Prosthetic Use and Treatment Interventions

how to establish readiness for a prosthesis

self-report, motivation, comorbidities, condition of residual and sound limb, LBP, UE pain, ROM, PLOF, type of amputation

potential causes of chronic LBP in one limb amputations

socket fit/height, gait deviations, trunk strength, hip flexor/hamstring tightness

ROM essential for fitting a socket

hip and knee extension

essential strength for using a prosthesis

hip ext/abd, knee extension, core strength

interventions received in acute care setting

pain management, wound care, limb shaping, transfers, wheelchair management

types of liners that require a lubricant

liners covered with fabric/nylon

why do you not want air pockets in the liner

they can cause bruising and will not have adequate suspension

skin check regimen during acute phase of wearing the prosthesis

check every hour for first 2-4 weeks

skin conditions where you should not wear a prosthesis

bloody drainage, blisters, abrasions

reasons why the limb shrinks a lot during the first few months

decrease in edema, atrophy, weight changes

things to consider when doing PT with a prepratory prosthesis

limited wear time and tolerance, may need stretching to increase ROM, will need core and LE strengthening

typical progression of ADs

RW → loftstrand (forearm) crutches → no AD

muscles that should be stretched in amputees

hip flexors and hamstrings

examples of core stabilization exercises

bridges, curl ups, leg lifts, side planks, ab brace with holding a ball out in front

examples of LE strengthening exercises

squats, lunges, leg press, STS

how to train proprioception in a prosthesis

weight shifts, cues for how limb moves in the socket (ex: exaggerated heel strike), stepping to normalize step length

examples of progressions of balance training

begin static with knee locked, train all directions of dynamic balance

factors of balance control over prosthetic limb during gait

control of musculature, proprioception/sensation of socket, awareness of prosthetic foot contacting ground

pre-gait training exercises

weight shifts, single limb stance, pelvic motion to help limb advancement

why should a more supportive AD be used at the beginning of gait training

safety, reduce energy expenditure, reduce compensations

benefits of treadmills for gait training

can increase he cadence, symmetrical stance time and step length, can provide a visual cue for step width

special considerations for aerobic training in prosthetic users

energy cost is already high, less residual comfort with higher impact activities

how to ascend a ramp with a prothesis

BW anterior to help with DF and to keep knee in extension

how to descend a ramp with a prosthesis

keep prosthetic limb slightly posterior to sound limb to keep knee in extension

when to refer to a prosthetist

discomfort, skin irritation, impaired alignment or socket fit

when to replace the socket

significant change in residual limb volume or stabilized and ready for definitive, increased activity level, wear-and-tear

reasons why pt may return to PT after d/c

progress to less restrictive device, receives upgraded components, change in medical status, update HEP/goals