUSES)

at midstance lateral thrust
PROSTHETIC

MEDIAL FOOT

ABDUCTED SKT.

SKT. M-L LOOSE

OTHER

LIGAMENTOUS LAXITY @ KNEE

AT MIDSTANCELATERAL THRUST

(CAUSES)

midstance to toe off
EARLY FLEXION (DROP OFF)

ANT. DISPLACEMENT SKT.

POST. DISPLACEMENT OF KEEL

EX. D.F. OF FOOT

SOFT D.F. BUMPER

DELAYED FLEXION

POST DISPLACEMENT SKT.

ANT DISPLACEMENT OF KEEL

EX. P.F. OF FOOT

HARD D.F. BUMPER

MIDSTANCE TO TOE OFF
gait deviations causes trans femoral
GAIT DEVIATIONS & CAUSES(TRANS FEMORAL)
  • LATERAL TRUNK BENDING
  • ABDUCTED GAIT
  • CIRCUMDUCTION
  • VAULTING
  • SWING PHASE WHIPS
  • FOOT ROTATION @ HEEL STRIKE
  • FOOT SLAP
  • UNEVEN HEEL RISE
  • TERMINAL IMPACT

10 UNEVEN STEP LENGTH

11 EXAGERATED LORDOSES

lateral trunk bending
PROSTHETIC

ABDUCTED SKT.

LATERAL SKT. WALL

PAIN D.L. FEMUR

SHORT TFB

OTHER

WEAK HIP ABDUCTORS

ABDUCTED GAIT

LATERAL TRUNK BENDING

(CAUSES)

abducted gait
PROSTHETIC

PAIN IN PERONEAL AREA

LONG TFP

VALGUS ALIGNMENT

HIP JT. MISALIGNED

OTHER

CONTRACTED HIP ABDUCTORS

PATIENT INSECURITY - COMPENSATES WITH WIDE GAIT

ABDUCTED GAIT

(CAUSES)

circumduction
PROSTHETIC

MECHANICAL

OTHER

INSUFFICIENT KNEE FLEXION (FEAR)

CIRCUMDUCTION

(CAUSES)

  • LOCKED KNEE
  • TIGHT EXT. ASSIST
  • TIGHT KNEE FRICTION
  • POOR SUSPENSION - CAUSES “PISTONING”
  • SKT. SMALL
  • EX. PF
vaulting
PROSTHETIC

LONG TFP (LOCK, SUSP. FRICTION EX. PF.

INSUFFICIENT OR EXCESSIVE KNEE FRICTION

OTHER

INSUFFICIENT KNEE FLEXION (FEAR)

HABIT

VAULTING

(CAUSES)

swing phase whips
PROSTHETIC

KNEE JOINT MISALIGNED

TIGHT OR IMPROPER SKT. CONTURE

OTHER

WEAK OR FLABBY MUCULATURE

SWING PHASE WHIPS

(CAUSES)

foot rotation at heel strike
PROSTHETIC

HARD PF CUSHION OR PF BUMPER

FOOT ROTATION AT HEEL STRIKE

(CAUSES)

foot slap
PROSTHETIC

PF BUMPER TOO SOFT

FOOT SLAP

(CAUSES)

uneven heel rise
PROSTHETIC

INS. KNEE FRICTION

ABSENT OR LOOSE EXT. AID

OTHER

FORCEFUL HIP FLEXION BY PATIENT

UNEVEN HEEL RISE

(CAUSES)

!EXCESSIVE!

uneven heel rise1
PROSTHETIC

EX. KNEE FRICTION

EX. AID TIGHT

MANUAL LOCK

OTHER

FEAR / AMPUTEE WALKS WITH LITTLE OR NO KNEE FLEXION

UNEVEN HEEL RISE

(CAUSES)

!INSUFFICIENT!

terminal impact
PROSTHETIC

INS. KNEE FLEXION

TIGHT EX. AID

EXTENSION BUMPER DEF.

OTHER

AMPUTEE FEAR OF KNEE BUCKLING

TERMINAL IMPACT

(CAUSES)

uneven step length
PROSTHETIC

LACK OF FRICTION OR LOOSE EXT. AID

INSUFFICIENT SKT. FLEXION

OTHER

PAIN / INSECURITY

HIP FLEXION CONTRACTURE

UNEVEN STEP LENGTH

(CAUSES)

exaggerated lordosis
PROSTHETIC

INSUFFICIENT SKT. FLEXION

INSUFFICIENT SUPPORT - ANTERIOR SKT. BRIM

OTHER

HIP FLEXION CONTRACTURE

WEAK HIP EXTENSORS

WEAK ABDOMINALS

EXAGGERATED LORDOSIS

(CAUSES)