prosthesis after amputation mabi
DESCRIPTION
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Prosthesis After Limb Amputation
Alit PawanaPhysical Medicine and Rehabilitation Department
Airlangga University - Dr. Soetomo Hospital
Amputation
Wrist Disarticulation (Melanoma maligna)Above Knee Amputation (Maligna Fibrous histioma)Below Knee Amputation (Chondrosarcoma)
LevelBelow Elbow 4
Partial Hand 3
Wrist Disarticulation 1
Above knee 1
Below knee 9
Syme 1
Transmetatarsal 1
CausalTraumatic 11
Vascular 7
Malignancy 3
Rehabilitation OPC RSUD Dr. Soetomo (July 2014 – July 2015)
Total : 21 (M=19, F =3)
Upper limb amputation
• Average 5000–10,000 upper limb amputation / year• Often caused by traumatic, cancer and vascular
disease• Most amputation level : transradial (57%) &
transhumeral (23%)• Age : 60% (21 - 64 yo), 10% (< 21 yo)• Ratio UL: LL = 1 : 4.9
Lower limb amputation
• Every years about 159,000 LL amputation in US• 7 % amputation associate with diabetic• Level amputation LL :– hip disarticulation (0,4%),– transfemoral (25,8%), – knee disarticulation (0,4), – transtibial (27,6%), – ankle disarticulation (0,8%), – midfoot (10,5%), – toes (31,5%)
Amputation in tumors
Phase Hallmark
Preoperative Asses body condition, patient education, surgical level discussion, postoperative prosthetic plan
Amputation Surgery & Reconstruction
Length, myoplastic closure, soft tissue coverage, nerve handling, rigid dressing
Acute Post Surgical Wound healing, pain control, proximal body motion, emotional support
Pre-Prosthetic Shaping, shrinking, increase muscle strength, restoration of patient locus control.
Prosthetic Prescription Team consensus on prosthetic prescription and fabrication
Prosthetic Training Increase prosthesis wear and functional use
Community Integration Resume family roles & community activities. Emotional equilibrium & healthy coping strategies. Recreational activities
Vocational Rehabilitation Asses & plan vocational activities for future. May need further training and job modification
Follow-Up Lifelong prosthetic, functional, medical assessment & emotional support
Phase of Amputee Rehabilitation
Levels of amputation upper limb
1. Transphalangeal2. Transmetacarpal3. Transcarpal4. Wrist disarticulation5. Transradial6. Elbow disarticulation7. Transhumeral 8. Shoulder disarticulation9. Forequarter amputation
Partial hand
Levels of amputation upper limb
• Partial toe • Toe disarticulation • Partial foot/ray resection • Transmetatarsal amputation (TMA)• Lisfranc• Chopart• Syme’s
Levels of amputation lower limb
• Transtibial• Knee disarticulation• Transfemoral• Hip disarticulation• Hemipelvectomy • Hemicorporectomy
Levels of amputation lower limb
Levels of amputation lower limb
Prosthesis
• An artificial substitute for a missing body part
• Medical considerations decision for a prosthesis:1. Determination of amputation level2. Careful assessment of bilateral proximal muscle strength
and ROM is critical when planning for prosthetic control mechanisms
3. Evaluation of general health
• Cognitive impairment and other neurologic problems can be a major roadblock to prosthetic training.
Energy Expenditure of Different Levels of Amputation
Energy Expenditure of Traumatic Amputees
Lower Limb Prosthesis
• Parts :– Suspension– Socket– Hip Joint– Knee unit– Shank (Tibia part/ femoral part)– Ankle foot assembly
Transfemoral Amputee Prosthetic Options.
Below Knee Prosthesis
Above Knee Prosthesis
Hip Disarticulation Prosthesis
Below knee prosthesis
PTB Socket
Exoskeleton shank
Ankle foot assembly
Energy Storing Single axis
Bilateral Below knee prosthesis (energy storing ankle foot)
Above knee prosthesis
MicrocontrollerKnee joint
Multiple axisKnee joint
Ground reaction force on standing balance test
Post above knee amputation ec osteosarcoma
Above knee prosthesis
Robotic above knee prosthesisOld above knee prosthesis
Post Hip Disarticulation ec Osteosarcoma
Hip Disarticulation Prosthesis
Hip Disarticulation Prosthesis
Upper Limb Prosthesis
• Cosmetics / pasif prosthesis
• Functional prosthesis– Parts :• Terminal Device• Shank• Socket• Elbow Unit• Shoulder Unit• Suspension
Terminal devices (TD):1. Passive Terminal device2. Body-powered terminal
devices (hooks or hands)3. Externally powered
(electric-powered)
Partial hand prosthesis functional(external powered)
Below elbow prosthesis functional (Body and external powered)
Above elbow prosthesis functional (Body powered)
Shoulder disarticulation prosthesis functional
(Body powered)
Above elbow prosthesis hybrid (body and
external powered)
Above elbow prosthesis functional(external powered)
Shoulder disarticulation prosthesis functional (external powered)
Myoelectric external powered schema for shoulder disarticulation prosthesis
External powered upper limb prosthesis
Conclusion
• Elective surgery for tumor amputation will provide comprehensive amputee rehabilitation to reach functional ability
• Prosthesis component after amputation caused by tumor, traumatic or vascular are the same
• Prosthesis prescription is depend on functional need of amputee patient in the level of their activities.
Thank You