prosthetics and orthotics video

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Sunday, December 12, 2010

From the orthopaedic dictionary!

Delbet walking cast:

A protective plaster device applied either during traction or at a later point in the fracture healing process.This cast is used in tibia fracture to allow weight bearing as well as knee and ankle motion. It is made of a series of overlapping plaster splints molded for weight bearing on the tibial condyles.

Friday, November 26, 2010

Transfermoral sockets in different view.


Flexible socket anterior view.

Ischial containment socket(POSITIVE Socket) in Transverse view.



Quadralateral socket(left) and Ischial containment socket(right) in Posterior view.





Quadralateral socket in transverse view.












Ischial containment socket(Transverse view)

Tuesday, October 26, 2010

Club Foot deformity.

FAB-Foot Abucted Brace

FAB is one of the method of treating CLUB foot
Club foot deformity: Is a birth defect that causes a new born baby's feet to point down and inward,this deformity doesnot cause pain but it can cause long term problems,affecting the child's abilit to walk.If club foot is properly treated the deformity can often be cured in early child hood.

the causes of club foot is not well understood ,it be associated with other congenital malformatio ns such as spina bifida,arthrogryposis etc.


Its features:

-forefoot adduction

-Hindfoot in varus and equinus

-Medial edges in cavus

Its treatment:

by serial manipulation with POP ,this should be immediately after born up to six months.

-followed by soft tissue release and POP in corrected position and Splint application (up to 3 years)

-4 years to 10 years -Soft tissue release and talectomy +CLUB FOOT SPLINT.

-after 10 years-Triple arthrodesis.

Thursday, September 30, 2010

The biggest T.F socket !!!!

To get a proper fitting the highly skills in P&O is needed.
It might be one of the biggest T.F Socket in the world.You can put it in your records.

Tuesday, September 21, 2010

OrthoProsthesis

Ortho Prosthesis side view.


Ortho Prosthesis anterior view.

Monday, August 16, 2010

From Orthopaedic dictionary!

Fiberglass cast:
An Immobilizing bandage made ofvself curing plastics.These casts are lightweight,long wearing and radiolucent as compared with plaster of paris.


Plaster Cast:
An Immobilizing circumferential bandage made from plaster-of -paris.

Tuesday, August 3, 2010

Diabetes Mellitus!

Transtibial stump as a result of diabetes
Diabetes i can say is a second main causes of amputation in Tanzania,after trauma,i hope even in your area diabetes is a problem but what differ is in which degree!.For that reason let us share this knowledge about diabetes
Diabetes mellitus.

This is a disease caused by deficiency or absence of insulin or rarely to impairment of insulin activity (insulin resistance) causing varying degrees of disruption of carbohydrate and fat metabolism.

Diabetes is a serious disease that affects your body‘s ability to change food into energy. Insulin helps you get energy from food .Some of the food you eat turns into a sugar called glucose. Glucose travels around your body in the blood. Your body stores glucose in cells to use for the energy. Insulin is the keys that open the door to the cells. In type 2 diabetes, your body does not make enough insulin, or has trouble using the insulin, or both. When you don’t have enough insulin or it doesn’t work right, the glucose stays in your blood .Over time, glucose will build up in your blood and spill into your urine. This can hurt your eyes, kidneys, nerves,heart, and blood vessels.

Insulin is made by the cells in the pancreas called beta cells. When you eat and at other time over the day, the pancreas releases insulin into the blood to take care of rises in glucose. If the beta cells die, insulin is no longer made. This is what happens in people with type 1 diabetes .This is why they must inject insulin to live, while a person with type 2 diabetes might inject insulin but does not depend on it to live.

Types 2 diabetes usually comes on slowly. may have only mild symptoms or not notice any symptoms at all for years. Some common symptoms are constant thirst ,constant hunger, frequent urination ,blurred vision, and fatique.You may also experience tingling ,numbness, or pain in her/his hands or feet; dry ,itchy skin; and infections of the skin ,gums, bladder , or vagina that keep coming back or heel slowly.

RISK FACTORS;
You are more likely to have type 2diabetes if you
- have relative with diabetes
- Are over weight
- Are at least 45 years old
- Have impaired glucose tolerance
- Have a high blood pressure or high blood fats
- Had gestational diabetes or delivered a baby weighing over 9 pounds.

WHAT CAN YOU DO ABOUT TYPE 2 DIABETES?
How ever there is no cure for diabetes. Your health care provider can not give you any thing to make it go away. It is a chronic disease, but there things you can do to treat it yourself
(i)Health eating
(ii)Exercise is the best treatment for type 2 diabetes

Every one with diabetes find it is easier to control if they eat healthy meals and exercise daily.
Certain food rise your blood glucose .How much a food rises your blood glucose is based on type of food ,how it is prepared ,how much you it of it, when you eat it, and what you eat along with it. You can find out how the foods you eat affect your blood glucose level by testing your blood glucose after eating.
Exercise lowers your blood glucose level by using some of the glucose in your blood. It also helps your muscles use insulin better, so even more glucose is removed from the blood. When you add exercise such as 20 minutes walk ,to your daily schedule, you may lose weight too since loosing as little as 10 pounds can help some people get their blood glucose level back to normal.
But if health eating and exercise do not bring your blood glucose levels down to where you want to be, you may need diabetes pills. Diabetes pills are drugs that lower blood glucose levels, they are not insulin. If healthy food, exercise, and diabetes pills do not lower your blood glucose, you may need to take insulin

HOW CAN YOU FIND OUT IF YOUR TREATMENT ARE WORKING?
(i) Self monitor your blood glucose levels
(ii) Have regular medical check ups
With a blood glucose meter ,you can check your blood glucose level at any time of the day and see what affect the food you ate, or exercise you did, had on your on your blood glucose level. This helps you make decisions-what to eat, when to exercise or how much medications to take in order to control your blood glucose level. This knowledge can give you more flexibility in your day to day activities, also will help you to predict what your blood glucose level will do ,you can change your schedule around –eat at later time, exercise more than usual and still keep your blood glucose levels under control.

By using a blood glucose meter ,you don’t have to wait until you go to your health care provider to know how you are doing .Still your health care provider is important. Only your health care provider will check your over all health to assess how your treatments are working .Having a physical exam at least once a year gives your health care provider a better chance of finding any potential problems.

WHY DOES DIABETES CONTROL MAKE SENSE?
Untreated type 2 diabetes can lead to serious diseases of the heart, blood vessels ,nerves, kidneys, and eyes.
These diseases are called diabetes complications .You may have had diabetes for years and not even known about it. During that time, high blood glucose levels may have may have been damaging these parts of your body. that is why is important for you to take control of diabetes as soon as you are diagnosed. You can do something to prevent or postpone diabetes complications. Bringing your blood glucose levels closer to normal will stop or slow the damage to your eyes ,nerves, and kidneys

HOW TO CARE FOR YOUR DIABETES?
-eat health food
-Control your health
-Stay physically active.
-Take diabetes pills or insulin, if needed
-test your blood glucose
-Get regular checkups.

HOW CAN YOU PROTECT YOUR FAMILY FROM TYPE 2 DIABETES?
Because you have diabetes, your children, siblings,or parents may be at risk for developing it,too.There are ways to help protect them:
-Share your health eating plan with your family; prepare family meal that every one can enjoy.
-Involve your family in your education; encourage them to visit your diabetes care provider, dietitian, and other health care team members with you.
-Make sure your family member have regular checkups with a health care provider experienced in diabetes. There are tests that can detect markers for diabetes before it develops.
-Ask your family members to be your exercise partners. Set goals together, and help keep each other motivated.

HOW DO YOU LIVE WITH DIABETES?

At first, you will need sometime to absorb all the information your health care providers give you. You may feel overwhelmed by all you must do and remember. You may feel sad about the loss of your good heath. You may feel angry because you have to make changes to the way you live. You may feel afraid of having a low blood glucose reaction, having to give yourself shots, or the thought of future complications. These and other strong emotions are all parts of living with chronic diseases.
Knowing these emotions are part of the disease may help you recognize them more quickly when they appear. This may help you to accept your anger, your fear, or your resentment. Seeking support from your family, friends, or a mental health professional may help.
Hopefully, you will come to accept your diabetes. Just realize that even after you have accepted it, you wont always want to follow a healthy meal plan and exercise. Some days will be easier than others. But that is okay, just do the best you can at the moment, and start fresh each day

FOOT CARE.

People with diabetes can get many kinds of foot problems, even minor ones can quickly turn into serious ones. This can lead to an amputation since the feet can develop a gangrene

Corns and Calluses
Calluses are areas of thick skin caused by regular or pronged pressure or friction
Corns are callus on a toe. Corns and calluses can develop on your feet when your body weight is borne unevenly. There are several things you can do to prevent calluses from forming.



Wear shoes that fits
Shoes that fits are comfortable when you buy them. Almost all new shoes are little stiff at the start and mold to your feet with wear, but this is different from buying the wrong size and trying to break them in. Make sure there is room for you to move your toes.

Wear shoes with low heels and thick soles.
Thick soles will cushion and protect your feet. Low heels distribute your weight more evenly.

Try padded socks
They not only cushion and protect feet but also reduce pressure. Be sure your shoe is large enough to fit this thicker sock. You may need extra –deep shoes.

Try shoes inserts
Ask your diabetes care provider or foot doctor about shoe inserts to better distribute your weight onto your feet.

If you get a callus or corn, have it trimmed by your diabetes care provider or foot doctor .Trying to cut corns or callus yourself can lead to infections .Trying to remove them with over-the counter chemicals can burn your skin .Untrimmed calluses can get very thick ,breakdown and turn into ulcers are not something you want.

Foot Ulcers
Foot ulcers are open sores or holes in the skin. Ulcers form most often over the ball of the foot or on the bottom of the big toe .Ulcers can be caused by a cut, callus or blister that is not taken care of .Ulcers on the sides of a foot are usually caused by shoes that don’t fit well. You can prevent ulcers by.

-Wearing shoes that fit.
-Wearing new shoes for just a few hours at a time.
-Throwing away worn-out shoes and sneakers.
-Wearing socks that fit
-Wearing socks without seams,holes,or bumpy areas in the
-Putting on clean socks each day
-Pulling or rolling your socks on gently
-Checking for pebbles or other objects before you put on your shoes.

An ulcer can be very painful. But if you have nerve damage you may not feel it. Even though you may not feel any pain from the ulcer, you need to get a medical attention right away. Walking on an ulcer can cause it to become larger and infected, an infected ulcer can lead to gangrene and amputation.

Poor Circulation
Poor circulation can make your feet feel cold and look blue or swollen .The best way to treat cold feet is to wear warm socks, even to bed .Do not use hot water bottles, heating pads, or electric blankets. They may burn your feet without you noticing .Keep your feet out of water that is too hot. Test it first with your elbow .If your feet are swollen, try lace-up shoes. You can tighten or loosen them to fit the shape of your feet.
To increase blood flow to your feet, start exercising (with your health provider’s approval). Avoid sitting with your legs crossed, which can interfere with blood flow .If you smoke, stop now, smoking limits blood flow to your feet.

Nerve Damage (Neuropathy)
Nerve damage can make your feet less able to feel pain, heat, and cold. If you have lost some of the feeling in your feet, don’t go barefoot. You could hurt your and not notice it. Check your shoes before you put them on. Make sure there are no stones, nailspaper clips,pins,or other sharp objects in them. Be sure the inside of the shoe is smooth and free of tears or rough edges.
Nerve damage can affect the nerves that cause sweating. As a result, your feet may become dry and scaly and the skin may peel and crack. If your feet have become dry and scaly, use a moisturizer twice a day. But don’t put the moisturizer between your toes, because the extra moisture can lead to infection. And don’t soak your feet, soaking dries out your skin..
Nerve damage can also deform your feet. Your toes may curl up, the ball of your foot may stick out more, and your arch may get higher. These changes can cause some parts of your feet to bear more weight. Those areas are then more likely to get calluses and corns. If the shape of your feet has changed, ask your diabetes care provider or foot doctor about shoe inserts or special shoes.

How to Care for your Feet
Check both of your feet each day. Look all over them. If you can not see well, have a friend or relative who can see well do it for you. Compare one foot to the other. Use a mirror to help see the bottom of your feet. Look for cuts, blisters, scratches, ingrown toenails, changes in color, changes in shape,punctures,anything that wasn’t there the day before.

Keep your feet clean,
Wash and dry them well, don’t forget to dry between your toes.

Keep your toenails trimmed
Trim your toenails to follow the curve of your toe. If you cant trim them yourself, have a member of your healthy care team to do it.

Have your feet checked regularly.
Take your shoes and socks off at every regular office visit to remind your health care provider to check your feet. Have your diabetes care provider check your feet for blood vessel, muscle, and nerve damage at least once a year.

Keep your blood glucose in control.
If blood glucose levels are high, you are more likely to get food problems

Keep you diabetes care provider informed
Call your provider if you have a foot problem, no matter how minor.
Source;ADA


Friday, May 14, 2010

Immediate Postoperative Prosthesis.(IPOP)


Bench alignment


In sagittal view


In anterior view
By KERIO RAPHAEL - BSc. P&O FINALIST TUMAINI UNIVERSITY/KCM-COLLEGE.
I recently concluded my Research study to which I was assessing the efficacy of Early Prosthetic fitting amongst Transtibial amputees. A total of 6 subjects were fitted with Rigid Casts out of POP in the Operating theatres and 3 days later the casts were fitted with terminal devices to form the IPOP,By the 4th day, the subject could learn to stand up, short distance transfers early weight bearing and early ambulations utilizing this technique,wound healing in tandem with rehabilitation goals.The results of this study indicated that this techinique accelerated wound healing,diminished post operative pain and oedema and early ambulations was attained.Certainly technique bridge the gape between amputation and definative prosthetic fitting thereby lessening overall rehabilitation period.
try it out and you will discover how valuable a prosthetist is in rehabilitationteam.Further you will find that as a Prosthetist you won't be confined to working in P/O labs/workshops only but also in operating theatres recovery wards.

Wednesday, May 12, 2010

Prosthetics and Orthotics Project Manager.

Prosthetic and Orthotic Project Manager, Gaza Strip, occupied Palestinian territory



Handicap International
NGO
Closing date: 15 May 2010

Location: occupied Palestinian territory - Gaza strip

Handicap International is looking for Prosthetic and Orthotic Project Manager
COUNTRY: Palestine
CITY: Gaza Strip
Starting date: June 2010
Length of the assignment: 7 months
Closing date for application: May 15th
Advertisement reference: PMPOGAZA

Handicap International is an international organisation specialised in the field of disability. Non-governmental, non-religious, non-political and non-profit-making, it works alongside people with disabilities, whatever the context, in response to humanitarian crises and the effects of extreme poverty. Handicap International implements programmes of assistance to persons and local organisations, inclusion programmes and programmes focusing on the fight against the main causes of disability. It runs projects in almost 60 countries, with the support of a network of 8 national associations (Germany, Belgium, Canada, United-States, Luxembourg, United Kingdom and Switzerland) The organisation employs almost 3300 people worldwide, 330 of whom work in France and in its European and North American sections. For more details on the association: http://www.handicap-international.fr/en/s/index.html

JOB CONTEXT:

The deteriorating socio-economical and security situation in Palestine has resulted in an increased number of persons in need of physical rehabilitation services. This is due to higher risk of injury and disease and poor access to relevant health care. Many persons injured during the last conflict became permanently disabled due to the extent of their injuries as well as secondary complications such as infected wounds, contractures, or secondary amputations. Although many of these people received physical rehabilitation and assistive devices, ongoing physical rehabilitation and assistance is still required to respond to all the needs of the persons with disabilities.

JOB DESCRIPTION:

Under the management of the Head of Mission (HoM) you will ensure the projects objectives mainly to ensure that Persons with Disabilities and persons with conflict related injuries have improved access to physical rehabilitation services in the Gaza Strip and more specifically Persons with amputations and orthopaedic impairments will have improved access to quality rehabilitation.Challenges and goals: You will ensure the overall management of the project called: “Reinforcement of the capacities of rehabilitation services for Persons with amputation or orthopaedic impairment in Gaza”.

1. Activities:

Project Management
• Participate to the methodology definition to be used in the project.
• Lead process for participatory project biannual review and planning sessions with her/his team and to ensure that project activities, outputs and outcomes are captured and documented adequately
• Direct the implementation of the project and project monitoring procedures.
• Ensure fluid communication with ALPC.
• Ensure in coordination with administrator and HoM that document related to partnership are done within HI framework.
• Write the activity reports related to the project.
• Manage the financial and Human resources of the project through HI procedures
• Launch and set up project’s quality approach in terms of realization and impact.
• Identify any technical or documentary resources or additional skills for guaranteeing the quality of the project. .
• Participate in capitalizing on the association's experience gained on the project.

CANDIDATE PROFILE:Mandatory: - P&O ISPO 1 (or 2?)
- At least 5 years of professional experience with an international org
- Experience/knowledge in assessment of therapists
- Experience as trainer (need assessment/ training design and training delivery) in P&O workshop
- Experience in management
- Excellent analytical, planning, organising and task prioritisation skills.
- Capacity to formalize tools and procedures
- Excellent communication skills (both oral and written)Complementary:
- Experience in the Middle East/Islamic contexts or conflict areas
- Budget management
- Arabic knowledge would be an advantage

REQUIRED LANGUAGE SKILLS: Excellent level of written and spoken English (working language).

JOB ENVIRONMENT:

The P&O PM will be based in the Gaza strip with travels to Jerusalem. The situation is very volatile. Violence could be on a daily basis (air strikes, ground to ground missiles, Israeli incursion, Home made rockets, etc.). Expatriates have to respect strict security rules. The guesthouse and the office are in the same building. Because of the difficult living conditions, she/he will have the opportunity to go out every two week-ends and to come to Jerusalem. In Jerusalem, the situation is tensed also but it is more possible to have a “normal” life: no curfew and no restriction of movements.

EMPLOYMENT CONDITIONS:
Volunteer: 750 or 850 Euros monthly indemnity + living allowance paid on the field + accommodation + 100% medical cover + repatriation insurance
Salary: 2000 to 2300 euros before tax + 457 Euros expatriation allowance + 100% medical cover + repatriation insurance

How to apply

Please send resume and covering letter with the reference: PMPOGAZA to: HANDICAP INTERNATIONAL - 14, avenue Berthelot - 69361 LYON CEDEX 07By Email: recrut05@handicap-international.org Or by our website: www.handicap-international.frPlease do not telephone
Reference Code: RW_84WJW6-91
Source: Reliefweb

Monday, May 3, 2010

From orthopaedic dictionary


Step length-The perpendicular distance in meters from the heel strike of one foot to the heel strike of opposite foot.




Stride length-The perpendicular distance in meters from the heel strike of one foot to the next heel strike of the same foot.


Monday, April 19, 2010

A congenital deformity!


Anterior view,main deformity at ankle joint plus malalignment of bones of the foot.



First stage of rehabilitation(follow my blog to see the final stage) .


Friday, April 16, 2010

Disability due to severe burn.

The challege is to rehabilitate him,the idea is to make him work despite of using crutches,if you have any idea how we can design an appliances please lets share!.(Side View)

Field work session is over.

Initial stage of fabricating a Knee disarticulation Prosthesis.
Bench aligment of the Exoskeleton Prosthesis

Side view of Knee disarticulation Prosthesis(made by tatcot student during field work)





Anterior view of the Knee disarticulation Prosthesis

Thursday, April 8, 2010

Its like an art!

CCBRT CASTING ROOM,modification of casts for different prosthetics and orthotics appliances.

Wednesday, April 7, 2010

From orthopaedic dictionary


Ape hand Deformity

Ape hand: A deformity in which the thumb is extended and the hand flattened.Ape hand is caused by wasting of abductor indicis,thenar and hypothenar,interroseii and lumbrical muscules.It is seen in progressive spinal muscular atrophy or lesions of the median and ulnar nerve.

Claw hand deformity
Claw hand: A deformity of the hand that has a clawlike appearence .It results from paresis of the ulnar and or/median nerves,in which there is extension of the metacarpophalangeal joints and flexion of the interphalangeal joints,with associated flattening of the hand due to musculotendinous imbalance.

Friday, March 26, 2010

lamination of Transfemoral Prosthesis.

Lamination on progress!

Fieldwork=Practical work!!!

Students from Tatcot,Robinson Kimwangana and Beatrice Kadashi ,during their fieldwork attachment in our dept.Practical work 100%
For them field work is equal to practical work.

Wednesday, March 17, 2010

STROKE

An Orthosis which used to stabilize the ankle joint of the stroke patient.


STROKE

Stroke is a term used to describe a cerebral vascular accident (CVA) that involves either ischemic or hemorrhagic lesion to the brain. This neurological disorder is a leading cause of death and disability for people over the age of 60.Unfortunately there is no cure for stroke ,emphasis continues to be placed on prevention.


In arteriosclerosis, the arteries can become hardened and brittle. A patient with high blood pressure may rupture one of these fragile cerebral arteries. The interrupted blood flow can cause ischemia to an area of the brain. Other causes of ischemia resulting in stroke are;

Ischemic
-thrombus, blood clot that forms in a cerebral artery blocking the flow of blood.

-tumour, this can cause a compression of cerebral blood flow.

-embolus, a clot formed and then transported to the brain

Hemorrhagic
-deformed blood vessels (aneurism)
Note:

Arteriosclerosis- Is the thickening and hardening of arteries due to the build up of calcium deposits on the insides of artery walls.

Atherosclerosis- Is a similar condition due to the build up of fatty substances,both have similar effects on the circulation of the blood throughout the body.

Ischemia- Is a condition in which blood flow(and thus oxygen) is restricted to a part of the body.

Brain cells, starved of vascular flow, will die within minutes without future regeneration. Therefore the degree of loss of brain function is dependant on two factors.

(a) The Extent of ischemia present in the brain
(b) The location in the brain and the resultant loss in that area.

Neurological deficits are varied and will change with time. Patients who survive the acute stage will generally show improvement. Any disability seen after six months will usually be permanent, how ever the paralysis to one side of the body (hemiplegia)is the most visible sign to the Orthotist.

REHABILITATION OF STROKE PATIENT.
The aims of Orthotics rehabilitation are directed towards the following;
(i) Retaining range of motion in all affected joints
(ii) Preventing contractures
(iii) Promoting weight bearing
(iv) Establishing control over balance
(v) Encouraging early ambulation and independence.

Rehabilitation for stroke patients will usually include a combination of efforts by physical and occupational therapist,Orthotist,psychologist,social worker,physiatrists,orthopaedic surgeon and other professions.

Wednesday, March 10, 2010

Scientific Presentation!

By Charles S.Mahua(P/O)

Syme Prosthesis.
This is one of the lower limb prosthesis which can be fitted to an amputee,where by the amputation is between tibia/fibula and talus this accompany with reshaping of tibia and fibula to remove sharp edges of medial and lateral malleoli.

Syme prosthesis can be fabricated in two ways.
(i) Prosthesis with hard outer socket and inner soft (soft liner) like in trans tibial prosthesis,as the distal end of the stump is wider than the mid-third area,the inner socket is cut to enable the stump distal end to go through in the socket..

(ii) Prosthesis with hard socket but with a soft cap at the distal end .Normally the socket used to have an opening cap posteriorly to easy donning of the prosthesis.

Advantages of the Syme Prosthesis.
The user can bear weight 100% at the distal end of the stump without or with minimal pain especially when calcaneous bone is fused to tibial (pirogoff).

Disadvantage of Syme Prosthesis.
Brings complications when fabricating of the prosthesis since the stump is too long,the assembling of the prosthetics foot and ankle block to the socket becomes difficult as the sound limb becomes shorter than the amputated side.
Prosthesis with hard socket but with a soft cap at the distal end.
The Prosthesis with hard outer socket and inner soft socket(soft liner)





Presenter Charles S. Mahua.
"The art of listening"when presenter is talking.





Thursday, March 4, 2010

Knee Disarticulation Amputation/Knee Disarticulation Prosthesis


Knee Disarticulation Prosthesis in alignment jig.

For the fitting of lower limb Prosthesis there are different level of amputation such as,
(i) Hip disarticulation
(ii) Transfemoral
(iii) Knee disarticulation
(iv) Trans tibial

Note; the above mentioned level of amputation are mostly found during Prosthesis fitting, for the starting let us learn a bit about knee disarticulation.

Knee disarticulation amputation – Is an amputation done between bone surfaces (femur and tibia) rather than by cutting bone.



Advantages of knee disarticulation amputation
-Has good end weight bearing
-No cut bone
-good muscular stabilation
-has long lever arm
-Epiphysis retained
-There is no terminal over growth of the bone.
-Patient can kneel without the prosthesis.
-Soft tissue adapted to weight bearing
-femoral condyles intact of which do help to control rotation and suspension.

Disadvantage to knee disarticulation Amputation
-Knee center difficult to match
-Socket must allow for femoral condyles (sometimes patella)
-has limited choice of knee mechanisms
-always are bulky in appearance
-poor cosmetics.

When we come to its biomechanics functions we find that;

Has greater control
-due to its intact at thigh musculature
-the stump has good weight bearing at distal area.
-maximum rotational control
-due to its suspension at its condyles
-due to its extended lever arm

Center of rotation
When we compare the center of rotation (COR) of knee disarticulation to transfemoral we found that:
COR of transfemoral is about the ischial tuberocity while COR of knee disarticulation is about the distal end

NOTE;
In prosthesis fabrication ,knee disarticulation is an excellent weight bearing stump.
-Its most often used in children and young adult.
-Its nearly always avoided in the elderly and patient with ischemic disease.






Wednesday, February 24, 2010

From orthopaedic dictionary

Brayant's Traction: A Techninique for application of vertical skin traction for the infants and
young chilidren with femur fractures or congenital abdomalities of the hip.The Patient is supine,and hips are flexed to a right angle.See the picture below.


Monday, February 15, 2010

From orthopaedic dictionary

Osteopetrosis: A rare hereditary disease characterized by an increased density of bones. It appear to result from impaired osteoclast function .Radiographically,one sees increased opacity with loss of cortically –medullary differentiation as well as a widening of the diaphysis and metaphysis resulting in an Erlenmeyer flask deformity .Increased brittleness can result in a multiple fractures and loss of marrow space can cause anemia .A severe form of a disease is probably inherited as an autosomal dominant trait .Bone marrow transplantation has recently been used for treatment .Also known as AlbersSchonberg Disease




Osteoporosis- A common bone disorder characterized by decreased density of normally mineralized osteiod .The etiology includes involutional osteoporosis ,known as type I(or postmenopausal ), and Type II(or aged related).Osteoporosis can also have less common causes,e.g, a secondary symptom to disuse ,drugs, dietary deficiencies, chronic illiness,neoplasm,endocrine abnormalities, genetic disorders, and idiopathic problems found in adolescents and middle aged males. It is characterized by bone fragility (vertebral fractures, and colles’s fractures)

Osteomalacia- Disturbance in the metabolism of calcium and phosphorus that results in impaired and decreased mineralization of osteiod (increased osteiod;prolonged mineralization rate, slurred mineralization front). A variety of underlying disorders may result on osteomalacia, including nutritional deficiency of vitamin D and other vitamin D disturbances, renal disorders, and congenital errors in metabolism.Patiencts generally present with diffuse bone pain, generalized weakness, and malaise.Radiographically, diffuse osteopenia is seen as noted or angular deformities on long-standing disease.

Monday, February 8, 2010

Low back pain/back pain


The device which can be used behind the chair can relieve backpain or alleviate the possibility of having it.After reading the causes of backpain below you will realise that among of the reason is those who do sit for long time .



Low Back Pain - What Increases Your Risk
Low back pain is often triggered by some combination of overuse, muscle strain, or injury to the muscles and ligaments that support the spine. Less commonly, low back pain is caused by illness or spinal deformity.
A risk factor is something that increases your chances of having back pain. More risk factors means you have a higher chance of having back pain.
Risk factors that you cannot change include:
· Being middle-aged (risk drops after age 65).
· Being male.
· Having a family history of back pain.
· Having had a previous back injury.
· Being pregnant. A woman's back is significantly stressed by carrying a baby.
· Having had compression fractures of the spine.
· Having had previous back surgery.
· Having spine problems since birth (congenital spine problems).
Risk factors that you can change with lifestyle changes or medical treatment include:
· Not getting regular exercise.
· Doing a job or other activity that requires long periods of sitting, lifting heavy objects, bending or twisting, repetitive motions, or constant vibration, such as using a jackhammer or driving certain types of heavy equipment.
· Smoking. Smokers are more likely than nonsmokers to have low back pain.
· Being overweight. Excess body weight, especially around the waist, may put strain on your back, although this has not been proven. But being overweight often also means being in poor physical condition, with weaker muscles and less flexibility. These can lead to low back pain.
· Having poor posture. Slumping or slouching alone may not cause low back pain, but after the back has been strained or injured, bad posture can make pain worse.
· Being under stress. Stress and other emotional factors are believed to play a major role in low back pain, particularly chronic low back pain. Many people unconsciously tighten their back muscles when they are under stress.
· Having long periods of depression.
· Using medicines long-term that weaken bones, such as corticosteroids.
Source:www.webmd.com






Monday, February 1, 2010

Bilateral transtibial/transfemoral amputee!

As you see from the picture above is a bilateral transtibial amputee,how the Prosthetist will get the lenth of the prosthesis?to avoid having too long or too short prosthesis since this will bring a direct impact in Centre of Gravity during gait.So please if you have the idea on how to determine the actual length lets share with other in this village.

Friday, January 22, 2010

Is being an albino a Disability?according to ICF!

ICF -Is the WHO 's frame work for measuring health and disability at both individual(patient) and population levels(research) where as the ICIDH classifies deseases as causes of death(-) and ICF classifies health by accounting for functioning(+)

ICF-International Classification Of Functioning
ICIDH-International Classification of Impairments,Disabilities and Handcaps.

ICF Consists of three components:

1st component-(Body function and Structures) which refers to Physiological functions and anatomic parts respectively,Loss or deviations from normal body functions and structures are referred to as impairements.

2nd component- Activity,activity refers to task execution by the individual and activity 'limitations' are difficulties,the individual may have in executing activities.

3rd components- Participation,participation refers to involvement in life situations where as participation restrictions are problems the individual may experience with such involvments.

So from the above explanation does Albino a disability? or we are using the word disability to Albino in wrong way?

Mdau nimetafsiri Tangazo hili hivi

Nikiwa kama mdau wa taaluma ya fundi sanifu viungo bandia napata tafsiri kwamba.
Kwa sasa nchi yetu ina wataalam husika wa kutosheleza jamii yote ya watanzania.Tafsiri hii inatokana na nafasi za mafunzo katika tangazo husika fani ya Fundi sanifu viungo bandia (Prosthetist/Orthotist/Orthopaedic Technologist) haipo.
Lakini kwa uzoefu wangu ni kwamba bado watanzania wanaendelea kutumia gharama nyingi kufuata huduma za viungo bandia katika vituo vilivyopo Dar es salaam( Taasisi ya mifupa MOI) ,KCMC Moshi na CCBRT ambavyo ndiko huduma hizi ni za uhakika.
Hivyo changamoto ambayo wizara ya afya inayo ni kuandaa wataalam hawa na kuwawekea miundombinu ya kuwawezesha kusaidia wenye mahitaji katika mikoa yote.
Tanzania baada ya miaka 48 ya uhuru si halali mlemavu anatoka Kigoma,Tabora,Mbeya nk. kufuata huduma ktk vituo nilivyotaja.

Wednesday, January 20, 2010

Hallux valgus deformity


Hallux valgus deformity






Correction of hallux valgus




This device can also support/correct hallux valgus deformity.

Sunday, January 17, 2010

From orthopaedic dictionary

STUMP-The termination of limb that remain after amputation or is any pedicle or piece of tissue remaining after removal or amputation of distal aspect.
and amputation- this is the removal of a limb part or any other protuberant body part.



Tuesday, January 5, 2010

Rehabilitation.

REHABILITATION.

Rehabilitation in Prosthetics and Orthotics is any measure aimed at restoring the physical ability of a disabled individual through treatment, training and re-integration.

REHABILITATION TEAM.
A rehabilitation team is a group of expert specialized in the rehabilitation of physical disability by appropriate measures of surgical, clinical, technical and physical intervation,treatment,training and re-intergration.The clinical team approach has proven to be the most appropriate method of providing Prosthetics and Orthotics management.

MEMBERS,
• The Patient
• Orthopaedic Surgeon
• Prosthetist/Orthotist
• Physical Therapist
• Occupational Therapist
• Social worker
• The Nurse
• Family member

The patient;

The patient is the most important member of the clinic team; she/he is the reason for the clinics existence and therefore should be the centre of attention of clinics activities.
Some of the clinics are for teaching; this is the valuable way to teach the principles of prescription and prosthetics/Orthotics evaluation.

Successful rehabilitation is largely dependent on patient’s willingness to co operate with the clinic team’s recommendations .The patients has certain goals and expectations with regard to the end result of the rehabilitation .It is the responsibility of the team members to help the patient attain these goals, provided the expectations are realistic
Members of the team must meet regularly to discuss each patient’s progress. Every one should be given the opportunity to provide input.

The Orthopaedic Surgeon;

He is the one responsible for planning and performing the actual surgical interventions and finally in most cases for the prescription of the orthopaedic appliances.
The surgeon has to be well informed about each of the team member’s specialties and about possible complications and solutions. The surgeon has to oversee the quality of the patient care and the outcome expectations in all aspects. Internationally prescribing surgeon is being held responsible for appropriate results for the paying agencies. Accordingly not only specialized medical education but also physiotherapist and Prosthetist and Orthotist should be an integral part of their studies.

The Prosthetist/Orthotist;

A Prosthetist/Orthotist is a professional who has been educated and trained to consider appropriate functional components and materials to design a prosthesis or an Orthosis .He or she measures/casts and modifies models ready for design,manufacture,aligning,fitting and delivery of the appliance. As the team member the Prosthetic/Orthotist must have the basic anatomy and pathology of various diseases related to P&O .He/She should be able to teach peers and patients about prosthetics and Orthotics issues.

The Prosthetist/Orthotist should able to advice the patient and the clinic team of the most appropriate options with regards to;
• Socket type.
• Suspension
• Component based on physical clinical assessment and the patient’s functional capabilities.

The Prosthetist/Orthotist is responsible for supervising the technical fabrication of the appliances to ensure that the device meets the requirements as set out in the prescription.
The Prosthetist/Orthotist should keep record of all modifications and inform the team any significant changes or problems with regard to fitting. It is important that the patient and the rest of the team understand the limitation of the prosthetic and Orthotic device so that expectations do not become unrealistic,

The Physical Therapist

Initially, one of the primary roles of physical therapist is to assess the patient’s muscles strength and range of motion. The therapist in consultation with the Physician/Orthopaedic Surgeon, should develop an individual programme of exercises that will improve those deficiencies identified by the assessment.

Re assessment should be performed after regular specified periods of time in order to evaluate the effectiveness of the prescribed exercise programme.The Therapist’s findings should be made available to the other team members, as this information may directly affect their treatment plan. This input will also affect the team’s expectations of the individual’s functional capabilities once prosthetic/orthotc fitting commences (if in fact prosthetic/orthotic fitting considered appropriate)

Controlling edema is another important role of Physiotherapist. The therapist will be responsible for instructing both the patients and the staff in the proper application of an elastic tensor bandage to the limbs.

The Physiotherapist will be also responsible for gait training .by monitoring the skin conditions of the limbs following these gait training sessions, the therapist is able to keep the Prosthetist/Orthotist informed if problem arise.

The Social Worker

The social worker is an integral member of rehabilitation team, while their role is to re-integrate the patient into the community, creating awareness and using community programmes, they are as well trained to observe.
• Patient behaviour
• Areas that may provoke anxiety
• Fear of family rejection.

• Fear for the inability to pay for the appliance.
• Fear of the job loss
Social worker has special knowledge of agencies that can help support the patient recovery and provide financial aid for obtaining the appliance. Social workers are a valuable liaison between the clinic team and patient’s family.

The social worker may also be instrumental in discharging planning process, especially if the patient’s existing house or apartment is inappropriate and or the patient requires a higher level of daily care.

Occupational Therapist

The occupation therapist is in majority of circumstances specialized in upper extremity e.g training in the use of arm prosthesis or development of skills to cope with pathological conditions.

The role of occupational therapist is to assess the patient’s functional capabilities with respect to activities of daily living. If possible the patient should be assessed for the independent activities of daily living both with and without the use of appliances (e.g., prosthesis, crutch, walker, wheelchair etc.)

The occupational therapist will concentrate on such things as;
• Self care
• Energy conservation
• Problem solving in new situation
The occupation therapist may be also be responsible for making recommendations for home modifications that may enhance independent living. They will provide the patients with adaptive equipments where necessaries static splinting, appropriate walking aids or wheel chair. The therapist may also investigate possible occupational and vocational options available to the patient.

The Nurse

The nurse’s role in the rehabilitation team is a varied one. He or she has the responsibilities of medical care, i.e administering prescribed medications, dress changes. The Nurse may work with both Physiotherapist and Occupation therapist in encouraging the patient to perform activities of daily living independently and or monitor recommended exercises .Upon discharge the Nurse may also be responsible arranging appropriate patient home care services as per the recommendation of the clinic team.