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.