Patient Education on Use, Care and Maintenance of Orthosis

and Prosthesis

PST 327 – Prosthetics and OrthoticsMiss Adebayo O.E

Prosthetic components

• Socket

• Liner/interface (may be absent)

•Method of suspension

• Foot

•Knee mechanism (transfemoral)

Prosthetic component

•Prosthetic socket

•Must support the body weight and hold the residual limb firmly and comfortably

• Socket interface

• Stump socks – it is used to manage volume loss in the residual limb

Prosthetic component

•Gel liners – cushions and protects the residual limb, helps support the prosthesis.

•Pylons – a structure (metal pipe) that connect the socket to the prosthetic ankle/foot complex

Gel liners

Use of the prosthesis

•Prosthesis must be comfortable, functional and cosmetic

•Patients must learn proper prosthetic donning and correct feel of the prosthesis to avoid injury

•Before donning the socket interface and prosthesis, the residual limb must be clean and dry.

•Nothing should be applied to the skin before wearing the socket interface.

Donning the prosthesis

Gel liners

• This fits directly over the residual limb

• Patient dons the liner by rolling it down and fitting the distal end of the residual limb directly into the distal end of the liner.

• Patient then rolls the liner smoothly over the residual limb. The top of the liner should not be pulled.

• There should be no space distally between the end of the residual limb and end of liner.

Donning the prosthesis

Limb/stump socks

• Some patients use socks instead of gel liners

• Sock is applied similarly as the gel liner.

• Socks must be smooth and wrinkle free

•When the limb shrinks, ply of socks may be added.

Donning a Transtibial prosthesis

•Donned in sitting position

• If patient is using a suction prosthesis, patient stands after donning to expel any remaining air.

• If the patient is using the shuttle lock system. The pin is fitted carefully into the receptacle and then patient stands to push the limb well into the socket until the lock is heard to click into place.

Donning a Trans femoral prosthesis

•Patient dons the ischial containment socket

•Care must be taken to ensure that the socket is not rotated internally or externally

• Some trans-femoral prosthesis may be donned in sitting and some in standing.

Ambulation with prosthesis

•Patient initiates ambulation with the sound leg then the prosthesis follows

•When ascending a stair, patient leads with the good leg and the prosthesis follows

•When descending stairs, patient leads with the prosthesis and the good leg follows

Wearing schedule

• The wearing time of the prosthesis should be gradually increased

• If the wearing time is excessive, there is possibility of skin breakdown.

Wearing schedule Day 1 – 3 3 times a day for 30 minutes each session.

Sitting with intermittent standing

Day 4 – 6 3 times a day for 60 minutes each session. Sitting with intermittent standing

Day 7 – 9 4 times a day for 2 hours sitting with intermittent standing

Care of the stump (residual limb)

• The residual limb(stump) must be washed everyday.

• The limb should be thoroughly rinsed and dried to avoid leaving soap residue on the skin (this can cause skin irritation).

•Cream and lotion should be applied only at night to give time for absorption.

Care of the stump (residual limb)

• The skin should be free of lotion when wearing the prosthesis.

• The limb should be checked regularly to make sure there are no pressure points.

Prosthetic sock management

• Limbs may change in shape and size over the course of a day due to •Post-operative swelling•Muscle atrophy•Changes in weight• Temporary reduction of fluids in the body.

Prosthetic sock management

•When the limb shrinks, the shape of the socket remains the same. To accommodate for these changes prosthetic socks is worn.

• The thickness of the socks can be adjusted to eliminate fitting problems such as;• Socket becoming too loose – layers of sock is added•Pressure on the limb from tight sock – layers of sock is

removed

Prosthetic sock management

• Socks should always be clean and dry. Dirty socks harbour bacteria that can lead to skin rash and wet socks can cause skin maceration (softening and breaking down of skin resulting from prolonged exposure to moisture).

• Socks should be washed with mild soap and warm water.

Prosthetic sock management

•Patient may have to change socks during warm weather due to sweat and dirt.

• Socks should be rotated on at least a three to four day schedule to retain original position.

Care of the liner

• The liner should be washed at night to allow plenty of time to dry

•Gel liner should be placed flat or on a stand to dry

• The liner should not be thrust into the prosthetic socket overnight

Care of the prosthesis•Patients should be made to understand that a prosthesis is

not designed for:•Wet environment•Unusually high impact activities•Chemical environment that may alter structural

integrity of the prosthesis

• Therefore situations like these should be avoided

Care of the prosthesis

•Plastic socket should be washed with damp cloth and dried thoroughly

•When not in use, patients should lie the prosthesis flat

• The prosthesis should be checked daily for any mechanical problems or cracks.

Care of the prosthesis

• If there are unusual signs (visible, audible or functional) or excessive wear it should be inspected by a prosthetistas soon as possible.

•Patient should not attempt to repair prosthesis themselves

•Patients usually need new sockets within 1 – 2 years depending on level of activity

Precautions

•Patients should not wear the prosthesis when there are skin problems such as dermatitis, furuncles, cyst and infections

•Patient with vascular disease must be alert to pressure on the residual limb

•Patients with impaired sensations should always inspect their limbs. The relatives can also help in the inspection.

Complications of use of prosthesis

•Degenerative changes in the intact limb

•Osteopenia /osteoporosis in the residual limb

•Back pain (may be due to poor prosthetic fit, postural changes, leg-length discrepancy and general deconditioning)

Pre-orthotic prescription assessment

• Functional assessment which includes assessment of impairment•Musculoskeletal examination•Neurological examination• Integumentary examination•Cardiovascular examination•Psychological and cognitive screening.

Orthotic checkout• Aim is to examine the appliance prescribed if it is

acceptable for wear in terms of fit, function and comfort. Orthotic checkout entails:

• Examination of the orthosis off the client

• Examination of the orthosis on the client – static

• Examination of the orthosis on the client – dynamic

• Examination of the skin after sustained orthotic wear

Education of patients on use of orthosis

•Orthosis must be comfortable.

• There should be no excessive pressure on bony prominences;

•Padding or relief areas should be appropriately located

• Splint does not impede movement at joints that should be free to move normally

•All mechanical joints are properly aligned with the anatomical joint

Education of patients on use of orthosis

•Orthosis does not gap away from or migrate on the limb during movement

• Straps have appropriate adjustability and fit snuggly, without pinching or “digging into” the skin of the patient

• Splint does not impede circulation

• Straps should be properly located to maintain total contact between orthosis and limb

Education of patient use of the orthoses

•After the orthotic check out, patient can start using the orthosis.

•Patient should start with conservative wearing schedule till the patient gets accustomed to the device

•Patients should always inspect the skin for red marks around the bony areas, signs of impaired circulation (blanching or bluish coloration of the skin)

Education of patient use of the orthoses

•Patients wearing plastic orthosis may need to wear a thin sock between orthosis and skin (plastic causes excessive sweating for some people)

•Patients may need to use ambulatory aids

• The appliance must be applied correctly.

Education of patient care of the orthoses

•Plastic devices should be cleaned everyday with damp cloth. Mild soap can be used for soiled areas. If soap is used, the device should be rinsed thoroughly to avoid skin irritation.

•Device should be inspected daily for unusual wear, cracks, tears and other damage.

•Any usual noise may be an indication of potential problems or unsafe conditions

EDUCATION OF PATIENTS ON USE OF ORTHOSIS

• If a stockinette is worn under the orthosis, it should fit properly

• There should be no wrinkles when worn under the splint

• The patient has extra so that the stockinette can be laundered