Prosthetic Training

Question 1

Preparatory Prosthesis

Answer 1

• Used during shrinkage period (usually 3-6 months)
• Allows gait training and adjustment of alignment and socket
• Socket and suspension sleeves, socks, liners should be cleaned daily
  ie: Wash with water and mild soap
  Rinse with clear water
  Dry

Question 2

Definitive Prosthesis

Answer 2

• Includes cosmetic finish

Question 3

Gait Training with prosthesis

Answer 3

• Much more difficult with bilateral amputee
• Mirror is helpful
• Maintain 2-4” distance between feet (tape floor)

Question 4

Work toward normal gait pattern

Answer 4

• Gait Training for Prosthesis
• Equal step length
• Even cadence
• Normal trunk and arm movements
• Start in parallel Bars

Question 5

Start in parallel bars

Answer 5

• Release sound side hand first, then prosthetic side hand

- Encourages increased weight bearing on the prosthesis

Question 6

Gait Training Progression

Answer 6

• Start in parallel bars
• Weight shift side to side, then no hands
• Diagonal weight shifts
• Continue until pt can move sound leg foot slowly
• Side stepping, backward stepping

Question 7

Diagonal Weight shifts

Answer 7

• Sound foot forward; FIRST
• Shift weight, on/then off
• Prosthesis foot forward, SECOND
• Shift weight, on/then off
• After each return to stable stance

Question 8

Stepping with prosthesis

Answer 8

• Sound leg first

- setp with prosthesis to heel strike, then foot flat, and emphasize toe off (activate swing)

Question 9

Initial Treatment Session

Answer 9

• Frequent skin checks (especially with Transtibial)
• Every 5-15 minutes (short time for diabetes & pt’s with fragile skin)
• If redness develops, wait a few minutes with shrinker on
• if redness persists, notify PT
• if redness does not develop or goes away within a few minutes, gradually increase wearing time in 5 min.
• Minimum soreness is expected

Question 10

Common Problems with Prosthetic Training

Answer 10

• settling (limb shrinks and may “bottom out” in socket)
• Pistoning (prosthesis slides on limb during swing)
• Distal Edema (check with PT)

Question 11

Advanced Gait Training for Transfemoral Amputee

Answer 11

• Tandem (heel-toe) walking
• Braiding (karioka) (sound limb in front at 1st)
• Sit to stand (weight on sound leg)
• Ascending stairs (good to heaven, bad to hell)
• Descending Stairs (Depends on the knee joint in transfemoral prosthesis)
• Work with pt to develop safe strategies

Question 12

Descending Stairs

Answer 12

• Step down with prosthesis and place heel on edge of step
• Maintain knee extension by using hep extensors
• Advanced sound leg forward toward next step
• Release prosthetic knee by allowing hip to flex
• Catch weight on the sound leg

Question 13

Safe Stratagies

Answer 13

• ramps
• Picking up objects from floor
• Stepping over objects
• Transfer floor to stand
• Falling
• Kneeling
• Running

Question 14

Guidelines for shrinker use

Answer 14

• Should be worn whenever the prosthesis is off
• Until prosthesis is worn regularly
• Try leaving shrinker on overnight
• Shrinker should be used any time prosthetic wearing is interrupted

Question 15

Discharge Parameters

Answer 15

• Continuous prosthesis use for 3 hours without problems