Prosthetic CPM study guide Practice questions for this set Terms in this set (92) AP(at PTB), M/L (at condyles), PML, What measurements for a TT Patient need to be collected for casting? Residual Length MTP- Floor Foot Size Circumferences every 2"

Prosthetic CPM study guide Practice questions for this set Terms in this set (92) AP(at PTB), M/L (at condyles), PML, What measurements for a TT Patient need to be collected for casting? Residual Length MTP- Floor Foot Size Circumferences every 2" What questions should you ask at evaluation for a prosthetics Cause and date of amputation Comorbidities (DM, kidney, hypertension0 Contralateral Limb integrity Skin Integrity Hand Dexterity/strength Vocational/Recreational Activities Goals Assistive Devices Used MMT/ROM (Thomas test) What are the advantages to a PTB style socket? Rotational Control, Relief over bony prominences What are the advantages to a TSB style socket Equal distribution of pressure over entire limb, use of liner to reduce shear forces and skin irritation, decreased pistoning What are the disadvantages to a PTB style socket? Concentrated pressures on select few areas, high pressure on patellar tendon What are the disadvantages to a TSB style socket Requires the use of liners patient must be able to don liner, lack of rotational control What are the advantages to locking liner suspension Auditory confirmation of lock increase confidence, can have patient start to don and engage lock while seated, easy to manage volume with socks What are the disadvantages to a locking liner suspension Pistoning/milking of the limb, can be difficult for patient to align pin and lock must be consistent, lack of a rotational control What are the advantages to a cushion liner/sleeve suspension Reduced pistoning of prosthesis, easy volume management, secure suspension, benefits of liner What are the disadvantages to a cushion liner/sleeve susupension Increased bulk around the knee that can reduce knee flexion, can be hot (extra layer), requires dexterity to use liner What are the advantages to a seal in system for suspension Decreased pistoning, increased proprioception, decreased apparent weight of prosthesis What are the disadvantages to a a seal in system for suspension? More difficult to control volume with socks, must have good balance to don prosthesis, requires exact fit What are the advantages to an elevated vacuum system Promotes limb health, decreases pistoning, increased proprioception, decreased sweating, decreased apparent weight What are the disadvantages to elevated vacuum Can cause damage to limb if fit is not appropriate, requires exact fit, bulky and increased weight, expensive What are the advantages of supracondylar suspension Good for short limbs, ligament laxity, knee instability Improves stability at knee, ease of don and doffing, increased M/L stability What the advantages to a cuff strap suspension? Easily adjusted if volume change, good secondary suspension, low maintenance What are the disadvantages to Supracondylar suspension? Must be able to tolerate pressure, pistoning, rubbing on condyles What are the disadvantages to cuff strap suspension Pistioning, impaired circulation What are the advantages to joint and corset suspension Partially offload residuum and knee, maximum M/L and AP stability What are the disadvantages to a joint and corset? Heavy bulky, allows for pistioning Prosthetic CPM study guide What are the disadvantages to a SACH foot Stiff keel, no energy return, no ground compliance What are the advantages to a Single Axis foot Foot flat that will quickly move GRF anterior to knee for stability and durability What are the disadvantages to a single axis foot? Rigid keel, no energy return, heavy What are the advantages to a multiaxial foot Accommodates uneven terrain, decreases stress on skin and proximal joint What are the disadvantages to a multiaxial foot Expensive, heavier What are the advantages to a flexible keel foot Smooth rollover to mimic natural gait, reduces socket forces on limb What the disadvantages to a flexible keel foot No energy return, limited push off on foot What are the advantages to a dynamic response foot Energy storage, reduces impact on proximal joints, decreases energy consumption while walking What are the disadvantages to a a dynamic response foot Expensive, weighs more, may require a higher build height Define a K0 patient? No ability/potential to ambulate. Not indicated for a prosthesis for ambualating or transferring Define a K1 patient and the available componentry Ability/potential to ambulate over event terrain at a fixed cadence, household ambulator Feet= Single axis, SACH Knee= Single axis, constant friction, locked Define a K2 patient and the available componentry Ability/potential to ambulate over uneven terrain at a fixed cadence Feet: Multiaxial, flexible keel, single axis with multi-axial Knee= Single axis, weight activated stance control Define a K3 patient and available componentry Ability/potential to ambulate over mixed terrian at a varying cadence, unlimited community ambulator Foot: Dynamic Response with multi-axial components Knee- pneumatic, hydraulic, microprocessor What is the issue and solution to a medial leaning pylon *Socket is too adducted foot is to Outset Solution- abduct the socket, inset foot What is the issue solution to a lateral leaning pylon Socket is too abducted or foot is to inset Solution= outset foot adduct socket What is the issue/solution to excessive anterior leaning pylon Socket is too flexed, foot is too dorsiflexed, foot is too far posterior Solution- move foot further anterior, extend socket What is the issue/solution to posterior leaning pylon Foot to anterior, socket too extended Solution - move foot posterior, flex socket What is the bench alignment for a TT patient Sagittal= 5 degrees of socket flexion, Socket Bisection 37mm anterior to foot bolt/ posterior third of foot Coronal= match sound side adduction, 12mm inset Transverse= 5-7 degrees of toe out, in line with 2nd ray What are the measurements necessary for a Transfemoral amputees casting IT- to distal end IT- floor KC- floor Foot length Circumference every 2 " Hip flexion angle What are the advantages to a ischial containment socket? Proximal tissue is contained, weight bearing surface at MSt, M/L stability via boney lock at MSt, rotational control What are the disadvantages to an ischial containment socket? Higher trimlines, pressure on ischium What are the advantages to a sub-ischial socket Lower trimlines, easier to sit, potential more ROM What are the disadvantages to a sub-ischial socket Requires more volitional control, rotational issues What are the advantages to skin fit suspension for TF Pulls residual tissue down, no bulk proximally What are the disadvantages to skin fit suspension for tf Requires mature limb, must be strong and balanced enough for pull in, cant have skin issues What are the advantages to supracondylar wedge/anatomical suspension for a knee disarticulation? Rotational control, takes advantage of the anatomy What are the disadvantages to supracondylar wedge/anatomical suspension for a knee disarticulation? Localized pressure in one area, difficult with fluctuating edema What are the advantages and advantages to a Silesian/tes belt Good auxiliary suspension for patients with fluctuating volume or very short limbs, can provide rotational control What are the disadvantages to a Silesian/Tes belt Pistioning, bulky, extra layer, adds another step to donning process What are the advantages to a pelvic band and hip joint? Maximum M/L stability, rotational control What are the disadvantages to a pelvic band and hip joint? Heavy, bulky, difficult to don, pistoning What are the advantages to a single axis knee Adv: inexpensive, durable What are the disadvantages to a single axis knee Fixed cadence, decreased stability What are the advantages to a weight activated stance control knee Stable during stance, and allowing for swing limb for more natural gait, good for new amputees, allows for easier sitting What are the disadvantages to a weight activated stance control knee Must fully unload knee to sit, a lot of stress on contralateral limb, single speed cadence What are the advantages to a polycentric knee More stable, Instantaneous center of rotation is more superior and posterior make knee inherently stable, knee center folds up under socket shortening limb in swing making good for longer limbs What are the disadvantages to a polycentric knee Increased weight, more maintenance Prosthetic CPM study guide What are the disadvantages to a manual lock knee Abnormal gait, difficult to sit with What are the advantages to a hydraulic/pneumatic knee Ambulate with varied cadence, adjustable resistances, more stance stability What are the disadvantages to a hydraulic/pneumatic knee Costly, more expensive What are the advantages to an MPK Varied resistances depending on situation/speed/incline, various different modes for different situations, most natural gait What are the disadvantages to a an MPK Heavy/bulky, expensive, not always covered by insurance What are the measurement that will be given for a the TF bench alignment task KC-floor, IT to floor, heel height, flexion contracture. Note whether KC-floor and IT-floor include shoe or not What is the bench alignment for a TF prosthesis Sagittal= 5 degrees of socket flexion plus contracture, 5-15 mm (1/4"-1/2") TKA anterior to knee center Coronal= foot(center of heel) 30-50mm outset from ischium, socket adducted 6-8 degrees, 2-4" base of support Transverse= Knee externally rotated 3-5 degrees, foot externally rotated 5-7 degrees, medial wall in line of progression What are some questions to always ask during the trouble shooting section Gained lost weight? Activity level changed? Limb volume change? Changed shoes? Donning liner/prosthesis correctly Did the problem start at delivery or a time period after Wearing socks Is the patient a child/have they grown Are there any gait deviation Are they washing the liner Are they wearing a shrinker Do they feel like they are falling medially or laterally Do they feel like the are walking up or down hill What is the cause and solution to a patient with discoloration/blistering on distal limb with appropriate socket fit Limb is being milked due to inappropriate liner donning Solution: educate patient on how to properly don liner What is the cause and solution to an upper limb patient with the TD opening with elbow flexion Too much force/not enough excursion in system Solution: Move EFA (Elbow Flexion attachment) distal, move Proximal Baseplate Retainer(PBPR) Lateral, Anterior, Proximally, Add forearm lift assist, check housing clearance, add rubber band What is the cause and solution to an upper limb patient with a TD that will not open all the way Too much excursion with in the system Solution: Move EFA proximal, Move PBPR Distal, Medial Posterior, remove rubber band, check housing clearance, add z strap, tighten CAS, add dual NW ring What is the cause and solution to a patient with Lack of ischial containment, lack of proximal control causing femur to adduct in socket Solution- pad medially, until ischium is contained and if this is not possible, re make socket What is the cause and solution to a patient Pushing through narrow socket, add a window door Prosthetic CPM study guide What is the cause and solution to a patient with transtibial pain/redness on bottom, distal Patel, and fibular head Bottoming out- solution add sock, pad pretibial and popliteal area What is the cause and solution to a knee disarticulation with pain on very bottom/condyles Using too many socks/ not reaching the bottom What is the cause of anterior proximal redness with a BK and solution Socket is too extended , flex socket Shoes were changed to lower heel height What is the cause of anterior distal redness Socket too flexed- extend socket Socket to anterior to foot- use offset plate to reverse Shoe heel to height AP too large- pad popliteal What is the cause of tibial tubercle/proximal fibular head redness Too many socks- reduce sock ply What is the cause of verrucous hyperplasia Lack of distal contact, reduce sock ply and use clay ball to ensure distal contact What is the cause of distal lateral and proximal medial pressure Socket to abducted, adduct socket What is the cause of distal medial and proximal lateral pressure Socket too adducted What is the cause of redness on distal end, fibular head, distal end of fibula Loss of volume making socket too large, add socks or pad socket What is the cause of proximal lateral and distal medial redness? Socket too adducted, medially leaning pylon, outset foot. Patient walking on inside of foot Solution abduct socket What is the cause of proximal medial and distal lateral redness for a BK Socket too abducted, foot too inset, walking on outside of foot Adduct sockeet What is the difference between a figure of 8 and figure 9 harness Figure 8 will have triceps cuff and be used for suspension (shoulder strap) and cabling Figure 9 is used for cabling/control only Where does the Control attachment strap sit on an upper limb patient. Inferior to C7 and towers the sound side What does lowering the CAS do to the upper limb cabling system Creates more excursion within the system How does one check the housing clearances on an upper limb patient to see if the housing is long and short enough Extend pronate and close- as long as possible should be 3mm between hanger and housing How does one check the housing clearances on an upper limb patient to see if the housing is short enough Flex, supinate, open- short as possible- 3mm between terminal device and distal housing, 6mm between proximal/distal housings What does a force problem in a transhumeral prosthesis look like, what are the solutions? TD opens while flexing the elbow Move EFA distal Move PBPR, lateral anterior, proximal (LAP) Add forearm lift assist Add second baseplate Check housing clearance Use teflon Prosthetic CPM study guide What does an excursion problem in a transhumeral prosthesis look like, what are the solutions? Terminal device does not open at mouth or waist Tighten CAS Check triple swivel and housing Move EFA proximal Add NW ring What does a force problem in a transradial prosthesis look like, what are the solutions? Too much force in system can not open TD Remove rubber bands, add teflon to reduce friction, remove sharp corners in cabling What does an excursion problem look like in a transradial system CAS too loose-tighten CAS to high- lower to capture more excursion Too much slack in axilla loop- tighten