Prosthesis and orthotics

1. PROSTHETICS AND
ORTHOTICS

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. •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. 3.COSMESIS:
LOOKS ,SMELLS,SOUNDS NORMAL
EASILY CLEANED
STAIN RESISTANT
4.FABRICATION:
FAST,MODULAR
READILY & WIDELY AVAILABLE

5. 5.ECONOMICS:
AFFORDABLE
COST EFFECTIVE.

6. MATERIAL USED:
1)METALS:STEEL,ALUMINIUM,ALLOYS OF
TITANIUM
2)PLASTICS:THERMOPLASTICS &
THERMOSETTING PLASTICS
3)WOOD
4)LEATHER
5)RUBBER
6)FABRIC

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. 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. 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. 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. IMPORTANT CHARACTERISTICS OF P & O
MATERIALS :
1)STRENGHT
2)DURABILITY
3)DENSITY
4)CORROSION RESISTANCE
5)EASE OF FABRICATION
6)COST & AVAILABILITY

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. •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. 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.

16. 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.

17. 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.

18. 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
6.VARIABLE FRICTION

19. 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

20. 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

21. 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.

23. 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

25. 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

27. 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

29. PROSTHETIC SHANKS:
 STRUCTURAL LINK B/W TWO PROSTHETIC
COMPONENTS
2 VARITIES –a) endoskeletal
b)exoskeletal

30. 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

32. 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

34. D)TRANSTIBIAL SOCKETS:
PATELLAR TENDON
BEARING LOADS ALL AREAS OF RESIDUAL
LIMB THAT ARE WT.
TOLERANT(PAT.TENDON,MEDIAL TIB,
FLARE,GASTROCNEMIUS,FIB SHAFT)

35. PROSTHETIC FEET:
CLASSIFIED INTO FIVE CLASSES:
1)SINGLE AXIS FOOT
2)SACH FOOT
3)SAFE FOOT
4)MULTIP AXIAL FOOT
5)DYNAMIC RESPONSE FEET

36. 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

37. 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

38. 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

39. B)REDUCES TORQUE ON RESIDUAL LIMB
C)ADJUSTABILITY
DISADVANTAGES:
A)INCREASED WT
B)INCREASED MAINTAINENCE
C)DECREASED COSMESIS
LESS STABILTY ON SMOOTH SURFACES

40. 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

42. 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

43. 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

45. 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

47. 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

49. 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

50. 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

51. 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