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OBJECTIVES

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At the end of this chapter, all students are expected to:

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  1. Compare and contrast the major types of feet, knee joints, socket designs, and methods of suspension for transfemoral and transtibial prosthetic replacements.

  2. Describe the function of different classes of components in relation to normal function.

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Physical Therapy students are expected to:

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  1. Make recommendations for prosthetic components for a simulated client.

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CASE STUDIES

Our four clients are listed below.

Janice Simmons, a 63-year-old female with a transtibial amputation secondary to diabetic gangrene.

Richard Canto, a 20-year-old male with a transtibial amputation secondary to an explosion while on military duty.

John Adams, a 72-year-old male with a transfemoral amputation secondary to arteriosclerotic gangrene.

Linda Bean, a 10-year-old female with a transfemoral amputation secondary to bone cancer.

Case Study Activities
  1. Describe the biomechanics and alignment characteristics of the transtibial and the ischial containment transfemoral sockets.

    1. Differentiate between the quadrilateral and the ischial containment socket.

    2. Describe the major characteristics of variations on the ischial containment socket.

  2. Differentiate between different types of prosthetic feet by function.

  3. Differentiate functionally between different types of knee components.

  4. Reflect on the extent that a person's lifestyle affects prosthetic replacement and selection of components.

  5. What components would you select for each of the clients?

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GENERAL CONCEPTS

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Physical therapists may or may not be involved in recommending specific types of components depending on the setting; however, physical therapists must understand the function of different components to train the patient in their use. Technology has led to the development of ever more sophisticated and ever more functional components. The prosthetist is the most knowledgeable person in this area, and physical therapists should develop a good working relationship with all prosthetists in their community.

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PROSTHETIC PRESCRIPTION

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Any prosthesis needs to be comfortable, functional, and cosmetic, in that order. If the prosthesis is not comfortable, the client will not wear it; pain or discomfort can be the greatest impediment to successful prosthetic rehabilitation. The prosthesis must also be functional. It must allow the individual to perform desired activities that he or she would not be able to do without a prosthesis and do them with the lowest possible expenditure of energy. For most individuals, a well-fitting prosthesis will allow them to perform a greater range of mobility activities than they could on crutches or with a wheelchair. This may not be true for elderly individuals with transfemoral amputations or those with bilateral amputations. When the energy demands for prosthetic mobility are greater than for mobility without a prosthesis, the prosthesis is rarely worn. (See Chapter 7 for more details on energy demands.) Finally, the prosthesis must be as cosmetic as possible. The importance of cosmesis varies with each person and each situation. It is not uncommon for individuals to wear a prosthesis without cosmetic cover, preferring the better foot ...

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