San Diego State University

DPT 857 PROSTHETICS AND ORTHOTICS

Units: 2, Clock Hours: Lecture 30
Spring 2015
TIME: 8:00-9:50 AM Wednesdays
LOCATION PG 1520
Instructor: Steven M Laslovich, PT, DPT, CPed
Office: Off Campus
Office hours: By Appointment

Phone: 760 994 3576 (cell)

E-mail: slaslovich@mail.sdsu.edu
Alternate: smatlaslovich@sbcglobal.net

Course Prerequisites
DPT 720 Musculoskeletal Therapeutics I
Course Materials
Required Text and Readings
1. Lusardi MM, Jorge M, Nielsen CC. Orthotics and Prosthetics in Rehabilitation 3rd Edition. St Louis, Mo., Elsevier Saunders;
2012. ISBN-13: 978-1437719369
2. APTA's Guide to Physical Therapist Practice 3rd Edition. 2014. Available: http://guidetoptpractice.apta.org/
th
3. OSullivan SB, Schmitz TJ. Physical Rehabilitation, 6 Edition. Philadelphia, F.A. Davis, 2013, ISBN10: 0803625790.
Optional Recommended Resources
Prosthetics:
1. Gailey RS, Gailey AM, Balance, Agility, Coordination and Endurance for the LE Amputee. Adv/ Rehab Therapy Inc. 1995.
Available: www.advancedrehabtherapy.com
2. Gailey RS, Gailey AM, Sendelbach SJ, Prosthetic Gait Training for LE Amputees Adv/ Rehab Therapy Inc. 1995. Available:
www.advancedrehabtherapy.com
3. DVDs: 1) Functional Prosthetic Training for the Transfemoral Amputee, 2) Functional Prosthetic Training for the
Transtibial Amputee, 3)The Essential of Running for the Lower Limb Amputee, 4) The Biomechanics of Lower Limb
Amputee Running. 2002. Available: www.advancedrehabtherapy.com
Orthotics and Prosthetics:
4. Orthotics and Prosthetics List Serve. http://www.oandp-l.org. This is an excellent forum for clinical and research
discussions. You can subscribe and post questions or responses to discussion questions. Additionally, you can search
their data base for previously discussed topics through a keyword search.
5. OandP.com http://www.oandp.com. This is also an excellent internet site dedicated to providing information and
services to the orthotics and prosthetics profession.
6. Journal of Prosthetics and Orthotics Online; http://www.oandp.org/jpo/. Free access to most articles with the JPO,
(blocked access to journal articles < 2 years old).
7. Prosthetics and Orthotics Demonstration Project. http://oandp.health.usf.edu/. This is a national educational website
funded by the Dept of Education to develop free educational materials for healthcare professionals in prosthetics and
orthotics and conduct pilot research to establish best clinical practices for prosthetic and orthotic choice and wear.
Purpose/Course Overview
This course is designed to introduce the entry-level physical therapy student to the theory, design, function, and application of
prosthetic and orthotic appliances for both the lower and upper extremity. In addition, the physical therapist's role in the
management of patients who utilize lower extremity prostheses, lower extremity orthoses, and spinal orthoses will be discussed.
Information regarding the fabrication and fitting of hand and wrist splints will also be presented.
Teaching Methods and Learning Experiences
The format of the course will be a combination of interactive lecture, lab experiences, and patient demonstrations.
Expected Student Outcomes, and Course Objective Related to Prosthetic Interventions:

I.

II.

III.

Based on specific limb amputations, comorbidities, prosthetic componentry, and functional patient goals, the
student will have the ability to identify relevant impairments and functional limitations enabling design &
implementation of appropriate stage-specific physical therapy rehabilitative interventions.
Based on the amputee patient response(s) to current physical therapy based treatment interventions and outcome
measures, the student will be able to interpret, modify and appropriately progress physical therapy
treatment/interventions.
Provide proper, consistent, and supportive patient/caregiver education as a contributing member of the
interdisciplinary health care team for the individual with limb amputation, lower limb diabetic related conditions, or
individual patient requiring orthotic intervention(s).

Course Objectives Related to Prosthetic Interventions

1.
Describe and apply basic biomechanical and motor control principles involved in the effective design and use of prosthetic
devices commonly used in rehabilitation settings.
2.
Describe the levels of upper and lower extremity amputation as well as the etiological factors leading to amputation.
3.
Accurately describe current evidence supported pre-operative and post-operative surgical management approaches for the
lower extremity amputee.
4.
Appropriately utilize and apply the various types of available post-operative compression wraps for both lower and upper
extremity residual limbs.
5.
Accurately describe the common prosthetic componentry and competently assess for the appropriate type and function of
suspension, alignment characteristics, and basic functional training procedures lower limb amputee
6.
Accurately describe the common prosthetic componentry and assess for the appropriate type and function of suspension,
alignment characteristics, and basic functional training procedures upper limb amputee.
7.
Describe and differentiate (discuss the pros and cons) the most commonly utilized types of lower extremity prosthetic
components and suspension methods as they relate to patients with traumatic, congenital, or vascular related amputations.
8.
Identify the specific and unique variables that must be considered when treating the very young and the older amputee
individual.
9.
Effectively utilize the basic components of a physical therapy interview, examination procedures, and prognosis assessment
with patients/clients that would benefit from a prosthetic device following amputation.
10.
Design and effectively implement a pre-prosthetic exercise program for a person with a lower extremity amputation.
11.
Successfully apply knowledge of clinical biomechanics and the normal gait cycle to Physical Therapy based rehabilitation of
the lower limb amputee individual.
12.
Adequately describe, determine, and perform the appropriate suitable evidence supported outcome measures and
predicted outcomes for patients with either transfemoral or transtibial prostheses.
13.
Appropriately integrate knowledge of lower extremity amputation(s) and energy consumption during gait into the design of
short and long term amputee rehabilitation interventions.
14.
Properly design and implement a proper prosthetic training program for both a transfemoral and transtibial amputee that
includes appropriate exercise training and techniques to improve gait efficiency, mechanics, and safety.
15.
Accurately describe and compare the basic components of an upper extremity prosthesis and discuss the mechanical
operation of a basic transhumeral and transradial prosthesis.
Expected Student Outcomes, and Course Objective Related to Diabetic Pedal Ulceration Prevention Based Course Objectives
IV.
Based on specific LE neurovascular status, comorbidities, and functional patient goals, the student will have the
ability to identify relevant impairments and functional limitations of the diabetic individual enabling design &
implementation of appropriate physical therapy rehabilitative interventions.
V.
Based on the diabetic patient response(s) to current physical therapy based treatment interventions and outcome
measures, the student will be able to interpret, modify and appropriately progress physical therapy
treatment/interventions
Course Objectives Related to: Diabetes Pedal Ulcer Prevention
16.
Correctly discuss the potential etiologies surrounding mechanically induced plantar ulcerations in diabetic neuropathic
amputees or diabetic individuals with loss of protective pedal sensation.
17.
Describe, determine, and accurately conduct the necessary special first line clinical neurological and vascular examination
procedures with the diabetic neuropathic individual with or without lower limb amputation.
18.
Properly utilize/implement the required ulcer prevention educational and management protocols with the diabetic
neuropathic individual with or without lower limb amputation.
19.
Select the most appropriate footwear management scheme for a patient with insensitive feet.

Expected Student Outcomes, and Course Objective Related to Orthotic Interventions:

V.

VI.

Based on specific neuromuscular or musculoskeletal conditions, comorbidities, orthotic componentry, and functional
patient goals, the student will have the ability to identify relevant impairments and functional limitations enabling
design & implementation of appropriate stage-specific physical therapy rehabilitative interventions.
Based on patient response(s) to current orthotic treatment interventions and outcome measures, the student will be
able to interpret, modify and appropriately progress physical therapy treatment/interventions.

Course Objectives Related to Orthotic Interventions

20.
Describe and apply basic biomechanical and motor control principles involved in the effective design and use of orthotic
appliances commonly used in rehabilitation settings.
21.
List and adequately determine the need(s) for the various types of lower limb orthoses commonly prescribed in clinical
practice.
22.
Describe and integrate the purpose(s), components, along with the mechanical and physiological factors involving the
proper fitting of standard or therapeutic foot wear used alone or in conjunction with lower limb orthoses.
23.
Describe and discuss the pros and cons of various lower limb orthotic devices to control gait and improve safety during gait
and transfers following neurological injury.
24.
Design and implement a proper lower extremity orthotic training program for patients presenting with neurological and
musculoskeletal dysfunctions.
25.
Outline the educational components necessary for patients or their family to prevent skin breakdown secondary to wearing
a prosthetic or orthotic device.
26.
Evaluate and discuss the various theoretical approaches to foot orthotic design and prescription and be able to justify
alternative approaches, which are supported by the published literature.
27.
Adequately describe, determine, and perform the appropriate evaluation procedures, (initial, interim, final) and utilize
suitable evidence supported outcome measures and predicted outcomes for patients utilizing for orthotic appliances
28.
Describe the general functions, components, and list the various types of spinal orthoses commonly prescribed in clinical
practice within rehabilitation settings.
29.
Restate the effects and effectiveness of spinal orthoses in relation to immobilization, motion control, support, and
deformity prevention as well as correction.
30.
Describe the materials, construction procedures, and standard modifications required to fabricate hand and wrist splints.
31.
Properly design and fabricate basic hand and wrist splints using low temperature thermoplastic materials.

Assessment/Grading Criteria
Student learning will be assessed through their performance on two examinations and by their participation in class/laboratory
activities. The format for all examinations will be a combination of true/false, multiple-choice, essay and short answer. Exam
questions will be taken from course lectures, laboratory sessions and the assigned readings. Approximately 10 percent of the
available points will be given for student class participation and attendance. The intended breakdown of points for the assignment
of grades will be as follows:
Mid-Term Exam (25 Q Multiple Choice)
Comprehensive Final Exam (50 Q Multiple Choice)
Gaitrite Lab Group Write up (25 pts)
Topic Papers (2 @50 pts each)
Group Case Scenario Write Ups (2 @ 25 pts each)

75 points
150 points
25 points
100 points
50 points

Ground Rxn Force Problem (extra credit)

A+
A
AB+
B

Grading Scale
>97.00%
B93.00 - 96.99%
C+
90.00 - 92.99%
C
87.00 - 89.99%
C83.00 - 86.99%
F

(10 points)
400 total points
80.00 - 82.99%
77.00 - 79.99%
73.00 - 76.99%
70.00 - 72.99%
<70.00%

Class Participation: Students are expected to participate in class activities including small and large group discussions. It is my
expectation that participation, including feedback, will be positive and constructive

Professional Behaviors: Successful completion of the course is dependent upon the students demonstration of behaviors consistent
with those outlined in the Professional Behaviors document (see Appendix). Student behaviors that are not consistent with those
identified in the Professional Behaviors document will be addressed with each student individually. An action plan will be developed
for those students who require remediation (a prior version of this document was titled Generic Abilities).
Academic Honesty: Cheating is the actual or attempted practice of fraudulent or deceptive acts for the purpose of improving ones
grade or obtaining course credit; such acts also include assisting another student to do so. Typically, such acts occur in relation to
examinations. However, it is the intent of this definition that the term cheating not be limited to examination situations only, but
that it include any and all actions by a student that are intended to gain an unearned academic advantage by fraudulent or deceptive
means. Plagiarism is a specific form of cheating which consists of the misuse of the published and/or unpublished works of others by
misrepresenting the material (i.e., their intellectual property) so used as ones own work. Penalties for cheating and plagiarism range
from a 0 or F on a particular assignment, through an F for the course, to expulsion from the University. For more information on the
Universitys policy regarding cheating and plagiarism, refer to the General Catalogue or the Graduate Bulletin section 41304.

Class Attendance: One of the professional responsibilities of a physical therapist student is to attend every scheduled class.
Learning experiences in the curriculum are arranged sequentially, to ensure that new information, knowledge, and skills are
integrated with previously introduced material. In addition, the DPT curriculum includes significant opportunities for collaborative
learning, where interaction between and among students and faculty are critical components of the students learning. Therefore,
these learning experiences cannot be repeated and your attendance is a professional responsibility. In the event the student is
absent due to illness or an emergent circumstance, the instructor must be notified before class begins. The student is responsible
for material covered while absent.
Corrective action for unexcused absences: Attending class is expected during the entire DPT curriculum. Missing class
adversely affects the learning experience and contributes to poor performance. Two unexcused absences in a course will
result in a grade of failure for that course. Please see your student handbook for complete details on policies for
attendance and absences.

Classroom Tardiness: Being on time to classes is expected. Missing class adversely affects the learning experience and contributes
to poor performance. Tardiness also disrupts the class, your peers and instructor. Like unexcused absences, tardiness is considered
irresponsible, disrespectful and unprofessional.
Corrective action for tardiness. Students in violation of the tardiness requirement will first receive a verbal warning with
corrective instruction for the first unexcused tardiness. If the same student breaks the tardiness policy a second time, the
violation will result in the student not being allowed in the class and will receive an unexcused absence for that day. This
may result in a reduced letter grade at the discretion of the instructor. A third unexcused tardiness violation will be
considered a second unexcused absence and will result in a grade of failure for that course. Please see your student
handbook for complete details on policies for classroom tardiness.
Attire: Students are required to wear attire which conforms to the image of the professional physical therapist. The DPT Program, is
a setting where students, faculty, guests, patients, other professionals, and the general public form an impression of us, based on
our appearance and conduct. Casual and faddish clothing are not permitted in the classroom, library, or laboratories.
Corrective Action for attire: Students in violation of the dress requirements will first receive a verbal warning with
corrective instruction. If the same student breaks the dress code a second time, the violation will result in the student
being sent home to change clothes and will receive an unexcused absence for that class. Please see your student handbook
for complete details on policies for attire in lectures and laboratories.
Missed Exams/Assignments: No make-up exams or assignments will be issued unless there is prior approval by the instructor. The
student will earn a grade of zero for a missed exam or late assignment.
a. If I excuse your absence on an exam day, make-up exams may be scheduled at a mutually convenient time. It is the
students responsibility to arrange a make-up schedule with me PRIOR to the absence if at all possible.
b. If I do NOT approve the absence, the student will forfeit the total point value of the exam.
c. If an absence is unexpected, arrangements for make-up exams must be made by the STUDENT within THREE (3) days of

the missed exam. If the student fails to take responsibility to schedule the make-up exam, the total point value of the
examination may be forfeited.
d. Late assignments will not be accepted without my prior approval.
Grade Disputes: If you would like to dispute a question or grade on an assignment or exam, you must do so in writing within 48
hours of when the assignment or exam is returned. In your written dispute, you must include your rationale for the dispute and any
related references.
Social Media: Students are expected to refrain from phone calls, text-messaging and online social networking during class and
laboratory sessions.
Posting of Course Materials on Blackboard: The instructor will make every effort to post course materials on Blackboard before the
scheduled lecture. However, this is not always possible and students should be prepared to take written notes in class. Any course
materials that are not posted prior to lecture will be posted immediately after lecture.
Religious Holidays: A student who is unable to participate in any class, examination, or assignment due to his or her religious holy
day requirements shall not be penalized, provided the instructor has been notified in writing within 3 weeks from the beginning of
the course.
Students with Disabilities: If you are a student with a disability and believe you will need accommodations for this class, it is your
responsibility to contact Student Disability Services at (619) 594-6473. To avoid any delay in the receipt of your accommodations,
you should contact Student Disability Services as soon as possible. Please note that accommodations are not retroactive, and that I
cannot provide accommodations based upon disability until I have received an accommodation letter from Student Disability
Services. Your cooperation is appreciated.
___________________________________________________________________________________________________________
TENTATIVE COURSE SCHEDULE****
****Course content and schedule may be subject to change as determined by the instructor
Note the class time during week 12----we will meet Monday instead of Weds.
Date
Course
Topics
Readings & Assignments
Objective(s)
Course Introduction/Overview
Fundamental Principles and Concepts of O and P
Lusardi: Chapters 1, 5
Review of fundamental biomechanical principles
1/21/15
related to O and P
1, 13, 16
Week 1
Review of gait and GRF as related to O and P
Introduction to Instrumented Walkways and
review of temporal spatial gait measures in O and P

1/28/15
Week 2

2/4/15
Week 3

12,13, 27

2/11/15
Week 4

Review of Homework Problem on GRFs

Etiology of Amputation
LAB: Gaitrite Introduction/and Preparation for
next time.
Extra credit GRF problems due at the beginning of
class
Gaitrite Lab and compile results for assignment
due next week.

2, 3

Amputation Levels and Surgical Considerations (UE

and LE)
Preoperative Rx Considerations and Approaches
Gaitrite Group Assignment due at the beginning of
class

Lusardi: Chapter 17
Handout: Gaitrite
Instrumented Walkway

Review ICF model of Disability

in terms of its
multidimensional and
interactive concepts (Guide to
Practice)

Lusardi: Chapter 19

2/18/15
Week 5

4, 8, 9, 10,
12

2/25/15
Week 6

5, 6, 7, 17

3/4/15
Week 7

11, 12

3/11/15
Week 8

12, 13, 14

3/18/15
Week 9

16,17

3/25/15
Week 10

18,19,22

4/1/15

4/8/15
Week 11

Postoperative Care and Pain

Evaluation/Management/Treatment Approaches
Pre-prosthetic Rehabilitation Approaches/Exercise
Principles
Hierarchical Functional Approach in Rehabilitation
of the Lower Limb Amputee
Lab: Residual Limb Wrapping (Demo and Practice)

20, 21, 22,

23, 24

Prosthetic Componentry for the LE amputee

Interactive Lab: Guest Prosthetist and patient
(please come in professional dress
Prosthetic Check Out
Group Case Scenario #1 due at the beginning of
class
Outcome measures in LE prosthetic rehabilitation
Transtibial and Transfemoral Amputee Gait
(Normal and Abnormal)
Lab: 2D Video review of amputee gait deviations

Continue LE Prosthetic Gait, Rehabilitation

Approaches and Considerations, Prosthetic Gait
Training and Outcomes
Exam 1 (first half of class) 50 questions multiple
choice (course objectives 1-14)Introduction to
lower limb neurovascular assessment of the at-risk
individual
Footwear as the foundation for gait and lower limb
function in the diabetic and the neurological
patient.
Exam Review
Lab: Vascular and Neurological Screening
Techniques for Use in Individuals with Diabetes and
or PAD
Individual Topic Paper # 1 is due at the beginning
of class
No Class Spring Recess
Principles of Orthotic interventions in rehabilitation
Lower limb orthoses for the neurological patient
Special interventions for the at-risk and ulcerated
diabetic foot

Lusardi: Chapter 20
Article: Phantom L. Pain
by Giummarra/Moseley
Case Scenario 1: Handout:
The Prescription of Exercise in
the Lower Limb Amputee;
Integrating Exercise Principles
to Targeted Goals The
Evolving Medical
Rehabilitation Case of Mary
Jane Smith (peer group
solutionswork
in groups of 4 & provide one
single report)due 2/25/15
See sample project on BB

Lusardi Chapters 21-24

Transtibial Gait and

Deviations Videos
Handout: Measuring the
Outcomes of Rehab Services
Following LE Amputation
Begin Working on Topic Paper
#1 (due 3/25/15
Transfemoral Gait and
Deviations Videos

Article: Foot Assessment in

Patients With Diabetes (Ogrin
& Sands--2006)

Handout: Neurovascular Lab

Activities, Please review
thoroughly before todays lab

Lusardi Chapter 9
Lusardi pp 484-494
Begin working on Topic Paper
#2: The Pros and Cons of
Lower Limb Orthotic
Interventions (due 4/29/15)

Monday
4/13/15
2:00 PM
Week 12

4/22/15
Week 13

23,30,31

UE orthoses in rehabilitation (Guest OT)

Lab: wrist and hand splinting techniques

Lower Limb Orthoses for the Musculoskeletal

Patient/Client
Principles of gait and functional training with use of
LE orthotic interventions
Evaluation and functional outcome assessment of
the individual utilizing orthotic interventions

20, 21, 27,

4/29/15
Week 14

20, 21, 26,

28, 29

Spinal orthoses
Principles of foot orthoses in rehabilitation
(musculoskeletal, diabetic, and neurological)
Traditional and modern FO measurement and
fabrication techniques
Lab: Slipper casting for FOs
Individual Topic Paper 2 is due at the beginning of
class

Lusardi Chapter 14

Lusardi Chapter 8
Lusardi pp 313-330
Article: Training the patient
with a stance control or free
walk orthosis (Ottobock)

Lusardi Chapter 13

Please review these readings

before you come to class this
week!

4/29/15
Week 15

Orthotic components in Rehabilitation

Guest Orthotist: Gavin Fortune, CPO (Hanger Inc.)
(Please come in professional dress)

Lusardi Chapter 10
Handout: Rancho Los Amigos
R.O.A.D.M.A.P)

20, 21, 23,

24, 25, 26

#2 Group Orthotic Case

Scenarios (peer group
solutions but submit your
own answers ---include all
names of group
members 3 or 4 max in your
submission) Due at the start
of the final exam.

5/tba/15
Week 16

1-31

Final Exam (comprehensive exam-50 question

multiple choice)
Group Orthotic Case Scenario due at the beginning
of class.

APPENDICES
1. Professional Behaviors
Professional Behavior
1. Critical Thinking

2.

Communication

3.

Problem Solving

4.

Interpersonal Skills

5.

Responsibility

6.

Professionalism

7.

Use of Constructive Feedback

8.

Effective Use of Time and Resources

9.

Stress Management

10. Commitment to Learning

Description
The ability to question logically; identify, generate and evaluate elements of logical
argument; recognize and differentiate facts, appropriate or faulty inferences, and
assumptions; and distinguish relevant from irrelevant information. The ability to
appropriately utilize, analyze, and critically evaluate scientific evidence to develop a
logical argument, and to identify and determine the impact of bias on the decision making
process.
The ability to communicate effectively (i.e. verbal, non-verbal, reading, writing, and
listening) for varied audiences and purposes.
The ability to recognize and define problems, analyze data, develop and implement
solutions, and evaluate outcomes.
The ability to interact effectively with patients, families, colleagues, other health care
professionals, and the community in a culturally aware manner.
The ability to be accountable for the outcomes of personal and professional actions and
to follow through on commitments that encompass the profession within the scope of
work, community and social responsibilities.
The ability to exhibit appropriate professional conduct and to represent the profession
effectively while promoting the growth/development of the Physical Therapy profession.
The ability to seek out and identify quality sources of feedback, reflect on and integrate
the feedback, and provide meaningful feedback to others.
The ability to manage time and resources effectively to obtain the maximum possible
benefit.
The ability to identify sources of stress and to develop and implement effective coping
behaviors; this applies for interactions for: self, patient/clients and their families,
members of the health care team and in work/life scenarios.
The ability to self direct learning to include the identification of needs and sources of
learning; and to continually seek and apply new knowledge, behaviors, and skills.

In addition to a core of cognitive knowledge and psychomotor skills, it has been recognized by educators and practicing
professionals that a repertoire of behaviors is required for success in any given profession (Alverno College Faculty, Assessment at
Alverno, 1979). The identified repertoire of behaviors that constitute professional behavior reflect the values of any given
profession and, at the same time, cross disciplinary lines (May et. al., 1991). Visualizing cognitive knowledge, psychomotor skills and
a repertoire of behaviors as the legs of a three-legged stool serves to emphasize the importance of each. Remove one leg and the
stool loses its stability and makes it very difficult to support professional growth, development, and ultimately, professional success.
(May et. al., Opportunity Favors the Prepared: A Guide to Facilitating the Development of Professional Behavior, 2002).

2. COURSE OUTLINE/OVERVIEW
I.

Introduction and Fundamental Principles in O and P

A. The need for O and P services
B. Terminology-related to O and P
C. The roles of PTs, orthotists, and prosthetists and other team members in the rehab of movement disordersinterdisciplinary team approach to:
1. The neurologically impaired individual requiring orthotic interventions
2. The pediatric-developmentally impaired individual requiring orthotic interventions
3. The musculoskeletal- impaired/traumatic individual requiring orthotic interventions
4. The geriatric individual requiring orthotic interventions
5. The amputee individual
D. Review of the Disablement framework and the Guide to PT Practice
E. Evidence based/supported O and P rehabilitation applications
1. Best external evidence, patient values/perspectives, clinical judgments
F. Common materials used in O and P and their mechanical properties
G. Biomechanical principles associated with O and P
H. Gait and GRF review

II.

Lower Extremity Prosthetics

A.
B.
C.
D.

History of Prosthetic Interventions and Rehabilitation

Prosthetist Education
Practitioner Requirements
Etiologies of Limb Amputation
1. Incidence and Cause
a. Dysvascular diseases
b. Trauma
c. Congenital
d. Cancer
D. Lower Limb Amputation Levels
1.
Hemipelvectomy
2.
Hip Disarticulation
3.
Transfemoral
4.
Knee disarticulation (or through-knee disarticulation)
5.
Transtibial
6.
Symes
7.
Rearfoot: Chopart, Pirogoff, Boyd
8.
Lisfranc (tarsal-metatarsal)
9.
Trans-metatarsal
10.
Toes
E.

Effect of Amputation on Energy Consumption during Walking

1. Transfemoral
2. Transtibial
3. Symes
4. Bilateral lower limb amputees
F. Pre-Operative Management of the Amputee
1. Evaluation
2. Goals
3. Treatment
G. Acute Post-Operative and Pre-prosthetic Management

1.

2.

3.
4.
5.
6.
7.
8.

Post-Op Dressing
a. Soft
b. Semi-rigid and Rigid
c. IPOP/EPOP
Exercise Programs and Principles
a. Clinic and home programs
b. Exercise principles review (strength, endurance, power, coordination)
Limb Positioning
Compression Wrapping
Complications
Residual Limb Maturation
Other factors affecting the residual limb
Protection of the Sound Limb

H. Transtibial Prostheses
1.
Componentry Overview
a. Endo vs. exoskeletal design components
b. Socket types and designs
2.
Suspension Systems
3.
Additional Support and Suspension Systems
a. Supracondylar Cuff
b. Removable Medial Wall/Wedge
c. Supracondylar/Suprapatellar sockets
d. Thigh Corset with Knee Joints
e. Fork/Cuff Strap
4. Static and Dynamic Alignment of the Prosthesis
a. Toe and heel levers
b. Foot and knee alignment
5.
Functional Training
a. Pre Prosthetic care
i.
ROM and muscle performance training
ii.
Clinic and home programs
b. Below knee mechanics as applied to walking
i.
TKA line and GRF vector
c. Temporary prosthesis
d. Definitive prosthesis
6. Common Gait Deviations

I.

Transfemoral Prostheses
1.
Components
a. Quadrilateral, Ischial Weight Bearing Socket (Ischial-ramal containment)
b. Suspension systems
c. Prosthetic Feet
d. Prosthetic Knees
i. Locked
ii. Single-Axis, Constant Friction
iii. Weight-Activated Stance Control
iv. Polycentric Knees
v. Fluid Swing-Phase Control
vi. Fluid Swing- and Stance- Phase Control
vii. Computer-controlled
viii. Powered knees
e. Additional Designs & Suspension
i.
Silesian Bandage
ii.
Hip Joint and Pelvic Band

2.

3.

4.

iii.
Suction
iv.
Osteointegration
Alignment
a. Static
b. Dynamic
Functional Training
a. Pre Prosthetic care
i.
ROM and muscle performance training
ii.
Clinic and home programs
b. Transfemoral mechanics as applied to walking
i.
TKA line and GRF vectors
c. Temporary prosthesis
d. Definitive prosthesis
Common gait deviations

J.

Knee Disarticulation
a. Prosthetic Design
b. Functional Training
i.
TKD mechanics as applied to walking

K.

Hip Disarticulation
a. Etiology
b. Prosthetic Design
c. Prosthetic Fitting
d. Functional Training

L.

Symes and Partial Foot Prosthesis

a. Prosthetic Design
b. Functional Training
c. Symes and Partial Foot Mechanics as Applied to Walking

III.

Functional Outcome Measures for the Lower Limb Amputee Individual

A. Physical Measures
1. Amputee specific outcome measurement tools
2. Instrumented walkways
B. QOL and Subjective Measures
C. Predictive Measures
D. K Levels (Medicare)

IV.

Pain and Pain Management and Psychological Issues involved with Limb Amputation
A. Pain and Non Pain Conditions
1. Phantom limb pain
2. Phantom limb sensation
3. Intrinsic and extrinsic pain
4. Contemporary treatment approaches
B. Psychological Issues
1. Anxiety, depression, grief, adjustment rxns
2. PTSD
3. Self-efficacy

V.

Neurovascular Assessment of the Lower Limb (protection of the residual and sound limb in the diabetic)
A. Pedal ulceration/amputation risk in the diabetic individual
1. Medicare requirements

B.

C.

VI.

VII.

Vascular assessment of the lower limb

1. ABI
a. Use of pocket doppler
2. Lower limb pulse assessment
3. Bruits
4. TBIs
5. Intermittent claudication
a. Treadmill testing
Neurological assessment of the lower limb
1. Vibration
2. Temperature
3. Light Touch (10 gram filament)

Upper Extremity Prosthetics

1.

Upper Limb Amputation Levels

1. Forequarter
2. Shoulder disarticulation
3. Transhumeral (short, med, long)
4. Elbow disarticulation
5. Transradial (short, med, long)
6. Wrist disarticulation
7. Transcarpal
8. Phalangeal

2.

Prosthetic Options
1. No prosthesis
2. Passive prosthesis (cosmetic device)
3. Body powered-cable-driven
4. Adaptive (activity specific)
5. Externally powered
a. Myoelectric
b. Computer controlled
6. Hybrid (combinations of body and electrically controlled

3.

Shoulder Units

4.

Elbow Units

5.

Wrist Units-passive

6.

Terminal devices
a. Voluntary opening
b. Voluntary closing

7.

Basic training techniques for cable controlled devices

Lower Extremity Orthotics

A. General Concepts
1. Terminology
2. 3-point force systems
3. Materials and material properties
4. Prefab, temporary, custom/definitive
5. Static vs. dynamic

B.

C.

Function(s) of Lower Extremity Orthoses

1. Gait
2. Neuromuscular
3. Joint protection and support
Footwear
1. Functions
2. Components
3. Basic Concepts for Fitting
4. Custom molded footwear
5. Modifications to footwear
a. Lifts
b. Wedges
c. Rockers
d. Heels
e. Upper modifications
f. Sole modifications
D. Foot Orthoses (FO)
a. Prefab vs. Custom
b. Accommodative vs. functional
c. Intrinsic and extrinsic posting
d. Heel cups
e. Flanges
f. Cutouts
g. Pads
h. Material considerations
i. Evidence

E.

Ankle-Foot Orthoses (AFO)

1. General concepts and indications for use
a. Weakness
b. Instability
c. Control of tone
2. Single and Double Upright AFO
a. T-straps
b. Hinges and Pins
3. Molded AFO
4. Leaf Spring AFO
5. Floor reaction AFO
6. Energy return
7. FES based (WalkAide and Bioness)

F.

Knee Orthoses (KO)

1. General concepts and indications for use
a. Rigid KO (Swedish Knee Cage)
b. Molded Plastic, Solid KO
c. Hyper-extension KO
d. Immobilizer KO
e. Hinged KO

G. Knee-Ankle-Foot Orthoses (KAFO)

1. General concepts and indications for use
a. Conventional vs. thermoplastic
b. Types
i. Locking

ii. Non locking

1. Joints
2. Single and Double Upright KAFO
3. Knee extension assist KAFO
4. Load response KAFO
iii. Stance Control (SCKAFO)
iv. Computer assisted
v. Evidence of effectiveness of KAFOs
H. Hip Orthoses (HO)
1. General concepts and indications for use
a. Hip Abduction HO
b. Toronto HO
c. Scottish Rite HO

VIII.

I.

Hip-Knee-Ankle-Foot Orthoses (HKAFO)

1. General concepts and indications for use
a. Conventional HKAFO
b. Reciprocating Gait Orthoses (RGO)

J.

Lower Extremity Fracture Orthoses

Spinal Orthoses
A. Historical Perspectives
B.

VI.

General functions and indications

1. Control of position/restriction of movement post injury
2. Corrective posturing/positioning/deformity prevention
3. Spinal stabilization
C. Components
1. Thoracic and Pelvic Bands
2. Paraspinal Supports/Uprights
3. Lateral Supports/Uprights
4. Abdominal Support Mechanisms
D
Commonly Prescribed Spinal Orthoses
1. Chair-Back LSO
2. Raney LSO Flexion Jacket
3. Knight LSOs
4. Williams LSO
5. Jewett and CASH TLSO with Anterior Control
6. TLSO Body Jackets
7. Cervical Orthoses
a. SOMI
b. Yale
c. Halo
d. Soft Collars
Hand Splinting
A.
Splinting Materials
B.
Fabrication Methods
C.
Splint Classifications
1.
Gutter Splint
2.
Wrist Extension Splint
3.
MCP Flexion Block Splint