Responses: Locking suspension systems
Jonathan Reynik
Description
Collection
Title:
Responses: Locking suspension systems
Creator:
Jonathan Reynik
Date:
1/15/2008
Text:
Dear Listmembers:
Below is my original inquiry regarding locking suspension systems followed by the responses I received.
Thank you to all for your contributions.
Firstly thank you to those of you who responded to myinitial inquiry about silicone suspension systems. The prevailingopinion was that the TEC liner was easy for the elderly to donn anddoff. Unfortunately, it appears I was not as clear as I had intended tobe. I am interested in learning about the types of locking suspensionsystems you are using for elderly patients to facilitate donning/doffingfrom a seated position. I have been using a clutch lock but find thatit occasionally binds up making it difficult for elderly patients tounlock it. I am looking for a similar mechanical suspension system thatwill not bind if the patient does not exactly line the pin or othermechanism exactly with the lock every time the prosthesis is donned. Myapologies for the confusion.
Make your own lanyard. No lock to bind. Push lanyard (dacron & Velcro)out through the distal anterior opening back up to a chafe and reflectit down against it's self. Foolproof. Remember to form a slight distalimpression into the socket for the attachment screw head on the distalend of your liner.
**********
Velcro works great...attach a string to where the pin goes in the liner .
Cut a hole in d-end of socket ,put strap through,and stick on side of socket
**********
I've been using the PDI Lanyard Lock. Very nice and simple. But patientneeds to be able to screw in the lanyard to the bottom of the liner andthat can be a problem for elderly or folks with limited mobility. Alsohow about the KISS suspension with no top attachment to the liner. Justpush the strap through the bottom and attach to side of socket.(thiseliminates the screwing into the liner part at least.)
**********
lanyard pull is virtually bulletproof. now, you need to keep in mind - lock binds as pin is not aligned properly. what usually happens is that when forced in out of kilter or otherwise dragged into the locked position, liner will kink distally, catching on the skin and causing stretch on it along the bigger radius of stretch. this may end up in skin breaks. we used to advise patients to locally lube that area with alps silicone, to break friction, but you should know what patient's compliance is worth. zilch.
so, i'd say - to avoid any problems, cushion liner and suction suspension, or sleeve. no worries about any kinks in the system.
**********
Most if not all of my patients don their pin systems sitting down and fully seat into the socket when they stand up. Some socket designs seem to allow further entry into the socket under weight bearing pressure and when the patient sits to doff the prosthesis the locking pin is under tension when relaxed and they have to really whack the release button to get out of the leg. This is a socket design or fit problem and the lock is not at fault. If the patient cannot align the pin correctly no lock will work. You may want to check out the KISS system, I use it often and it works well and has rotational stability to boot.
**********
We had similar issues with the gereatrics as well as the Bil amputees while sitting. Lateley I'm using a suction socket with the help of the Performance sleeve from Ossur, the Balance is not durable and the endurance is just too tight. You can also use the sleeve from Ipos, it is rather soft and easy to put on and don’t cause any skin issues. The other reason I do it is for cosmetic reasons, when they sit you cant see the socket edges. You can also slighty lower the posterior wall due to the added support due to the suction suspension. If you have fat amputees that cant bent over to push the button it also works rather well. I had a woman with big thighs and the liner kept on rowling down the result with the sleeve it was excelent . Try the new E-Vac from OWW works well.
The Seal –In works rather well as another option; on the bigger sizes, but as soon as it is a 25 and smaller the amputees with hand issues rather battle to put it on. This is one reason I would rather fitt them with a Stabilo then a Dermo. (Don’t under size them) The multi Seal-In also works well for amputees that would like to sit and don and doff their prosthesis.( Not too sure when they will launch it) I made a disition to move away from locking liners due to that problem with the 200 serios locks, the problem is not that bad with the 600 but still an issue. Bock’s is not so bad, but then you’re a bit stuck with lateral shift. I also don’t fit the locking liners due to the milking effect causing early re fits, the suction is just a personal preferance.
**********
There is a vacuum donning technique that has been used and researched. You may be able to find the article on RECAL or OandP.com. You would be able to use a TEC liner and augment suspension with enhanced suction-the pin alignment would become a nonissue and the prosthesis would essentially don itself. OWW has a new electronic system, Jim Smith's is revamped and you could find a small vacuum of your own to facilitate donning as well.
**********
Gator grip. Flexible cable like pin that renders binds inconsequential.
Kind regards,Jonathan ReynikNOTE: This email is confidential and meant only for the intended recipient(s) of the transmission and may be a communication privileged by law. If you receive this email in error, any review, use, dissemination, distribution, or copying is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and kindly delete the email and destroy all copies.
_________________________________________________________________
Get the power of Windows + Web with the new Windows Live.
<URL Redacted>
Below is my original inquiry regarding locking suspension systems followed by the responses I received.
Thank you to all for your contributions.
Firstly thank you to those of you who responded to myinitial inquiry about silicone suspension systems. The prevailingopinion was that the TEC liner was easy for the elderly to donn anddoff. Unfortunately, it appears I was not as clear as I had intended tobe. I am interested in learning about the types of locking suspensionsystems you are using for elderly patients to facilitate donning/doffingfrom a seated position. I have been using a clutch lock but find thatit occasionally binds up making it difficult for elderly patients tounlock it. I am looking for a similar mechanical suspension system thatwill not bind if the patient does not exactly line the pin or othermechanism exactly with the lock every time the prosthesis is donned. Myapologies for the confusion.
Make your own lanyard. No lock to bind. Push lanyard (dacron & Velcro)out through the distal anterior opening back up to a chafe and reflectit down against it's self. Foolproof. Remember to form a slight distalimpression into the socket for the attachment screw head on the distalend of your liner.
**********
Velcro works great...attach a string to where the pin goes in the liner .
Cut a hole in d-end of socket ,put strap through,and stick on side of socket
**********
I've been using the PDI Lanyard Lock. Very nice and simple. But patientneeds to be able to screw in the lanyard to the bottom of the liner andthat can be a problem for elderly or folks with limited mobility. Alsohow about the KISS suspension with no top attachment to the liner. Justpush the strap through the bottom and attach to side of socket.(thiseliminates the screwing into the liner part at least.)
**********
lanyard pull is virtually bulletproof. now, you need to keep in mind - lock binds as pin is not aligned properly. what usually happens is that when forced in out of kilter or otherwise dragged into the locked position, liner will kink distally, catching on the skin and causing stretch on it along the bigger radius of stretch. this may end up in skin breaks. we used to advise patients to locally lube that area with alps silicone, to break friction, but you should know what patient's compliance is worth. zilch.
so, i'd say - to avoid any problems, cushion liner and suction suspension, or sleeve. no worries about any kinks in the system.
**********
Most if not all of my patients don their pin systems sitting down and fully seat into the socket when they stand up. Some socket designs seem to allow further entry into the socket under weight bearing pressure and when the patient sits to doff the prosthesis the locking pin is under tension when relaxed and they have to really whack the release button to get out of the leg. This is a socket design or fit problem and the lock is not at fault. If the patient cannot align the pin correctly no lock will work. You may want to check out the KISS system, I use it often and it works well and has rotational stability to boot.
**********
We had similar issues with the gereatrics as well as the Bil amputees while sitting. Lateley I'm using a suction socket with the help of the Performance sleeve from Ossur, the Balance is not durable and the endurance is just too tight. You can also use the sleeve from Ipos, it is rather soft and easy to put on and don’t cause any skin issues. The other reason I do it is for cosmetic reasons, when they sit you cant see the socket edges. You can also slighty lower the posterior wall due to the added support due to the suction suspension. If you have fat amputees that cant bent over to push the button it also works rather well. I had a woman with big thighs and the liner kept on rowling down the result with the sleeve it was excelent . Try the new E-Vac from OWW works well.
The Seal –In works rather well as another option; on the bigger sizes, but as soon as it is a 25 and smaller the amputees with hand issues rather battle to put it on. This is one reason I would rather fitt them with a Stabilo then a Dermo. (Don’t under size them) The multi Seal-In also works well for amputees that would like to sit and don and doff their prosthesis.( Not too sure when they will launch it) I made a disition to move away from locking liners due to that problem with the 200 serios locks, the problem is not that bad with the 600 but still an issue. Bock’s is not so bad, but then you’re a bit stuck with lateral shift. I also don’t fit the locking liners due to the milking effect causing early re fits, the suction is just a personal preferance.
**********
There is a vacuum donning technique that has been used and researched. You may be able to find the article on RECAL or OandP.com. You would be able to use a TEC liner and augment suspension with enhanced suction-the pin alignment would become a nonissue and the prosthesis would essentially don itself. OWW has a new electronic system, Jim Smith's is revamped and you could find a small vacuum of your own to facilitate donning as well.
**********
Gator grip. Flexible cable like pin that renders binds inconsequential.
Kind regards,Jonathan ReynikNOTE: This email is confidential and meant only for the intended recipient(s) of the transmission and may be a communication privileged by law. If you receive this email in error, any review, use, dissemination, distribution, or copying is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and kindly delete the email and destroy all copies.
_________________________________________________________________
Get the power of Windows + Web with the new Windows Live.
<URL Redacted>
Citation
Jonathan Reynik, “Responses: Locking suspension systems,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 23, 2024, https://library.drfop.org/items/show/228959.
