Orthotics and Prosthetics in Rehabilitation

Cover
ORTHOTICS AND PROSTHETICS IN REHABILITATION
Copyright
Contributors
Preface
Acknowledgments
1
Orthotics and Prosthetics in Rehabilitation: Multidisciplinary Approach
	Orthotists and Prosthetists
	History
	Prosthetic and Orthotic Professional Roles and Responsibilities
	Disablement Frameworks
	Characteristics of Rehabilitation Health Care Teams
		Values and behaviors
		Rehabilitation teams
	Summary
	References
Section I: Building Baseline Knowledge
2
Aging and Activity Tolerance: Implications for Orthotic and Prosthetic Rehabilitation
	Oxygen Transport System
	The Aging Heart
		Cardiovascular structure
			Myocardium
			Valves
			Coronary Arteries
			Conduction System
			Arterial Vascular Tree
		Cardiovascular physiology
			Sensitivity to β-Adrenergic Stimulation
			Baroreceptor Reflex
		Functional consequences of cardiovascular aging
			Preload
			Afterload
			Left Ventricular Ejection Fraction
	Pulmonary Function in Later Life
		Changes within the lung and airway
		Changes in the musculoskeletal system
		Control of ventilation
		Functional consequences of pulmonary aging
	Implications for Intervention
		Precautions
			Estimating Workload: Heart Rate and Rate Pressure Product
			Blood Pressure as a Warning Sign
			Respiratory Warning Signs
		Optimizing cardiopulmonary performance
			Preparation for Activity and Exercise
		Monitoring the cardiorespiratory response to exercise
			Heart Rate and Blood Pressure
			Perceived Exertion
			Exercise Testing Protocols
		Physical performance training
	Energy Cost of Walking
		Self-selected walking speed
		Measuring energy costs of walking
			Oxygen Rate and Oxygen Cost
			Serum Lactate
			Heart Rate and Physiologic Cost Index
		Energy expenditure at self-selected walking speeds
		Work of walking with an orthosis
		Work of walking with a prosthesis
			Technologic Advances Impacting Energy Demands
	Summary
	References
3
Motor Control, Motor Learning, and Neural Plasticity in Orthotic and Prosthetic Rehabilitation
	Why Think About Motor Control, Motor Learning, or Neuroplastcity?
	Theories of Motor Control
		Dynamic systems perspectives
			Resources of the Individual
			Nature of the Task
			Characteristics of the Environment
		Skill acquisition models
	Theories of Motor Learning
		Evolution of models of motor learning
		Temporal considerations
		Implicit and explicit aspects of motor learning
		Role of aerobic exercise in motor learning
	The Importance of Practice
		Appropriate level of challenge
		Motivation and self-efficacy
		Variability
		Practice conditions: blocked, random, or serial?
		Part- versus whole-task training
		Relationships: practice, retention, and transfer
	Intrinsic and Extrinsic Feedback
		Knowledge of Performance and Knowledge of Results
			How and When Should Feedback Be Used?
			What Modality for Feedback Is Appropriate?
			Using Normative Feedback
			Mental Practice and Imagery
			Role of Sleep in Motor Learning
			Importance of Patient/Client-Centered Goals
		Neural plasticity in motor control and motor learning
			Use It or Lose It
			Use It and Improve It
			Specificity Is Significant
			Repetition, Repetition, Repetition
			Intensity Is Important
			Time and Timing
			Salience Is Substantial
			Considering the Life Span
			Transference
			Interference
			Task Success Reinforcement
		Aerobic exercise, neuroplasticity, and neuroprotection
	Application: Case Examples
		Questions to consider
			Functional Considerations
			Motor Learning Issues
	Summary
	References
4
Evidence-Based Approach to Orthotic and Prosthetic Rehabilitation
	What Is Evidence-Based Practice?
	Process of Evidence-Based Practice
	Step 1: Formulating an Answerable Clinical Question
		Patient characteristics
		Intervention
		Defining the outcome
	Step 2: Locating and Accessing the Best Evidence
		Sources of evidence
			Textbooks
			Primary Sources: Journal Articles
			Secondary Sources: Integrative and Systematic Review Articles
			Secondary Sources: Clinical Practice Guidelines
		Electronic resources and search strategies
			Locating Citations
			Executing Search Strategies
			Searching for Interventions
			Diagnosis as the Intervention
			Natural History or Prognosis
			Systematic Review
		Locating full-text articles
	Step 3: Critically Appraising the Evidence
		Overall methodologic quality
			Sample: Adequacy and Appropriateness
			Outcome Measures
	Step 4: Applicability to Patients and Clinical Practice
		Clinical relevance
	Integrating Clinical Expertise and Skill
		Staying current with the literature
	Summary
	Appendix 4.1
	Appendix 4.2
	Appendix 4.3
	References
5
Clinical Assessment of Gait
	Normal Gait
	Kinetic and Kinematic Descriptors of Human Walking
	Gait Cycle
		Functional task 1: Weight acceptance
			Initial Contact
			Loading Response
		Functional task 2: Single limb support
			Midstance
			Terminal Stance
		Functional task 3: Limb advancement
			Preswing
			Initial Swing
			Midswing
			Terminal Swing
	Describing Pathological Gait
		Common gait deviations observed during stance
		Common gait deviations observed during swing
		Gait deviations associated with abnormal muscle tone
	Qualitative Gait Assessment
	Instrumented Gait Analysis
		Technology in gait assessment
		Measuring temporal and distance parameters
		Assessing the energy cost of walking
		Kinematic and kinetic systems
		Electromyography
		Pressure-sensing technology
	Choosing the Appropriate Assessment Tool
	Function-Based Assessment
		Functional measures
			Walking Speed
			Timed Up and Go
			Dynamic Gait Index
			Functional Ambulation Classification
			Modified Gait Abnormality Rating Scale
	Choosing an Assessment Strategy
	Clinical Examples of Gait Deficiencies: Impact of Functional Tasks During Gait
		Clinical characteristics of gait in hemiplegia
		Clinical characteristics of gait in spastic diplegic cerebral palsy
		Clinical characteristics of gait in children with spina bifida
	Gait Patterns in Individuals With Amputation
		Transtibial prosthetic gait
			Studies of Transtibial Prosthetic Gait
			Transtibial Alignment
			Initial Contact and Loading Response
			Midstance
			Terminal Stance
			Preswing
			Swing Phase
		Common gait deviations in transtibial prosthetic gait
		Transfemoral prosthetic gait
			Temporal Values
			Transfemoral Alignment
			Initial Contact and Loading Response
			Midstance
			Terminal Stance
			Preswing
			Swing Phase
		Common gait deviations in transfemoral prosthetic gait
	Summary
	References
6
Materials and Technology
	Orthotics and Prosthetics in the 20th Century
	Materials
		Leather
		Metals
			Steel
			Aluminum
			Titanium and Magnesium
		Wood
		Plastics and composites
			Thermoplastics
				Thermoforming
			Thermosetting Materials
				Composites
				Processing Technologies and Composite Fabrication
			Foamed Plastics
			Viscoelastic Polymers
	Prescription Guidelines
		Orthotic prescription
		Prosthetic prescription
	Fabrication Process
		Measurement
		Negative mold
		Fabricating and modifying the positive model
		Fabricating the orthosis or prosthetic socket
	Computer-Aided Design/Computer-Aided Manufacture
		Data acquisition
		Shape-manipulation software
		Milling and production
	Central Fabrication and Mass Production
		Central fabrication facilities for custom devices
		Mass production
			Technologies Poised to Transform Prosthetics and Orthotics and Rehabilitation
				Biosensors
				Power Assistance and Actuation
				Exoskeletal Robotics
				3D Scanners and Shape Manipulation Software
				3D Printers and Additive Manufacturing
	Maintenance of Orthoses and Prostheses
	Summary
	References
7
Footwear: Foundation for Lower Extremity Orthoses*
	Components of a Good Shoe
		Sole
		Upper
		Heel
		Reinforcements
		Lasts
		Enhancing function
		Orthotic-related function
	Proper Fitting of a Shoe: ``If the Shoe Fits´´
		Determining measurements
		Foot Contour
		Obesity and Edema
	Special Considerations
		Pediatric foot
	Flexible and Rigid Flatfoot
		Foot during pregnancy
		Foot in later life
	Choosing Appropriate Footwear and Socks
		Athletic shoe gear
		Walking shoes
		Dress shoes
		Socks
	Prescription Footwear, Custom-Molded Shoes, Accommodative Molded Orthoses, and Shoe Modifications
		Moldable leathers
		Custom-molded shoes
		Plastazote shoe or sandal
		Shoe modifications
			Lifts for Leg-Length Discrepancy
			Heel Wedging
			Sole Wedging
			Metatarsal Bars and Rocker Bottoms
			Thomas Heels
			Offset Heels and Shoe Counters
			Attachments for Orthoses
			Shoe Stretching
			Blowout Patches and Gussets
	Footwear for Common Foot Deformities and Problems
		Problems in the forefoot
			Metatarsalgia
			Sesamoiditis
			Morton Syndrome
			Morton (Interdigital) Neuroma
			Metatarsalgia of the Fifth Metatarsophalangeal Joint
			Hallux Rigidus (Limitus)
			Hallux Valgus (Bunions)
			Hammertoes, Claw Toes, and Mallet Toes
		Problems in the midfoot
			Pes Planus
			Pes Equinus
			Pes Cavus
			Plantar Fasciitis
		Problems in the rearfoot
			Arthrodesis
			Achilles Tendinitis, Bursitis, and the Haglund Deformity
	Diagnosis-Related Considerations in Shoe Prescription
		Arthritis
		Gout
		Diabetes
		Peripheral vascular disease
		hemiplegia
		Amputation and congenital deformity
	Reading the Wear on Shoes
	Summary
	References
8
Foot Orthoses
	History of the Functional Foot Orthosis
	Triplanar Structure of the Foot
		Talocrural joint
		Rearfoot
		Midfoot
		Forefoot
		Plantar fascia and arches of the foot
	Function of the Foot in Gait
		Shock absorption
		Adaptation to surfaces
		Propulsion
	Biomechanical Examination
	Non-Weight-Bearing Open Chain Examination
		Examination of the rearfoot
			Subtalar Neutral Position
			Calcaneal Range of Motion
			Talocrural Joint Range of Motion
			Rearfoot Deformities
		Examination of the forefoot
		Neutral Forefoot Position
			Mobility Testing: Locking Mechanism
			Identifying Forefoot Deformities
			The First Ray
			The Hallux
		Additional observations
	Static Weight-Bearing Closed Kinetic Chain Examination
		Frontal plane
			Calcaneal Alignment to the Floor
			Tibiofibular Alignment
			Alignment of the Pelvis and Lower Leg
		Sagittal plane
			Knee Position
			Navicular Drop
			Talar Bulge and Arch Height
		Transverse plane
			Toe Sign
			Torsional Deformities
	Dynamic Gait Assessment
	Functional Foot Orthoses
		Criteria for abnormal pronation
		Causes of abnormal foot mechanics
			Structural Malalignment
			Muscle Weakness or Imbalance
			Compromised Joint Integrity
	Goals of Orthotic Intervention
	Measurement and Fabrication
		Negative impression
			Comparison of Negative Casting Techniques Used for Fabrication of Foot Orthotics
			Direct Pressure Impression Technique
			Errors in Negative Casting
		Positive cast modifications
			Forefoot Posting
			Rearfoot Posting
		The orthotic shell
			Covering Materials
	Managing Rearfoot Deformity
	Managing Forefoot Deformity
	Orthotic Checkout and Troubleshooting
	Controversy With Roots Paradigm
		Reliability of measurement
		Subtalar position in stance
		Criteria for normal alignment
	Foot Type and Lower Extremity Biomechanics
	Foot Type and Lower Extremity Overuse Injuries
		Foot strike pattern during running and lower extremity biomechanics
		Foot strike pattern during running and lower extremity injuries
	Orthoses and Lower Extremity Function
		Effect on rearfoot biomechanics
		Effect on lower limb biomechanics
		Effect of the neuromuscular system
			Electromyographic and Imaging Evidence
			Balance and Postural Control
	Management of Overuse Injuries
		Pain associated with foot deformity
		Patellofemoral pain syndrome
		Plantar fasciitis
		Morton neuroma
		Low back pain
	Summary
	References
Section II: Orthoses in Rehabilitation
9
Principles of Lower Extremity Orthoses
	What Type of Orthosis is Best?
	Determinants of Functional Gait
	Rockers of Stance Phase
	Prefabricated, Custom Fit, or Custom Molded?
	Appropriate Footwear
	Ankle-Foot Orthoses
		Biomechanical principles
	Static Ankle-Foot Orthoses
		Solid ankle-foot orthoses
			Solid Ankle-foot Orthoses Control Systems
			Progression Through Stance Phase
			Indications for Solid Ankle-foot Orthoses
		Anterior floor reaction ankle-foot orthosis
		Weight-relieving ankle-foot orthoses
	Dynamic Ankle-Foot Orthoses
		University of california biomechanics laboratory orthosis
		Dynamic ankle-foot orthosis
		Posterior leaf spring ankle-foot orthosis
		Additional dorsiflexion assist options
			Carbon Fiber Spring Orthoses
			Functional Neuromuscular Electrical Stimulation
			Commercially Available Dorsiflexion-Assist Designs
		Hinged thermoplastic ankle-foot orthosis
		Conventional dorsiflexion-assist ankle-foot orthosis
		Ankel-foot orthosis designs, tone, and postural control
	When Should a Knee-Ankle-Foot Orthosis Be Considered?
		Challenges to knee-ankel-foot orthosis use
		Knee function and alignment
	Knee-Ankle-Foot Orthosis Design Options
		Conventional knee-ankel-foot orthoses
		Thermoplastic knee-ankel-foot orthoses
		Carbon composite knee-ankel-foot orthoses
		Controlling the ankle
		Controlling the knee
			Single-Axis Knee Joints
			Single-Axis Locking Knee
			Offset Knee Joint
			Variable Position Orthotic Knee Joint
			Stance-Control Orthotic Knee Joints
		Medially linked bilateral knee-ankle-foot orthosis designs
	KAFO Delivery and Functional Training
	When Is a Hip-Knee-Ankle-Foot Orthosis Indicated?
	Hip-Knee-Ankle-Foot Orthosis Design Options
		Conventional hip-knee-ankle-foot orthoses
		HIP guidance orthosis and parawalker
		Reciprocal gait orthoses
		Hybrid orthoses: functional electrical stimulation
	Implications for Rehabilitation
	Outcome Measures in Orthotic Rehabilitation
		Walking speed
		Endurance during walking
		Mobility and balance while walking
	Summary
	Case Examples
	References
10
Neurological and Neuromuscular Disease Implications for Orthotic Use
	Movement Impairment in Neurological and Neuromuscular Pathology
	Differential Diagnosis: Where Is the Problem?
		The central nervous system
			Pyramidal System
			Extrapyramidal System
			Coordination Systems
			Somatosensory and Perceptual Systems
			Visual and Visual-Perceptual Systems
			Executive Function and Motivation
			Consciousness and Homeostasis
		Peripheral nervous system
	Determinants of Effective Movement
		Muscle tone and muscle performance
			Hypertonus
			Rigidity
			Hypotonus
			Flaccidity
			Fluctuating Tone: Athetosis and Chorea
		Postural Control
		Movement and coordination
	Management of Neuromuscular Impairments
		Medical and surgical care
		Rehabilitation
		Selecting the appropriate orthosis
	Summary
	References
11
Orthoses for Knee Dysfunction
	Introduction
	Anatomy of the Knee
		The tibiofemoral joint
			Medial Collateral Ligament
			Lateral Collateral Ligament and Iliotibial Band
			Anterior Cruciate Ligament
			Posterior Cruciate Ligament
		Posterolateral corner of the knee
		Patellofemoral joint
	Biomechanics of Knee Motion
	Knee Orthoses Components
	Prophylactic Knee Orthoses
		Biomechanical implications
		Evidence of effectiveness
		Recommendations
	Orthoses for Anterior Cruciate Ligament Insufficiency
		ACL insufficiency
			Biomechanical Implications
			Functional Implications
			Recommendations
		Postoperative acl reconstruction
			Biomechanical Implications
			Role in Rehabilitation
			Recommendations
	Orthoses for Osteoarthritis
		Biomechanical implications
		Evidence of effectiveness
		Recommendations
	Orthoses for Patellofemoral Disorders
		Patellofemoral osteoarthritis
			Biomechanical Implications
			Conservative Management
			Recommendations
		Patellofemoral pain syndrome
			Biomechanical Implications
			Conservative Management
			Recommendations
	Summary
	References
12
Orthoses in Orthopedic Care and Trauma
	Bone Structure and Function
	Bone Growth and Remodeling Over the Life Span
	Orthoses in the Management of Hip Dysfunction
		When are hip orthosis indicated?
		Hip structure and function
		Infants and children with developmental dysplasia of the hip
		Incidence and etiology of developmental dysplasia of the hip
		Early orthotic management of developmental dysplasia of the hip: birth to 6 months
		Management of developmental dysplasia of the hip: Age 6 Months and Older
		Goals of orthotic intervention for children with developmental dysplasia of the hip
		Complications of orthotic management of developmental dysplasia of the hip
		Orthotic management of legg-calvé-perthes disease
			Etiology of Legg-Calvé-Perthes Disease
			Evaluation and Intervention for Legg-Calvé-Perthes Disease
			Orthotic Management in Legg-Calvé-Perthes Disease
		Pediatric postoperative care
			Postoperative Hip Orthoses
		Management of the adult hip
			Total Hip Arthroplasty
			Posttrauma Care
	Fracture Management
		Mechanisms of fracture healing
		Fracture classifications
		Casts and splints
			Casting and Splinting Materials
			Cast Application
			Lower Extremity Casts
			Cast Removal
		Hybrid cast braces
		Fracture orthoses
			Types of Fracture Orthoses
		External fixation devices
		Postfracture management and potential complications
	Summary
	References
13
Orthoses for Spinal Dysfunction*
	Anatomy and Biomechanics
	The Three-Column Concept
	Fit and Function of the Spinal Orthosis
		Regional orthoses
			Cervical
		Cervicothoracic and thoracic orthoses
		Thoracolumbar
		Lumbosacral
			Cervicothoracolumbosacral
			Sacroiliac Joints
	Scoliosis
		Prevalence and natural history
		Biomechanics
		Evaluation
		Types of braces
			Milwaukee Brace
			Boston Thoracolumbosacral Orthosis
			Charleston Nighttime Brace
			SpineCor
	Orthotic Prescription
		Complications
		Future directions
	Summary
	References
14
Orthoses in the Management of Hand Dysfunction*
	Nomenclature
		Articular and nonarticular orthoses
		Location
		Direction
		Purpose of orthosis
			Immobilization
			Mobilization
			Restriction
			Examples
			Design Descriptors
			Choices of Orthotic Designs
				Static Orthoses
				Serial Static Orthoses
				Dynamic Orthoses
				Static Progressive Orthoses
			Objectives for Orthotic Intervention
				Immobilization Orthoses
				Mobilization Orthoses
				Restriction Orthoses
	Anatomy-Related Principles
		Arches of the hand
		Palmar creases
		Metacarpal length and mobility
		Positioning the hand
		Tissue precautions
	Tissue Healing
		Stages of tissue healing
		Factors that influence tissue healing
	Mechanical Principles
		Levers
		Stress
		Angle of force application
		Force application
	Material and Equipment
		Thermoplastic materials
			Handling Characteristics
				Conformability and Resistance to Stretch
				Memory
				Bonding
			Physical Characteristics
				Thickness
				Perforations
				Colors
			Categories of Orthosis Materials
		Strapping
		Padding and lining
		Components
		Equipment
	Overview of the Orthotic Fabrication Process
	Summary
	References
15
Orthoses in Burn Car
	Burn Injury
		Causes of Burns
		Burn Depth
		Surgical Management of Burns
		Burn Size
		Location of the Burn
	Wound Care
		Topical Agents and Wound Dressing
	Psychology of Burn Injury
	Rehabilitation Intervention
		Wound Healing and Scar Formation
		Operative Scar Management
		Nonoperative Scar Management
	Burn Rehabilitation Interventions
		Therapeutic Exercise
			Active Exercise
			Gait Training
			Passive Exercise and Stretching
		Physical Agents
		Positioning
	Splinting and Orthotics
		Neck
		Axilla and Shoulder
		Elbow and Forearm
		Wrist and Hand
		Trunk and Pelvis
		Lower Extremity
		Face and Mouth
		Additional Considerations
	Amputation and Prosthetics in Burn Rehabilitation
		Skin Condition
		Contracture
		Delayed Fitting
		Stabilization of Body Weight
	Education
	Summary
	References
16
Prescription Wheelchairs: Seating and Mobility Systems*
	Principles of Seating and Mobility
		Principle 1: Address seating before mobility
		Principle 2: Strive for optimal postural alignment
		Principle 3: Apply seating solutions in a proximal to distal direction
		Principle 4: Provide correction before accommodation
		Principle 5: Measure accurately
	The Seating System
		Seating components
	The Frame
	The Mobility System
		Manual wheelchairs
		Power wheelchairs
	The Seating and Mobility Assessment Process
		Subjective/History
		Diagnoses and related health information
		Prior experience with assistive technology
		Mobility-Related activities of daily living
		Funding sources
		Physical examination and associated considerations
		Tests and measures used in seating and mobility assessments
			Neuromuscular
			Musculoskeletal
			Cardiopulmonary
			Integumentary
			Comorbidities
	Ordering the Wheelchair
	Delivering the Wheelchair
	Follow-Up
	State of the Art
	Summary
	References
17
Etiology of Amputation
	Epidemiology of Amputation
	Levels of Amputation
	Causes of Amputation
		Diabetes and peripheral artery disease
			Amputation Rates and Racial and Ethnic Populations
			Outcomes of Dysvascular Conditions and Amputation
		Traumatic amputation
		Cancer
		Congenital limb deficiencies
	Rehabilitation Issues for the Person With an Amputation
	Rehabilitation Environment
	Summary
	References
Section III: Prostheses in Rehabilitation
18
High-Risk Foot and Wound Healing
	Normal Wound Healing
	Assessment of the High-Risk Foot
		Vascular assessment
		Sensory assessment
		Motor assessment
		Autonomic assessment
		Footwear assessment
		Gait and balance
	Wound Assessment
		Location
		Wound color
		Odor
		Size
		Depth
		Drainage
		Periwound skin
	Wound Management
		Preparing the wound bed by eliminating the source of inflammation or infection
		Providing an optimal wound-healing environment
		Reducing further trauma to the wound
			Total Contact Casting
			Removable Cast Walkers
			Instant Total Contact Cast
			Wound-Healing Shoes
			Other Pressure-Relieving Options
		Prevention of ulceration or reulceration
	Summary
	References
19
Amputation Surgeries for the Lower Limb*
	Introduction
	Indications for Lower Extremity Amputation
		Dysvascular and neuropathic disease
			Prevalence and Risk Factors
			Patient Assessment
			Vascular Examination
			Indications for Amputation Versus Revascularization
		Trauma
			Incidence and Patient Population
			Evaluation of the Threatened Limb
			Limb Salvage Versus Reconstruction
			Considerations Unique to Traumatic Amputations
		Neoplasm
			Incidence and Patient Population
			Evaluation of the Patient
			Limb-Sparing Surgery Versus Amputation
		Limb deficiency disorders
	Surgical Principles of Amputation
		Determining the level of amputation
		Technical considerations
			Bone
			Soft Tissue and Muscle
			Nerve
			Vessels
	Postoperative Care
		Dressings
		Pain management
	Complications
		Wound healing
		Fluid collections
		Heterotopic ossification
		Pain
	Outcomes
	Amputations of the Foot and Ankle
		Amputations of the toes
			Ray Resection
			Transmetatarsal Amputation
		Amputations of the midfoot
		Syme amputation
	Transtibial Amputation
		Modified burgess procedure
		Modified bruckner procedure
		Modified ertl procedure
	Knee Disarticulation
	Transfemoral Amputation
	Hip Disarticulation and Hemipelvectomy
	Future Directions
		Osseointegration
			Indications
			Implant Fixation
			Skin Implant Interface
			Rehabilitation Protocol
			Complications
			Outcomes
		Active lower limb prostheses and the human-machine interface
	Neuroma Prevention and Treatment
	Summary
	References
20
Postoperative and Preprosthetic Care
	Patient-Client Management After Amputation
		Individuals with new amputation
		Patient-centered care and multidisciplinary teams
	Examination
		Patient-client history and interview
			Demographic and Sociocultural Information
			Developmental Status
			Living Environment
			Health, Emotional, and Cognitive Status
			Medical, Surgical, and Family History
			Current Condition
		Systems review
		Test and measures
			Assessing Acute Postoperative Pain
			Phantom Sensation and Phantom Pain
			Assessing Residual Limb Length and Volume
			Assessing Integumentary Integrity and Wound Healing
			Assessing Circulation
			Assessing Range of Motion and Muscle Length
			Assessing Joint Integrity and Mobility
			Assessing Muscle Performance and Motor Control
			Assessing Upper Extremity Function
			Assessing Aerobic Capacity and Endurance
			Assessing Attention and Cognition
			Assessing Sensory Integrity
			Assessing Mobility, Locomotion, and Balance
			Assessing Posture, Ergonomics, and Body Mechanics
			Assessing Self-Care and Environmental Barriers
			Monitoring for Postoperative Complications
	Process of Evaluation, Diagnosis, and Prognosis
		Physical therapy diagnosis
		Plan of care: prognosis
		Plan of care: determining appropriate goals
	Interventions for Persons With Recent Amputation
		Postoperative pain management
		Dealing with phantom limb sensation and phantom pain
			Physical Therapy for Postoperative and Phantom Pain
		Limb volume, shaping, and postoperative edema
			Soft Dressings and Compression
			Pressure Garments: ``Shrinkers´´
			Nonremovable Rigid Dressings
			Removable Rigid Dressings
			Removable Polyethylene Semirigid Dressings
			Zinc Oxide-Impregnated Semirigid Dressing
			Pneumatic Compression for Early Ambulation
			Rigid Dressing as a Base for Immediate Postoperative Prostheses
			Selecting the Appropriate Compression Strategy
		Skin care and scar management
		Range of motion and flexibility
		Muscle performance
		Endurance
		Postural control
		Wheelchairs, seating, and adaptive equipment
		Bed mobility and transfers
		Ambulation and locomotion
		Patient and family education: care of the remaining limb
	Preprosthetic Outcome Assessment
	Summary
	References
21
Understanding and Selecting Prosthetic Feet
	Factors in Selecting a Prosthetic Foot
		Functional level
		Activities of daily living, vocational, and work requirements
		Body weight
		Residual limb
		Comorbidities
		Environmental exposure and durability
		Shoe choices (Heel heights and shoe shape)
		Interaction with other prosthetic components
		Prior prosthetic feet and gait habits
		Psychological influences and personality traits
		Skin tone
		Cost
		Bilateral limb loss
	Performance Features and Appearance of Available Prosthetic Feet
		Functional level 1 feet
		Functional level 2 feet
		functional level 3 feet
		Functional level 4: high activity and specialized feet
	Summary
	References
22
Postsurgical Management of Partial Foot and Syme Amputation
	Partial Foot Amputations
		Gait characteristics after partial foot amputation
		Prosthetic management
			Toe Fillers and Modified Shoes
			Partial Foot Inserts and Toe Fillers
			Cosmetic Slipper Designs
			Prosthetic Boots
			Partial Foot Prostheses Incorporating an Ankle-Foot Orthosis
			Chopart Prostheses
	Syme Amputation
		Postoperative care: Walking casts
		Prosthetic management
			Canadian Syme Prostheses
			Medial Opening Syme Prostheses
			Sleeve Suspension Syme Prostheses
			Expandable Wall Prostheses
			Tucker-Winnipeg Syme Prostheses
		Prosthetic feet for syme prostheses
			Determining the Prosthetic Clearance Value
			Nonarticulating Syme Feet
			Dynamic Response Syme Feet
			Alignment Issues
	Summary
	References
23
Transtibial Prosthetics*
	Evaluation for a Prosthesis
	Early Management of a Prosthesis
	Prescription of a Prosthesis
	Socket Designs
		Patellar tendon-bearing socket
		Total surface-bearing socket
	Interface Materials
		Hard socket
		Socks and sheaths
		Soft inserts
		Flexible inner socket
		Expandable wall socket
		Gel liner
	Suspension
		Waist belt
		Joints and corset
		Cuff strap
		Supracondylar suspension
		Supracondylar/suprapatellar
		Sleeve
		Suction
		Locking liners
		Semirigid locking liner
		Elevated vacuum
	Impression Techniques
		Hand casting
		Pressure casting
		Optical scanning
	Alignment
		Bench alignment
		Height
		Dynamic alignment
		Electronic alignment
	Additional Features
		Torque absorber
		Shock absorber
		Dynamic pylon
			Microprocessor-Controlled Foot/Ankle Systems
			Prosthetic Feet
		Diagnostic sockets
	Finishing Techniques
		Endoskeletal considerations
		Exoskeletal considerations
	Deviations in Gait
		Initial contact
			Sagittal
			Frontal
			Transverse
			Loading Response
				Sagittal
			Frontal
			Transverse
		Midstance
			Sagittal
			Frontal
			Transverse
		Terminal stance
			Sagittal
			Frontal
			Transverse
		Preswing
			Sagittal
			Frontal
			Transverse
		Swing phase
			Sagittal
			Frontal
			Transverse
	Troubleshooting
	Specialty Prostheses
	Summary
	References
24
Transfemoral Prostheses
	Components of the Transfemoral Prosthesis
		Foot-ankle assembly
	Shank
	Knee Unit
		Axis
			Single-Axis Knee Units
			Polycentric Knee Units
		Stance control
			Manual Locking Knee Units
	Braking Mechanisms
		Swing phase control
			Extension Aid
		Hydraulic knee units
		Pneumatic knee units
		Microprocessor knee units
		Socket
		Materials
		Shape
			Quadrilateral
		Ischial containment
			Suspension Systems
		Suction
	Elevated Vacuum (Subatmospheric) Suspension
		Liners
		Roll-on liners
			Cushion Liner With Air Expulsion Valve
			Shuttle Locking Liner
			Lanyard
		Total elastic suspension belt
		Silesian belt
		Pelvic belt
			Osseous Integration
		Transfemoral alignment
		Sagittal alignment
		Frontal alignment
		Evaluation of the prosthesis
		Base of support
		Transfemoral gait
		Side view
		Rear view
		Changing shoe heel height
		Overuse
		Improper donning
		Inadequate suspension
		Worn or loosened components
		Patient innovation
		Transfemoral prosthetic gait
			Balance
			Assessing Ability to Walk
		Energy expenditure
		Early stance compensations
			Lateral Trunk Bending
			Abducted Gait
		Knee instability
			Foot Slap
			External Rotation of the Prosthetic Foot
		Midstance to late stance compensations
			Swing Phase Compensations
			Excessive Knee Flexion (High Heel Rise)
			Lateral and Medial Whips
			Terminal Impact
			Vaulting
			Circumduction
			Hip Hiking
		Other issues
	Summary
	References
25
Prosthetic Options for Persons With High-Level and Bilateral Amputation*
	High-Level Lower Limb Loss
		Etiology
		Biomechanics
		Component selection
			Choosing a Prosthetic Foot
			Choosing a Prosthetic Knee Unit
			Choosing a Prosthetic Hip Joint
			Torque Absorbers
		Energy consumption
		Socket design
		Rehabilitation outcomes after high-level amputation
	Bilateral Lower Limb Loss
		Energy cost
		Component selection
			Bilateral Transtibial Amputations
			Bilateral Transfemoral Amputation
			Transfemoral and Transtibial Amputation
		Socket designs and suspension
	Summary
	References
26
Early Rehabilitation in Lower Extremity Dysvascular Amputation
	Components of the Physical Therapy Examination
		Patients history
		Systems review
		Tests and measures
	The Evaluation Process
	Establishing a Physical Therapy Diagnosis and Prognosis
		Plan of care
	Preprosthetic Interventions
		Range of motion
		Strength
		Balance and postural control
		Cardiovascular endurance
		Edema control of the residual limb
		Soft tissue mobility of the residual limb
		Sensory status of the residual and remaining limbs
			Hyposensitivity
			Hypersensitivity
			Phantom Limb Sensations
			Phantom Limb Pain
			Residual Limb Pain
		Care of the sound limb
		Candidacy for a prosthesis and prescription
	Early Training for Use of a Prosthesis
		Donning and doffing the prosthesis
			Prosthetic Fit: Socket Design and Sock Use
		Alignment of the prosthesis
		Wearing schedule for the prosthesis
		Positioning
		Prevention and management of skin problems in the residual limb
		Care of prosthetic equipment
	Prosthetic Gait Training
		Initial training
		Assistive devices
		Prosthetic gait
		Gait training on alternate surfaces
		Functional activities
		Outcome assessment
	Summary
	References
27
Advanced Rehabilitation for People With Microprocessor Knee Prostheses
	Historical Development
	Overview of Non-Microprocessor Knee Prostheses
	Introduction to Microprocessor Knee Prostheses
	Microprocessor Knee Prostheses Control Mechanisms
	Common Mobility Problems and Potential Solutions
		Stance phase
	Stairs and Ramps
	Outcomes
	Prescriptive Cases
	References
28
Athletic Options for Persons With Limb Loss*
	Introduction
	Barriers and Motivation
	Organizational Support for Sports or Recreation Participation
		Disabled Sports, USA21
		Amputee Coalition23
		Challenged Athlete Foundation25
		US and International Paralympic Committees27,28
	Sport Classification29
	Summer Paralympic Sports
		Archery30
		Badminton30
		Athletics (Track and Field)30
		Canoeing30
		Cycling30
		Equestrian30
		Fencing30
		Triathlon30
		Powerlifting30
		Rowing30
		Rugby30
		Sailing30
		Shooting30
		Swimming30
		Table Tennis30
		Taekwondo30
		Wheelchair Tennis30
		Sitting Volleyball30
		Wheelchair Basketball30
	Winter Paralympic Sports
		Alpine Skiing30
		Nordic Skiing30
		Curling30
		Sled (Sledge) Hockey30
		Snowboarding30
	Non-Paralympic Sports and Recreational Activities for Individuals With Limb Loss
		Fishing32
		Hunting32
		Golf33
		Trail Orienteering34 and Climbing35
		Sky Diving36
	Additional Water Sports and Activities
	Prosthetic Components for Athletes With Limb Loss
	Prosthetic Components for Athletes With Lower Limb Loss
		Suspension and Sockets
		Prosthetic Knee Joints
		Lower Leg/Foot/Ankle Components
	Athletes With Upper Limb Loss
	Children With Limb Loss in Sport
	Prosthetics in Sports: What Is Best?
	References
29
Rehabilitation for Children With Limb Deficiencies
	Comprehensive Considerations in Childhood
		Classification and causes of limb deficiencies
		Developmental milestones
		Accommodating growth
		Postoperative care
		Psychosocial factors in habilitation and rehabilitation
			Infants
			Toddlers
			School-age Children
			Older Children and Adolescents
	Rehabilitation and Prosthetic Decision Making
		Rehabilitation of children with upper-limb amputation
			Infants
			Toddlers
			School-age Children
			Older Children and Adolescents
		Rehabilitation of children with lower-limb loss
			Infants
			Toddlers
			School-age Children and Adolescents
		Rehabilitation of children with multiple limb amputation
	Summary
	References
30
Prosthetic Options for Persons With Upper Extremity Amputation
	Length of the Residual Limb
	Etiology of Upper Extremity Amputation
	Preprosthetic Care
	Prosthetic Options
		No prosthesis
		Prosthetic prescription
			Prosthetic Socket
	Passive Functional Prostheses and Restorations
	Partial-Hand Prostheses
	Disarticulation Considerations
	Transradial and Transhumeral Considerations
	Body-Powered Components
		Terminal devices for body-powered prostheses
		Wrists for body-powered prostheses
		Elbows for body-powered prostheses
	Body-Powered Control
		Figure-of-eight harness for suspension and control
		Figure-of-nine harness for control with self-suspending sockets
		Control and suspension for bilateral prostheses
	Electric Components
		Electric terminal devices
		Electric wrists
		Electric elbows
	Externally Powered Control
		Myoelectric control systems
			Dual-Site Control
			Pattern Recognition Control
		Alternative control systems
	Hybrid Prostheses
	Activity-Specific Prostheses
	Summary
	References
31
Rehabilitation for Persons With Upper Extremity Amputation*
	Rehabilitation after Upper Extremity Amputation
	Incidence and Causes of Upper Extremity Amputation
	Classification and Functional Implications
	Stages of Rehabilitation
		Postoperative Care
			Comprehensive Evaluation
			Pain Management
			Wound Healing
		Edema control
			Range of Motion, Flexibility, and Body Symmetry
			Psychological Support
		Preprosthetic training
			Psychological Support
			Edema Control and Limb Shaping
			Enhancing Range of Motion and Strengthening
			Myosite Testing and Training
			Basic Training in Activities of Daily Living
			Determining a Prosthetic Plan
		Basic prosthetic training
			Residual Limb Hygiene and Care of the Prosthesis
			Wearing Schedule
			Donning and Doffing the Prosthesis
			Controls Training and Functional Use Training
			Control and Functional Use of Body-Powered Prostheses
			Control and Functional Use of the Myoelectric Prosthesis
			Advanced Functional Skills Training
			Current Research and Advancements in Technologies
	Summary
	References
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
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	K
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	M
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	T
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