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OBJECTIVES

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

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  1. Diagnose problems that may lead to patient complaints of pain or dysfunction when using a prosthetic or orthotic device.

  2. Analyze the gait of individuals using a prosthesis or orthosis to determine possible biomechanical or neuromuscular abnormalities.

  3. Differentiate between problems caused by

    1. The appliance

    2. Patient impairment

    3. Use of the appliance

  4. Select appropriate interventions to reduce pain and improve function.

    1. Appropriately refer patients to the prosthetist or orthotist.

  5. Implement a plan of care as needed for remediation.

    1. Determine the effect of wearing a prosthesis or orthosis on other parts of the body.

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Physical Therapist Assistant students are expected to:

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  1. Evaluate patient responses or statements regarding prosthetic or orthotic wear to

    1. Appropriately inform the physical therapist regarding the patient's status and needs.

    2. Differentiate between critical and noncritical problems and respond appropriately.

    3. Implement a remediation program as developed by the physical therapist.

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CASE STUDIES

Betty Lukas, a 50-year-old teacher for the deaf, has Charcot-Marie-Tooth disease. She developed equinovarus deformities at both ankles that caused pressure ulcers on the plantar surfaces of both fifth metatarsal heads. The ulcers were treated and are healed. To prevent reulceration, she underwent bilateral Achilles tendon lengthening and was fit with bilateral ankle–foot orthoses (AFO) to stabilize her ankles during gait and prevent the development of fixed equinovarus deformities. She has been wearing the orthoses for 3 months. She returns stating that she is having difficulty going up and down steps and getting up from a low chair. She also states that she has pain in her knees when she walks longer distances which she did not have before she received the orthoses. She states that her gait is stiff and awkward. She is basically unhappy with the appliances.

Harry Green, a 67-year-old man, suffered a cerebral vascular accident causing a right hemiplegia (see Chapter 2 for details). He was discharged from rehabilitation one year ago using a floor reaction AFO to facilitate knee extension and a single-point cane. He has been living independently in his home with support from members of his extended family, church, and community agencies. He is happy with his functional abilities and uses his orthosis to walk around his home, the local senior center, as well as for short distances within his community. He has not experienced any falls and is confident in his walking. However, over the last month he has developed right posterior knee pain that gets worse when he walks longer distances or is on his feet for longer periods of time and is relieved with rest. Harry is afraid this knee pain will cause him to fall or restrict his ability to maintain his independence. His doctor diagnosed mild tibiofemoral osteoarthritis and suggested that he take acetaminophen to relieve pain and that he work with his orthotist and therapist to determine if his orthosis or his gait pattern can ...

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