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Prosthesis and orthotics

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Prosthesis and orthotics

  1. 1. PROSTHETICS AND ORTHOTICS
  2. 2. INTRODUCTION PROSTHESIS: IT’S A DEVICE DESIGNED TO REPLACE A MISSING PART OF THE BODY OR TO MAKE A PART OF THE BODY WORK BETTER. ORTHOSES: IT’S A DEVICE THAT SUPPORTS OR CORRECTS THE FUNCTION OF A LIMB OR THE TORSO
  3. 3. • SPECIFICATIONS FOR IDEAL PROSTHESIS/ORTHOTICS: 1. FUNCTION: a) MEET USERS NEED b) SIMPLE c) EASILY LEARNED d) DEPENDABLE 2.COMFORT: a) FITS WELL b) EASY TO PUT ON AND TAKE OFF c) LIGHT WEIGHT d) ADJUSTABLE.
  4. 4. 3.COSMESIS: LOOKS ,SMELLS,SOUNDS NORMAL EASILY CLEANED STAIN RESISTANT 4.FABRICATION: FAST,MODULAR READILY & WIDELY AVAILABLE
  5. 5. 5.ECONOMICS: AFFORDABLE COST EFFECTIVE.
  6. 6. MATERIAL USED: 1)METALS:STEEL,ALUMINIUM,ALLOYS OF TITANIUM 2)PLASTICS:THERMOPLASTICS & THERMOSETTING PLASTICS 3)WOOD 4)LEATHER 5)RUBBER 6)FABRIC
  7. 7. 1)METALS:  A)STEEL:USED IN – PROSTHETIC & ORTHOTIC JOINTS,METAL BANDS,CUFFS,SPRINGS,BEARINGS.   B)ALUMINIUM: UPPER EXTERIMITIES,PEDIATRIC,WHERE WT IS A MAJOR CONCERN  C)TITANIUM:HIGH COST
  8. 8. 2)PLASTICS: CAN BE MADE INTO COMPLEX ANATOMIC SHAPES A)THERMOPLASTICS: LOW TEMPERATURE THERMOPLASTICS:UPPER LIMB ORTHOTICS & TEMPORARY USE(# BRACE).HIGH TEMPERATURE PLASTICS B)THERMOSETTING:
  9. 9. WOOD:MAPLE & HICKORY-PROSTHETIC FOOT ,BASEWOOD,WILLOW,LINDEN FOR PROSTHETIC KNEES & SHINS LEATHER: VEG.TANNED COWHIDE- SUSPENSION STAPS,WAIST BELTS,SOCKET LINERS ,COVERINGS FOR ORTHOSES & PROSTHESES
  10. 10. FABRIC:WOOL, COTTON,SILK(NAT),SYNTHETIC- NYLON,OLEFIN,POLYESTER,RAYON,VINYL PROSTHESIS:USED FOR-WAIST BELTS,STRAPS,HARNESS,SOCKS WHICH KEEP SKIN DRY,CUSHIONING ORTOSES:CORSETS;BELTS,STOCKINGS RUBBER: SEALS IN HYDRAULIC & PNEUMATIC MECHANISMS –HEELS,BUMPERS IN PROSTHETIC FEET & SPECIAL FOOTWEAR
  11. 11. IMPORTANT CHARACTERISTICS OF P & O MATERIALS : 1)STRENGHT 2)DURABILITY 3)DENSITY 4)CORROSION RESISTANCE 5)EASE OF FABRICATION 6)COST & AVAILABILITY
  12. 12. PROSTHETICS • 1. UPPER LIMB: THE SHOULDER PROVIDES THE CENTRE OF RADIUS OF THE FUNCTIONAL SPHERE OF UPPER LIMB,THE ELBOW ACTS A CALIPER TO POSITION THE HAND. • MULTIPLE JOINT-SEGMENT ACTIVITIES ARE USUALLY DONE SIMULTANEOSLY,WHERE AS UPPER LIMB PROSTHESES PERFORM THESE TASKS SEQUENTIALLY,THUS LIMB SALVAGING IS MORE CRITICAL FOR UPPERLIMB.
  13. 13. • AFTER AMPUTATION PROSTHETIC FITTING SHOULD BE DONE AS SOON AS POSSIBLE,EVEN BEFORE COMPLETE WOUND HEALING HAS OCCURRED. • MYOELECTRIC PROSTHESES PROVIDE GOOD COSMESIS & ARE USED FOR SEDENTARY WORK. • BODYPOWERED PROSTHESIS ARE USED FOR HEAVY LABOUR.
  14. 14. WHEN RESIDUAL FOREARM IS SO SHORT: SUPRACONDYLAR SUSPENSION (MUNSTER SOCKET) AND STEP UP HINGES CAN BE USED TO AUGMENT FUNCTION. THE BEST FUNCTION WITH LEAST WEIGHT AT LOWEST COST IS PROVIDED BY HYBRID PROSTHETIC SYSTEMS –MYOELECTRIC+BODY POWERED+BODY DRIVEN.
  15. 15. WHEN THE LEVER ARM CAPACITY OF THE PROXIMAL TRANSHUMERAL OR SHOULDER DISARTICULATION AMPUTATIONS,LTD FUNCTION IS ACHIEVED – MANUAL UNIVERSAL SHOULDER JOINT POSITIONED BY THE OPPOSITE HAND,COMBINED WITH LIGHT WEIGHT HYBRID PROSTHETIC COMPONENTS.
  16. 16. LOWER LIMB PROSTHETICS: 1.PROSTHETIC KNEES: USED IN TRANSFEMORAL & KNEE DISARTICULATION PROSTHESES AND CHOSEN BASED ON PATIENT NEEDS,THEY PROVIDE CONTROLLED KNEE MOTION. ALIGNMENT STABILITY(POSITION OF PR. KNEE IN RELATION TO PATIENTS LINE OF WEIGHT BEARING:  POSTERIOR:STANCE CONTROL ;MAKES FLEXION DIFFICULT.
  17. 17. ANTERIOR:FLEXION IS EASY,CONTROL DIFFICULT SO, ONLY THE POLYCENTRIC KNEE TAKES ADVANTAGE- HAS A VARIABLE CENTRE OF ROTATION. SIX TYPES:B 1.POLYCENTRIC(4- BAR LINKAGE) 2.STANCE PHASE CONTROL 3.FLUID CONTROL 4.CONSTANT FRICTION 5.MANUAL LOCKING KNEE
  18. 18. 1.POLYCENTRIC KNEE: HAS A MOVING INSTANT CENTRE OF ROTATION,ITS RECOMMENDED FOR : a)PATIENTS WITH TRANSFEMORAL AMPUTATIONS b)PATIENTS WITH KNEE DISARTICULATIONS c)B/L AMPUTEES
  19. 19. 2.STANCE PHASE CONTROL(SAFE/WT.ACTIVATED): FUNCTIONS LIKE A CONSTANT –FRICTION KNEE DURING THE SWING PHASE ,FREEZES WHEN WT. IS APPLIED TO THE LIMB.ITS USED IN OLD PATIENTS,HIGH LEVEL AMPUTEES / USE ON UNEVEN TERRAIN
  20. 20. 3.FLUID CONTROL KNEE: 1. ALLOWS ADJUSTEMENT OF CADENCE RESPONSE BY CHANGING RESISTANCE TO KNEE FLEXION – PISTON MECHANISM.IT PREVENTS EXCESSIVE FLEXION & IS EXTENDED EARLIER IN THE GAIT CYCLE – FLUID GATE  USED-ACTIVE PATIENTS ;GREATER UTILITY & VARIABILITY @ EXPENSE OF MORE WEIGHT.
  21. 21. 4.CONSTANT FRICTION KNEE: DAMPEN KNEE SWING VIA SCREW/RUBBER PAD THAT APPLIES FRICTION TO THE KNEE BOLT. USED ON UNEVEN TERRAIN MOST COMMON KNEE USED IN CHILDHOOD PROSTHETICS DISADVANTAGE: ALLOWS ONLY SINGLE –SPEED WALKING & RELIES ON ALIGNMENT FOR STANCE PHASE
  22. 22. 5.VARIABLE FRICTION KNEE(CADENCE CONTROL): ALLOWS RESISTANCE TO KNEE FLEXION TO INCREASE – KNEE EXTENDS BY EMPLOYING A NUMBER OF STAGGERED FRICTION PADS.  ALLOWS WALKING @ DIFFERENT SPEEDS  NOT DURABLE,NOT AVAILABLE IN ENDOSKELETON
  23. 23. 6.MANUAL LOCKING KNEE: CONSISTS OF CFK HINGE WITH A POSITIVE LOCK IN EXTENSION THAT CAN BE UNLOCKED TO ALLOW FUNCTION SIMILAR TO CFK  LTD INDICATIONS:WEAK UNSTABLE PATIENTS,BEGINNERS,BLIND AMPUTEES
  24. 24. PROSTHETIC SHANKS:  STRUCTURAL LINK B/W TWO PROSTHETIC COMPONENTS  2 VARITIES –a) endoskeletal b)exoskeletal
  25. 25.  SUSPENSION SYSTEMS: MAINLY VIA SOCKET DESIGN & SUSPENSION SLEEVES  SOCKETS ARE DESIGNED :FUNCTON CONTROL& EVEN- PRESS. DISTRIBUTION ON AMP. STUMP A)TRANSTIBIAL SUSPENSION:  GEL- LINER SUSPENSION SYSTEMS WITH LOCKING PIN IS PREFERED.ALLOWS UNRESTICTED KNEE FLEXION  PROSTHETIC SLEEVES  SUPRACONDYLAR SUSPENSION(RESID.LIMB<5 CM)  SUPRACONDYLAR-SUPRAPATELLAR SUSPENSION
  26. 26. B)TRANSFEMORAL SUSPENSION:  VACCUUM SUSPENSION IS COMMONLY USED. STABLE BODY WT. IS NEEDED C)TRANSFEMORAL SOCKETS:  QUADILATERAL SOCKETS ARE USED,DIFFICULT TO KEEP FEMUR IN ADDUCTION  ISCHIAL CONTAINMENT SOCKETS – COMFORTABLE  ALLOWS 10°ADDUCTION & 5°FLEXION
  27. 27. D)TRANSTIBIAL SOCKETS: PATELLAR TENDON BEARING LOADS ALL AREAS OF RESIDUAL LIMB THAT ARE WT. TOLERANT(PAT.TENDON,MEDIAL TIB, FLARE,GASTROCNEMIUS,FIB SHAFT)
  28. 28. PROSTHETIC FEET: CLASSIFIED INTO FIVE CLASSES: 1)SINGLE AXIS FOOT 2)SACH FOOT 3)SAFE FOOT 4)MULTIP AXIAL FOOT 5)DYNAMIC RESPONSE FEET
  29. 29. 1)SINGLE AXIS FOOT: BASED ON ANKLE HINGE-DOSIFLEXION & PLANTARFLEXION LTS:POOR DURABILITY & COSMESIS,NO LATERAL MOVEMENT 2)SACHS FOOT(SOLID ANKLE CUSHIONED HEEL): • ADVANTAGES: a)MODERATE WEIGHT b)DURABILITY
  30. 30. C)NO MOVING COMPONENT d)MIN MAINTAINENCE e)GOOD SHOCK ABSORPTION DISAVANTAGES: a)LTD PLANTAR FLEXION & DORSIFLEXION ADJUSTABILITY b) HEEL CUSHION DETERIORATES OVERTIME C) MAY LOOSE ELASTICITY d)POOR SHOCK ABSORPTION FOR HIGH – OUTPUT ACTIVITIES
  31. 31. 3)SAFE FOOT(STATIONARY ATTACHMENT FLEXIBLE ENDOSKELETAL): PERMITS TRIPLANAR MOVT.& EASY ROLL-OVER LIGHT WEIGHT-OLDER PEOPLE 4)MULTIAXIAL FOOT: PROVIDE MORE ANKLE MOTION ENDOSKELETAL & EXOSKELETAL PROSTHESES ADVANTAGES:  A)ALLOWS MOTION IN ALL PLANES
  32. 32. B)REDUCES TORQUE ON RESIDUAL LIMB C)ADJUSTABILITY DISADVANTAGES: A)INCREASED WT B)INCREASED MAINTAINENCE C)DECREASED COSMESIS LESS STABILTY ON SMOOTH SURFACES
  33. 33. 5)FLEXIBLE KEEL DYNAMIC – RESPONSE FEET: INDICATED FOR PEOPLE – GAIT PATTERNS GENERATE ENOUGH ENERGY ELASTIC KEEL STRUCTURES- ABSORB ENERGY DURING MIDSTANCE & TERMINAL STANCE,RELEASE IT DURING PRESWING & INITIAL SWING DURABILITY OF MATERIAL IS NOT TESTED
  34. 34.  ORTHOSES:  STATIC/DYNAMIC/COMBINED  NAMED ACCORDING TO THE JOINTS THEY CONTROL & METHODS  THE FOLLOWING ARE USED: A)SHOES-DIABETIC SHOES:XTRA DEPTH,SACH HEELS:PARALYTIC FOOT,ROCKER SOLE:METATARSALGIA,HALLUX RIGIDUS & FOREFOOT PROBLEMS
  35. 35.  B)FOOT ORTHOSES:  THEY ARE USED TO: 1)ALIGN & SUPPORT 2)PREVENT,CORRECT/ACCOMODATED DEFORMITIES 3)IMPROVE FOOT FUNCTION  3 TYPES:RIGID,SOFT,SEMIRIGID  RIGID:FLEXIBLE DEFORMITIES  SOFT:FIXED DEFORMITIES
  36. 36. C)A.F.O: MOST COMMONLY USED TO CTRL ANKLE JOINT GOALS:ABSORPTION OF GROUND REACTION FORCES,PROTECTION OF FUSION SITES,PROTECTION OF MIDFOOT D)K.A.F.O: EXTENDS :UPPER THIGH – FOOT CONTROL UNSTABLE /PARALYSED KNEE JOINT PROVIDES MEDIOLATERAL STABILITY
  37. 37. E)H.K.A.F.O: PROVIDES HIP & PELVIC STABILITY RARELY USED USED IN CHILDREN WITH UPPER LUMBAR MYELOMENINGOCELE F)ELBOW ORTHOSES: HINGE ELBOW ORTHOSES-LIGAMENT INSTABILITIES DYNAMIC SPRING LOADED ORTHOSES- FLEXION/EXTENSION CONTRACTURE
  38. 38. G)W.H.O: USED FOR POSTOP CARE AFTER INJURY/RECONSTRUCTIVE SURGERY STATIC/DYNAMIC OPPONENS SPLINT-PREPOSITIONING THUMB LOWER CERVICAL QUADRIPLEGICS LT.FACTORS:WT & CUMBERSOMNESS
  39. 39. H)FRACTURE BRACES: TREATMENT OF ISOLATED # TIBIA & FIBULA PRE-FABRICATED:ANKLE#,ANKLE SPRAIN,HAND INJURIES I)PEDIATRIC ORTHOSES:  THE PAVLIK HARNESS – TREATMENT OF DEVELOPMENTAL DISLOCATION OF HIP USED IN PERTHES DISEASE
  40. 40. J)SPINE: 1)CERVICAL SPINE: NUMEROUS ORTHOSES ARE USED TO IMMOBILISE SPINE COLLARS,HALO VEST 2)THORACOLUMBAR: STABILISATION OF MECHANICAL BACKPAIN – INCREASING BODY CAVITY PRESSURE

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