Prosthetic prescription

Prosthetic Prescription. The director of the prosthetic clinic (e.g., orthopedist or physiatrist) typically writes the prosthetic prescription, with input from the physical therapist and prosthetist team members. Prosthetic prescription refers to specification of the prosthetic socket design, commercial componentry (foot, knee units), suspension, and interface materials (insert, stump socks). Prosthetic selection is influenced by the age and general condition of the patient, his or her skin and vascular status, the presence or absence of disease, and any limitations imposed by such disease. 

FIGURE 33.12 Prosthetic prescription options for individuals with transfemoral amputation. (Adapted from Ref. 4, Fig. 4.14.)... 

Decreased international normalized ratio (INR) (a standardized scale used to report the results of blood coagulation tests) was reported in a patient taking warfarin and other prescription drugs for cardiovascular conditions (Janetzky and Morreale 1997). Thrombosis of a prosthetic aortic valve and a decrease in INR were reported in a patient taking warfarin and ginseng (species and dose unspecified). The patient had a history of erratic INR levels (Rosado 2003). 

Following amputation surgery, the patient is often referred to physical therapy for education regarding proper limb positioning and residual limb care and to a prosthetic/amputee clinic. The clinic team typically includes a physician, a physical therapist, and a prosthetist. It may also include a social worker and/or vocational counselor. These multidisciplinary teams were first established after World War II to provide evaluation, prescription, delivery, and follow-up prosthetic services. ... 

Prosthetic Feet. With the exception of partial foot amputees, the prostheses for all lower extremity amputees require a prosthetic foot. The prescription criteria for these feet take into consideration the amputation level, residual limb length, subject activity level, cosmetic needs, and the weight of the individual. Prosthetic feet range from the SACK (solid ankle cushioned heel) foot, which is relatively simple and inexpensive, to dynamic-response or energy-storing feet that are more complicated and considerably more costly. Note that prosthetic feet are often foot and ankle complexes. As such, prosthetic feet may replace plantarflexion/dorsiflexion, pronation/supination, and inversion/eversion. Prosthetic feet are typically categorized in terms of the function(s) they provide or replace and whether or not they are articulated. 

Finally, finite-element models have potential sqiplicability in CAD of prosthetic sockets. Current prosthetic CAD systems emulate the hand-rectification process, whereby the socket geometry is manipulated to control the force distribution on the residual limb. Incorporation of the finite-element technique into future CAD would enable prescription of the desired interface stress distribution (i.e., based on tissue tolerance). The CAD would then compute the shape of the new socket that would theoretically yield this optimal load distribution. In this manner, prosthetic design would be directly based on the residual limb-prosthetic socket interface stresses. 

Leading U.S. prosthetics manufacturers, such as Becker Orthopedic and the Hanger Orthopedic Group, sell primarily to special laboratories and workshops. Such workshops are staffed by trained and certified prosthetists and orthotists. Physicians contact these workshops to place an order or fill a prescription for a prosthesis to be fitted on a patient. 

Prosthetic Devices. In urology, a prosthetic device almost always refers to a penile implant, which is a treatment option for men with erectile dysfunction for whom other treatments have failed. About 30 million men in the United States have erectile dysfunction, and about one-third of them do not respond to other treatments. Implantation requires a surgical procedure, which is why other options are tried first. Implants have several advanfc es. They do not require the doctor visits for prescriptions and monitoring that are necessary with pills, creams, suppositories, and injections, and they are available for immediate use and are aesthetically pleasing because they prevent the penis from contracting when cold. 

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