Advanced Prosthetic Knee Rehabilitation. Carolyn A Hirons HCPC Registered & Chartered Physiotherapist BACPAR Conference 2014

Transcription

1 Advanced Prosthetic Knee Rehabilitation Carolyn A Hirons HCPC Registered & Chartered Physiotherapist BACPAR Conference 2014

2 Objectives l Gain familiarity with different prosthetic knee components l Understand knee functions, including stance resistance (yield) l Consider advanced rehab l Demonstrate training techniques

3 SIGAM E & F EIndepen dent FNormal Walks 50m or more without walking aids expect to improve confidence in adverse terrain or weather. Normal or near normal walking Disability Definition A Non-limb user Those who have abandoned the use of an artificial limb or use only non-functioning prostheses B Therapeutic Wear prostheses ONLY in the following circumstances; for transfer, to assist nursing, walking with the physical aid of another OR during therapy. C Limited/restricted Walks up to 50m on even ground with or without walking aids; a=frame, b=2crutches/sticks, c=1crutch/stick, d=no walking aids. D Impaired Walks 50m or more on level ground in good weather with walking aids; a= 2 sticks/crutches, b= 1stick/ crutch. E Independent Walks 50m or more without walking aids expect to improve confidence in adverse terrain or weather. F Normal Normal or near normal walking

4 The purpose of a prosthesis is to replace a body part & its function l Bones & Joints l Ligaments & tendons l Muscles l Sensation To support normal movement, to allow function. Note designed for this!!!

5 Muscles l Control movement with gravity (lengthening) l Hold a movement (static length) l Generate movement & power against gravity (shortening) l Respond to sensation l Sensory motor loop

6 Eccentric quadriceps action Control movement with gravity (lengthening) Stance resistance for sitting, stair and ramp descent. Referred to as yield

7 Upright posture is imperative Essential for: l Central head position l Muscle recruitment l Balance reactions l Comfort & ease l Energy efficiency l Confidence Prosthetic alignment is crucial

8 Co-ordination & practise perfect practise!

9 Knee characteristics what to consider? l What controls stance (WB)? l What controls swing? l How does it switch between the two? l Does it have stance flexion? Other: l Has it other functions? l How do you initiate these? l Can the user do it?

10 But knees are like cars! l l l l l User learns how to drive but not how the car works! Expensive sports car does not make you a good driver! Efficiency of a car depends on how you drive it! Poor tracking causes wear & tear! Lazy driving habits!

11 Mechanical knees with yield l KX06 (Endolite) l 3R80 (Otto Bock) l Mauch Knee (Ӧssur) l VGK (Orthomobility) l Sensor (OrthoEurope) *Separate swing & stance controls

12 KX06 (Endolite) l Polycentric knee l Hydraulic cyclinder swing & stance control l Swing only (hyperextend knee, lift lever) l Can lock l Mode to cycling/run

13 3R80 (Otto Bock) l Rotary hydraulic system for stance & swing l Weight activated stance, responds to GRF, variable l Unload to swing, variable speeds

14 Mauch Knee (Ӧssur) l Single axis hydraulic cylinder l Swing & stance control l Swing only (hyperextend knee, lift lever) l Hyperextension moment to disengage stance l Manual lock

15 VGK (Orthomobility) l Adaptive fluidic joint l Third technology l Variable swing l Stumble recovery l Stance resistance (yield) l Bike mode l Water resistant

16 Sensor (OrthoEurope) l Weight activated hydraulic knee l Downstairs leg over leg yield l Stance lock l Electronic device records activity (steps taken, distance walked

17 Microprocessor Controlled (MPC) knees with yield l Orion (Endolite) l Plié (Freedom Innovations) l Rheo knee III (Ӧssur) l C leg (Otto Bock) l Genium/X3 (Otto Bock) l Power knee II (Ӧssur)

18 Orion (Endolite) l Hydraulic stance, drops off in swing l One speed yield l No stance flexion l Toe load stance release l High stance resistance if no battery but adjusts

19 Orion (Endolite) l Pneumatic, variable swing l Weather proof l 2 modes l Can run/cycle

20 Plié (Freedom Innovations) l Stance flexion l Variable swing phase l Water resistant l Stumble control l Can run l Plié 3 submersible & robust

21 Rheo knee III (Ӧssur) l Default is free in NWB l Stance - weight activated l Magneto-rheological fluid l Release into swing: toe load & pelvic rotation creates extension moment at knee l Manual lock

22 Rheo Knee III (Össur) l Stance resistance adjusts to weight l More load, more resistance* l Unload for swing on slopes & stairs (no extension moment required)

23 C leg (Otto Bock) l Default straight; unload or with no battery or in sitting l Initiate swing via toe load l Not for sport but will run l Care backwards as may trigger swing phase!

24 C leg (Otto Bock) l Constant hydraulic stance flexion resistance, initiate through heel load (sit, slope, stairs) l Resistance does not adapt to different weight shoes or carrying luggage

25 Genium/X3 (Otto Bock) l Stance resistance down stairs, initiate foot over step l Weight activated stance l Position and weight deactivated swing l Adjusts to weight changes (shoes, bags) l X3 water proof, run mode

26 Genium/X3 (Otto Bock) l Intuitive stance allows more normal posture (stand on flexed knee) l Stance flexion pre set 4º l No concentric power but step up or over on locked flexed knee l Safe backwards, no toe trigger l 5 extra modes, splash proof, will run l Straight when no power, can alter

27 Power knee II (Ӧssur) l Position and weight activated l Concentric power in stance Climb a stair & slope Rise/lower in sitting Push through objects Rest in knee flexion l Uneven ground l Off road, unload sound leg l Will not run l Two batteries a day required

28 Why are MPC knees the bees knees? l Stable, responsive and forgiving l Allow more normal posture l Allow more normal movement pattern l Less compensations l Fewer falls l Increased confidence

29 So, what does the knee do - functions & features? l Stance flexion resistance variability l Stumble recovery l Stairs ascent l Water proof l Hobbies (run, bike) l Battery life l Noise l Size, build height l Appearance l Battery empty l Additional modes l Weight of unit l Weight of user l Car charger l Power l Socket fit l Foot function

30 What can the user do? What does the user need? Motor skills co-ordination, flexibility, body control, endurance, stamina, fitness, athletic prowess and agility, proprioceptivity Co-morbidities - contralateral limb, OA, other amputations and injury, pain, socket stability, suspension and comfort, residual limb condition Lifestyle, goals, attitude, intelligence, technical interest, compliance, diligence, motivation, support network, Confidence & fear of falling, commitment, time & ability to learn, personality, cosmetic requirements, previous prosthetic history and bad habits, expectations Access to specialist physiotherapy?

31 Advanced Rehabilitation l Lifting & carrying l Head turning l 360º turning l Eyes shut *Use Tinetti & AmpPro as guide

32 Advanced rehabilitation? l Shopping centres Escalators Stairs & slopes Crowds l Park - grass good for running & yield l Chill factor e *Use ABC scale as guide

33 Fitness, exercise & running l Core stability: mat, gym ball, Theraband l Step box routine, with weights l Trampet l Running drills l Boxing

34 Fitness, exercise & running l Nordic walking l Fitness Initiative (gym) l Personal trainers & buddies l AlterG treadmill & balance plate l Cycling l Sports groups

35 Training commitment

36 Thank You & Demonstration Yield training: l Stand to sit weight thru heel, flex hip l Down steps load stance flexion, foot over step l Down slopes load stance flexion, not a walking action