Clinical Procedures in Prosthetics

1. Clinical Procedures in Prosthetics Part 1: Assessment for Prosthetic Use & Stump Management

2. Objectives • 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

3. What do youneed to know? Patient information • Demographic data • Diagnosis • Subjective information • Personal / Social history

4. Health Information • Diabetes • Heart condition • High blood pressure • Medications

5. Daily Living Information • Living Status • Living conditions • Profession • Normal Daily activities • Recreation activities

6. Residual Limb Assessment

7. Residual Limb Assessment • Anthropometric measurements • Knee stability • Shape of the stump • Incision • Skin • Bones • Subcutaneous tissue • Sensation • Phantom sensation / pain • Condition of the remaining lower extremity

8. Anthropometric measurements • Length Measurements • Girth Measurements

9. Shape of the stump • Cylindrical • Conical • Bulbous

10. Incision • Location • Condition • Inflammation? Open area? Scabbed area? Adhesions? Blisters?

11. Skin • Delicate • Average • Tough

12. Subcutaneous tissue • Heavy • Average • Light

13. Sensation • Light touch • Dull / Sharp pain • Visual skin inspection

14. Remaining Lower Extremity • Vascularity • Sensation • Skin • ROM • Muscle strength

15. Prosthesis Assessment

16. What are the questions that you need to answer? Below-knee prosthetic users • Is the prosthesis as prescribed? • 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?

17. What are the questions that you need to answer? Below-knee prosthetic users • Is the knee stable without feeling pushed into excessive flexion and extension? • Is suspension adequate? • Can the patient sit comfortably with the knee flexed 90deg and shoe flat on the floor?

18. What are the questions that you need to answer? Above-knee prosthetic users • Is the ischial tuberosity properly located within the socket? • Is adductor longus channel properly located in the socket? • Is the knee unit stable on weight bearing?

19. What are the questions that you need to answer? Above-knee prosthetic users • Is suspension adequate to minimize pistoning of the residual limb when prosthesis is raised off the floor • 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?

20. What are the questions that you need to answer? Above-knee prosthetic users • Does the knee remain flexed in sitting? • Does the patient experience pressure on the posterior thigh?

21. After the prosthesis is removed? • Are the forces appropriately distributed over the residual limb? • Discoloration • Skin breakdown

22. Comfort Assessment • Groin area • Distal end • Suspension system • Weight of the prosthesis • Donning and doffing • Fatigue

23. Activity Assessment • Ability of prosthesis to keep up with activities • Balance • Transfers • Ambulation • Indoor • Outdoor • Speed • Stairs

24. ADL Ax • 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?

25. Transfers and Mobility • Ask if patient can do the task and if he can demonstrate • Safety issues

26. Others • Confidence of patient in using the prosthesis • Resemblance to sound side • Use of other assistive device • Injuries acquired • Other patient concerns

27. Making referrals • Other members of the prosthesis team

28. References • 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.