advanced prosthetic knee rehabilitation · pneumatic, variable swing ! weather proof ! 2 modes !...
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Advanced Prosthetic Knee Rehabilitation
Carolyn A Hirons HCPC Registered & Chartered
Physiotherapist BACPAR Conference 2014
Objectives
l Gain familiarity with different prosthetic knee components
l Understand knee functions, including stance resistance (yield)
l Consider ‘advanced rehab’ l Demonstrate training
techniques
SIGAM E & F
EIndependent
Walks 50m or more without walking aids expect to improve confidence in adverse terrain or weather.
FNormal Normal or near normal walking
Disability Definition A Non-limb user Those who have abandoned the
use of an artificial limb or use only non-functioning prostheses
B Therapeutic Wear prostheses ONLY in the following circumstances; for transfer, to assist nursing, walking with the physical aid of another OR during therapy.
C Limited/restricted Walks up to 50m on even ground with or without walking aids; a=frame, b=2crutches/sticks, c=1crutch/stick, d=no walking aids.
D Impaired Walks 50m or more on level ground in good weather with walking aids; a= 2 sticks/crutches, b= 1stick/crutch.
E Independent Walks 50m or more without walking aids expect to improve confidence in adverse terrain or weather.
F Normal Normal or near normal walking
The purpose of a prosthesis is to replace a body part & its function
l Bones & Joints l Ligaments & tendons l Muscles l Sensation To support normal movement,
to allow function. Note – designed for this!!!
Muscles
l Control movement with gravity (lengthening)
l Hold a movement (static length)
l Generate movement & power against gravity (shortening)
l Respond to sensation l Sensory motor loop
Eccentric quadriceps action
Control movement with gravity (lengthening) Stance resistance for sitting, stair and ramp descent. Referred to as ‘yield’
Upright posture is imperative Essential for: l Central head position l Muscle recruitment l Balance reactions l Comfort & ease l Energy efficiency l Confidence Prosthetic alignment is crucial
Knee characteristics – what to consider?
l What controls stance (WB)? l What controls swing? l How does it switch between
the two? l Does it have stance flexion? Other: l Has it other functions? l How do you initiate these? l Can the user do it?
But…knees are like cars!
l User learns how to drive but not how the car works!
l Expensive sports car does not make you a good driver!
l Efficiency of a car depends on how you drive it!
l Poor tracking causes wear & tear!
l Lazy driving habits!
Mechanical knees with yield
l KX06 (Endolite) l 3R80 (Otto Bock) l Mauch Knee (Ӧssur) l VGK (Orthomobility) l Sensor (OrthoEurope) *Separate swing &
stance controls
KX06 (Endolite)
l Polycentric knee l Hydraulic cyclinder swing
& stance control l Swing only (hyperextend
knee, lift lever) l Can lock l Mode to cycling/run
3R80 (Otto Bock)
l Rotary hydraulic system for stance & swing
l Weight activated stance, responds to GRF, variable
l Unload to swing, variable speeds
Mauch Knee (Ӧssur)
l Single axis hydraulic cylinder
l Swing & stance control l Swing only (hyperextend
knee, lift lever) l Hyperextension moment to
disengage stance l Manual lock
VGK (Orthomobility)
l Adaptive fluidic joint l Third technology l Variable swing l Stumble recovery l Stance resistance
(yield) l Bike mode l Water resistant
Sensor (OrthoEurope)
l Weight activated hydraulic knee
l Downstairs leg over leg yield
l Stance lock l Electronic device records
activity (steps taken, distance walked
Microprocessor Controlled (MPC) knees with yield
l Orion (Endolite) l Plié (Freedom
Innovations) l Rheo knee III (Ӧssur) l C leg (Otto Bock) l Genium/X3 (Otto Bock) l Power knee II (Ӧssur)
Orion (Endolite) l Hydraulic stance,
drops off in swing l One speed yield l No stance flexion l Toe load stance
release l High stance
resistance if no battery but adjusts
Plié (Freedom Innovations) l Stance flexion l Variable swing phase l Water resistant l Stumble control l Can ‘run’ l Plié 3 – submersible &
robust
Rheo knee III (Ӧssur) l Default is free in NWB l Stance - weight activated l Magneto-rheological fluid l Release into swing: toe
load & pelvic rotation creates extension moment at knee
l Manual lock
Rheo Knee III (Össur)
l Stance resistance adjusts to weight
l More load, more resistance*
l Unload for swing on slopes & stairs (no extension moment required)
C leg (Otto Bock) l Default straight; unload or
with no battery or in sitting l Initiate swing via toe load l Not for sport but will ‘run’ l Care backwards as may
trigger swing phase!
C leg (Otto Bock)
l Constant hydraulic stance flexion resistance, initiate through heel load (sit, slope, stairs)
l Resistance does not adapt to different weight shoes or carrying luggage
Genium/X3 (Otto Bock)
l Stance resistance down stairs, initiate foot over step
l Weight activated stance l Position and weight
deactivated swing l Adjusts to weight changes
(shoes, bags) l X3 – water proof, run mode
Genium/X3 (Otto Bock)
l Intuitive stance – allows more normal posture (stand on flexed knee)
l Stance flexion pre set 4º l No concentric power but step
up or over on ‘locked’ flexed knee
l Safe backwards, no toe trigger l 5 extra modes, splash proof,
will ‘run’ l Straight when no power, can
alter
Power knee II (Ӧssur) l Position and weight activated l Concentric power in stance
• Climb a stair & slope • Rise/lower in sitting • Push through objects • Rest in knee flexion
l Uneven ground l ‘Off road’, unload sound leg l Will not ‘run’ l Two batteries a day required
Why are MPC knees the bees knees?
l Stable, responsive and forgiving
l Allow more normal posture l Allow more normal
movement pattern l Less compensations l Fewer falls l Increased confidence
So, what does the knee do -functions & features?
l Stance flexion resistance variability
l Stumble recovery l Stairs ascent l Water proof l Hobbies (run, bike) l Battery life l Noise l Size, build height
l Appearance l Battery empty l Additional modes l Weight of unit l Weight of user l Car charger l Power l Socket fit l Foot function
What can the user do? What does the user need?
Motor skills – co-ordination, flexibility, body control, endurance, stamina, fitness, athletic prowess and agility, proprioceptivity
Co-morbidities - contralateral limb, OA, other amputations and injury, pain, socket stability, suspension and comfort, residual limb condition
Lifestyle, goals, attitude, intelligence, technical interest, compliance, diligence, motivation, support network,
Confidence & fear of falling, commitment, time & ability to learn, personality, cosmetic requirements, previous prosthetic history and bad habits, expectations
Access to specialist physiotherapy?
‘Advanced’ Rehabilitation
l Lifting & carrying l Head turning l 360º turning l Eyes shut *Use Tinetti &
AmpPro as guide
‘Advanced’ rehabilitation? l Shopping centres
• Escalators • Stairs & slopes • Crowds
l Park - grass good for running & yield
l Chill factor e *Use ABC scale as guide
Fitness, exercise & running l Core stability:
mat, gym ball, Theraband
l Step box routine, with weights
l Trampet l Running drills l Boxing
Fitness, exercise & running
l Nordic walking l Fitness Initiative (gym) l Personal trainers &
buddies l AlterG treadmill &
balance plate l Cycling l Sports groups