RESPONSES: Bilateral AK
Kelsey Holden
Description
Collection
Title:
RESPONSES: Bilateral AK
Creator:
Kelsey Holden
Date:
1/7/2022
Text:
Thank you to everyone who responded!!! Like always, there are a few different routes to go.
1. You may request or ask the patient to request his exam notes from old provider so you can get some insight from the previous practitioner on how he did with what they fit him with. It may be different than what he or his mom reports. I don’t have anything to add on the stubby question.
2. I work with a lot of bilateral AKs that range in all ages. My young people are always gonna get a set of stubbies for starter and balance training. Stubbies give them an accessory to do more and helping to get around with less stress. Some people find that stubbies are more functional for daily life. Especially people who are really active. I use the shortened aks with locking knees for older patients that want the better appearance. When everyone graduates to more stability and mobility then I move to more function. Young people I stay with microprocessors mostly. Get a good socket setup that is functional and responsive. Dont be afraid to hybrid the designs. Adjustable sockets are very beneficial with bigger people that might lose weight rapidly once walking starts. You have to stay motivated with them. They will always need “tune ups” so stay active in their follow ups. You are changing their life for the better. Above all, listen to them. You would be amazed at just how intuitive their feedback can be on complete design. Even if they are new to the game. Good luck!Couple of questions: How tall is he supposed to be? How long are his residual limbs? How is his core strength?
1. If he is a 6’ tall guy with short limbs I do something like a ofm2 knee locked out with stubby feet from College Park. If his limbs are long, I just do the stubby feet. If he is short I’ll do knees locked out with stubbies. Basically I shoot for a length that is easy enough to sit straight down to the ground. If the are strong with good core I’ll shoot for a height that allows them to back up to a chair and slide into. So if a chair is 18” I make so their inseam is 17” with legs on. Stubbies are their preparatory legs and I will deliver knees that lock out if at all possible so they can progress with them.
2. If the be patient is an experienced user of his old AK prosthesis it may not be necessary to use stubbies. Use your best judgement. As for a locked knee, I would suggest it to start until the patient becomes used to shifting their weight line. Hope that helps. Also don’t put them in bilateral hydraulic feet if that’s what the old foot was. Too unstable.
3. I NEVER start with stubies. Always with knees. Usually knees that you can lock. Short so patient is in a mechanically advantaged position to scoot forward on chair and stand. Also so sitting is easy. Just for some perspective you may want to walk on your knees and try and get into a chair from the ground.
4. I would not put anyone in stubbies any more. Studies whow the sooner you get a patient into prostheses the greater the success rate. I would fit him in some type of hydraulic safety knee. Idealy C-legs if finances allow otherwise something like the Ossur Total knee's or the Otto Bock's 3R80. Be absolutely sure of your alignment. Both knee's must be set up correctly so they are safe from buckling but not so safe he cannot walk easily or he will give up on them. Also, just as important is to have him set up with a P.T. who knows what they are doing with bilateral amputee's. And third, have him back frequently for fine-tuning, re-aligning and solving issues that will no doubt arise.
5. As in your case the patient is old user of TF Prosthesis on one side and may be due to existing vascular condition associated with over weight, he had had new amputation at TF level on other side so that he could be fit for full length Prosthesis directly. This is also supported by the fact that he is young. Again, it is important to find a. His readyness/willingness for full length Prosthesis b. Physical potential (stump lever and muscle strength, upper limb and trunk condition c. His participation need: whether needing to move outside home for recreational or occupational need or has to remain inside home (in that case stubbies may be more preferable for easy ADL) d. His living environment and community. Overall, plz seek ICF (INTERNATIONAL CLASSIFICATION OF FUNCTIONS, DISABILITIES AND HEALTH) for setting goal. That will help in appropriate prescription. Regarding knee joint, for safety the side which is newly amputated may be given lock type of knee joint while other side if in good condition could be polycentric one. Thank you.
6. Kelsey it really depend on the balance of the patient. Maybe the previous prosthetic wear would help to start with a locked knee that is a polycentric when unlocked at the level they are at.Stubbies are definitely advisable if the patient begins as a bilateral transfemoral. However, it maybe a good place to start. The big thing is to prevent someone from feeling they are falling backward.
7. Hello! I like using the OttoBock Presedo knees with College Park Side kick “feet”. This way they are still in “stubbies” but have some height and can feel a little better about themselves being taller than “stubbies”. The OB knees help the pt sit down without having to de-weight or plopping down.
8. Next, socket fit and balance is the key. Consider the Thomas test but standing balance is best
9. Definitely start with stubbies and then you can raise up as he progresses. I start at 18 inches no knees (chair height). Some active patients continue to use stubbies for certain activities where they need to be more stable later along with their full legs.
10. Start him with stubbies. If he advances quickly he will still have then to use around the house and yard when the full length limbs are off. Like taking off your shoes and putting on slippers. The stubbies will also serve as a backup if repairs or adjustments are required on the full length set. Balance and safety is key to a successful transition to full length
11. Some thoughts come to mind: 1) how proficient was was he with the first prosthesis and he he using it at the current time for standing activities? 2) assuming he isn’t using his first prosthesis, Is he fearful of standing “so high up” on prosthesis which could lead to falls and additional injury if fit with full height prostheses. 3). You could start with stubbiest OR I’ve used modular prostheses with socket and a simple foot turned backward w/o knee or pylon. I believe a formal rehab program is mandatory with some informal explanations or training of PT working with him depending on their previous experience in gait training of amputees especially of this type. A modular system could then modified to definitive type prostheses, if appropriate. I personally would use a locking stance control knee system with positive lock and knee extension assist if after initial training I believe he will actually become at least a household ambulatory. Future prostheses prescription could be modified to meet his prosthetic needs at that time. After initial gait training (should he become a household ambulatory) I would probably change feet to single axis feet. A thorough paid evaluation by a more experienced prosthetist could also be useful as a second opinion assuming you’d be comfortable that clinician wouldn’t “poach” your patient.
12. Hello! I like using the OttoBock Presedo knees with College Park Side kick “feet”. This way they are still in “stubbies” but have some height and can feel a little better about themselves being taller than “stubbies”. The OB knees help the pt sit down without having to de-weight or plopping down.
1. You may request or ask the patient to request his exam notes from old provider so you can get some insight from the previous practitioner on how he did with what they fit him with. It may be different than what he or his mom reports. I don’t have anything to add on the stubby question.
2. I work with a lot of bilateral AKs that range in all ages. My young people are always gonna get a set of stubbies for starter and balance training. Stubbies give them an accessory to do more and helping to get around with less stress. Some people find that stubbies are more functional for daily life. Especially people who are really active. I use the shortened aks with locking knees for older patients that want the better appearance. When everyone graduates to more stability and mobility then I move to more function. Young people I stay with microprocessors mostly. Get a good socket setup that is functional and responsive. Dont be afraid to hybrid the designs. Adjustable sockets are very beneficial with bigger people that might lose weight rapidly once walking starts. You have to stay motivated with them. They will always need “tune ups” so stay active in their follow ups. You are changing their life for the better. Above all, listen to them. You would be amazed at just how intuitive their feedback can be on complete design. Even if they are new to the game. Good luck!Couple of questions: How tall is he supposed to be? How long are his residual limbs? How is his core strength?
1. If he is a 6’ tall guy with short limbs I do something like a ofm2 knee locked out with stubby feet from College Park. If his limbs are long, I just do the stubby feet. If he is short I’ll do knees locked out with stubbies. Basically I shoot for a length that is easy enough to sit straight down to the ground. If the are strong with good core I’ll shoot for a height that allows them to back up to a chair and slide into. So if a chair is 18” I make so their inseam is 17” with legs on. Stubbies are their preparatory legs and I will deliver knees that lock out if at all possible so they can progress with them.
2. If the be patient is an experienced user of his old AK prosthesis it may not be necessary to use stubbies. Use your best judgement. As for a locked knee, I would suggest it to start until the patient becomes used to shifting their weight line. Hope that helps. Also don’t put them in bilateral hydraulic feet if that’s what the old foot was. Too unstable.
3. I NEVER start with stubies. Always with knees. Usually knees that you can lock. Short so patient is in a mechanically advantaged position to scoot forward on chair and stand. Also so sitting is easy. Just for some perspective you may want to walk on your knees and try and get into a chair from the ground.
4. I would not put anyone in stubbies any more. Studies whow the sooner you get a patient into prostheses the greater the success rate. I would fit him in some type of hydraulic safety knee. Idealy C-legs if finances allow otherwise something like the Ossur Total knee's or the Otto Bock's 3R80. Be absolutely sure of your alignment. Both knee's must be set up correctly so they are safe from buckling but not so safe he cannot walk easily or he will give up on them. Also, just as important is to have him set up with a P.T. who knows what they are doing with bilateral amputee's. And third, have him back frequently for fine-tuning, re-aligning and solving issues that will no doubt arise.
5. As in your case the patient is old user of TF Prosthesis on one side and may be due to existing vascular condition associated with over weight, he had had new amputation at TF level on other side so that he could be fit for full length Prosthesis directly. This is also supported by the fact that he is young. Again, it is important to find a. His readyness/willingness for full length Prosthesis b. Physical potential (stump lever and muscle strength, upper limb and trunk condition c. His participation need: whether needing to move outside home for recreational or occupational need or has to remain inside home (in that case stubbies may be more preferable for easy ADL) d. His living environment and community. Overall, plz seek ICF (INTERNATIONAL CLASSIFICATION OF FUNCTIONS, DISABILITIES AND HEALTH) for setting goal. That will help in appropriate prescription. Regarding knee joint, for safety the side which is newly amputated may be given lock type of knee joint while other side if in good condition could be polycentric one. Thank you.
6. Kelsey it really depend on the balance of the patient. Maybe the previous prosthetic wear would help to start with a locked knee that is a polycentric when unlocked at the level they are at.Stubbies are definitely advisable if the patient begins as a bilateral transfemoral. However, it maybe a good place to start. The big thing is to prevent someone from feeling they are falling backward.
7. Hello! I like using the OttoBock Presedo knees with College Park Side kick “feet”. This way they are still in “stubbies” but have some height and can feel a little better about themselves being taller than “stubbies”. The OB knees help the pt sit down without having to de-weight or plopping down.
8. Next, socket fit and balance is the key. Consider the Thomas test but standing balance is best
9. Definitely start with stubbies and then you can raise up as he progresses. I start at 18 inches no knees (chair height). Some active patients continue to use stubbies for certain activities where they need to be more stable later along with their full legs.
10. Start him with stubbies. If he advances quickly he will still have then to use around the house and yard when the full length limbs are off. Like taking off your shoes and putting on slippers. The stubbies will also serve as a backup if repairs or adjustments are required on the full length set. Balance and safety is key to a successful transition to full length
11. Some thoughts come to mind: 1) how proficient was was he with the first prosthesis and he he using it at the current time for standing activities? 2) assuming he isn’t using his first prosthesis, Is he fearful of standing “so high up” on prosthesis which could lead to falls and additional injury if fit with full height prostheses. 3). You could start with stubbiest OR I’ve used modular prostheses with socket and a simple foot turned backward w/o knee or pylon. I believe a formal rehab program is mandatory with some informal explanations or training of PT working with him depending on their previous experience in gait training of amputees especially of this type. A modular system could then modified to definitive type prostheses, if appropriate. I personally would use a locking stance control knee system with positive lock and knee extension assist if after initial training I believe he will actually become at least a household ambulatory. Future prostheses prescription could be modified to meet his prosthetic needs at that time. After initial gait training (should he become a household ambulatory) I would probably change feet to single axis feet. A thorough paid evaluation by a more experienced prosthetist could also be useful as a second opinion assuming you’d be comfortable that clinician wouldn’t “poach” your patient.
12. Hello! I like using the OttoBock Presedo knees with College Park Side kick “feet”. This way they are still in “stubbies” but have some height and can feel a little better about themselves being taller than “stubbies”. The OB knees help the pt sit down without having to de-weight or plopping down.
Citation
Kelsey Holden, “RESPONSES: Bilateral AK,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/255737.
