Prosthetic Device ComplaintsThere may be more to the complaint than meets the eye. There may be obvious issues, such as a failed component resulting in a fall, a skin breakdown that on the surface appears that it was as a result of overuse or a rough area within the prosthetic socket.
By: Dr. John Schulte
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Legal complaints related to the utilization of the Prosthetic device are best handled by bringing a Board Certified Prosthetist to your legal team. Prosthetic devices are by nature a rigid replacement for the loss of a human extremity. They are custom designed to provide an intimate skin tight fit that will mimic the shape and function of the upper or lower extremity. When designed well, they become essentially a removable functional replacement for the part lost. Reasoning for the loss varies from Trauma, birth defect or disease. Your Board Certified Prosthetic Expert will help you with the reasoning for the injury.
There are many reasons that the prosthetic wearer may sustain an injury from overuse to mal-fitting of the socket itself. Additionally, there is the dynamic alignment (placement of the socket to the knee, the upper extremity terminal device or hand to the mechanical componentry. Physical anomalies and skin type, weight or underlying disease all could be factors in the determination of the issue at hand (no pun intended).
There are no simple reasons for someone to suffer from the loss or a limb (or limbs). The reasons for the Limb Loss are many. Some of the most common are;
- Birth Defect or Medical Mistake
- Trauma: Slip, Trip or Fall, Auto and Industrial Accident
- Medical Condition: Diabetes, Circulatory issues as examples
Prostheses (Artificial Limbs) Prosthesis (singular) designs come in many different designs, hard outside (Exoskeletal) or soft on the outside and modular tube construction (Endoskeletal). The receptacle that the residual limb (stump) fits into is custom fashioned for EACH individual person or residual limb is called the socket (some residuum are longer length than others depending on the extent of damage to the limb such as in a Traumatic amputation or blood supply available such as with the diabetic person or vascular insufficient person or extremity).
Other major components of the prosthesis are;
Prosthetic Socket;The purpose of the prosthetic socket is to create an intimate connection between the residual limb (residuum or stump) and the mechanical prosthesis.
The Below Knee (trans-tibial) prosthesis socket tends to be more involved as far as intimacy of the socket vs. the residuum, the Tibia and Fibula (bones of the lower leg) are prominent and the normal limb has muscles (that offer padding over bony prominences) and essentially there is just skin covering the bones in the front of the residual limb. The instances of the Below Knee amputated limb developing abrasions, blisters or ulcerations from overuse, mal-fit or design are higher than wearers of the Above Knee prostheses.
The Above Knee (Trans-femoral) prosthetic socket need for an intimate fit is the same as other levels of limb amputation however as there is only a single bone when amputated above the knee (the Femur) Control of the residual limb in the Trans-femoral prosthetic socket is achieved by both the intimate fit of the soft tissue of the limb as well as the design of the top part (proximal) of the prosthetic socket. The brim design is important that it is properly shaped to the patient's pelvis anatomy but does not impinge on the bony prominences. If this happens, the gait of the wearer will be affected as they will place the residuum in abnormal positions to try to alleviate the painful pressures.
Suspension; (the means that the prosthetic device is held onto the residuum) can be by strap, negative pressure (suction), sleeve or a number of combinations.
Prosthetic Feet; are designed for actual anatomical foot size and shape, heel height of the particular shoe being worn, activity level of the individual using the prosthesis, sport or work applications and individual patient weight. They can be attached to the prosthetic device by a bolt, glue or lamination onto the shank (or shin) of the prosthetic limb.
Prosthetic Knee; There are many, many different designs, too many to list here however, the basic functions are: Locked, Free Swing, Stance Control (to help stabilize the prosthetic knee unit to reduce the risk of an uncontrolled fall from a trip or a higher level of function while ambulating of Microprocessor (computer controlled) design. Current technology allows the incorporation of the Knee, Ankle or an entire Knee Ankle Foot system to be computer controlled within the prosthesis. This technology utilizes the computer to allow control of the valves in the device to speed up, slow, or limit the articulation of the mechanical joint. This control provides the wearer of the prosthesis the ability to function at a level not previously available to users with simple mechanically articulated knees and ankle units. Current devices require the unit to be recharged with normal use every 24 - 72 hours depending on the manufacturer and activity level of the prosthetic user.
The need to select the most appropriate materials, design and components all that together create the functional prosthetic device is of paramount reasoning. Cosmesis and lightness of the completed device is also an issue with the prosthetic user's acceptance of the prosthesis.
Don't overlook the design of a LifeCare plan to accurately determine future requirements for replacement and maintenance of their prosthetic device. Most insurance carriers have rules and regulations for the application, type of materials, componentry and expected longevity of the device. These rules are based on many factors, individually and combined that include Age, body type, what area of the body is being treated, activity level, previous occupation and even hobbies. Your client's interests are paramount when designing the most appropriate LifeCare plan will assure them a trouble free future.
John F. Schulte is an accomplished Orthotic and Prosthetic practitioner with 40 plus years of experience consulting and treating Body and External powered upper and lower extremity prosthetics for all age groups. Mr. Schulte's intimate knowledge in prosthetic and orthotic clinical practice and management, component prescription recommendation, and selection and utilization for all patient ages and levels of function make him an excellent expert witness resource.
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