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Glossary of Terms Relating to Amputation

March 2007

AAOP: American Academy of Orthotists and Prosthetists, A professional society of ABC board certified practitioners. Founded 1970

ABC: American Board for Certification in Orthotics and Prosthetics, A certification board for individuals and facilities providing orthotic and prosthetic services. Established 1948

Acquired Amputation: Limbs surgically removed due to disease or trauma.

Adherent Scar Tissue: Tissue stuck down, usually to bone.

AE: Above elbow. Also referred to as transhumoral.

AFO: Ankle-Foot Orthosis; device that encompasses the lower leg and foot.

AK: Above knee. Also referred to as transfemoral.

Alignment: Position of prosthetic socket in relation to foot and knee.

Amputation: The loss or absence of all or part of a limb.

AOPA: American Orthotic and Prosthetic Association. A trade association of facilities (no individuals) that provide orthotic and prosthetic services. Founded 1917.

ARL: Alignment Reference Line

Assistive/Adaptive Equipment: Devices that assist in performance or mobility, including ramps and bars, changes in furniture heights, environmental control units and specially designed devices.

BE: Below elbow. Also referred to as transradial.

Bilateral: A double amputee. Both legs or both arms as in Bilateral BK etc.

BK: Below knee. Also referred to as transtibial.

Bumper: A rubber like (polymer based) device inserted into a knee or ankle component as a resistance or extension aid. Bumpers come in different durometers (color coded) which allow the amputee to have different resistance levels.

CAT/CAM, (Contoured Anterior Trochanteric/Controlled Alignment Method): The popular term coined by John Sabolich, CPO for his socket shape derived from the work of Ivan Long, CP. The term was replaced by the trademarked name "Sabolich Socket" do to internal conflicts within the prosthetic industry that prohibited trade-marking CAT/CAM in the United Sates.

CAPP: Body-powered device named for the Child Amputee Prosthetics Project at UCLA where it was designed to promote gross motor functioning and early grasp.

CAPO: Canadian Association of Prosthetists and Orthotists.

Certification: A level of training that is verified by the appropriate professional organization. It is your proof that the practitioner has the required TECHNICAL training. It in no way certifies the personality or business practices of the practitioner or facility.

Check or Test Socket: A temporary socket, often transparent, made over the plaster model to aid in obtaining a proper fit. A successful test socket will then be remade into the definitive socket.

(Codes) L-Codes: Procedure codes for orthotics and prosthetics developed through the efforts of HCFA (Health Care Financing Administration) and AOPA.

Congenital Amputee: Individual born missing a limb(s). Technically, these individuals are not Amputees, but are considered to be "Limb Deficient.”

Congenital Anomaly: A birth abnormality such as a missing limb (amelia) or deformed limb (phocomelia).

Congenital Defiency: condition present at birth, when all or part of a limb fails to develop normally.

Control Cable (Bowden Cable): A cable system taken from the aircraft industry to control the operation of a prosthetic arm. Can also be used for lower extremity prostheses and orthotic systems as well.

Cosmesis: The outer, aesthetic covering of a prosthesis, usually made of foam or a rubber like material. Foam cosmeses are almost always covered by a cosmetic stocking.

DAK: Double above knee (aka bilateral). Also referred to as Bilateral transfemoral.

Definitive, or "Permanent" Prosthesis: A replacement for a missing limb or part of a limb which meets accepted check-out standards for comfort, fit, alignment, function, appearance, and durability.

Disarticulation: An amputation through a joint: the hip, shoulder, knee, ankle, elbow, or wrist.

Donning and Doffing: The act of putting on and taking off a prosthesis.

Dorsiflexion: Pointing the toe/foot upward, toward the body.

Durometer: Means different 'density' or strength and in the context of prosthetics means it will allow the ankle or knee to move, bend, flex more or less.

Early prosthetic fitting: A procedure in which a preparatory prosthesis is provided for the amputee immediately after removal of the sutures. (See IPOP)

ED: Elbow Disarticulation

Edema: Swelling of the tissues.

Endoskeletal Prosthesis: One built more like a human skeleton with support and components on the inside and a cosmetic cover on the outside.

Energy Storing Foot: A prosthetic foot design that stores energy when weight is applied to it and releases energy when the amputee transfers weight to the other foot.

Eversion: To turn outward.

Exoskeletal Prosthesis: A prosthesis that is hollow on the inside with a hard outer surface to bear weight.

Extension Assist: A method of assisting the prosthetic to "kick forward" on the swing through phase to help speed up the walking cycle. Used primarily for seniors, high AK amputations and those with limited strength in the residual limb.

Forquarter Amputation: Interscapulthorasic amputation.

Gait Training: The method of learning to walk properly using a lower limb prosthetic device.

GRIP/ADEPT: Body-powered, voluntary-closing terminal devices that close with tension is applied to the cable.

Hip Disarticulation (HD):. Amputation which removes the leg at the hip joint, leaving the pelvis intact.

HP Hemi-Pelvectomy (HP): An amputation where approximately half of the pelvis is removed.

HKAFO: Hip-Knee-Ankle-Foot Orthosis; device that encompasses the hip and leg.

Hand/Mitt: Either passive or active (terminal) device used to replace the hand.

Hard Socket: A prosthetic socket made of rigid materials.

Heel Strike: The moment when the heel makes contact with the floor at the end of the swing through phase.

IPOP or Immediate Post Operative Prosthesis: A temporary prosthesis applied in the operating room immediately after the amputation. inversion: To turn inward.

Ischial Containment Socket: (SEE ischial tuberosity): The Ischial Containment socket cups the Ischial bone on the inside and back as well as the bottom to accomplish two things: 1) By cupping, or containing this bone inside the socket, the socket tends not to shift laterally (outside) when weight is put on it, making walking more efficient. This style of socket can have a very intimate fit and may take some time to get used to in order for it to become comfortable.

Ischial Tuberosity: The bone that protrudes from the back of the pelvis (the "butt bone") that may get sore when sitting on a hard surface for extended periods of time.

KAFO: Knee-Ankle-Foot Orthosis; device that encompasses the entire leg.

KD: Knee disarticulation. Amputation through the knee joint.

Knee Components: devices designed lo create a safe, smooth walking pattern.

Lateral: To the side, away from the mid-line of the body.

Liners: Used for suspension, comfort and protection of the residual limb. Includes rigid, silicone and neoprene.

LSO: Lumbosacral Orthosis; device that encompasses the lower torso .

Manual Locking: Device that locks the knee in complete extension to prevent buckling and falls.

Medial: Toward the mid-line of the body.

Modular Prosthesis: An artificial limb assembled from components, or modules usually of the endoskeletal type where the supporting member, or pylon, is covered with a cosmetic covering (See “Cosmesis”) shaped and finished to resemble the natural limb.

Multiaxis Foot: Allows inversion and eversion and rotation of the foot and is effective for walking on uneven surfaces.

Myoelectrics: Literally muscle electronics. Myoelectric prosthesis were first developed in Russia. This is a technology used in upper-extremity prosthetics. The prosthesis contains electrodes which are used to control the prosthesis via muscle contractions which in turn control a motor in the terminal device, wrist rotator or elbow . An attached battery pack provides the power system which translates the muscle contractions into movements of the prosthesis.

Myodesis: Muscles anchored to end of bone.

Myoplasty: Muscles anchored to opposing muscles.

Neuroma: The end of a nerve left after amputation, which continues to grow in a cauliflower shape. Neuromas can be troublesome, especially when they are in places where they are subject to pressure from the prosthesis socket.

Normal Shape/Normal Alignment (NSNA)- also know as a narrow ML socket: First described by Ivan Long, this socket more closely approximates the shape of the musculature of a residual limb, when compared to a quad socket. The sides, or medial/lateral measurement is tightened down to squeeze the residual limb, with most of the squeezing taking place on the outside or lateral side. This helps control the rotation of the socket by putting pressure along the fleshy area of the leg that can handle some side to side pressure.

Nudge Control: A mechanical switch that operates one or more joints of the prosthesis.

Occupational Therapy/OT: Evaluation and training to maximise independence and function in daily living.

Orthosis/Brace: A plastic or metal device used to straighten and/or Support a body part, improve function, or aid recovery.

Orthotics: The profession of providing orthotic services.

Orthotist: A patient-care practitioner who evaluates, designs, fabricates and fits orthoses (braces) and other devices to straighten or support the body and/or the limbs.

Partial Foot Amputation: An amputation on the front part of the foot; also called “Choppart Amputation.”

Physical Therapy/PT: The evaluation and treatment of disease, injury or disability through the use of therapeutic exercises and modalities to strengthen muscles, improve range of motion and decrease pain.

Pistoning (or Milking): The term used when your liner stretches resulting in your residiual limb pulling in and out - like a piston.

Planarflexed/Planar Flexion: Means the toe is pointing down, toward the sole. Almost like pushing the gas pedal down and simulating that position or alignment.

Pneumatic/Hydraulic: Provides controlled changes in the speed of walking.

Polycentric: Multiple-axis joint, particularly useful with a very long residual limb.

Prehension: To hold, grasp or pinch.

Preparatory Prosthesis: An unfinished functional replacement for an amputated limb, fitted and aligned in accordance with sound biomechanical principles which is worn for a limited period of time to accelerate the rehabilitation process. It is generally without cosmetic finishing and is used to expedite prosthetic wear and use; it also aids in the evaluation of amputee adjustment and component selection.

Prosthesis: An artificial part of the body.

Prosthetics: The profession of providing cosmetic and/or functional restoration of missing human parts.

Prosthetist: A person involved in the science and art of prosthetics; one who designs and fits artificial limbs.

Posterior: The back side of the body.

Pylon: A rigid member, usually tubular, between the socket or knee unit and the foot that provides weight bearing support shaft in an endoskeletal prosthesis.. This is referred to as a “pole” in a temporary prosthesis.

Quad Socket: The Quad socket has a shelf about one inch wide on the posterior wall of the socket which the Ischial Tuberosity rests on . The Quad socket has four clearly defined sides.

Residual Limb: The remaining portion of a limb after amputation, also called the “stump.”

RGO: Reciprocating Gait Orthosis; special HKAFO that allows paralyzed persons to walk step over step; generally used with crutches for balance

Rigid Dressing: A plaster wrap over the stump, usually applied in the operating or recovery room immediately following surgery, usually in below the knee amputations, for the purpose of controlling edema (swelling) and pain and to promote shrinkage and shaping of the residual limb in preparation for a prosthetic fitting.

S.A.C.H.: Solid Ankle Cushioned Heel foot component. A very basic, “passive” foot; very stable.

SD: Shoulder Disarticulation-- Amputation through the shoulder joint.

Shrinker: A prosthetic reducer made of elastic material and designed to help control swelling of the residual limb and/or shrink it in preparation for a prosthetic fitting.

Single Axis Foot: Used since the Civil War, this foot has an ankle hinge that provides dorsiflexion and planar flexion. i.e. , toe up & toe down. The disadvantages of a single axis foot include poor durability & cosmesis.

Single Axis Knee: Free singing knee with small amount of friction.

Socket: Portion of prosthesis that fits around residual limb/stump and to which prosthetic components are attached.

Soft Socket: Inner socket liner of foam, rubber, leather, other material for cushioning the residual limb.

Split Hooks: Terminal devices with two hook-shaped fingers operated through the action of harness and cable systems.

Stance Control: Friction device with an adjustable brake mechanism to add stability.

Stance Flexion: Mimics normal knee flexion at heel strike.

Stockinette: Tubular open-ended cotton or nylon material.

Stump: A word commonly used to refer to the residual limb. (SEE RESIDUAL LIMB)

Stump Sock: Wool or cotton sock worn over residual limb to provide a cushion between the skin and socket interface.

Stump Shrinker: An elastic wrap or compression sock worn on a residual limb to reduce swelling and shape the limb.

Suction: Provides suspension by means of negative pressure vacuum in a socket; achieved by forcing air out of the socket through a one-way valve when donning and using the prosthesis.

Supercondular Suspension: A method of holding on a prosthesis by clamping on the bony prominence above a joint, called “Condyles”

Suspension System(s): The method used to hold the prosthesis on to the body. Includes locking pin, TES belt, suspension sleeve, waist belt, and suction.

Swing Phase: Prosthesis moving from full flexion to full extension

Switch Control: use of electric switches to control current from a battery to operate an electric elbow, wrist rotator or terminal device.

Symes: A disarticulation amputation through the ankle joint that retains the fatty heel pad portion for cushioning.

Temporary Prosthesis: A prosthesis made soon after an amputation as an inexpensive way to help retrain a person to walk and balance while shrinking the residual limb.

Terminal Devices: devices attached to the wrist unit of an upper extremity prosthesis that provide some aspect of the function (grasp, release, cosmesis, etc.).

TES Belt: A neoprene or Lycra suspension system for AK prostheses that has a ring which the prosthesis slides into. There is a neoprene belt that attaches around your waist by velcro/hook and loop fastener.

TLSO: Thoracolumbar-Sacral Orthosis; device that encompasses the entire torso.

Transtarsal Amputation: Through the tarsal (tarsus) or foot bones. (SEE “PARTIAL FOOT AMPUTATION”)

Voluntary-Closing Devices: Terminal devices that are closed by forces on a control cable; grasp is proportional to the amount of pull on the cable.

Voluntary-Opening Devices: Terminal devices that are opened by body motion and closed by elastic bands or springs.

WHO: Wrist-Hand Orthosis; device that encompasses the wrist and hand.

Wrist Unit: Component that allows interchanging or repositioning of terminal devices.