PROSTHETIC COURSE

Bryan Humble CPO/LPOPrecision 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

·MEDIUM

·LONG

TRANS FEMORAL (ABOVE KNEE)

KNEE DISARTICULATION TRANS FEMORAL •SHORT

•MEDIUM

•LONG

HIP DISARTICULATION / HEMIPELVECTOMY

MAJOR COMPONENTS

SUSPENSIONLINERKNEE JOINTSSOCKETPYLONFOOT

SUSPENSION

SUCTION SILICONE WITH LOCK SLEEVE PTB CUFF JOINT AND CORSET BELT

LINERS

SILICONEPELITEC-FLEXHARD SOCKET

KNEE JOINTS

LOCKINGSINGLE AXISSAFETY4-BARHYDRAULICCOMPUTER CONTROLLED

FEET SACH SINGLE AXIS MULTI-AXIS ENERGY STORING (SEATTLE) DYNAMIC RESPONSE (FLEX

FOOT)

COMPONENT SELECTION MUST MATCH PATIENT AND ACTIVITY LEVEL. *(K-LEVEL)

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 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

STUMPS SOCKS CHANGED EVERY DAY

SILICONE LINER CLEANED & DISINFECTED EVERY DAY.

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)

1 HEEL STRIKE TO MIDSTANCE2 AT MIDSTANCE3 MIDSTANCE TO TOE OFF

HEEL STRIKE TO MIDSTANCEEXCESSIVE KNEE FLEXION

PROSTHETICPROSTHETIC EXCESSIVE D.F.

OR S.F. STIFF HEEL ANTERIOR SKT.

OTHEROTHER FLEXION

CONTRACTURE

(CAUSES)

HEEL STRIKE TO MIDSTANCEABSENT KNEE FLEXION

PROSTHETICPROSTHETIC EXCESSIVE P.F. SOFT HEEL ANTERO-

DISTAL PAIN

OTHEROTHER WEAK QUADS HABIT

(CAUSES)

AT MIDSTANCELATERAL THRUST

PROSTHETICPROSTHETIC MEDIAL FOOT ABDUCTED

SKT. SKT. M-L LOOSE

OTHEROTHER LIGAMENTOUS

LAXITY @ KNEE

(CAUSES)

MIDSTANCE TO TOE OFF

A EARLY FLEXION EARLY FLEXION (DROP OFF)(DROP OFF)

ANT. DISPLACEMENT SKT.

POST. DISPLACEMENT OF KEEL

EX. D.F. OF FOOT SOFT D.F. BUMPER

B DELAYED DELAYED FLEXIONFLEXION

POST DISPLACEMENT SKT.

ANT DISPLACEMENT OF KEEL

EX. P.F. OF FOOT HARD D.F. BUMPER

GAIT DEVIATIONS & CAUSES(TRANS FEMORAL)

1 LATERAL TRUNK BENDING2 ABDUCTED GAIT3 CIRCUMDUCTION4 VAULTING5 SWING PHASE WHIPS6 FOOT ROTATION @ HEEL STRIKE7 FOOT SLAP8 UNEVEN HEEL RISE9 TERMINAL IMPACT10 UNEVEN STEP LENGTH11 EXAGERATED LORDOSES

LATERAL TRUNK BENDING

PROSTHETICPROSTHETIC ABDUCTED SKT. LATERAL SKT.

WALL PAIN D.L. FEMUR SHORT TFB

OTHEROTHER WEAK HIP

ABDUCTORS ABDUCTED

GAIT

(CAUSES)

ABDUCTED GAIT

PROSTHETICPROSTHETIC PAIN IN PERONEAL

AREA LONG TFP VALGUS

ALIGNMENT HIP JT.

MISALIGNED

OTHEROTHER CONTRACTED HIP

ABDUCTORS PATIENT

INSECURITY - COMPENSATES WITH WIDE GAIT

(CAUSES)

CIRCUMDUCTION

PROSTHETICPROSTHETIC MECHANICAL

OTHEROTHER INSUFFICIENT KNEE

FLEXION (FEAR)

(CAUSES)

•LOCKED KNEE

•TIGHT EXT. ASSIST

•TIGHT KNEE FRICTION

POOR SUSPENSION - CAUSES “PISTONING”

SKT. SMALL

EX. PF

VAULTING

PROSTHETICPROSTHETIC LONG TFP (LOCK,

SUSP. FRICTION EX. PF.

INSUFFICIENT OR EXCESSIVE KNEE FRICTION

OTHEROTHER INSUFFICIENT

KNEE FLEXION (FEAR)

HABIT

(CAUSES)

SWING PHASE WHIPS

PROSTHETICPROSTHETIC KNEE JOINT

MISALIGNED TIGHT OR

IMPROPER SKT. CONTURE

OTHEROTHER WEAK OR

FLABBY MUCULATURE

(CAUSES)

FOOT ROTATION AT HEEL STRIKE

PROSTHETICPROSTHETIC HARD PF CUSHION OR PF BUMPER

(CAUSES)

FOOT SLAP

PROSTHETICPROSTHETICPF BUMPER TOO SOFT

(CAUSES)

UNEVEN HEEL RISE

PROSTHETICPROSTHETIC INS. KNEE

FRICTION ABSENT OR

LOOSE EXT. AID

OTHEROTHER FORCEFUL HIP

FLEXION BY PATIENT

(CAUSES)

!EXCESSIVE!!EXCESSIVE!

UNEVEN HEEL RISE

PROSTHETICPROSTHETIC EX. KNEE

FRICTION EX. AID TIGHT MANUAL LOCK

OTHEROTHER FEAR /

AMPUTEE WALKS WITH LITTLE OR NO KNEE FLEXION

(CAUSES)

!INSUFFICIENT!!INSUFFICIENT!

TERMINAL IMPACT

PROSTHETICPROSTHETIC INS. KNEE

FLEXIONTIGHT EX. AIDEXTENSION

BUMPER DEF.

OTHEROTHERAMPUTEE FEAR

OF KNEE BUCKLING

(CAUSES)

UNEVEN STEP LENGTH

PROSTHETICPROSTHETIC LACK OF

FRICTION OR LOOSE EXT. AID

INSUFFICIENT SKT. FLEXION

OTHEROTHER PAIN /

INSECURITY HIP FLEXION

CONTRACTURE

(CAUSES)

EXAGGERATED LORDOSIS

PROSTHETICPROSTHETIC INSUFFICIENT

SKT. FLEXION INSUFFICIENT

SUPPORT - ANTERIOR SKT. BRIM

OTHEROTHER HIP FLEXION

CONTRACTURE WEAK HIP

EXTENSORS WEAK

ABDOMINALS

(CAUSES)