AmputeeOT: Liner Primer! All about liners for prosthetic legs

Hi guys! This is Christina, the Amputee OT. In this video, I’m going to be talking about liners for your prosthetic leg. I only have a few examples of the wide wide variety of liners that are available for people with lower extremity amputations who wear prosthetics. To be honest, there are a TON of different liners. There’s different brands. There’s different models. There’s gel and there’s silicone There’s different viscosities. There’s stretchier wands and firmer ones, and It’s kind of overwhelming how many liners are there, but this is more or less just a basic primer on liners for prosthetic legs. There are three main types of liners. Probably the most common one is a locking liner. A locking liner has an umbrella, which is this white thing in this liner –at the bottom of the liner–and at the bottom of the umbrella are threads; and you can screw any number of pins to the bottom of the umbrella. The way this liner works is that when you put your leg on, you put your leg into your prosthetic– and these pins lock onto a lock at the bottom of the prosthetic. So this is a pin lock liner, or a locking liner. This is a cushion liner. A cushion liner does not have an umbrella at the bottom; instead, it just has cushiony material at the bottom of the liner. This is not a locking liner; and if you use this type of type of liner, then you need to use some other method of suspensions, such as suction– or in my case, you can convert it into a locking liner by using a coyote proximal lock or a ratchet lock. The other common type of liner is a suction liner. The way this liner works is that your prosthetic has a one-way valve on it, when you step down into your prosthetic, all the air comes out of your socket; and then the air doesn’t enter back into your socket, and this forms a seal around your socket so that your liner cannot come back out, and your leg cannot come back out of your prosthetic. So you might be wondering, “Well, how then do you get your leg out of your prosthetic if you have a suction liner with a one-way valve?” . Well, the answer is that usually the one-way valve has a button on the end of the one-way valve that allows air back in if you press the button. Liners usually have a cloth outer material, but not always; and the inner material is made of silicone or gel. The silicon or gel comes in different thicknesses, ranging from very thin –like one millimeter to three millimeters, which is what THIS one is–and all the way up to six millimeters, in the case of THIS liner. This is an Ice Ross Dermal liner. The liner starts out at three millimeters thick, and gradually increases until it’s about seven millimeters thick at the bottom; and then the very bottom of the liner is about fourteen millimeters thick. Another interesting thing about liners is that you can have the thickness of the silicone be thicker on the front to where your tibia is at; and thinner on the back– the back of your knee. So this is like–This is an example of that kind of liner. So you can see that *this* part is definitely a lot thicker than *this* part. This part’s for the front of your leg, where your tibia is at; and this part is for the back of your leg. The way you put a liner on your residual limb is, you take the liner and turn it inside out. You press the end of the liner all the way against your residual limb, and then you roll the liner on to your leg, kinda like this. Usually, liners come in one length; but you can trim the liners if you so desire to whatever length you like. So this liner–this gray one is full length, and this one has been trimmed. Liners also come in different widths depending on the size of your residual limb, and whether or not you’re a below-knee amputee or an above-knee amputee. Just, obviously usually an above-knee amputee is going to have a wider residual limb than a person with an amputation below their knee. Sometimes liners are measured in inches, and sometimes they’re measured in centimeters, depending on which brand of liner that you’re using. These Ice Cross liners are measured in centimeters, and they’re measured in the diameter. So, to measure yourself for a liner, you measure up about 4 centimeters from the end of your leg. You measure all the way around in circumference; and then you choose the liner that most closely matches that circumference– or even a liner that’s smaller than the circumference of your leg, if you want it to be a little bit tighter. And you should definitely talk to your prosthetist about figuring out what size liner you need. Hopefully, you can tell that there’s a clear difference in the size of these two liners. *This* is an 18 centimeter liner and *this* is a 26 and a half centimeter liner. THIS liner is a 23 and a half centimeter, which means that the inside measures 23 and a half centimeters all the way around, right about here. Surprisingly, a lot of liners don’t have a proximal measurement, which is measurement at the other end of the liner. And the reason for that is that liners are usually pretty stretchy? So this liner is only about this wide, but I can actually stretch it to about that wide. Certain liners are more durable than other liners. I found that the ice Ross liners are actually very durable liners; and I’ve heard accounts of people using these for five, six, seven years without having to replace them. But there are other brands of liners that are not durable and then wear out pretty quickly. Here’s another example of a different brand of pinlock liner This liner is superduper stretchy, and is really really flexible and floppy; compared to this liner, which is stiffer. I used this liner for a while; and while I found it to be really comfortable, I also did not find it to be quite as durable. So there’s sort of a trade-off between this liner, in this liner this liner is more durable. But, it’s also made of a little bit firmer stiffer material; and so it might not be good for residual limbs that are very sensitive and This liner is very flexible and very comfortable, but it’s not very good for a very active person. It stretches when it’s inside your leg; and so it kind of makes your prosthetic, like, not a stable as wearing a firmer stiffer liner. This liner would probably be really good for maybe a very low-impact, older person, who’s not going to be very active with their prosthetic ;and this liner– the Ice Ross liner–is better for somebody who’s more active. This is a silo liner. It’s made by Silicos. Here, you can see how the pin comes unscrewed from the umbrella of the liner. You also may have noticed that this liner’s got waves in it; and THIS liner does not. These are actually the same liner; but one is the Wave version of the ice Ross dermo liner, one is just a regular version. The waves make it easier for you to bend at the knee. Some people don’t really like the wave, so it’s definitely up to you to decide which one you prefer. But I prefer this kind. These are the liners that I use now. A question I get pretty frequently about liners is whether or not my leg gets hot or sweaty inside the liner; and that question has a really weird answer. So the answer is: I found that when I was wearing this liner, which is much looser on my skin, and much stretchier, that my leg got really, really, really sweaty. So I would be literally taking this thing off several times a day, and dumping sweat out; and sweat would be dripping off my leg. And I don’t get that with this liner. And the reason is that your leg tends to sweat a lot less with a liner that’s relatively tight and conforming versus a liner that’s too loose . If your liner is too loose, then that might lead to situation in which your residual leg is sweating a whole lot more than a correct sized liner. To be honest though, I have really no idea why this is, and I would really like to know. So if any of you guys out there in Internet Land know why this is –why a tighter liner would cause your leg to sweat less, and a looser liner would cause your like to sweat more– I’d really like to hear it, because I’m very curious as to why that happens. All right, everybody. I hope you enjoyed this basic Prosthetic Liners 101 video! If you have any questions, please ask them in the comment section. Don’t forget to subscribe; and see you later! Bye-bye!

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