The following steps are followed at CFH during the prosthetic fabrication process:
1. Joint Screening: - Every Monday is joint screening day, where a team of Prosthetist and Physiotherapist assess the person who needs prosthesis to check whether his stump is ready for prosthetic fitment and set physiotherapy goal of stump preparation for prosthesis.
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Joint Screening |
2. Detailed Prosthetic Assessment: Prosthetist does the detailed assessment of patient’s stump, living standards, general health condition, job conditions etc. before prescribing suitable prosthesis.
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3.Measurements:- Circumference around stump, medial-lateral, anterior-posterior and height measurements are taken by a qualified Prosthetist.
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Plaster casting by a Prosthetist |
4. Casting: - Prosthetist casts the residual stump with Plaster of Paris bandages for making the socket of the prosthesis. This cast is called a negative cast. |
5. Pouring: - This is a process, where the negative cast is filled with Plaster of Paris paste to make a positive mould of the stump.
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Prosthetists modifying positive mould |
6. Modification: - This is a process where, a Prosthetist modifies the positive mould based on biomechanical principles to relieve pressure in sensitive areas in the socket. Most of the positive moulds are modified on total contact design where weight is distributed through out the sub tissues of the stump.
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7. Liner Fabrication: - A soft liner made out of EVA is fabricated over modified positive moulds, which acts as soft interface between the stump and hard Trans -Tibial prosthetic socket.
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Socket fabrication with terra colour polypropylene |
8. Socket Fabrication: - Socket is made out of lightweight beige or terra colour 4 -5 mm thick polypropylene sheet depending on patient skin colour.
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9. Assembly and Bench Alignment: - The polypropylene components are assembled together based on biomechanical principles of weight line.
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Assembly and bench alignment |
10. Static and Dynamic Alignment: - The modular design of Polypropylene technology allows the Prosthetist to effect static and dynamic alignment for greater comfort and better gait.
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11. Gait Training: - A team of physiotherapists trains the patient to walk near to normal walking patterns inside and out side parallel bars.
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Gait training inside parallel bars |
12. Advance Gait Training: - Advance gait training is given to the patient for walking in different uneven terrain and crossing the ground related Obstacles found in day-to-day life.
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13. Final Finishing: - There are three types of finishing done over endoskeletal design PP technology based on individual need.
- Hard Finish: - The Prosthesis is covered with water resistant polypropylene material matching the contour and colour of sound side limb. This finish is suitable for farming
- Soft Finished: - The Prosthesis is covered with soft EVA material matching the contour and colour of sound side limb. This finish is suitable for office work.
- Jaipur Finish: - The Prosthesis is covered with soft EVA material matching the contour of sound side limb. Finally, it is covered with a layer of cotton stockinet and painted skin colour using water resistant paint. This finish is suitable for office work and farming both but the fabrication is time consuming.
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Bench technician finishing a prosthesis with soft EVA
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14. Checkout: - An extensive checkout of the Prosthesis for its function, workmanship and overall appearance is done by a qualified Prosthetist before delivery of the prosthesis. |
Prosthetist performing functional checkout |
15. Follow - ups: - Follow - up appointment is made before final discharge. New amputee is usually called for a follow up check after 3 month where as an established amputee is called in annually. |
16. Database: - All the details about the amputees are recorded in a database system, which is kept confidential and used for follow-ups.
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