Prosthetic Training

Question 1

When would a PT typically order a definitive prosthesis for a person post amputation

Answer 1

when the person is proficient with a preparatory prosthesis

Question 2

Prosthetic timeline

Answer 2

• specific timeframe varies from facility to facility
• prepartory prosthesis usually 4-6 months post healing
• training: DON/Doff procedure, gait train, progression AD and surface
• definitive prosthesis (12-18 months post surgery - when serial girth measurements/stable with socks indicates stable volume

Question 3

education during prosthetic training

Answer 3

• care of prosthesis, socks, and residual limb
• use lotion sparingly - apply at night
• use sunscreen on residual limb when exposed to sun
• may need antiperspirant appled at night
• protect the remaining limb
• DO NOT apply lotion between toes or around open wounds

Question 4

Wearing schedule: skin checks

Answer 4

• successful prosthesis use requires skin adapation
• skin needs to develop ability to sustain weight-bearing in area not inherently desgined for weight-bearing
• most individuals with vascular dysfunction have a degree of sensory impairement
• transtibial: skin check is VERY important as they are more likely to have effects of neuropathy still

Question 5

What is the recommended wearing schedule when getting adjusted to a prosthetic

Answer 5

• wear for 2 hrs on, 2 hrs off and up to 20 minutes weight bearing each hour
• 2-2-20 rule

Question 6

Pressure tolerant areas

Answer 6

• patellar tendon ligament primary WB surface
• pretibial muscle mass
• lateral surface of fibula
• inferior surface of medal tibial condyle
• popliteal fossa
• pressure sensitive areas are over body landmarks

Question 7

pressure sensitive areas

Answer 7

• patella
• tibial tubercle
• tibial crest
• anterodistal end of tibia
• head of fibula
• hamstring tendon

Question 8

Socket fit

transtibial prosthesis

Answer 8

• redness from patella tendon bar on skin of resdiual limb after WB - reference used to determine if socket fits properly
• if mark is too high = pt is too deep = more socks needed
• if mark is too low = pt is not deep enough in socket = remove socks

Question 9

Socket fit

transfemoral prosthesis

Answer 9

• pt usually complains of groin pressure if too deep in socket
• check iliac crest heights

Question 10

Basic transtibial prosthetic checkout

whenever patient stands or ambulates

Answer 10

complaints of discomfort in socket

• generalized discomfort = continue
• localized discomfort = remove prosthesis, check for excess pressure in pressure sensitive areas

is prosthesis correct length - check iliac crest

• is piston action minimal
• hike leg up and down and observe
• can result in skin probelms
• makes limb too long during swing

is A-P alignment satisfactory

• no excess knee flexion or extension when standing/ambulating
• heel on floor at midstance

Is M-L alignment satisfactory

• no excess knee valgus or varus
• foot flat on floor

after ambulation/WB: remove prosthesis and socks

• is pressure in pressure tolerant areas

Question 11

Basic transfemoral

prosthetic checkout

Answer 11

complains of discomfort in residual limb when WB

• generalized = continue
• local = remove and check for excessive pressure

is socket in proper rotational position on residual limb

• knee slightly ER and foot slightly toed out
• if not loosen suspension and ER socket on residual limb

is prosthesis correct length

• check iliac crest height

Is A-P alignment correct

• prosthetic knee should be stable

Is M-L alignment correct

• foot flat on floor at midstance (not on medial or lateral border)

Is piston action minimal

after ambulation/WB remove prosthesis check for areas of excessive pressure on skin

Question 12

Gait training challenges
transtibial vs transfemoral

Answer 12

Transtibial

• easy to teach to walk
• difficulty to keep skin in tact

transfemoral

• challenge to teach to walk safely and well
• skin NOT the issue

Question 13

What should be the first priority for initial gait training with prosthesis

Answer 13

find center>weight shift control>stance control on prosthetic side.>step with prosthetic foot

Question 14

Finding center

Answer 14

• new amputee usually feels like they are leaning toward prosthetic side when COM is centered
• stand with UE support
• mirror in front
• find equal WB on BLE
• progression: lift one hand, lift both hands, look away from mirror - try to maintain centered position

Question 15

Weight shift control

Answer 15

• dynamic control
• weight shift toward non-prosthetic leg
• then weight shift toward prosthetic leg
• move hips side to side “hula hoop”
• pay attention to sensory input related to where weight is on foot

Question 16

Stance control

Answer 16

• need to control dynamic WB during stance on prosthetic leg
• shift toward prosthetic leg - contract extensors in prosthetic leg
• step up with sound foot onto step
• pogression: one hand, alternate one hand, no hand

Question 17

Prosthetic step training -stance phase

Answer 17

• start with non-posthetic leg slightly posterior to prosthetic leg
• find center, shift weight onto prosthetic leg
• PT hands on ASIS
• shift weight onto prosthetic leg until pylon vertical
• allow non-prosthetic knee to flex
• then step through with non-prosthetic leg
• keep weight on prosthetic leg