Download MBBS Physical Medicine and Rehabilitation Presentations 15 Prosthesis Lecture Notes

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? replace the lost part of the body
? appearance and function

? Objectives of LL prosthesis

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? Transfer body weight

? Simulate normal locomotion

? Objectives of UL prosthesis

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? Simulate normal hand function


ORTHOSIS

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An external device applied on the body to:-
?Limit motion
?Correct deformity
?Reduce axial loading

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?Improve function in certain segment of the body.

Functional levels

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Lower Limb Amputation level

Lisfranc / chopart amputation

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The options are

1. high-top shoe with fil er

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2. AFO with fil er

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Syme's amputation

socket extends proximally

til the patellar tendon

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to make it easier to insert

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the bulbous stump inside

a window is provided

(medial / posterior)

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or

a flexible inner wall

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is used

suspension is provided

by a constriction proximal to

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SACH / dynamic response foot

the bulbous end

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Below Knee/Transtibial Prosthesis

Suspension Cuff

PTB Socket

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Prosthetic Shank / Shin

Foot Ankle Assembly

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B/K amputation

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? foot-ankle assembly

types

# SACH foot

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# single axis foot

# multiaxis foot

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# dynamic response foot

# jaipur foot

# madras foot

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B/K amputation

# exoskeletal

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# endoskeletal/modular

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B/K amputation

? socket

types

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? PTB socket
? total surface bearing

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B/K amputation

? suspension

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types

# supracondylar cuff

# sleeve

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# distal attachment

# suction

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# thigh corset

# fork strap & waist belt

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Above Knee/Transfemoral Prosthesis

Socket (Quad Socket

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or Ischial containment)

Silesian Suspension

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Knee Unit

Prosthetic Shank / Shin

Foot Ankle Assembly

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Knee Joints

? Constant Friction Single axis knee joints
? Manual Locking knee

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? Polycentric knee units
? Weight Activated Stance Control knee
? Hydraulic knee units
? Pneumatic knee units
? Microprocessor controlled knee joints

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A/K amputation

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quadrilateral

socket

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ischial

containment

socket

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A/K amputation

? suspension

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types

# suction

# silesian belt

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# hip joint & pelvic band

# total elastic suspension belt

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# shoulder suspension


Knee disarticulation prosthesis

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# knee joints

the options are

1. outer hinges

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2. polycentric knee joint

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hip disarticulation / hemipelvectomy / <5 cm residual femur

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translumbar amputation / hemicorpectomy

? for sitting

bucket prosthesis

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slits for bladder / bowel

drainage bags

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Proximal focal femoral deficiencies

? extension prosthesis

features

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? socket ? is like an AFO
? if adequate weight-bearing is not

possible on the foot, the socket is

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extended upto the ischium
? below the socket

a shoe raise is given

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(if limb length discrepancy is less)

or

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a prosthetic foot is given

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(if limb length discrepancy is more)


energy consumption

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? traumatic unilateral B/K 7% more than non-amputees
? vascular unilateral B/K 25%
? traumatic unilateral A/K

25%

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? vascular unilateral A/K

87%

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? bilateral amputees

more

UPPER LIMB LEVELS OF AMPUTATION

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? Transphalangeal

? Transmetacarpal

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? Transcarpal

? Wrist disarticulation

? Transradial

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? Elbow disarticulation

? Transhumeral

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? Shoulder disarticulation

? Forequarter amputation
MAJOR MOTOR FUNCTIONS OF THE HAND

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? GraspSpherical

Cylindrical

Hook

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? Release

? Precision

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Pinch-tip to tip, pulp to pulp, lateral key

Three jaw chuck

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VARIOUS UPPER LIMB PROSTHESES

? Cosmetic: least function
? Body powered: most harnessing & body movt. needed

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? Battery powered (myoelectric or switch controlled): heavy, expensive

& extended therapy time

? Hybrid (cable to elbow or TD and battery powered)

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BODY POWERED PROSTHESES : COMPONENTS

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? Socket
? Suspension
? Control cable system
? Terminal device

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? Interposing joints (wrist, elbow, shoulder)

TERMINAL DEVICES

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1.Passive: cosmetic hand , flexible mitts

2.Active: hook devices , prosthetic hand

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a. Voluntary opening

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b. Voluntary closing

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CONTROL CABLE MECHANISMS

SOCKET

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? Socket
dual-wall design

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SUSPENSION

Harness

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1.Figure of 8/ Standard trans radial harness

2.Shoulder saddle and chest strap

Self suspending

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1.Muenster

2.Supracondylar

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Suction

1.Suction socket with air valve

2.Gel sleeve with locking pin

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JOINTS: WRIST, ELBOW & SHOULDER UNITS


External y powered prostheses/Myoelectric prostheses

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BIONIC HAND