A "STEP-WISE REFINEMENT" PROCESS
Stokosa Prosthetic Clinic offers complete prosthetic care. Each patient receives a thorough evaluation. We listen to your needs and what you want to accomplish. Together, we create a plan to achieve your goals. See Jan Stokosa's "What Is Possible?" formula.
Prosthetic fitting has seen a tremendous evolution - from the 1950’s wood, rawhide, leather straps, and buckles to today’s flexible, elastic, plastic, carbon fiber, silicone, urethane, hypobaric, suction, vacuum suspensions, microprocessor knees and ankles, etc.
The fitting of the socket of the prosthesis is the most important element in the ability of the amputee to be functional. The more comfortable and stable the amputee feels upon weight-bearing in the socket, the more active she/he can be - from simple walking to the more demanding activities involving running, jumping, bicycling, carrying heavy objects, etc.
Keeping in mind that the most important aspect of prosthetic fitting is the comfort and stability afforded by the prosthesis socket, our emphasis is to first establish comfort and stability in designing the socket.
Once we achieve comfort and stability, we then proceed to mobility - walking with ease and efficiency. This is accomplished by having you walk test several different foot, ankle, and in the case of higher level amputations, knee and hip component elements to determine which provide you with the most comfortable, energy efficient dynamic walk.
We then proceed to any and all higher level activities to develop the appropriate foot, ankle, knee component elements to maximize performance in your specific activity/s. This could require a set of different foot, ankle, knee component elements that function more effectively for a particular activity or sport.
With comfort, stability and function successfully achieved we address the external appearance of your prosthesis. The options are many, including symmetrical anatomic shaping with synthetic skin, color-matched to you, or exposed components representing a high-tech look, decorative sockets, etc.
THE FITTING PROCESS
- VIDEOS -
1. RESIDUAL-LIMB IMPRESSION PROCEDURE
2. CAST IMPRESSION
3. CAST DESIGN MODIFICATION, CREATING A MASTER POSITIVE MODEL
4. FABRICATION OF DIAGNOSTIC SOCKET & DIAGNOSTIC PROSTHESIS
5. DIAGNOSTIC PROSTHESIS FITTING PROCEDURE - A SERIES OF 3-12 APPOINTMENT SESSIONS
After the proper fit is achieved and the proper components are identified, the definitive socket & prosthesis is fabricated and delivered to the patient. This is followed by regular follow-ups and any additional appointments as necessary.
THE FITTING PROCESS
- OUTLINE -
0. Initial evaluation: consult with consulting physician, etc.; creation of a treatment plan
1. Residual-limb impression procedure (video above)
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2. Cast impression (video above)
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3. Cast design modification, creating a master positive model (video above)
4. Fabrication of diagnostic socket & diagnostic prosthesis (video above)
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5. Diagnostic prosthesis fitting procedure - a series of 3-12 appointments including explanation of workings of the prosthesis; refinements to socket fit and biomechanical alignment to minimize energy expenditure (short video above)
6. Functional comparative prosthetic foot/ankle evaluation/testing: patient evaluates different
prosthetic foot/ankle systems (chosen by us based on patient's activity level) to optimize balance, stability, heel-to-toe smoothness, minimizing energy expenditure to walk; patient will decide on the best one for them (keeping in mind that different foot/ankle systems may function differently in different environments, for example: daily walking on level surfaces vs. working outside on uneven ground vs. working out in the gym or running).
7. Patient leaves with Diagnostic Prosthesis for a prescribed period of time to allow their limb to acclimate to the new environment of encasement and pressure.
8. Patient will return weekly, or sooner as needed, to make any adjustments necessary to maintain comfort and function.
9. Definitive prosthesis socket fabrication: once optimal socket fit is achieved, choice of
prosthetic foot/ankle is made, and the biomechanical alignment is refined, the definitive prosthesis socket is fabricated from a cloning of the final diagnostic socket. New endoskeletal system couplings are connected to the new prosthetic foot/ankle. (While this is often called the "permanent" prosthesis, that isn't fully accurate because limbs will change and socket refitting will be necessary periodically, when adjustments can no longer be made to accommodate the changes to maintain comfort, stability, and function.)
10. The final procedure is to create the external appearance the way you want it: some want
the Prosthesis to look anatomically natural; some want special, fun designs, such as a school
mascot, colors, camouflage, USA flag, etc. Most anything can be done.
11. FINAL APPOINTMENT IN THE PROSTHESIS FITTING PROCESS: We will review all aspects
of the Prosthesis, how to care for and maintain it. The patient will walk out of the Clinic with a final,
finished Prosthesis. Periodic follow-up appointments will be made to monitor progress
and make sure the Prosthesis is functioning properly. Patient will schedule appointments on an as
needed basis between these scheduled follow-up appointments.
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