Limb Pros The Tics
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What is the difference between a prosthesis and an orthosis? A prosthesis is a device or an artificial substitute designed to replace, as much as possible, the function or appearance of a missing limb or body part. An orthosis is a device designed to supplement or augment the function of an existing limb or body part. A prosthesis is often also referred to as a prosthetic device. Similarly, an orthosis is often referred to as an orthotic device. What are some of the determinants of a successful outcome with prosthetic use? The level of motivation of the individual should be assessed. Ideally discussions about prosthetic use should begin preoperatively and should involve the surgeon, physiatrist, prosthetist, and patient. Foremost, a prosthesis must be comfortable to wear, easy to don (put on) and doff (take off), light weight and durable, and cosmetically pleasing. Furthermore, a prosthesis must function well mechanically and have reasonably low maintenance requirements. What should be considered when choosing a prosthesis? • • • • • • •
What is the amputation level? What is the expected function of the prosthesis? What is the cognitive function of the patient? What is the patient's vocation (desk job vs manual laborer)? What are the patient's avocational interests (ie, hobbies)? What is the cosmetic importance of the prosthesis? What are the patient's financial resources (eg, medical insurance, worker's compensation)?
What are the most common reasons for a lower extremity amputation? In contrast to upper extremity amputations, which most commonly result from trauma in the young male population, most lower extremity amputations occur in individuals older than 60 years because of complications of medical disease. Diabetes and peripheral vascular disease are the leading complications of medical disease requiring amputation, followed by thromboembolism and vasculitis. Trauma is the second most common cause of lower extremity amputation and typically occurs in the young male population. Tumors and congenital malformations less commonly result in lower extremity amputation. What are the minimal functional requirements to fit a patient with a lower extremity prosthesis?
The patient must demonstrate sufficient trunk control, good upper body strength, static and dynamic balance, and adequate posture in order to be functionally successful with a prosthesis. Once these basic requirements are met, then stability, ease of movement, energy efficiency, and the appearance of a natural gait are key elements to achieve with prosthetic use. How long does an average prosthesis last? Minor cosmetic modifications aside, prostheses can be expected to last at least 2 years with standard daily use. Children may need much more frequent modifications or adjustments as they grow. Determination of functional level for Medicare patients Centers for Medicare & Medicaid Services (CMS), formerly known as Health Care Financing Administration (HCFA), requires a determination of functional level with certificates of medical necessity for prostheses. Level 0: Does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance his/her quality of life or mobility. Level 1: Has the ability or potential to use a prosthesis for transfers or ambulating on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator. Level 2: Has the ability or potential for ambulating with the ability to traverse environmental barriers such as curbs, stairs, or uneven surfaces. Typical of the limited community ambulator. Level 3: Has the ability or potential for ambulating with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion. Level 4: Has the ability or potential for prosthetic ambulating that exceeds basic ambulating skills, exhibiting high impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete.
What are the most common reasons for a lower extremity amputation? In contrast to upper extremity amputations, which most commonly result from trauma in the young male population, most lower extremity amputations occur in individuals older than 60 years because of complications of medical disease. Diabetes and peripheral vascular disease are the leading complications of medical disease requiring amputation, followed by thromboembolism and vasculitis. Trauma is the second most common cause of lower extremity amputation and typically occurs in the young male population. Tumors and congenital malformations less commonly result in lower extremity amputation. What are the minimal functional requirements to fit a patient with a lower extremity prosthesis? The patient must demonstrate sufficient trunk control, good upper body strength, static and dynamic balance, and adequate posture in order to be functionally successful with a prosthesis. Once these basic requirements are met, then stability, ease of movement, energy efficiency, and the appearance of a natural gait are key elements to achieve with prosthetic use. How long does an average prosthesis last? Minor cosmetic modifications aside, prostheses can be expected to last at least 2 years with standard daily use. Children may need much more frequent modifications or adjustments as they grow. Determination of functional level for Medicare patients Centers for Medicare & Medicaid Services (CMS), formerly known as Health Care Financing Administration (HCFA), requires a determination of functional level with certificates of medical necessity for prostheses. Level 0: Does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance his/her quality of life or mobility. Level 1: Has the ability or potential to use a prosthesis for transfers or ambulating on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator. Level 2: Has the ability or potential for ambulating with the ability to traverse environmental barriers such as curbs, stairs, or uneven surfaces. Typical of the limited community ambulator. Level 3: Has the ability or potential for ambulating with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental
barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion. Level 4: Has the ability or potential for prosthetic ambulating that exceeds basic ambulating skills, exhibiting high impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete. Preamputation Since most lower extremity amputations are the result of disease and are to some extent preplanned, the rehabilitation team often is able to meet with the patient prior to surgery. During this time, an assessment of the patient's postoperative needs and desires can be made, and range of motion (ROM) exercises, strengthening, and activities of daily living (ADL) training can be initiated. The rehabilitation team typically consists of a physiatrist (a physician who specializes in physical medicine and rehabilitation), an occupational therapist, a physical therapist, a prosthetist, a recreational therapist, and a case manager/social worker. Surgical procedure During the amputation surgery, several actions can be taken to maximize the function of the residual limb. These actions include 1) beveling the bone end, 2) sharply transecting the nerve to decrease the likelihood of neuroma formation, and 3) positioning the wound edges to avoid bony prominences at the far distal end of the residual limb. Acute postsurgery The major issues in this phase are adequate wound healing; pain management; and physical and occupational therapy to train the patient to perform ADL, mobility, ROM, and strength. During this time, initiate a program to prepare the residual limb for the prosthesis. A skin desensitization program consists of (1) gentle tapping on the distal portion of residual limb to mature the site, (2) massage to prevent excessive scar formation, and (3) edema control with ace wraps or a residual limb (stump) shrinker. Prosthetic fitting and testing When the suture line has completely healed, fitting for the prosthesis can begin. The prosthesis must be individually fitted to the patient. Prostheses are described at this stage as either preparatory or definitive. The preparatory prosthesis is fitted while the residual limb is still remolding. This allows the patient to commence the rehabilitation program of donning and doffing, transfer training, building wear tolerance, obtaining balance and
ambulating with the prosthesis several weeks earlier in the process. A preparatory prosthesis often allows a better fit in the final prosthesis as the preparatory socket can be used to mold the residual limb into the desired shape. Sometimes a preparatory prosthesis is not feasible because of financial considerations. In this case, the patient can only be fitted for the definitive (final) prosthesis. If the patient is being fitted for a final prosthesis without ever having a preparatory prosthesis, delay fitting for the socket until the residual limb is fully mature (usually 3–4 mo) or until general stabilization occurs in the patient's weight and stump circumference Initially, teach the patient the basics of prosthetics care, including how to don and doff the prosthesis, how to inspect the residual limb for signs of skin breakdown (should be completed daily), and how to perform safe transfers (moving from one position or surface to another). Then, shift emphasis to weight bearing with the prosthesis. Finally, address ambulation on level surfaces with a walker or other assistive device. Once the patient has mastered these skills, begin training on stairs, uneven surfaces, and ramps/inclines. The end goal is for the patient to safely ambulate on all usual surfaces without adaptive equipment. Weight bearing An individual with a lower extremity amputation must bear full body weight on soft tissues not designed for that function. The socket must be designed such that these forces are distributed as much as possible and as evenly as possible over pressure-tolerant areas. These include the patellar tendon, the pretibial muscles, the residual posterior muscles, the medial flare of the tibia, and the lateral fibula. The presence of ongoing pain, skin breakdown, change in the ability to don and doff the prosthesis, and change in the number of sock plies indicates that the prosthesis needs to be modified. Erythema normally appears within a few minutes after removing the prosthesis and should fade quickly. Erythema that is present upon removing the prosthesis or that does not completely resolve within 20 minutes is particularly worrisome. Phantom pain versus phantom sensation versus postoperative pain In addition to the usual postoperative pain, most individuals with amputation experience phantom sensation. Phantom sensation is the perceived sense that the amputated limb or part of it is still present. Phantom sensation is not painful, and the patient usually just needs to be reassured that this sensation is very common and that they are “not crazy.” The phenomenon of “telescoping” can accompany phantom sensation. This is the sensation that the amputated limb has shrunk (eg, the toes are at the ankle, the foot is at the knee). Telescoping is normal and usually fades without sequelae. Phantom pain is the sensation of pain originating in the amputated part. Phantom pain may or may not be dermatomal in nature. Individuals describe a burning,
stinging, or cramping pain, or they describe the feeling that the missing body part is “positioned awkwardly or painfully.” The pain usually is most intense right after the amputation and resolves with time, although some patients can still experience phantom pain years after the amputation. The pain is usually worse at night, after the extremity has been in a dependent position, and can be worsened by anxiety and stress. Unlike postsurgical pain, which responds well to opioids such as Percocet or Lortab, phantom pain is best treated with low doses of tricyclic antidepressants (eg, Amitriptyline 10 mg PO qhs) or anticonvulsants (eg, Neurontin 300 mg PO qhs). Choke syndrome When the proximal part of the socket has too snug a fit on the residual limb, venous outflow can be obstructed. When this is combined with an empty space more distally in the socket, swelling can occur until that empty space is filled. In an acute choke situation, the skin is red and indurated and may have an orangepeel appearance with prominent skin pores. If the constriction is not resolved, then chronic skin changes with hemosiderin deposits and venous stasis ulcers can develop. Dermatologic problems Common skin management issues include contact dermatitis, sebaceous cysts, scar management, and excessive sweating. The liner, socks, and suspension mechanism are the usual culprits for contact dermatitis. The socket is a less likely cause. Treatment is identification and removal of the offending item and symptomatic treatment with topical Benadryl or cortisone creams. Cysts and sweating can be a sign of excessive shear forces and components that are improperly fitted. Scar management is focused on massaging and lubricating the scar to obtain a well-healed result without dog ears or adhesions. The increase in energy requirements can be the limiting factor in ambulation. An individual who has a lower extremity amputation and requires a walker or crutches to ambulate uses 65% more energy than someone with a normal gait. Increased levels of energy consumption (percentage above normal) by amputation level are as follows: • • • •
Below knee unilateral amputation - 10-20% Below knee bilateral amputation - 20-40% Above knee unilateral amputation - 60-70% Above knee bilateral amputation - >200%
Energy consumption is actually less with a BKA than ambulating with crutches. However, ambulating with an AKA requires more energy, which makes the cardiopulmonary status of the patient more significant.
Caption: Picture 1. Lower limb prosthetics. Below knee endoskeletal prosthesis with patellar tendon bearing socket with Pelite liner, supracondylar cuff strap suspension, SACH foot (anterior view). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 2. Lower limb prosthetics. Below knee endoskeletal prosthesis with patellar tendon bearing socket with Pelite liner, supracondylar cuff strap suspension, SACH foot (oblique view). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 3. Lower limb prosthetics. Below knee endoskeletal prosthesis with patellar tendon bearing socket with Pelite liner, supracondylar cuff strap suspension, SACH foot (lateral view). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 4. Lower limb prosthetics. Left above knee prosthesis with ischial
containment socket, TES (total elastic suspension) belt, single axis knee with extension assist, endoskeletal components, energy storing foot (anterior view). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 5. Lower limb prosthetics. Left above knee prosthesis with ischial containment socket, TES (total elastic suspension) belt, single axis knee with extension assist, endoskeletal components, energy storing foot (lateral view with flexed knee). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 6. Lower limb prosthetics. Left above knee prosthesis with quadrilateral socket, hip joint and pelvic band suspension, endoskeletal components with cosmetic foam cover and hose, single axis knee, energy storing foot (close-up of socket and suspension system). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo
Caption: Picture 7. Lower limb prosthetics. Silicone gel locking liner (front view). View Full Size Image eMedicine Zoom View (Interactive!) Picture Type: Photo Caption: Picture 8. Lower limb prosthetics. Silicone gel locking liner (posterior view with turned down cuff to expose inner surface). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 9. Lower limb prosthetics. Silicone gel locking liner on below knee prosthesis model (lateral view - bulge would be patient's patella). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 10. Lower limb prosthetics. Left to Right: SACH (single axis composite heel) foot, Seattle light foot (energy storing foot with Delrin keel), Carbon Copy II (energy storing foot with carbon keel).
View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 11. Lower limb prosthetics. Seattle Light Foot (energy storing foot with Delrin keel). Note space between 1st and 2nd toe, which allows patient to wear toe strap sandals. View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo •
• •
•
Colwell MO, Spires MC: Lower extremity prosthesis and rehabilitation. In: Grabois M, ed. Physical Medicine and Rehabilitation: The Complete Approach. 2000: 583-607. Glennon TP, Smith BS: Amputations. In: Garrison SJ, ed. Handbook of Physical Medicine and Rehabilitation Basics. 1995: 34-60. Leonard JA Jr, Meier RH III: Upper and lower extremity prosthetics. In: DeLisa JA, ed. Rehabilitation Medicine: Principles and Practice. 1998: 669-696. Tan JC: Prostheses. In: Practical Manual of Physical Medicine and Rehabilitation. 1998: 229-259.
What is the amputation level? What is the expected function of the prosthesis? What is the cognitive function of the patient? What is the patient's vocation (desk job vs manual laborer)? What are the patient's avocational interests (ie, hobbies)? What is the cosmetic importance of the prosthesis? What are the patient's financial resources (eg, medical insurance, worker's compensation)?
What are the most common reasons for a lower extremity amputation? In contrast to upper extremity amputations, which most commonly result from trauma in the young male population, most lower extremity amputations occur in individuals older than 60 years because of complications of medical disease. Diabetes and peripheral vascular disease are the leading complications of medical disease requiring amputation, followed by thromboembolism and vasculitis. Trauma is the second most common cause of lower extremity amputation and typically occurs in the young male population. Tumors and congenital malformations less commonly result in lower extremity amputation. What are the minimal functional requirements to fit a patient with a lower extremity prosthesis?
The patient must demonstrate sufficient trunk control, good upper body strength, static and dynamic balance, and adequate posture in order to be functionally successful with a prosthesis. Once these basic requirements are met, then stability, ease of movement, energy efficiency, and the appearance of a natural gait are key elements to achieve with prosthetic use. How long does an average prosthesis last? Minor cosmetic modifications aside, prostheses can be expected to last at least 2 years with standard daily use. Children may need much more frequent modifications or adjustments as they grow. Determination of functional level for Medicare patients Centers for Medicare & Medicaid Services (CMS), formerly known as Health Care Financing Administration (HCFA), requires a determination of functional level with certificates of medical necessity for prostheses. Level 0: Does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance his/her quality of life or mobility. Level 1: Has the ability or potential to use a prosthesis for transfers or ambulating on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator. Level 2: Has the ability or potential for ambulating with the ability to traverse environmental barriers such as curbs, stairs, or uneven surfaces. Typical of the limited community ambulator. Level 3: Has the ability or potential for ambulating with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion. Level 4: Has the ability or potential for prosthetic ambulating that exceeds basic ambulating skills, exhibiting high impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete.
What are the most common reasons for a lower extremity amputation? In contrast to upper extremity amputations, which most commonly result from trauma in the young male population, most lower extremity amputations occur in individuals older than 60 years because of complications of medical disease. Diabetes and peripheral vascular disease are the leading complications of medical disease requiring amputation, followed by thromboembolism and vasculitis. Trauma is the second most common cause of lower extremity amputation and typically occurs in the young male population. Tumors and congenital malformations less commonly result in lower extremity amputation. What are the minimal functional requirements to fit a patient with a lower extremity prosthesis? The patient must demonstrate sufficient trunk control, good upper body strength, static and dynamic balance, and adequate posture in order to be functionally successful with a prosthesis. Once these basic requirements are met, then stability, ease of movement, energy efficiency, and the appearance of a natural gait are key elements to achieve with prosthetic use. How long does an average prosthesis last? Minor cosmetic modifications aside, prostheses can be expected to last at least 2 years with standard daily use. Children may need much more frequent modifications or adjustments as they grow. Determination of functional level for Medicare patients Centers for Medicare & Medicaid Services (CMS), formerly known as Health Care Financing Administration (HCFA), requires a determination of functional level with certificates of medical necessity for prostheses. Level 0: Does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance his/her quality of life or mobility. Level 1: Has the ability or potential to use a prosthesis for transfers or ambulating on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator. Level 2: Has the ability or potential for ambulating with the ability to traverse environmental barriers such as curbs, stairs, or uneven surfaces. Typical of the limited community ambulator. Level 3: Has the ability or potential for ambulating with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental
barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion. Level 4: Has the ability or potential for prosthetic ambulating that exceeds basic ambulating skills, exhibiting high impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete. Preamputation Since most lower extremity amputations are the result of disease and are to some extent preplanned, the rehabilitation team often is able to meet with the patient prior to surgery. During this time, an assessment of the patient's postoperative needs and desires can be made, and range of motion (ROM) exercises, strengthening, and activities of daily living (ADL) training can be initiated. The rehabilitation team typically consists of a physiatrist (a physician who specializes in physical medicine and rehabilitation), an occupational therapist, a physical therapist, a prosthetist, a recreational therapist, and a case manager/social worker. Surgical procedure During the amputation surgery, several actions can be taken to maximize the function of the residual limb. These actions include 1) beveling the bone end, 2) sharply transecting the nerve to decrease the likelihood of neuroma formation, and 3) positioning the wound edges to avoid bony prominences at the far distal end of the residual limb. Acute postsurgery The major issues in this phase are adequate wound healing; pain management; and physical and occupational therapy to train the patient to perform ADL, mobility, ROM, and strength. During this time, initiate a program to prepare the residual limb for the prosthesis. A skin desensitization program consists of (1) gentle tapping on the distal portion of residual limb to mature the site, (2) massage to prevent excessive scar formation, and (3) edema control with ace wraps or a residual limb (stump) shrinker. Prosthetic fitting and testing When the suture line has completely healed, fitting for the prosthesis can begin. The prosthesis must be individually fitted to the patient. Prostheses are described at this stage as either preparatory or definitive. The preparatory prosthesis is fitted while the residual limb is still remolding. This allows the patient to commence the rehabilitation program of donning and doffing, transfer training, building wear tolerance, obtaining balance and
ambulating with the prosthesis several weeks earlier in the process. A preparatory prosthesis often allows a better fit in the final prosthesis as the preparatory socket can be used to mold the residual limb into the desired shape. Sometimes a preparatory prosthesis is not feasible because of financial considerations. In this case, the patient can only be fitted for the definitive (final) prosthesis. If the patient is being fitted for a final prosthesis without ever having a preparatory prosthesis, delay fitting for the socket until the residual limb is fully mature (usually 3–4 mo) or until general stabilization occurs in the patient's weight and stump circumference Initially, teach the patient the basics of prosthetics care, including how to don and doff the prosthesis, how to inspect the residual limb for signs of skin breakdown (should be completed daily), and how to perform safe transfers (moving from one position or surface to another). Then, shift emphasis to weight bearing with the prosthesis. Finally, address ambulation on level surfaces with a walker or other assistive device. Once the patient has mastered these skills, begin training on stairs, uneven surfaces, and ramps/inclines. The end goal is for the patient to safely ambulate on all usual surfaces without adaptive equipment. Weight bearing An individual with a lower extremity amputation must bear full body weight on soft tissues not designed for that function. The socket must be designed such that these forces are distributed as much as possible and as evenly as possible over pressure-tolerant areas. These include the patellar tendon, the pretibial muscles, the residual posterior muscles, the medial flare of the tibia, and the lateral fibula. The presence of ongoing pain, skin breakdown, change in the ability to don and doff the prosthesis, and change in the number of sock plies indicates that the prosthesis needs to be modified. Erythema normally appears within a few minutes after removing the prosthesis and should fade quickly. Erythema that is present upon removing the prosthesis or that does not completely resolve within 20 minutes is particularly worrisome. Phantom pain versus phantom sensation versus postoperative pain In addition to the usual postoperative pain, most individuals with amputation experience phantom sensation. Phantom sensation is the perceived sense that the amputated limb or part of it is still present. Phantom sensation is not painful, and the patient usually just needs to be reassured that this sensation is very common and that they are “not crazy.” The phenomenon of “telescoping” can accompany phantom sensation. This is the sensation that the amputated limb has shrunk (eg, the toes are at the ankle, the foot is at the knee). Telescoping is normal and usually fades without sequelae. Phantom pain is the sensation of pain originating in the amputated part. Phantom pain may or may not be dermatomal in nature. Individuals describe a burning,
stinging, or cramping pain, or they describe the feeling that the missing body part is “positioned awkwardly or painfully.” The pain usually is most intense right after the amputation and resolves with time, although some patients can still experience phantom pain years after the amputation. The pain is usually worse at night, after the extremity has been in a dependent position, and can be worsened by anxiety and stress. Unlike postsurgical pain, which responds well to opioids such as Percocet or Lortab, phantom pain is best treated with low doses of tricyclic antidepressants (eg, Amitriptyline 10 mg PO qhs) or anticonvulsants (eg, Neurontin 300 mg PO qhs). Choke syndrome When the proximal part of the socket has too snug a fit on the residual limb, venous outflow can be obstructed. When this is combined with an empty space more distally in the socket, swelling can occur until that empty space is filled. In an acute choke situation, the skin is red and indurated and may have an orangepeel appearance with prominent skin pores. If the constriction is not resolved, then chronic skin changes with hemosiderin deposits and venous stasis ulcers can develop. Dermatologic problems Common skin management issues include contact dermatitis, sebaceous cysts, scar management, and excessive sweating. The liner, socks, and suspension mechanism are the usual culprits for contact dermatitis. The socket is a less likely cause. Treatment is identification and removal of the offending item and symptomatic treatment with topical Benadryl or cortisone creams. Cysts and sweating can be a sign of excessive shear forces and components that are improperly fitted. Scar management is focused on massaging and lubricating the scar to obtain a well-healed result without dog ears or adhesions. The increase in energy requirements can be the limiting factor in ambulation. An individual who has a lower extremity amputation and requires a walker or crutches to ambulate uses 65% more energy than someone with a normal gait. Increased levels of energy consumption (percentage above normal) by amputation level are as follows: • • • •
Below knee unilateral amputation - 10-20% Below knee bilateral amputation - 20-40% Above knee unilateral amputation - 60-70% Above knee bilateral amputation - >200%
Energy consumption is actually less with a BKA than ambulating with crutches. However, ambulating with an AKA requires more energy, which makes the cardiopulmonary status of the patient more significant.
Caption: Picture 1. Lower limb prosthetics. Below knee endoskeletal prosthesis with patellar tendon bearing socket with Pelite liner, supracondylar cuff strap suspension, SACH foot (anterior view). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 2. Lower limb prosthetics. Below knee endoskeletal prosthesis with patellar tendon bearing socket with Pelite liner, supracondylar cuff strap suspension, SACH foot (oblique view). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 3. Lower limb prosthetics. Below knee endoskeletal prosthesis with patellar tendon bearing socket with Pelite liner, supracondylar cuff strap suspension, SACH foot (lateral view). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 4. Lower limb prosthetics. Left above knee prosthesis with ischial
containment socket, TES (total elastic suspension) belt, single axis knee with extension assist, endoskeletal components, energy storing foot (anterior view). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 5. Lower limb prosthetics. Left above knee prosthesis with ischial containment socket, TES (total elastic suspension) belt, single axis knee with extension assist, endoskeletal components, energy storing foot (lateral view with flexed knee). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 6. Lower limb prosthetics. Left above knee prosthesis with quadrilateral socket, hip joint and pelvic band suspension, endoskeletal components with cosmetic foam cover and hose, single axis knee, energy storing foot (close-up of socket and suspension system). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo
Caption: Picture 7. Lower limb prosthetics. Silicone gel locking liner (front view). View Full Size Image eMedicine Zoom View (Interactive!) Picture Type: Photo Caption: Picture 8. Lower limb prosthetics. Silicone gel locking liner (posterior view with turned down cuff to expose inner surface). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 9. Lower limb prosthetics. Silicone gel locking liner on below knee prosthesis model (lateral view - bulge would be patient's patella). View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 10. Lower limb prosthetics. Left to Right: SACH (single axis composite heel) foot, Seattle light foot (energy storing foot with Delrin keel), Carbon Copy II (energy storing foot with carbon keel).
View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo Caption: Picture 11. Lower limb prosthetics. Seattle Light Foot (energy storing foot with Delrin keel). Note space between 1st and 2nd toe, which allows patient to wear toe strap sandals. View Full Size Image
eMedicine Zoom View (Interactive!)
Picture Type: Photo •
• •
•
Colwell MO, Spires MC: Lower extremity prosthesis and rehabilitation. In: Grabois M, ed. Physical Medicine and Rehabilitation: The Complete Approach. 2000: 583-607. Glennon TP, Smith BS: Amputations. In: Garrison SJ, ed. Handbook of Physical Medicine and Rehabilitation Basics. 1995: 34-60. Leonard JA Jr, Meier RH III: Upper and lower extremity prosthetics. In: DeLisa JA, ed. Rehabilitation Medicine: Principles and Practice. 1998: 669-696. Tan JC: Prostheses. In: Practical Manual of Physical Medicine and Rehabilitation. 1998: 229-259.
