Donning and Doffing a Prosthetic Limb - Prosthetic Training: Episode 4

Summary

In this instructional video, David Lawrence demonstrates the correct techniques for donning and doffing a prosthetic limb. He covers various suspension methods including roll-on liners, pin systems, lanyard straps, and seal-in systems, offering guidance on how to ensure a secure fit and avoid common issues. The video is part of a series on prosthetic rehabilitation, available on the MissionGait YouTube channel.

Takeaways

• 🤖 The video demonstrates how to properly don (put on) and doff (take off) a prosthetic limb, focusing on different types of liners, suspension, and sockets.
• 🧦 Most patients are given roll-on liners for prosthetic limbs, which are preferred over suction fits due to their ease of use and audible click mechanism for secure attachment.
• 🔐 The click system helps patients know how far they should insert their limb into the prosthetic socket, with 11-12 clicks indicating the bottom of the socket.
• 👣 For above-knee amputees, a lanyard strap is commonly used to pull the residual limb down into the socket, avoiding the 'ice cream cone' effect of pushing the limb up over the top.
• 🔄 The seal-in system uses a gasket and liner material without a pin or lanyard, creating a broad attachment point around the socket for a secure seal.
• 💧 Hand sanitizer is used with the seal-in system to lubricate the gasket and socket for easy sliding and sealing once the sanitizer dries.
• 🌀 The vacuum or elevated vacuum system uses a sleeve over the socket to create a seal, with the liner extending at least four fingers higher than the top of the socks for a secure fit.
• 🦿 The design of below-knee (transtibial) sockets focuses on weight-bearing on the patellar tendon and total contact around the residual limb, with reliefs to avoid pressure points.
• 🦵 Above-knee (transfemoral) sockets often use an ischial containment design, ensuring the sit bone fits into a shelf within the socket for better force distribution.
• 🛑 Brimless sockets provide comfort when sitting by eliminating the back of the socket, but may compromise suspension and load-bearing consistency.
• 👕 Proper hygiene and care of the liners are crucial to prevent dermatitis, including daily cleaning without wetting the nylon material and avoiding contact with irritants.

Q & A

What is the main focus of the video presented by David Lawrence?

The main focus of the video is to show how to properly put on and take off a prosthetic limb, a process known as donning and doffing.

What types of liners are most commonly used by patients today?

Most patients today are given roll-on liners. Suction fits are becoming more rare.

How does a pin suspension system work in a prosthetic limb?

A pin suspension system involves rolling a liner onto the body, which then connects to a socket using a pin. This creates an audible connection that helps the patient know they are securely locked in.

What should a patient consider if they hear 12 clicks when engaging the pin suspension system?

If a patient hears 12 clicks, it means they are bottomed out and probably need to add more sock layers.

Why are lanyard systems more common with above-knee amputations?

Lanyard systems are more common with above-knee amputations because they help draw the residual limb down into the socket, which prevents the limb from being pushed up and over the top due to the soft tissue around a single bone.

What is the purpose of using hand sanitizer with a seal-in system?

Hand sanitizer is used to lubricate both the liner and the socket, allowing them to slide together easily. It then dries, creating a seal that holds the prosthetic limb in place.

What is a potential issue with having an air pocket at the bottom of the socket in any of the discussed systems?

Having an air pocket at the bottom of the socket can create a negative pressure effect, similar to a hickey, which can cause discomfort or skin damage.

What are the benefits of a brimless socket design?

The benefits of a brimless socket design include less pressure on the back when sitting, making it more comfortable. However, it may not provide as stable a suspension for active individuals.

What is the importance of ensuring no air gaps or wrinkles when donning a liner?

Ensuring no air gaps or wrinkles is important to prevent discomfort, skin damage, and to ensure the prosthetic limb fits securely and functions properly.

Why is it important to clean the inside of the liner daily?

It is important to clean the inside of the liner daily to prevent contact dermatitis and to maintain hygiene. The liner should be cleaned with mild soap and kept dry to avoid odors.

Outlines

00:00

🤖 Donning and Doffing Prosthetic Limbs

David Lawrence introduces the process of donning and doffing a prosthetic limb, focusing on the use of liners, suspension, and sockets. He explains the roll-on liner and pin system for creating an audible connection, which helps patients know their depth of insertion. The importance of knowing the number of clicks for proper fit is emphasized, with guidance on adjusting the number of socks for a correct fit. The video also covers the use of a lanyard strap for above-knee amputees and the seal-in system for creating a broad attachment point.

05:01

🦿 Understanding Socket Designs and Fittings

This paragraph delves into the specifics of socket design for below-knee (transtibial) and above-knee (transfemoral) amputees. It discusses the importance of weight distribution, total contact, and reliefs in transtibial sockets. For transfemoral sockets, the ischial containment socket is highlighted, along with different types of suspension systems. The video also addresses the benefits and challenges of brimless sockets and vacuum systems, providing insights into fitting a transtibial amputee with a silicone suspension system and a pin.

10:04

🧦 Proper Use of Liners and Socks in Prosthetic Fittings

The focus shifts to the correct application of liners and socks for prosthetic fittings. The process of rolling on the liner without wrinkles or air gaps is detailed, along with the importance of cleaning and maintaining the liner's hygiene. The use of Lycra-based socks is explained, cautioning against stretching them and ensuring they maintain their three-ply integrity. The paragraph also describes the application of a sleeve over the liner and socket, emphasizing the need for a good seal and vacuum.

15:06

🔩 Pin Suspension System and Alignment

This section describes the pin suspension system for below-knee amputees, including the importance of aligning the pin as an extension of the residual limb. It explains the process of checking the pin's alignment before putting on socks and ensuring it is free from the bottom of the sock to avoid getting locked into the socket. The paragraph also addresses how to deal with a prosthetic device that cannot be easily removed, suggesting the use of warm water for a potential solution.

20:11

🤲 Lanyard System and Above-Knee Socket Fittings

The paragraph explains the process of fitting an above-knee amputee with a lanyard system, which involves a liner with a Velcro-based strap for suspension. It details the steps of turning the liner inside out, ensuring no air pockets, and rolling it up the residual limb. The use of a special sock with a hole at the bottom and the positioning of the lanyard strap through a hole in the socket are also covered. The video demonstrates how to adjust the lanyard strap for a secure fit and the importance of pulling from the bottom of the strap rather than the D-ring to avoid damage.

25:13

💧 Seal-In System for Above-Knee Sockets

The final paragraph discusses the seal-in system for above-knee sockets, which uses a roll-on sleeve with a built-in gasket for suspension without the need for straps or pins. The correct way to don the liner, ensuring it is fully inside out and flush at the bottom, is described. The process of dampening the gasket with a moisturizing agent like Purell and sliding the socket onto the residual limb while expelling air for a snug fit is detailed. The paragraph concludes with the importance of adjusting clothing and maintaining a stable position after fitting the prosthetic.

Keywords

💡Prosthetic Limb

A prosthetic limb is an artificial device that replaces a missing body part, such as an arm or leg. In the context of the video, the focus is on how to properly put on and take off a prosthetic limb, which is crucial for the comfort and functionality of the device. The script mentions various types of prosthetic components and their correct application for optimal fit and use.

💡Donning and Doffing

Donning and doffing refer to the process of putting on and taking off a prosthetic limb, respectively. The video script provides a detailed tutorial on this process, which is essential for individuals with amputations to maintain independence and mobility.

💡Liners

Liners are an integral part of a prosthetic system, serving as an interface between the residual limb and the prosthetic socket. They can be roll-on or suction fits and are designed to provide comfort, support, and a secure fit. The script discusses different types of liners and how they are used in conjunction with other components for suspension.

💡Suspension

Suspension in the context of prosthetics refers to the method by which the prosthetic limb is held in place on the residual limb. The script covers various suspension techniques, such as pin systems, lanyard straps, and seal-in systems, each serving to secure the prosthetic and ensure a proper fit.

💡Socket

The socket is the part of a prosthetic device that encloses the residual limb, providing support and connection to the rest of the prosthetic. The video script describes different types of sockets, such as those for below-knee (transtibial) and above-knee (transfemoral) amputations, and how they are fitted and secured.

💡Pin System

A pin system is a type of prosthetic suspension mechanism that uses an audible click to indicate when the prosthetic is properly engaged with the socket. The script explains how to use a pin system to ensure the prosthetic is securely in place and how to determine the correct depth of insertion.

💡Lanyard Strap

A lanyard strap is a component used in some prosthetic systems, particularly for above-knee amputations, to help draw the residual limb down into the socket. The script demonstrates how to use a lanyard strap to achieve a secure fit without causing discomfort or pressure issues.

💡Seal-In System

A seal-in system is a type of prosthetic suspension that utilizes a gasket and a moistened liner to create a seal within the socket. The script explains the process of donning a seal-in system, emphasizing the importance of proper lubrication and ensuring the residual limb is fully seated within the socket.

💡Elevated Vacuum System

An elevated vacuum system is a type of prosthetic suspension that relies on creating a vacuum seal between the liner and the socket. The script mentions this system in the context of using a sleeve over the socket to maintain the vacuum and ensure a secure fit.

💡Transtibial Amputation

Transtibial amputation refers to the surgical removal of a limb below the knee. The video script provides specific instructions for fitting a prosthetic to a patient with a transtibial amputation, including the use of liners, socks, and sleeves for proper suspension and comfort.

💡Transfemoral Amputation

Transfemoral amputation is the removal of a limb above the knee. The script discusses the unique considerations for fitting a prosthetic to a patient with a transfemoral amputation, such as the use of a lanyard strap and the importance of proper socket design for suspension and comfort.

Highlights

David Lawrence demonstrates the proper technique for donning and doffing a prosthetic limb.

Explanation of the use of roll-on liners and the process of engaging them with a pin system.

The importance of an audible click to indicate correct depth of liner insertion into the socket.

Guidance on determining the appropriate number of clicks for a secure and comfortable fit.

Introduction to the lanyard strap system for above-knee amputees and its method of securing the prosthetic.

The 'ice cream cone effect' and how the lanyard system helps to prevent it.

How to properly apply and secure a seal-in liner system for a vacuum seal.

The use of hand sanitizer to create a seal-in system and the correct procedure for doing so.

Differentiating between various types of sockets for below-knee and above-knee amputees.

The benefits and drawbacks of brimless sockets and their impact on comfort and suspension.

Detailed steps for fitting a below-knee amputee with a silicone suspension system.

The necessity of keeping liners clean and the correct method for doing so to prevent dermatitis.

How to properly roll on a liner and the importance of avoiding wrinkles and air pockets.

Instructions for using a hybrid system combining pin suspension with a ratchet for socket adjustment.

Demonstration of fitting an above-knee amputee with a lanyard system, emphasizing the correct positioning and tensioning.

The process of fitting an above-knee socket with a seal-in system, including the use of a gasket and special socks.

Final tips for ensuring a snug and secure fit of the prosthetic, including adjusting shorts and using a walker.

Invitation to view additional videos on prosthetic rehabilitation and subscribe to the Mission Gait YouTube channel.

Transcripts

Hi,

I'm David Lawrence and in this video I'm going to show you how to properly put

on and take off a prosthetic limb, a process known as donning and doffing.

Okay. Now we're going to talk about liners, suspension, and sockets.

Most patients these days are going to be given some sort of roll-on liner.

There are still some suction fits out there, but that's becoming more rare.

With a liner like this, it rolls on to the body, um,

which we'll show you with actual patient fitting,

but you basically are going to use a pin system like this into a socket and

you're going to create a connection. That's going to be an audible connection,

which is really beneficial for the patient to know that I'm in there,

I'm locked in to know how deep I'm in.

But the big question I often get is how far should I be in how many clicks?

How do I know where I'm at? Well,

the best way to do it is to put your liner or put a liner on your arm or on your

hand, slide in and engage the mechanism till you hear a click.

As it clicks,

you just keep going down one click at a time until the device goes all the way

in. Sometimes you can get two or three times, you just got to count those.

You get down to 11-12 clicks.

That means you're on the bottom. The patient needs to know that they should,

if there are 12 clicks, that means they're bottomed out.

They probably need to have a little more sock on.

If they've only got about six clicks, that means they really don't have a,

they have too many socks, and they're not getting in far enough.

Somewhere in the range of 11, 10, 11 maybe 9, 10,

11 clicks is going to be about right in most sockets.

That gives a patient a start point to know whether they need to add socks or not

to a pin suspension system.

Now with a very similar type of liner,

you can add a lanyard strap.

This is much more common with an above the knee or transfemoral amputation.

For the trans tibial amputation,

you basically are going to have a fixed tibia with not a lot of soft tissue

around it.

That's going to lock well into the bottom of the socket and not have to be

pulled in. However,

when you're dealing with an above the knee socket,

you have a lot of more soft tissue around a single bone tucked deeper into the

soft tissue. So oftentimes what happens if you try to push into a pin system,

you get a bit of an ice cream cone effect.

Pushing the residual limb up over the top.

Lanyard systems work better because what you're going to do with the lanyard

system is take this strap and run it down through a small hole that the

prosthetist will place in the base of the socket.

Once you get the lanyard into the strap, you basically just pull it through.

You can see how then you can draw the residual limb down into the socket.

Instead of it being pushed up over. Once you pull it down through,

you're going to pull the strap up,

run it through the D ring and wrap it back over and Velcro it to itself.

Now the key with these when you put them on is you always pull the strap tension

from here and then just run it through the ring and re strap it.

You don't want to pull on this D-ring as your lynch point because it's very easy

to pull this rivet out or pull the D-ring apart,

but that locks that individual down into the socket so there's no way that it

can come off. Okay.

The next form is a seal-in system. This is using the same kind of gasket,

the same type of liner material, but you notice there's no pin or lanyard,

nothing that's going to attach them to the bottom of the socket or hang it from

the base of the socket.

This is going to create a system in which you're trying to bring the attachment

point more broad all the way around and higher up into the socket.

What you do with a seal-in is you put hand sanitizer all the way around it to

get it well lubricated.

Put a little bit of hand sanitizer down into the socket as well and slide these

two together while it's still wet. You want to be pressing all the way down in.

This is a one way valve so air will come out but can't go back in.

You can press on this valve to make sure you're getting all the way down in and

then you give it no more than 30 seconds.

45 seconds and the Purell will dry once it dries you are sealed in.

If you're worrying or wondering how deep they are in the socket,

you can take this valve out and check to make sure that the residual limb is

right there or filling the base of the socket.

You never want an air pocket at the bottom and if any of these sockets,

because you create a pressure,

a negative pressure which creates a almost like a hickey effect on the skin,

so you put this back in place, you're sealed in or locked in place.

Last system I want to talk about is if you are using a non seal-in type system

or if you're just having a basic,

what we call a vacuum or elevated vacuum system.

With that you're going to need a liner. This is basically the same type of,

or sleeve I should say. Excuse me, same type of material as made of the liner.

But this is a sleeve that goes over the socket.

So in this particular case you would put this over top of the socket and get a

good seal to the socket itself.

And then the liner will run up the leg.

Now the key is how much and where does the liner need to go to? Well,

what you're going to have in a socket,

like this is a liner here on the inside with socks that are going to come a

certain amount of height above the socket.

You want your sleeve to come up at least, well,

I like to say four fingers higher than the top of the socks.

That means there's at least that much area of the liner.

Um, connecting excuse me the sleeve, the sleeve connecting to your skin.

If there's not enough, you can lose your vacuum,

lose your connection and the device can come off.

So you want as much contact on the skin as you possibly can get.

So the liners fit into the socket.

And we looked at the suspension systems in various ways.

It was important to get a general sense of sockets themselves below the knee or

trans tibial sockets, uh,

tend to be a design in which you're going to bear some weight on the patellar

tendon,

but most as much as possible in total contact or pressure all the way around the

residual limb. Remember, you have a fairly bony structure below the knee,

which means there's not a lot of soft tissue,

so the socket's going to have to be developed to create reliefs in the right

area so we don't get too much pressure like on the fibular head. Um,

and there's enough room for you to slide down into the socket completely. Um,

there can be different types of ways to suspend it,

but most of your systems are going to involve some sort of level of either

suspension right at the knee or they can bring the socket up a little bit higher

than the,

to get a little bit more suspension around it based on the prosthetist you're

working with and your individual needs.

When you're talking above the knee sockets,

this is probably your most common socket design now.

Well they called your narrow ML or ischial containment socket.

This is the type of socket in which your ischial tuberosity or your sit bone

should sit right here on a shelf inside the socket, right?

So it has a place for it to sit right here or be cupped is probably the best

word and you've locked them ischial-wise into the socket that distributes force

all the way down through the socket. But there's a bony landmark on the top.

Now there are older sockets, um,

which are a quadrilateral socket where there's actually a seat for the ischial

tuberosity so you don't have to sit down into it and very modern or more new

sockets out there.

The Moss socket is one that has a different form of suspension all the way to

the top or support for the skeletal structure.

And then the issue is now you hear a lot with what's called brimless sockets.

Where you have elevated vacuum to hold the patient into the socket and there's

no brim whatsoever. What's the benefit of that?

The benefit is that when you sit, uh, there's nothing to sit on.

There's no socket back here to be uncomfortable,

so you have a lot less pressure in that area.

The negative is trying to get a suspension that if you're going to be an active

individual, the prosthetics not going to rotate on your spin.

or stay consistently bearing load. If you can have the ischial containment,

you actually get a better distribution of load directly to the skeletal system,

not going through soft tissue,

which is the way you're designed on the sound side of having a bone structure to

the ground.

Alright now we're going to be talking about fitting the below the knee or trans

tibial amputation and with a trans tibial or below the knee socket.

In this particular system, we're going to use a liner,

a system with a sleeve over the top of a socket.

So to get started,

what you want to do is roll this liner all the way out,

alright? So there's no wrinkles and no gap here at the bottom.

Really important on these issues as well as the hygiene of these liners.

You want to clean them every day.

It is very easy to get a contact dermatitis from these and you want to clean the

inside. Don't get the outside wet.

If you get this nylon material wet, it'll smell and it will stay pretty smelly.

So if you wash it right in the sink, like I'm holding it now,

let it rinse off completely mild soap, no deodorant,

no um, smells or perfumes or anything like that. Lemon fresh,

just the most simple of soaps turned inside out,

hanging on a stand or lay it out,

but don't ever lay it down with this inside material touching anything that it

touches. Cat hair, dog hair, a newsprint of a newspaper.

Everything will be picked up.

And then that will be a problem with putting it into the limb when you put it on

or push it into your skin. So you turn this all the way inside out.

Make sure that there's no air gap.

You're going to put it right on the end of the residual limb use...

Notice I'm using the flats in my hands,

not grabbing with my fingertips and I'm just sliding my hands towards her As I

do that, the the device or the sleeve basically wants to pull itself on.

This one has some wear, so it's going to roll on easier. A new one,

you have to put a little bit more effort in to get it to roll all the way up.

At that point in time,

you just want to make sure there's no wrinkles and no air pockets from top to

bottom,

and the thicker side of the liner should always be in the top and the thin on

the backside. That means it'll bend easier without pinching behind the knee.

If the patient needs socks. And in Carol's case we need that,

so we're going to put a sock over the top. With socks,

it's important to realize these are Lycra based, so this is a three ply sock.

If you yank it hard enough, you can turn it into a one ply sock.

So you want to keep it a full three ply sock by pulling the wrinkles out,

but not stretching or yanking on it.

That way it gets the sleeve solid with a sock over top of it with no wrinkles.

The next issue becomes the sleeve over top. This is the liner, the sock,

and now the sleeve. With the sleeve,

what we want to do is we want to put it into a position where it has plenty of

contact on the socket.

That means it's well-connected on the socket and plenty of material to maintain

position and create that vacuum or seal to the skin.

You roll the outside down and when you roll it down,

you always want to roll it down past the back wall of the prosthetic socket.

If not, that will pinch or catch on the way on and then you may lose suspension.

Or be just very uncomfortable as well.

From this point when you take our socket and simply slide it into place with the

knee cap sitting right in the center of the groove.

So bend your knee a little bit, Carol. There you go.

And that knee cap should sit in the middle though I don't want to put that on on

an angle in any way that's going to be uncomfortable directly in the center of

the groove. Now with a new patient with a lot more soft tissue or more swelling,

you have to take your time a little bit to work the socket into place because it

will hold and maybe hang up somewhat. Once she's in there in that position,

you're basically wanting to do the same idea of the flats of your hands to to

slide the the liner up onto the residual limb.

Now,

here we have a little bit of the liner underneath catching and what can help

that is ask your prosthetist to put a little bit of prosthetic tape right around

the top by base of the liner to hold it down and then it won't adhere or stick

to the liner as you're rolling it up. So we get this position,

we roll it right to the top.

Now you'll notice here that I stopped rolling it up right at the top of her um,

liner internally. So as I pull this sleeve up,

I want to make sure when I get to that point I have about again four fingers of

width for this liner to make good contact or sleeve, excuse me,

good contact with the skin.

So at that point I'm just going to roll that up and make good contact with the

skin and bring it all the way up. Now

at this point in time you notice that there's no wrinkles all the way down.

Yeah.

And tension wise that is locked onto her residual limb and all the way down and

she can bend it right into position, but that gives it a good stable base.

Right now we're fitting the below-knee amputee or trans tibial amputation with a

silicone suspension system and a pin.

That means we have a roll on sleeve that has a pin that engages audibly down

into the bottom of the socket.

This is helpful for patients to know how deep they are.

They can count the clicks and determine the depth they are down into the socket.

With a system like this, much like any other, uh,

liner suspension, you want to roll it inside out.

You always want to keep this very clean, top to bottom, uh, and make sure,

again, when you clean it, you don't get the uh,

nylon side wet or it will smell usually come in here and grab the pin,

hold that under the water and you can rinse it really good inside out to dry it.

Don't ever lay it down like this. If you're going to lay it down anywhere,

roll it back, right side out. At this point in time,

our key is that we have to have the pin become an extension of her,

the bone of her leg.

So if you put that on in a position too low and you start to roll up,

you're going to see that pin is not facing directly out from the end of her leg

it is not going to engage well in the housing. This sounds simple,

but it's a difficult thing for patients to always get that pin right.

So what you're going to do is put that and try and get that pin as a direct

extension of the bottom of the leg. And again, using the flats of the hands,

not the fingertips, just slide that liner all the way up.

If we have a good position,

we have the pin coming directly off of the end of the limb.

Before you put any socks on is a good time to check and see if you generally

have it right. If you do, you can hear those clicks. It is clicked into place.

That means we do have the sleeve in the right position.

Once you put the socks on that she normally needs to be able to walk.

It's going to be harder to get it to engage.

So a good way to check your alignment is just slide it on first.

She uses a five ply sock. Remember with our socks, they can come in one, three,

five, two ply, whatever.

This basically stands for five one ply sock.

So it is a thicker sock that has a hole in the bottom.

Now why is that important?

Because if you put this prosthetic on with the pin pulling through the sock like

this,

it will sometimes go down in and engage but it will not come off at that point.

You become locked into the socket.

You have to contact the prosthetist to have the prosthetic device taken apart

from underneath to get out of the socket.

So it's really important to make sure that if you put a sock on over top of a

pin suspension that the pin clearly and completely is free from the bottom of

the pin.

Now in an absolute difficult situation where you can't get to that prosthetic

limb maker, what you can do,

and it is possible that if you can take warm water and pour enough warm water

down inside this liner and you get enough water in there,

you can slide it off. It's like being extremely sweaty all the way around.

It takes a lot of water,

a lot of patience and a lot of time so that way you can get it off without

having to get the pin disengaged from the socket.

But to never make that mistake is the best way.

And to make sure you always have the patient come down,

put their hand down and just check to make sure they feel that pin is completely

free from the sock, nothing to get caught up in the housing.

From there, we don't have any external sleeve at this point in time.

All the suspension is going to come from within the socket,

so in this position we're here,

kneecap should be in the center of the horseshoe in the front.

Relax that knee a little bit.

Most patients want to stiffen the knee up and become real stiff and tight and

that causes the leg to expand and then it becomes a bit of a Chinese finger

torture. The harder you press, the more does not want to engage,

but if you can get them to relax that leg a little bit,

let it bend a little bit,

then we can get it down and you can hear that engagement that's starting to

click in there is a click. So now she's engaged.

One click means that's not coming off. You can pull,

it's not coming off and the rest of it can come from pressing in or when she

stands up to click in the rest of the way,

so here we let that knee bend a little bit,

try to be relaxed and give a little more press to get down into the socket.

If she's doing that herself, she's going to bend her knee.

She can put her hands and go ahead and do it Carol, as far as pressing down in,

there we go.

So then that's down in and clicked into position and she's locked in.

If she got up and started walking around,

this leg would click in a click or two deeper and that would be at the base it's

a fairly short pin system.

Now the big key then is she is locked in.

How does she get out of it at that point in time on the inside wall there's

going to be a button.

Sometimes there's a cosmetic cover where you have to feel for that opening,

but on this one you can see the opening.

All Carol has to do is press on that button and lift her leg up and the pin

comes directly out.

All right,

a hybrid system that's available is a system in which you use a pin suspension

on a sleeve and you combine that with a system that allows you to ratchet down

and tighten up the socket all the way around from both sides and from the back.

So, um,

how this works is you're going to put this guy on bend the knee there for me,

Percy. There you go.

And we're going to slide in till you hear the clicking that's engaging that

prosthetic down in. However, one of the additional components here,

which is nice,

is the individual then can engage this strap and tighten up these windows to

adjust the fit based on more or less swelling and getting the fit right where

they want it for that particular given time.

When we're fitting the above the knee or transfemoral patient with a lanyard

system that's basically a liner that has a strap that's a Velcro based lanyard

strap that will attach and hold suspension from below the socket.

So how you put this on, you'll notice that the,

the prosthetist has cut it lower on the inside than the outside.

That should be the groin side.

You want to turn the liner completely inside out and completely flush at the

bottom. Remember there can be no air pocket here at the bottom.

If you put this on with an air pocket, you create a hickey effect at the bottom.

You can create a lot of skin damage,

so you always want to flush it all the way out either if the therapist is doing

this or the patient, you make sure that that lower side,

it's cut up higher I should say is on the inside.

Stick this right on the end of the residual limb, flush to it, and again,

roll it up. What you're looking for is simply keeping your hands flush.

Don't grab it with your fingernails. You can cut holes in the liner.

Just kind of use the flat of your hand to slide it up the leg.

It's going to want to work its way up there. When they're new,

they're a little bit stiffer and don't roll it quite as easily.

But once we get up at about this far, Percy,

go ahead and help me out and pull that guy all the way up around.

There you go and you have to kind of lift up to get it to clear the base and

then pull the shorts out so that you're not got everything caught up in the

socket. Here we go and bring it around the front.

Now we've got our lanyard strap. We want to unhook that lanyard strap.

We're going to take our prosthesis at this point in time and you'll notice in

this prosthetic we have socks.

That means if the patient has got a fit that needs a sock,

you need a particular sock that has a hole built into the bottom of it.

What you're going to do is take that sock,

put your lanyard strap through it here and pull it up flush.

Percy. If you'll grab him, pull that sock up flush, that'd be great.

And we get that level and you pull it all the way to the top cause you want your

socks to come up over the brim of the socket.

That also keeps some of the plastic from rubbing on your skin and also keeps any

wrinkles out of the socket or the liner. From that point,

the lanyard strap goes down through a hole that the prosthetist has cut in the

bottom of the socket. Again, you do this yourself as a patient.

You're looking down through and pulling the leg through that or the lanyard

through that hole.

You're going to pull that leg up as best you can into position.

That doesn't have to be on perfectly, just close,

and so you get to a position where you pull up the best you can,

give it a little tug down and at this point in time,

that thing is not on all the way, but it is on solid.

You could really drag someone across the clinic floor with it in this position.

You don't need to do that.

Now what you're going to do is bring up the a walker in a position here,

so the patient's in a stable position.

I'm going to let you Percy go ahead and stand up. When you're ready.

There you go. And lean forward into it. Beautiful.

From that position he just brings the prosthetic back and settles his weight

down into it.

I'm going to adjust and he can do the same with just socks and liner,

pull the shorts out a little bit,

but you'll notice what's happening here is this lanyard strap will start to

become a little bit loose,

so you grabbed that lanyard strap and give it a bit of a tug down and that pulls

you in a little bit tighter. Notice when you pull on the lanyard strap,

you pull from the bottom of the strap. You don't pull from the D ring.

This ring up on the top cause you'll pull the rivet right off it.

You always pull from the bottom, come through the D ring and take up the slack.

Now that makes a good solid fit. Now Percy,

show them how you would do that yourself. If you adjust that strap.

There you go right there. Just showing them how it's done. There you go.

Here you go.

Notice how he's balancing with one hand using one hand to pull it through,

taken up the slack and he's got a good solid fit. From there,

the shorts come out and he's in a stable position.

All right what we're doing here is fitting the above knee socket,

um, with a seal-in system.

That's a system that has a roll on sleeve and a gasket built into it.

The gasket will seal to the prosthetic socket and that gives us our suspension.

There is no need for a strap or pin in this type of system.

When you're donning the liner,

it's really important that you turn that liner all the way inside out to start

with and you're not going to come down and leave any space.

You want to pull it all the way inside out until it flattens out completely.

At the second point you're going to look and see that it's been cut by the

prosthetist lower on one side than on the other.

So you want to make sure that is going to go into the groin side.

So you flush this out completely.

You're going to put that right on the and break it down a little bit,

right on the end of the residual limb and basically as you come up it's going to

want to drag itself or pull itself up the leg and that's all you're doing is

you're pulling that and sliding up. To the patient, it's the same way,

you notice I'm not using my fingertips and yanking on it.

I'm basically just using the flat of my hand and letting it roll up.

Very large shorts are helpful in this area so that you have room to work and

we'll pull it all the way up. So Percy,

if you want to go ahead and help me pull that all the way up into place.

A lot of times with the chair you have to kind of lift up a little bit to get

the base all the way underneath and bring it all the way around.

Go and bring your leg all the way down.

There we go and we flush it all the way out.

That way we know the socket's going to sit right in the right position. Perfect.

Now the gasket here can turn inside out. And if the patient needs (socks),

you need special socks, these are socks with a wide open end.

And what you're going to do with this sock,

let's put it over top of the liner.

Come above the gasket here,

but pull the base of the sock right down to the liner or the gasket and pull it

over top.

This holds the sock down in place and then we would roll the sock all the way up

flush before putting the prosthetic on. In this particular case,

the patient doesn't need this, so I'm going to take it off,

but just showing you how that works and we'll take this off and set it aside.

Now when the gasket is in place,

it's lying flush and flat in this direction.

And what you need is some sort of uh,

sanitary moisturizing stuff,

a Purell or whatever the version you need or have is fine and you want to get

the gasket fully damp. Alright,

any excess on your hand,

you want to go ahead and wipe in the socket so that it will slide down in.

If not, it's going in here. Then you have a fairly time-sensitive.

You want to go ahead and get the socket into place and begin to slide it.

Don't stand up.

We're just going to slide it into place the best we can to begin to get that

pressure down in there. Excellent.

And when we've got it in that far and that's far enough to get a basic seal,

you can bring a walker around whatever the patient needs and go ahead and stand

up for me. Percy comes right down into it. There you go.

And loads it, puts the pressure right down on it. Now it's a one way valve.

That means it's going to start expelling air immediately.

But if you press on that valve,

you'll also get more pressure and more air coming out.

So what patient does is go ahead, show him what you do, Percy,

you put the pressure on the sock... There, you go on the socket,

press on it and press down into it and you'll literally hear the air coming out

of it and you want to do that.

You want to evacuate all the air out of the base of the socket until the

residual limb is sitting flush down into the base of the socket. Many times,

once he does this a little bit, he may have to walk a few steps,

get around and then try that again until it settles all the way down in tight so

he's got a very snug fit and that's what you want to have a good solid fit

moving forward. From there,

you just make sure shorts are pulled out from the socket because they hit on

many times we'll hang up and give him room to be in a good stable position.

Thanks for watching and we hope that you found this information helpful.

This video is part of a series on prosthetic rehabilitation ranging from

managing the residual limb after amputation and progressing to running with a

prosthesis.

We encourage you to view our other videos in this series and to share them as

well. You can find them on our YouTube channel at youtube.com/MissionGait.

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