REHABILITATION
Definition of Prosthesis
A device designed to replace as far as possible the function
(and sometimes the appearance) of a missing limb or part
thereof.
Common Terminologies
Myodesis: direct suture of muscle or tendon to bone (via drill
holes)
Myoplasty: suturing agonist and antagonist muscles together
Residual limb: remaining portion of the amputated limb
Build-up: area of convexity designed for areas tolerant to
high pressure
Relief: area of concavity within the socket designed for high
pressure bony prominence areas
Traditional vs Newer
Componentry
Traditionally prostheses were made in
the form of exoskeleton, usually of wood
or plastic
Modern prostheses are endoskeletal
Constructed in a tube frame fashion
Flexible foam cover is used for the
outer surface
Elements adjustable individually and
detachable
Chief Goals of Prosthesis
Fitting
Limb substitution
Cosmesis
Locomotion (LL amputees)
Basic Principles of LL Amputation Surgery:
Preserve the knee joint whenever it is practical to
do so and fashion the stump at the lowest
practical level
Very short stumps make fitting extremely difficult.
However, very long transtibial stumps are prone
to circulation problems in the elderly dysvascular
patient
Elements to Consider in UL
Prostheses
The level of amputation
Cognition
Expected function required of prosthesis
The job of the patient, e.g. sedentary vs.
manual
Patients hobbies
Cosmesis, importance can be increased if
female or if the child grows up
Other considerations: finance
Socket and Suspensions
Socket Fitting: Introduction
No matter whether we are using an
advanced or traditional prosthetic
knee and foot, the socket remains an
important component of a
comfortable and well-functioning
prosthesis
It is the interface between the body
of the amputee and the distal
mechanical construction
Function of the Lower Limb
Socket (According to Foort)
To guide and link the residual limb to the prosthesis
n For transmission of support and control of forces
n The whole surface of the residual limb and its
muscular system
should be used for load transmission and guidance
of the prosthesis
n Provides wearing comfort
n If possible to provide sensory information used in
controlling the
prosthesis
n Protect the stump from the environment
Biomechanical Principles of Socket (According to Hall)
n Pioneered by
Kristinsson
Sometimes called
Scandinavian
Flexible Socket
Featuring a flexible
inner socket and
outer rigid frames
Some variations in Design Rationale
design have windows Improved sitting comfort
cut out in the outer Improved proprioception
frame to provide Possibly improved heat
pressure relief dissipation
The challenge: to find Improved muscle activity
Less heavy
the reasonably durable
Better suspension (if
thermoplastic material
suction is used)
offering the right
Easily interchange without
amount of flexibility loss of alignment
without expanding or (The only weak point is that
permanent deformation it may be less durable)
Sockets for the Transtibial Amputee
Total Contact Socket
Previously sometimes called patella
tendon-bearing socket
This is a misnomer since the patella
tendon does not bear high loads in this
type of socket: weight distribution is
quite even
There are relief areas for pressure points
like the fibula head, hamstrings, and a
wide tibial flare to even out the pressure
Icelandic Scandinavian New York
Socket
Featuring an outer rigid and inner flexible frame, as
just mentioned
Windows are present in the outer frame to provide
pressure relief
Not very durable
Adjuncts
Inserts like silicone gel may provide added protection
for the dysvascular patient or one with abundant
scars. These should not be too proud in case they
decrease surface contacts
A soft foam at the distal socket may decrease the
chance of verrucous hyperplasia formation
Suspension Systems
Proper suspension is important in its
contribution to the comfort and safety of
the prosthesis
For example, before World War II, many
traditional suspension systems made of
belts caused lots of vertical pistoning
and inefficient gait, abrasions, and distal
stump oedema, etc., thus demonstrating
the importance of proper suspension
Transfemoral Amputee
Silicon Liner with Shuttle Lock
Can be used for both transfemoral and transtibial
amputees
Can be used for all K-level users
Popular since advantages include: good
cushioning, torque control, total contact, less shear
on the stump, lessens distal oedema build-up
Prosthetic socks can be added as needed to
accommodate stump volume fluctuations
Good alternative for users with difficulty donning
the full suction socket
Suction Systems
Also popular means of suspension, works by
negative pressure and surface tension
Not usually used in transtibial amputees as the
local anatomy is not very suitable for a tight seal
Advantages include: good contact between
residual limb and socket, good level of comfort
and control
Highly active amputees may need additional
suspension belts
Drawback: DM patients with weak hand intrinsics
can have difficulty donning and doffing as well as
those with poor standing balance
New Seal-In Liner by Ossur
This new development is promising as the
user simply rolls on the liner, steps into the
socket, and an integrated hypobaric sealing
membrane (HSM) automatically creates a
firm suspension.
To remove the socket, the user just pushes a
button
Pistoning is decreased by the full-length
matrix; while the seal and distal pad enhance
rotational control, the HSM can conform to
the shape of the socket wall creating a quick
air-tight seal for easy donning
Total Elastic Suspension