Transcript Clinical Procedures in Prosthetics

Part 1: Assessment for Prosthetic Use &
Stump Management
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Obtain pertinent subjective information from
a patient with amputation
Perform stump assessment on a patient with
amputation
Perform prosthetic check-out
◦ Static
◦ Dynamic
◦ Functional Ax
Patient information
 Demographic data
 Diagnosis
 Subjective information
 Personal / Social history
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Diabetes
Heart condition
High blood pressure
Medications
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Living Status
Living conditions
Profession
Normal Daily activities
Recreation activities
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Anthropometric measurements
Knee stability
Shape of the stump
Incision
Skin
Bones
Subcutaneous tissue
Sensation
Phantom sensation / pain
Condition of the remaining lower extremity
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Length Measurements
Girth Measurements
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Cylindrical
Conical
Bulbous
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Location
Condition
◦ Inflammation? Open area? Scabbed area?
Adhesions? Blisters?
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Delicate
Average
Tough
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Heavy
Average
Light
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Light touch
Dull / Sharp pain
Visual skin inspection
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Vascularity
Sensation
Skin
ROM
Muscle strength
Below-knee prosthetic users
 Is the prosthesis as prescribed?
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Is the patient experiencing discomfort while
standing with equal weight on each side with
the feet 4-6 inches apart?
Is the length of the prosthesis correct?
Below-knee prosthetic users
 Is the knee stable without feeling pushed into
excessive flexion and extension?
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Is suspension adequate?
Can the patient sit comfortably with the knee
flexed 90deg and shoe flat on the floor?
Above-knee prosthetic users
 Is the ischial tuberosity properly located
within the socket?
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Is adductor longus channel properly located
in the socket?
Is the knee unit stable on weight bearing?
Above-knee prosthetic users
 Is suspension adequate to minimize pistoning
of the residual limb when prosthesis is raised
off the floor
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Does the socket maintain its position on the
residual limb in sitting?
Do the lengths of the prosthetic leg and thigh
section approximate those of the sound side?
Above-knee prosthetic users
 Does the knee remain flexed in sitting?
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Does the patient experience pressure on the
posterior thigh?
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Are the forces appropriately distributed over
the residual limb?
◦ Discoloration
◦ Skin breakdown
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Groin area
Distal end
Suspension system
Weight of the prosthesis
Donning and doffing
Fatigue
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Ability of prosthesis to keep up with activities
Balance
Transfers
Ambulation
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Indoor
Outdoor
Speed
Stairs
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Evaluate skills that the patient need to have in
order to perform daily tasks
Frequency of performance of said tasks
Measures and considerations with regards the
environment
◦ Environmental Ax
◦ Barriers?
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Ask if patient can do the task and if he can
demonstrate
Safety issues
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Confidence of patient in using the prosthesis
Resemblance to sound side
Use of other assistive device
Injuries acquired
Other patient concerns
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Other members of the prosthesis team
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O’ Sullivan, A. & Schmitz, T. (2007).
Physical Rehabilitation: Assessment &
Treatment 5th Ed. Philadelphia, F.A. Davis
Company.
Patrick, D.G. (1995). Prosthetics. In R.S.
Myers (Ed.) Saunders Manual of Physical
Practice. USA: WB Saunders Co.
Mariano, L.M.M.Jr. (2007). PT150 archives.