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The Align Clinic Blog
​ Your Home For Orthotic and Prosthetic Knowledge

What You Should Know Before Getting an Above Knee Prosthetic

5/18/2023

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People who have undergone leg amputation can use prosthetic legs, which mimic the function and appearance of a real leg, to enhance mobility and quality of life. With the right information, you can make a wise decision for your condition or help your loved one find a solution for their pain.

Above-the-Knee Prosthetic Types

Here are the common types of prosthetics for above-the-knee amputees:

  • C-Leg 
  • Genium
  • X3 knees
  • Power/Rheo knees
  • Propio Foot
  • i-Limb 
  • I-digits Quantum
  • Be-Bionic Hand

Your prosthetist will help you determine the most suitable prosthetic option for your specific requirements.

What Type of Prosthesis Replaces the Leg Above the Knee?

Individuals who require an above-knee prosthesis (known as a transfemoral prosthesis) typically receive a personalized socket, a knee joint, a pylon, a foot, and a suspension system to hold the prosthesis in place. It's typical for patients to be fitted for a prosthetic a few days following the surgery.

After the above-knee amputation surgery, an Immediate Post-Operative Prosthesis (IPOP) will be provided to reduce swelling, protect wounds, and accelerate healing. To make the prosthetic more comfortable, an AK shrinker may also be used, which not only shapes the limb for the prosthetic but also desensitizes the limb in certain cases.

To ensure that the long-term prosthesis is the right type and fit for your needs, the process shouldn't be rushed. The following steps will be taken:

  1. A liner will be provided to cushion your limb.
  2. A cast of your limb will be made.
  3. A diagnostic socket will be tried to ensure alignment for the final prosthesis.
  4. Subsequent diagnostic sockets will be provided to achieve the right fit.
  5. A final socket version will be given to start gait training.
  6. Finally, the knee and prosthesis best suited to your needs will be selected.

How Does an Above-Knee Prosthetic Work?

Above-knee prostheses consist of several components, such as the socket, knee joint, ankle joint, and foot parts. When starting the prosthetic fitting, patients typically receive a temporary prosthesis while their residual limb heals, shrinks, and changes shape over a few months. The prosthetic device can be customized to ensure a proper and comfortable fit for the individual's residual limb.

The following provides further details on how the various components of an above-knee prosthesis work in harmony:

  • The prosthetic leg is constructed using tough, lightweight materials. Depending on the level of amputation, the leg may or may not include functional knee and ankle joints.
  • The socket is tailored to your residual limb, ensuring a comfortable and secure fit. The socket serves as the connection point between the prosthetic and your body.
  • The suspension system, which keeps the prosthesis attached to the limb, may involve sleeve suction, distal locking, or vacuum suspension

When recovering from an above-knee amputation, the rehabilitation process typically involves using a wheelchair and walking aids such as crutches or a walker. Before learning to walk with an above-knee prosthesis, patients should work closely with their physical therapist to learn the necessary skills to use the prosthesis and to care for it. This includes learning about skin checks, hygiene, contracture prevention, exercises, and positioning.

Daily Activities with Above-Knee Prosthetics

To maintain the functionality of your prosthesis, it’s important to invest time in ongoing therapy and at-home exercises supervised by your doctor. Consistent effort can help improve your balance and coordination, and rehabilitation can take up to a year. Daily checks of the remaining limb for irritation, skin breaks, or redness are also essential. 

A prosthetic does not mean you can’t have an enjoyable and productive life. Your doctor can advise you on what activities you can do at home, such as washing the remaining limb with soap and water. Depending on your individual case, you may even be able to drive or return to work as early as 4-8 weeks post-surgery, although full recovery may take longer.

1. How Do People with Above-Knee Prosthetics Walk?

Is walking normally with a prosthetic leg possible after an above-knee amputation? Since bearing weight is more difficult in this case and the risk of falling is higher, individuals typically use a wheelchair until their risk of falling is reduced. They work with a physical therapist to build strength and be fitted with short prosthetic training feet to aid in relearning balance. 

The height of the prosthetic leg is gradually increased to build the necessary strength for a full-length prosthetic. With time and practice, you can progress to walking without any assistance devices.

2. How Far Can You Walk with a Prosthetic Leg?

The ability to walk after amputation and with a prosthetic limb varies depending on the individual's injury and healing process. While some people may experience fatigue or pain after walking short distances, others may be able to walk around as before the surgery.

3. How to Play Sports with a Prosthetic Leg

Various sports have distinct requirements, and people with prosthetic legs can engage in various activities. Some non-weight-bearing sports, such as cycling and swimming, are particularly popular. Others may enjoy activities such as walking, running, dancing, gardening, or practicing yoga. Consider exploring new activities beyond traditional sports.

4. How to Safely Fall with an Above-the-Knee Prosthetic

Mastering the art of falling can assist in preventing injuries for those who have prosthetic legs. Your physical therapist should guide you through the process of falling safely. 
If you lose your balance, it's essential to let go of any walking aids and make your body flexible. Soften the impact using slightly bent elbows and roll to the side immediately to lessen the blow. You should also tuck your chin to your chest to prevent head injury.

5. How to Sit with Regular Above-Knee Prosthetics

To maintain proper posture while sitting with a prosthetic limb, keeping your shoulders back and your pelvis aligned underneath you is important. Aim your prosthetic limb towards the floor and let it hang naturally close to your other leg.

Tips to Feel Comfortable with a Prosthetic Leg

  • Make it gradual: When starting to walk with your new prosthetic leg, taking it slow and being patient is important. Parallel bars can be helpful in providing support and building confidence without the risk of falling.
  • Practice shifting weight: As you take steps, shifting weight between your legs is important. Make sure to practice this movement while learning to walk.
  • Repetition builds confidence: Once you feel comfortable with the basic mechanics of walking, repeat them often to build your confidence. The more confident you become, the better you'll be able to navigate the world with your prosthetic leg.

What Are the Negative Effects of Prosthetics?

Adapting to a prosthetic leg can pose both physical and mental difficulties. The following are common obstacles to overcome:

  • Skin issues may arise if excessive sweating affects how the prosthesis fits.
  • The residual limb shape may change during the first year following amputation.
  • Weakness in the residual limb can make it challenging to use the prosthesis for extended periods.
  • Phantom limb pain can occur.

Making an Above Knee Prosthetic Leg Work for You

Working with a licensed and certified prosthetist is essential if you need to get a prosthetic limb. Our team of experts will help restore your mobility and improve your quality of life. Reach out for questions regarding prosthetic limbs. Call us today, and we’ll be glad to help you.
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KAFO: A Comprehensive Guide to Understanding Knee-Ankle-Foot Orthosis

5/11/2023

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A KAFO or knee-ankle-foot orthosis is a specially molded plastic shell with metal uprights and knee joints designed to provide corrective and supportive functions to the ankle, foot, and knee areas. It can improve posture, body alignment, mobility, and bone and muscle strength. It also increases independence and confidence levels in patients.

Whether you're a patient, caregiver, or healthcare professional, this post covers everything you need to know about KAFO, from its design and function to its benefits and limitations.

How to Put on a KAFO

Here is a simple process for putting on a KAFO:

  1. Begin by releasing all Velcro straps and unlocking and flexing the knee joints.
  2. Put on the full-length KAFO sock provided by your orthotist.
  3. Gently position your leg and foot inside the KAFO, ensuring your heel is securely placed all the way down inside.
  4. Ensure that the ankle (instep) strap is the first to be fastened, ensuring it’s snug enough to restrict any motion in the KAFO.
  5. Continue by fastening the fabric fastener straps along your calf and thigh.
  6. Straighten the knee to lock the knee joints (if applicable).
  7. Check that the joints are properly locked before standing up.

How to Remove a KAFO

Although KAFOs are designed to be worn for extended periods, they must be removed occasionally for activities like bathing, sleeping, and skin inspection.  Proper KAFO removal technique is essential to prevent injury and ensure the long-term effectiveness of the device.

Follow these steps to remove your KAFO safely:

  1. Loosen all the straps and buckles holding the KAFO. 
  2. If any padding or liners are inside the KAFO, remove them carefully.
  3. You may need help getting seated on the edge of a bed or chair.
  4. Unlock the knee, ankle, and foot joints of the KAFO.
  5. Gradually lift the KAFO off your leg while gently bending the knee and ankle.
  6. Once the KAFO has been removed, check your skin for any signs of irritation or redness.
  7. Clean the KAFO with a damp cloth and store it in a dry, cool place.

It's important to note that the specific steps for removing a KAFO may vary depending on the orthosis design and the patient's needs. It's best to follow the instructions provided by the healthcare provider or physical therapist.

How to Take Care of Your KAFO

Ensuring the proper upkeep of your KAFO is crucial. To maintain it, use a damp cloth to clean and towel dry. Avoid exposing it to direct heat. If you notice any wear and tear on the hook and loop straps, linings, or padding, contact your orthotic facility for repair. Additionally, attend the clinic annually for knee joint service or as per your orthotist's instructions.

Types of KAFOs

KAFOs, or knee-ankle-foot orthoses, come in various types that cater to the diverse needs of patients. Different types of KAFOs available, each with its specific features and benefits.

1. Total Surface Bearing/Thermoplastic KAFOs

Total Surface Bearing (TSB) or Thermoplastic KAFOs are commonly prescribed for patients with a flaccid or weak lower limb requiring full leg support. These KAFOs are custom-made from a mold of the patient's leg using a thermoplastic material that becomes pliable when heated. 

The mold creates a socket that distributes pressure evenly over the leg's surface, reducing the risk of skin irritation or pressure sores. These KAFOs also provide medial and lateral support to the knee and ankle joints, making them an effective option for patients who need joint stability.

Advantages 

Here are some advantages of Total Surface Bearing/Thermoplastic KAFOs:
​
  • Even pressure distribution: The custom-made socket distributes pressure evenly over the leg's surface, reducing the risk of skin irritation and pressure sores.
  • Greater joint stability: The medial and lateral support TSB/Thermoplastic KAFOs provide improves joint stability. That makes it an ideal choice for patients who need substantial joint support.
  • Improved mobility: The TSB KAFOs can improve mobility by providing a stable base of support for the leg helping patients stand and walk more confidently.
  • Custom-fit: These KAFOs are custom-made from a mold of the patient's leg, ensuring a perfect fit tailored to their needs.
  • Lightweight and durable: Thermoplastic materials are lightweight yet durable, providing patients with a comfortable and long-lasting orthotic solution.

Disadvantages

Here are some potential disadvantages of Total Surface Bearing/Thermoplastic KAFOs:
​
  • Time-consuming fabrication: Creating a custom mold for TSB/Thermoplastic KAFOs can be time-consuming, which may delay the patient's treatment.
  • Limited adjustability: There is limited adjustability once the KAFO is made. Any changes in the patient's condition or requirements may require the fabrication of a new orthosis.
  • Difficulty with donning and doffing: Due to the rigid nature of the thermoplastic material, the TSB KAFOs may be more challenging to put on and remove compared to other types of KAFOs.
  • Cost: TSB/Thermoplastic KAFOs are generally more expensive than other types of KAFOs due to their custom-made nature and the materials used in their fabrication.
  • Skin irritation: While TSB/Thermoplastic KAFOs are designed to distribute pressure evenly over the leg's surface, some patients may still experience skin irritation or pressure sores.

2. Stance Phase Control KAFO

Stance Phase Control (SPC) KAFOs are designed to provide stability and control during the stance phase of walking. They are typically prescribed for patients with weakness or paralysis of the quadriceps muscle, which can cause knee buckling or collapse during weight-bearing activities. 

SPC KAFOs use a combination of mechanical joints and spring mechanisms to provide the necessary support and stability for the patient. They are usually custom-made to ensure a proper fit and function for each patient's needs. SPC KAFOs are an effective orthotic solution for patients with gait abnormalities caused by quadriceps weakness or paralysis.

Advantages

Here are s few advantages of SPC KAFOs:

  • Improved gait: SPC KAFOs are designed to provide support and stability during the stance phase of walking, which can improve the patient's gait pattern and overall mobility.
  • Increased confidence and independence: Patients who use SPC KAFOs may experience increased confidence and independence during weight-bearing activities like walking or standing.
  • Customizable: They can be custom-made to fit each patient's needs, ensuring optimal function and comfort.
  • Adjustable: The KAFOs can be adjusted as needed to accommodate changes in the patient's condition or gait pattern.
  • Durability: They are typically constructed using durable materials, making them a long-lasting orthotic solution for patients who require support and stability during the stance phase of walking.

Disadvantages 

Here are the main disadvantages of Stance Phase Control KAFOs:

  • Limited functionality: SPC KAFOs are designed specifically for the stance phase of walking, which means they may not provide adequate support or control during other phases of gait.
  • Bulky: They can be relatively bulky and may limit the patient's ability to wear certain clothing or footwear.
  • Cost: They can be more expensive than other orthoses due to their custom design and construction.
  • Maintenance: The KAFOs may require regular maintenance to ensure proper function and fit, which can be time-consuming and costly.
  • Discomfort: SPC KAFOs can be uncomfortable for some patients, particularly if they are not properly fitted or adjusted.

Take the First Step Toward Pain Relief

Knee orthotics have the potential to greatly reduce pain and improve mobility, enabling individuals to maintain an active lifestyle. You can make wise decisions regarding treatment options with the information provided in this guide.

At Align Clinic, we strive to assist patients in selecting the most appropriate option for their needs. Contact us today and we’ll be happy to help you find an optimal solution for your knee pain.
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Everything You Need to Know About a TLSO Brace

5/4/2023

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A TLSO, or thoracolumbosacral orthosis, is a type of back brace used to limit motion and promote healing in the thoracic, lumbar, and sacral regions of the spine. It's typically prescribed after surgery or for stable middle and lower back fractures and can also be used to correct lateral scoliotic curves. Proper use of the TLSO can help the patient maintain proper alignment and mobility during recovery.

Using a TLSO Brace

Bracing is based on the idea that increased weight on a particular area of a growing spine can inhibit its growth. A TLSO brace utilizes specialized pads placed in certain areas to apply pressure on abnormal curves, which helps slow their growth.

By controlling the progression and keeping the Cobb angle below 40 degrees, a patient may be able to avoid surgical interventions such as spinal fusion.

Typically, bracing is limited to the pediatric population as it's most effective for growing spines. Children between the ages of 12 and 15 with Cobb angles ranging from 20 to 40 degrees are often prescribed TLSO braces, typically pre-fabricated in a corset style using rigid plastic and available in small, medium, or large sizes.

In the US, the Boston brace is the most commonly used design. For bracing to be effective, the child is required to wear the brace for a minimum of 18 to 23 hours per day. The recommended duration of bracing is three to five years.

While wearing a TLSO brace underneath loose clothing is feasible, many adolescents may hesitate to wear one that restricts their movements throughout the day. The effectiveness of the brace heavily relies on consistent and prolonged usage.

Unfortunately, many teenagers choose to remove their braces as soon as they arrive at school, resulting in a substantial decrease in the success rate of the treatment.

How To Wear A TLSO Brace

If you've been prescribed a TLSO, brace for an injury or medical condition, it's important to know how to wear it properly. A TLSO brace is designed to provide support and stability to your thoracic, lumbar, and sacral spine areas.

By following some simple steps, you can ensure that the brace effectively manages your condition or injury and is comfortable to wear throughout the day.

Here are some key tips on how to wear a TLSO brace correctly:
  • While lying flat on a bed, roll to one side without twisting.
  • Position the back piece of the brace under your back, ensuring that the pelvic indentation or groove lines up with the edge of your pelvic or hip bone.
  • Roll onto your back and check that the brace is in the correct position with the hip indentation in place and the brace centered and at equal heights on both sides of your body. If not, adjust the brace by rolling to the opposite side and repositioning it correctly.
  • Attach the abdominal strap.
  • Place the front piece of the brace on top, ensuring that it overlaps the bottom piece.
  • Thread all six sides of Velcro straps through the metal loops, starting with the bottom two, then the middle two, and finally, the top two, tightening them evenly to achieve a snug fit.
  • Bring the two shoulder straps over your shoulders and thread them through the top metal loops, fastening them securely.
  • You may now get out of bed.
  • If the brace is uncomfortable or not fitting correctly, do not attempt to adjust it yourself. Contact the Orthotist who fitted you for the brace.
  • Wear the brace at all times while sitting or standing, but it can be removed while lying down.

How to Remove Your TLSO Brace

Removing a TLSO brace properly is important to prevent further injury or discomfort and ensure that the brace continues functioning as intended.

Here are the steps on how to remove your TLSO brace safely and comfortably:
​
  1. Lie flat on your back.
  2. Unfasten the Velcro straps.
  3. Remove the front section of the brace first.
  4. Roll like a log onto the side that's most comfortable for you.
  5. Slide out the back section of the brace.

General Tips for Using TLSO Brace

Following some basic guidelines, you can prevent skin irritation and achieve the best possible results from your brace.

Here are some key points to remember when wearing a brace, including tips on how to safely apply it, how frequently to wear it, and how to check for signs of skin irritation.

  • To prevent skin irritation and absorb sweat, wearing a T-shirt underneath the brace is recommended.
  • Follow the doctor's instructions on how frequently and for how long you should wear the brace each day. Unless otherwise directed, 
  • It's not necessary to wear the brace while sleeping.
  • If needed, ask your doctor for a specialized brace to wear while showering.
  • Safely apply the brace as demonstrated in the hospital, and seek assistance if necessary.
  • Regularly check for signs of skin irritation or redness caused by the brace. Consider adjusting the brace or consulting your doctor for a different size if these occur.
  • To feel more comfortable and absorb sweat, consider wearing a singlet or a tight-fitting top under the brace.
  • Ensure all straps are tightened as much as possible. The shoulder straps should keep your shoulders back to prevent gaps between your back and the top part of the brace.
  • Avoid lifting objects heavier than 2kg.
  • If you notice redness on your skin, do not apply padding, as it could worsen the pressure. Instead, seek help from your Orthotist.

Disadvantages of Bracing

To wear a brace for up to five years without the ability to bend the torso makes breathing difficult and exercise impossible. While wearing the brace, activities like dancing, sports, and even simple movements become a challenge.

The physical discomfort is compounded by the psychological harm of teasing and peer stares. Some teenagers feel that the risk of spinal surgery is not worth enduring the challenges associated with wearing a brace.

While a brace can prevent scoliosis from worsening, it doesn't correct the Cobb angle, meaning that misalignment is still present after removing the brace.

That can cause scoliosis to wear out the discs in the spine more quickly, resulting in an increased Cobb angle. Although wearing a brace has a 75% success rate in preventing surgery, one in every four patients will still require surgery.

A Cobb angle of 30 degrees is often the tipping point for whether or not scoliosis progresses to surgery in adulthood, with a high chance that it'll increase at least 10 degrees over time. Doctors may consider surgery for patients with 40-degree Cobb angles or higher.
 

While a brace can prevent surgery during the teenage years, as the teenager ages, the spine may deteriorate, potentially making surgery necessary despite the brace being considered "successful."

Making the Best Decision for Your Scoliosis Treatment

TLSO Braces can significantly reduce spinal pain, improve posture and help maintain an active lifestyle. With the correct information, you can decide about your treatment options.
​

At Align Clinic, we help you select the right TLSO Brace for your needs. Call us today and we'll guide you toward the best solution to your spinal condition.
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San Mateo, California
700 S Claremont St
Suite #105
San Mateo, CA 94402 
Hours: 8:30-5:30 M-F
​Phone: (650) 375-2231
Fax: (650) 627-4632
Sacramento, CA
3000 Lava Ridge Court,
Suite 110,
Roseville, CA 95661
Tuesdays and Thursdays
Phone: (248) 417-4047
andrea@align-clinic.com
Green Bay, Wisconsin
445 Cardinal Lane
Suite #110
Green Bay, WI 54313
Hours: 8:30-5:30 M-F
Phone: (920) 940-5277
Fax: (844) 308-8462


Houston, Texas
1001 Medical Plaza Drive,
​Suite #130
The Woodlands, TX  77380
Hours: 8:30-5:30 M-F
​Phone: (346) 770-2970
Fax: (281) 419-1615
Photos used under Creative Commons from shixart1985, wuestenigel, shixart1985, istolethetv, shixart1985, shixart1985
  • Home
  • Locations
    • AC San Mateo, CA >
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        • Grant Wood
        • Steve Baum
        • Miguel Bustamante
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  • The WCR Brace
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    • Brace Articles
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    • Past Events >
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