clinical procedures in prosthetics

Part 1: Assessment for Prosthetic Use & Stump Management

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

Patient information Demographic data Diagnosis Subjective information Personal / Social history

Diabetes Heart condition High blood pressure Medications

Living Status Living conditions Profession Normal Daily activities Recreation activities

Anthropometric measurements Knee stability Shape of the stump Incision Skin Bones Subcutaneous tissue Sensation Phantom sensation / pain Condition of the remaining lower extremity

Length Measurements Girth Measurements

Cylindrical Conical Bulbous

Location Condition

◦ Inflammation? Open area? Scabbed area? Adhesions? Blisters?

Delicate Average Tough

Heavy Average Light

Light touch Dull / Sharp pain Visual skin inspection

Vascularity Sensation Skin ROM Muscle strength

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?

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?

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?

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?

Above-knee prosthetic users Does the knee remain flexed in sitting?

Does the patient experience pressure on the posterior thigh?

Are the forces appropriately distributed over the residual limb?◦ Discoloration◦ Skin breakdown

Groin area Distal end Suspension system Weight of the prosthesis Donning and doffing Fatigue

Ability of prosthesis to keep up with activities

Balance Transfers Ambulation

◦ Indoor ◦ Outdoor◦ Speed ◦ Stairs

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?

Ask if patient can do the task and if he can demonstrate

Safety issues

Confidence of patient in using the prosthesis

Resemblance to sound side Use of other assistive device Injuries acquired Other patient concerns

Other members of the prosthesis team

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.