response to options for water prostheses

response to options for water prostheses

DeAnna Clough

6/16/2011

ORIGINAL POST:

I have been requested by a physician to provide a prosthesis for a patient
to do aqua therapy where she will be using a treadmill in the water.

 

I wanted to see if anyone had suggestions on building this type of
prosthesis and/or a general swim/shower/water prostheses in general.

 

This patient has a transtibial amputation, but I have had requests by
transfemoral amputees as well for water prosthesis, so any suggestions on
components (feet, knees, pylons, covers etc) that you have successfully used
with a patient would be beneficial.

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RESPONSES:

Thanks to all who responded with several great ideas. All responses are
posted below. Most suggestions were for an exoskeletal prosthesis that is
carefully fabricated to allow for water drainage and buoyancy. However,
due to patient's changing conditions (working on increased ROM in her knee -
same knee as prosthesis), I am going to try an endoskeletal without
laminating the socket until she has had a few therapy sessions in the pool
to see how she performs and make any necessary adjustments . She is
currently wearing a liner with suspension sleeve for suction suspension, so
we will see how that works in the water as well. Again, thank you to all of
the suggestions.

 

 

. I have a similar case and plan to use a modified Dycor K series
foot with stainless steel fittings. I plan to use an exosleletal cosmesis
with large drain holes at the ankle.

 

. I made a BK water leg for a patient about a year ago following the
instructions found at <URL Redacted> Rampro makes the activankle.
They have set by set slides on their web-site that show how to fabricate an
exoskeletal BK swim leg. I used the Kingsley Wayfarer foot. The owner of
Rampro was very helpful and returned all my phone calls.

 

. I made it two different ways. Exoskeletal with a beach comber foot
from Kingsley. And Endolite (aqua limb) makes a foot attached to a plastic
pylon that has a rubber cover that goes right over the socket. I have
suspended several different ways: a hard socket with socks with a latex
sleeve and a silicone gel liner or seal in liner with a latex sleeve over
top the socket and seals at the thigh.

 

. AK= exoskeletal = 3K5 is made from Otto bock same suspension.
There are two knees out there that are endo. 1 is from Otto bock

 

. Contact Ortho Remedy in New Jersey. Tom Vellenti has a
prosthesis which he developed years ago. The entire Trans Tib prosthesis to
include socket and pylon is made of Co-P and the ankle block is made of
delrin and is toatally water proof. No need for an expensive foot as the
pylon is dynamic due to the flexion properties of co-p. Suspension is your
choice. I use an Active suspension sleeve. The Seattle Natural sach foot
is a good foot for water and is very reasonably priced, under $100.00. The
system is a single drape pull and works great. They wil c fab or send a DVD
with step by step video instuction. As far as a knee unit, the only one I
know of which is water proof is the AULIE knee. It is a single axis knee
with a sealed hydraulic unit. I am in Tampa and have used this knee several
times for my folks that are in the water a lot.
The knee is incredibly durable and totally maintenance free other than
hosing out the sand, dirt and grime that may accumulate.

 

. Kingsley Steplite Wayfarer KC10T) with Active Ankle

 

. Standard socket and shuttle lock, any flex foot most likely
without the shell and crepe attached. I find the iceross silicone liners
stay on well in the water. Alpha/Alps type come off easier, but should work
with a tight fit and a sleeve. If there is an issue with water gaining entry
into the liner a suspension sleeve should eliminate that issue. Stainless
Steel hardware i.e. nuts and bolts are a must to prevent corrosion. Pylon
and adaptors are non issue all standard industry parts can handle the water.
Cover??? I would say none. It only adds weight and a place for water to get
trapped and for mold to grow. With an AK I depending on what they want to
do ie swim in the pool or water ski, there are sport specific knees like the
ollie, or something like a 3r60 I think would work fine. The real key the
prosthesis needs to be flushed with fresh water after it has been in the
pool. The chlorine or salt will corrode.

 

. I made myself a surfing/fishing/shower leg using a copoly socket,
sleeve suspension using an Otto Bock Axtion DP foot. I used truck bedliner
paint on the hardware for waterproofing. It works great. As for water knees
for AK patients, the Aulie is what we typically use with no issues.

 

. Visit this product of RSLsteeper at
<URL Redacted>
s . I used it for a BK amputee who loved to swim

 

. Do you use a pin lock? If so, you can still use the liner but I'd
leave off the lock and pin. I like to use a laminated socket or blister
pull thermoplastic so no seams with a neoprene sleeve suspension. You can
set it up either endo or laminated exo. Endo I would have them remove the
pin and still use the liner but using the neoprene sleeve to keep water out
of the socket. I like to use a Seattle Sach or Seattle Flexible keel foot
because it's all plastic and rubber. Still need to use an Aquasock on the
foot to keep from slipping. If you go exo, use foam, cut and hollow out,
then once laminated, drill a couple 1/2 inch holes proximal and distal in
the hollow area so it can fill with water and be neutrally buoyant (and so
it can drain when they get out of the water). Be sure to drill the holes on
an angle so the water will drain out.

 

. I'm not a physician or anything, but I am an amputee. I'm not
exactly sure what you are looking for. But when I went on vacation to NJ to
go to the beaches, I ask my prosthetist for something of a water proofer to
protect my prosthetic and liner from all the salt water. I got a thick
clear plastic/rubber kind of material....a clear sleeve if you will....that
went over the top of the prosthetic and past the liner to make a seal that
kept the water out from inside the leg and the liner. It worked well, but I
had limited range of motion, but if you are going to have your patient do
light walking or such, it should be fine. I also kept the shell off, but had
a cats paw put on the bottom of the foot for protection an traction on the
foot. cats paw kinda of a rubber material that has ridges or small bumps
on the bottom side. It works well for me in pools and other bodies of water.

 

. My first choice is the Aulie knee. Another option available is
the LA Ankle.

 

. I used to build these when I was with Otto Bock back in the 70's
and into the mid eighties, the transtibs are simple exo design with drainage
holes for neutral buoyancy. The Transfemoral designs utilized a single axis
locking knee that was not durable but was designed for aqua use only. The
Aulie knee is an option that may suffice-you may be best to contact a
central fab company see what they recommend.

 

. We use a seattle foot and ankle block with an exo finish shaped
using bees wax then melt out the wax and place a proximal and distal hole to
allow water in and air out. This helps to keep the Prosthesis neutrally
buoyant. For transfemoral we use a seattle foot again and usually a Aulie
knee using titan components with stainless screws.

 

. You could try and use a socket with similar design to what he is
wearing. I have found good success with the Rampro Active Ankle and the
Kingsley Beachcomber foot. There are many different suspension methods that
could work, just depends on how much ROM needs at his knee.

 

 

DeAnna M. Clough, MSPO, CPO, LPO

Gainesville Prosthetics

6800 NW 9th Blvd, Suite 3

Gainesville, FL 32605

 < <URL Redacted>> www.gainesvilleprosthetics.com

Phone: 352.331.4221

Fax: 352.332.8074

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