LECTURE # 4

PROSTHESIS
Dr. SHOAIB KAYANI (PT)
DPT (King Edward Medical University)
MS-OMPT (Riphah International University)
PGC Neurology . PGD Ortho Rehab
 WHAT IS A PROSTHESIS?
• A prosthesis is an artificial device attached or applied to the body to
replace a missing part.
• Orthotist/Prosthetists are qualified in the provision of a full range of
external prostheses for the lower and upper limb, which are individually
prescribed, designed, manufactured and fitted to restore the function
and cosmesis of an amputated limb after a full and thorough client
assessment.
• Due to modern advances in prosthetic technology, prostheses are
becoming lighter, stronger and more naturally functioning.
• Technological advances include the ‘energy storing foot' and the 'myo-
electric' (bionic) hand.
• The myoelectric prosthesis have sensors able to acquire muscle
signals from a electromyography devices, in which the signal is
processed, features are extracted, and classified to be transformed
in movements.
 WHAT IS THE DIFFERENCE BETWEEN
A CUSTOM-MADE AND
PREFABRICATED ORTHOSIS?
• A Prefabricated orthosis is a device which is pre-made and is
subsequently customised to meet the specific needs of the client.
• Often prescribed for short term use .
• A variety of health practitioners are involved in fitting a small range of
prefabricated orthoses, however orthotist/prosthetists are the only health
professionals qualified to fit orthoses to the entire body.
• All pre-fabricated orthoses should be modified and customised to fit the
client
• Ensure the treatment goals are met
• Best functional outcome obtained.
 ---CUSTOM MADE
• A custom-made orthosis is a highly specialised device that is
manufactured from a cast or mould of the individual client.
• It is not able to be fitted to another person, as it has been designed and
manufactured to meet the specific needs of the individual.
• Selected health practitioners provide custom made orthoses for either the
foot or the upper limb
• Only orthotist/prosthetists are qualified to fit custom made orthoses for the
entire body.
• A clinical assessment and consultation by an orthotist/prosthetist will
ensure that entire body or limb segment is assessed and the full range of
orthotic treatment options considered.
 ABOVE KNEE PROSTHESIS

• A prosthesis utilized for acquired

amputations or congenital absences
of the foot, ankle, shin and thigh,
above the knee. joint level
 ABOVE KNEE
PROSTHESES AND
COMPONENTS
• Conventional construction (wooden /
plastic)
• Foot-ankle assembly
• Shank
• Knee assembly
• Thigh piece
• Socket
• Suspension device
 MODULAR
CONSTRUCTION
• Socket attachment block
• Socket adaptor
• Thigh tube
• Knee joint
• Shank tube
• Foot adaptor
• Foot
• Foam cover cosmetic
 IMPORTANT ASPECT OF
PROSTHETIC TRAINING
• Applying prosthesis correctly
• Balancing , alignment and pressure distribution
• Walking on level surfaces
• Sitting and rising from chair
• Picking up object from floor
• Self protection in falling
 PROSTHETIC KNEE
STABILITY
Stability of the Prosthetic knee for weight bearing may be
accomplished by one or more of the following method :
1.The amputation stump may hold the knee stable at heel strike
and during standing by exerting a backward force within the
socket.
2.The prosthesis may be aligned so that the knee axis is placed
posterior to the weight line .
3.By locking mechanism .
 SOCKET
• Made of plastic or wood
• Classified according to the shape of the interior of the proximal
portion and the design of the distal end
• May be :
Plug fit socket
Quadrilateral socket
Total contact
Non-total contact
 PLUG FIT SOCKET
• Conically shaped interior, especially the same shape as stump.
• Amputee’s weight borne chiefly on the peripheral musculature of the thigh stump.
• Such design does not permit the remaining musculature to perform to its full
capabilities, resulting in atrophy of limb
 QUADRILATERAL
• Proximal shape is approx. quadrangular.
BRIM
Advantages :
• Aid venous return and help prevent edema, and dermatological problems.
• Increase the available area to support body weight
• Provide some increased sensory feed-back, which help the amputee to
control his prosthesis.
 TOTAL CONTACT SOCKET
In this type of the socket the entire surface of the stump, including the
distal end is in contact with the socket .
 NON-TOTAL CONTACT

• In this socket there is an empty space below

the end of the stump.
• The space or chamber, may have an opening
permitting free movement of air in and out
of the socket.
 PROSTHESIS MAINTENANCE
• Cleaning the socket
• Keep the spring in the valve tight by screwing it .
• Adjustment of the friction mechanism is needed when the shank swings
through too rapidly or too slowly .
• Care of the ankle and foot frequently by removing the shoe.
• If the covering is torn , have it repaired immediately
• If the foot gets wet at any time , remove the shoe and dry the foot as soon
as possible.
• Care of the leather by keep it clean and dry
• Return the limb to the Prosthetist at regular intervals to check on wear
and breakdown of parts.
 PROSTHESIS ALIGNMENT
• The relative position of the socket with respect to the knee axis, shank and
the foot, that influence the direction of the forces on the stump.
 BENCH ALIGNMENT
• It is the term used to denote the geometric relationship in which the
plastic socket, an artificial foot properly fitted in the patient’s shoe and
the above-knee adjustable leg are initially attached to each other.
• As it produce direct effect on the function , so all parts must be placed in
such a way as to provide stability and comfort to the patient
• Used less energy consumption in walking.
• Produce a gait pattern close to normal.
 STATIC ALIGNMENT
• The purpose of the static alignment (standing) is to check the fit and
comfort of the socket
 DYNAMIC ALIGNMENT

• Dynamic (walking ) alignment adds the further considerations of gait

symmetry, conservation of energy and safety or stability
• Alteration of the socket contours, as well as changes in a relationships of
components, may be require during the alignment process
 THROUGH KNEE PROSTHESIS

• A prosthesis utilized for acquired

amputations or congenital absences
of the foot, ankle and shin at the knee
joint level.
 DIFFERENCE B/W KNEE
DISARTICULATION & ABOVE KNEE
AMPUTATION
stump Knee disarticulation Above-knee amputation

Thigh muscles preserved Partially preserved

Bony outgrowth impossible possible

Lever arm long short

Shape bulbous conic

End bearing total Non or partial

Ischeal bearing none total

Hip joint range of motion free limited

 DIFFERENCE B/W KNEE DISARTICULATION &
ABOVE KNEE AMPUTATION
Prosthesis Knee disarticulation Above-knee amputation

Socket contact Total Partial or total

Socket quality soft Rigid
Belt suspension None Frequent
Ischeal seat None Compulsory
Skin hygiene Good Poor
Knee design:
friction unit
swing phase control Available Available

lock
Modular / conventional Available Available

cosmesis Satisfactory Satisfactory