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.

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.

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.

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.