Intermediate Recovery Stage

Prosthetics

practice of fabricating and fitting artificial limbs

Prosthetist

a practitioner who specializes in prosthetics

When is the definitive prosthesis fabricated?

9-12 months after amputation

Educate patient on prosthetic management with initial prosthesis?

Don/doff

Daily wearing schedule - without prosthesis, continued shrinker usage

Daily volume management - atrophy, wearing of prothesis increases positive pressures on the limb

Goals for Intermediate Stage

Continue to manage residual limb volume, promote healing

Educate patient on prosthetic management with initial prosthesis

Continued strengthening, stretching, balance training

Prosthetic gait training

Causes of volume changes >2 mo. post op:

Limb muscle atrophy

Initial prosthetic fitting

Continued disease processes

Weight loss/gain

Center of mass

point at which the body’s mass is evenly distributed

Base of support

the part of the body that is in contract with the supporting surface

In standing, where is the base of support in reference to?

position of the feet

Center of pressure

average of all pressures over the surface of the area in contact with the ground

Parts of gait cycle that are double limb support?

Initial contact

Pre-swing

Rocker at initial contact?

initiation of heel rocker

Rocker at end of loading response through mid stance?

ankle rocker

Rocker in terminal stance?

forefoot rocker

Rocker in pre-swing?

toe rocker

If somebody cannot reach forefoot rocker, what will happen to the step length?

shorter

Single limb stance (SLS)

episode when only one foot is in contact with ground

% of stance in SLS?

40%

% of stance in DLS?

20%

Double Limb Support (DLS)

total time both feet are in contact with the ground

Initial DLS

time when both feet are on the ground at beginning of stance phase

Terminal DLS

time when both feet are on the ground at end of stance phase

Ground reaction force

horizontal and vertical forces exerted by the surface on which a body is moving

Where do GRFs orignate?

COP

Where are GRFs directed toward?

COM

In what phase of gait do GRFs occur in?

stance phases

When is the risk of the knee buckling highest in stance?

end of loading response

At Loading Response, in normal gait, the GRF runs _________ to the knee (sagittal) and _______ to knee/thigh (frontal)

posterior, medial

What moments are produced during loading response?

External flexion and adduction moments

What couples with excessive dorsiflexion at the ankle?

excessive knee flexion and hip flexion

What couples with excessive plantar flexion at the ankle?

knee extension and hip flexion

Implications of GRF in prosthetics

GRF vector should be primary concern during prosthetic alignment

Should be normalized as possible or it will contribute to gait deviations

May affect trust in the prosthesis

During loading response if GRF is not properly aligned =

detrimental to balance

K0 Componentry

No prosthesis

K1 componentry

SACH foot, locking knee

K2 componentry

multi-axial foot, polycentric knee

no carbon fiber or hydraulics

K3 componentry

Dynamic response feet, hydraulic knees, Microprocessor knee (MPK) devices

K4 componentry

all components