Life Without Limitations - PDF Free Download

Mobility Grades Product Selection Life Without Limitations Presenter: Matt Henderson Ossur Asia Pacific

Agenda What is missing? K Level Review Required features for given K Levels A Look at Specific Products and Functions

Key to SUCCESS Understanding what is lost Understanding what are your client s needs Understanding products capabilities GOOD prescription comes through matching an amputee s needs to product capabilities as this will provide the best outcome!

What have our clients lost? Transtibial amputees what are the components of the gait cycle

Loading Response Occurs 0-10% of the Gait Cycle Function: Shock Absorption Weight Bearing Stability Forward Progression

Loading Response Shock Absorption During normal gait, the body has a period of free fall at the end of terminal swing The body weight falls about 1 cm causing high impact

Loading Response B.W. Shock Absorption During normal gait, the body has a period of free fall at the end of terminal swing % of B.W. The body weight falls about 1 cm causing high impact 12% % of Stance Phase 60% of the body weight is transferred in 0,02 sec

Loading Response Shock Absorption Shock Absorption mechanisms: Controlled ankle plantarflexion Knee Flexion Unlocked Subtalar joint Plantar arches of the foot Calcaneal heel pad

Loading Response Shock Absorption Shock Absorption mechanisms: Controlled ankle plantarflexion Knee Flexion Joints of the foot STJ, TN, CC Plantar arches of the foot Calcaneal heel pad

Loading Response % of B.W. 200 100 Walk Slow Walk Run Shock Absorption Tissue break down, back pain and long term injury can be the result of missing shock absorption Shock absorbing systems assist to achieve natural efficient gait 0 % of Stance Phase 0 62% Prosthetic foot requirements: 1. Shock absorbing mechanisms

Loading Response Weight Bearing Stability Anatomical foot demonstrates inversion/eversion characterisitics during loading response/stance phase To accomplish a natural gait pattern the prosthetic foot has to provide eversion and inversion, this also reduces socket pressures. Prosthetic foot requirements: 1. Shock absorping mechanisms 2. Eversion and inversion

Mid Stance Occurs10-30% of the Gait Cycle Function: Tibial Progression Weight Bearing Stability

Mid Stance Dorsiflexion Plantarflexion Tibial Progression Tibial progression of 15 occurs during mid stance (Gastroc/soleus complex is providing power to assist with progression) Prosthetic foot requirements: 1. Shock absorping mechanisms 2. Eversion and inversion 3. Smooth progression through gait cycle (energy return & power)

Mid Stance Weight Bearing Stability Rotation In early midstance the knee axis is 10 internal, and the ankle 2 externally rotated

Mid Stance Weight Bearing Stability Rotation In late midstance the knee is in 0 (neutral), and the ankle in12 externally rotation

Mid/Terminal Stance Weight Bearing Stability Rotation In terminal stance the knee exhibits 15 and the ankle 3 of internal rotation

Mid/Terminal Stance Weight Bearing Stability Rotation Rotation occurs within all joints throughout the gait cycle! Without rotation natural and efficient gait will be compromised The more proximal the level of amputation the more anatomical options for rotation are absent Prosthetic foot requirements: 1. Shock absorping mechanisms 2. Eversion and inversion 3. Smooth progression through gait cycle (energy return & power) 4. Torque absorption mechanisms

Terminal Stance Occurs 30-50% of the Gait Cycle Function: Forward progression/propulsion the body of

Terminal Stance Full Length Toe Lever Short forefoot lever: Pelvis drops Knee instability Resulting in: Shorter step and higher impact on the contralateral side

Terminal Stance 600 Units KPa Forward progression/propulsion Weight bearing pressure heel strike to toe off of the foot (Gastroc/soleus complex providing power) 520 Prosthetic foot requirements: 1. Shock absorping mechanisms 2. Eversion and inversion 3. Smooth progression through gait cycle (energy return & power) 4. Torque absorption mechanisms 5. Full length toe lever Cavanagh PR, Michiyoshi AC. A technique for the display of pressure distributions beneath the foot. J Biomech 13:69-75 1980

Proportional Response The muscle action during natural gait adjusts to the impact applied. Various impact requires various response. % of B.W. % of Stance Phase Prosthetic feet perform most efficiently when designed according to the load applied Prosthetic foot requirements: 1. Shock absorping mechanisms 2. Eversion and inversion 3. Smooth progression through gait cycle (energy return & power) 4. Torque absorption mechanisms 5. Full length toe lever 6. Potential to respond to different loadings (energy return & power).

Adaption to terrain & heel heights Uneven terrains Changing shoes

Primary characteristics required in a prosthetic foot: Shock absorping mechanisms Eversion and inversion Smooth progression through gait cycle (energy return & power) Torque absorption mechanisms Full length toe lever Potential to respond to different loadings (energy return & power). Ability to adapt to terrain and heel height...

Agenda What is missing? K Level Review Required features for given K Levels A Look at Specific Products and Functions

Definitions for Classification Levels: K 0 Does not have the ability to ambulate or transfer with or without assistance and a prosthesis does not enhance quality of life or mobility. K 1 Has the ability or potential to use a prosthesis for transfers or ambulation in level surfaces at a fixed cadence. Typically of the limited and unlimited household ambulator. K 2 Has the ability or potential for ambulation with the ability to traverse low-level environment barriers such as curbs, stairs or uneven surfaces. Typical of the limited community ambulator. K 3 Has the ability or potential for ambulation with variable cadence. Typical of the community ambulatory who has the ability to traverse most environmental barriers and may have vocational, therapeutic or exercise activity that demands prosthetic use beyond simple locomotion. K 4 Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress or energy levels. Typical of the prosthetic demands of the child, active adult or athlete.

Agenda What is missing? K Level Review Required features for given K Levels A Look at Specific Products and Functions

Functional Classification What is required for a prescription at each classification level?

K0 Does not have the ability to ambulate or transfer with or without assistance and a prosthesis does not enhance quality of life or mobility. Not a viable prosthetic user Consideration can be given to a cosmetic prosthesis or a removeable rigid dressing for protective purposes.

K1 Has the ability or potential to use a prosthesis for transfers or ambulation in level surfaces at a fixed cadence. Typical of the limited and unlimited household ambulator.

K1 - Keys Comfort Light weight Safety Compliance to walking surface Simplicity

K2 Has the ability or potential for ambulation with the ability to traverse low-level environment barriers such as curbs, stairs or uneven surfaces. Typical of the limited community ambulator

K2 - Keys Comfort Compliance Safety/Security Energy efficiency becoming focal

K3 Has the ability or potential for ambulation with variable cadence. Typical of the community ambulatory who has the ability to traverse most environmental barriers and may have vocational, therapeutic or exercise activity that demands prosthetic use beyond simple locomotion.

K3 - Keys Stability & Comfort Protection eg Shock and torque attenuation Energy efficiency Componentry must optimize physical potential rather than limit functional outcome.

K4 Has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress or energy levels. Typical of the prosthetic demands of the child, active adult or athlete.

K4 - Keys High level of energy efficiency Stability/Comfort/Protection Impact reduction Durability

Agenda What is missing? K Level Review Required features for given K Levels A Look at Specific Products and Functions

What can we get back from a Prosthesis?

Prosthetic foot requirements: 1. Shock absorping ability 2. Eversion and inversion 3. Smooth progression through walking cycle (energy return & power) 4. Torque absorption mechanisms (Rotation) 5. Full length toe lever 6. Potential to respond to different loadings (energy return & power). 7. Adaption to terrain (and heel height)

Historical Foot Terminology SACH foot SACH is an acronym for "solid ankle, cushion heel," and refers to a compressible heel wedge that provides "pseudo-plantar flexion" after heel strike. The rigid wooden keel provides midstance stability but little lateral movement. The SACH is frequently prescribed because it is inexpensive, light, durable, and available in various heel heights so people can wear different shoes. It has no contraindications. When SACH feet are prescribed for people with bilateral amputations, they must have firm heel cushions, to prevent the tendency to fall backward that people experience with soft heel cusions. Single axis foot Two bumpers limit and control ankle dorsi- and plantar flexion. The PF bumper permits the foot to contact the floor more rapidly during loading response than the SACH foot. The more rapid "foot flat" allows the ground reaction force line to move anteriorly, so that it falls in front of the knee and promotes early knee extension and stance stability. However, the single-axis foot is heavier than the SACH, offers no more lateral movement, and requires more frequent maintenance because dirt can foul the bumper mechanisms. SAFE foot SAFE is an acronym for "stationary attachment flexible endoskeletal," a foot whose arrangement of several flexible, internal keels permits triplanar movement and an easy "rollover." Nevertheless, the foot is stiff and stable during stance, and is a good choice for older people because of its light weight. Multiaxial foot Dynamic Response Foot

Flex-Foot Designed to match individual needs Lightweight carbon fiber technology matches weight and impact High energy storage and release capacity Tall and short foot modules to match clearance and dynamic requirements Foot modules with torque and/or shock absorbers Multi-axial feet Specialty feet and Bionic systems for unique requirements

Flex-Foot Low energy return systems Flex-Foot Assure and Balance are specifically designed for the low impact household and limited community ambulator

Flex-Foot Balance Indications for use For household and limited community ambulation Amputation level: TT & TF

Flex-Foot Assure Indications for use For limited community ambulation & smooth roll-over characteristics Amputation level: TT & TF

Flex-Foot High energy return systems Modular III, Vari-Flex and LP Vari-Flex with EVO are classic, lightweight designs delivering superior performance and durability

Modular III Indications for use For unlimited community ambulators who seek a lightweight prosthesis, highest efficiency, and rugged durability in tough environments Amputation levels: TT & TF

Vari-Flex & LP Vari-Flex with EVO Vari-Flex and LP Vari-Flex with EVO are lightweight designs which deliver superior performance and durability to a wide range of users

Vari-Flex & LP Vari-Flex with EVO Indications for use The dynamic performance, durability and lightweight design meets the demands of the workplace and most recreational activities. This versatility makes the Vari-Flex series a popular choice globally.

Flex-Foot Multi-axial systems Flex-Foot Axia and Talux are designed to adapt to uneven surfaces and to enhance balance, stability and comfort

Talux Indications for use For unlimited community ambulators who desire easier and more comfortable walking on level ground, uneven ground and slopes Amputation levels: TT&TF

Talux Outcome: Restores balance and stability

Flex-Foot Axia Indications for use For unlimited community ambulators with longer limbs who desire increased ground compliance and a comfortable toe-break Amputation levels: TT

Flex-Foot Vertical shock and rotation systems Re-Flex Rotate, Re-Flex Shock and LP Ceterus systems allow for a variety of shock, torque absorption, and energy return options to suit active amputees.

Re-Flex Rotate with EVO Re-Flex Rotate with EVO offers an ideal combination of torque and shock absorbing elements in addition to high energy return.

Re-Flex Rotate with EVO Indications for use For active individuals seeking additional shock and torque absorption for walking and recreational activities Amputation level: TT & TF

Re-Flex Shock with EVO Re-Flex Shock with EVO is a highly dynamic vertical shock system providing best energy return for daily activities and recreational athletics

Re-Flex Shock with EVO Indications for use For active individuals who require superior vertical shock absorption and energy return for faster walking and recreational athletic activities including extreme conditions. Amputation level: TT & TF

Flex-Foot Special applications Functional systems designed for specific applications or amputation levels

Elation Elation is ideal for individuals interested in wearing a variety of footwear with differences in heel height

Flex-Symes and Chopart Flex-Symes and Chopart are specially designed for longer amputations

Flex-Symes TM Indications for use Symes amputation: Disarticulation of ankle including heel pad Insufficient clearance for Axia or LP Vari-Flex systems Low, medium, and high impact users

Chopart Indications for use Chopart: Calcaneus, Talus and Navicular Low, medium and high impact levels

Chopart Partial foot prostheses Floor reaction AFO TT socket design

Flex-Foot Junior Flex-Foot Junior is designed to meet the rigorous demands of children

Flex-Foot Junior Indications for use For children 15-45kg participating in a variety of activities. Will accommodate use of sandals. Amputation level: TT & TF

PROPRIO FOOT The only prosthetic foot which uses Motor Power to replace PLANTAR and DORSI-FLEXION

Overview User Interface: Buttons LEDs Vibration Sound Sensors Motion Sensors Artificial Intelegence - Terrain Logic TM Actuation Stepper Motor Battery Pack Carbon Composite Flex-Foot

Adaption to terrain (and heel height) Elation Proprio

Flex-Foot Sport Flex-Foot Cheetah, Flex-Sprint and Flex-Run offer athletes the performance and energy return required for competitive running.

Contact info Matthew Henderson Ossur Asia-Pacific Tel. +61 8838 2800 Mobile +61 400 232 251 E-mail mhenderson@ossur.com www.ossur.com

Thank You!