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Clinical Procedures in Prosthetics. Part 1: Assessment for Prosthetic Use & Stump Management. Objectives. 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. - PowerPoint PPT Presentation
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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.