amputees

Amputation is the removal of a body extremity by surgery or due to trauma. Losing a can be an overwhelming experience for anyone to go through. It requires a combined professional approach to help you adjust to living without your limb. Physiotherapists play a key role during the rehabilitation of individuals who have had an amputation.

amputees rehabilitation

ABOVE KNEE PROSTHESIS

Prosthesis is an artificial leg which is used for an amputation (removing part/whole limb) person, which helps him to become independent and makes him potentially to work, and transmits its weights equally in lower limbs.
Above knee prosthesis is used for persons with above knee amputation. Which mimic cosmetically as a normal limb.

Symptoms
 Pain
 Limb length difference
 Weakness
 Pricking sensation

Causes for amputation
 Peripheral vascular disease
 Trauma,
 Malignancy, and
 Congenital deficiency.
 Vascular disease
 Absence or abnormality of a limb at birth.

Physiotherapy Treatment
 Amputated limb management
 Muscle strengthening
 Prosthetic training

Prosthetic Checkout
1) Whether prosthesis is comfortable for patient?
2) Whether socket and contours smoothen?
3) Length of the prosthesis?
4) Whether patient is affordable to take prosthesis?
5) What are the needs he/she has to be meet after having prosthesis?
6) Any difficulty while walking, sitting and in other activities?
7) Proper training for patient to use and care taken for prosthesis?

ABOVE ELBOW PROSTHESIS

INTRODUCTION
The purpose of an above elbow prosthesis is to replace a lost arm. Depending on the patient's preference, the prosthesis might range from a functional arm to an arm that is aesthetically pleasing for the people who are missing a portion of a limb above the elbow, prosthetics are available. A specially built socket, suspension system, wrist unit, and prosthetic hand make up the prosthesis.
Custom Body Powered, Myo-Electric, and Passive Prostheses are available options.

CAUSES
 severe infection resulting in significant tissue damage
 Gangrene
 injury or accident-related trauma, such as a crush or blast wound
 Conversion amputation for leg deficiencies in children or congenitally weak limbs
 Congenital limb or digit malformations
 Congenital additional limbs or fingers
 Necrotizing or Necrosis Fasciitis
 Cellulitis
 Elimination of tumours, health condition problems, or other factors
 Traumatising mishaps
 Other elements

PHYSIOTHERAPY MANAGEMENT
 Start with breathing support and limb amputation pain relief. To keep the remaining limb strong, begin strengthening it as well. Show the
patient how to properly wrap the residual limb.
 By avoiding prolonged sitting and encouraging the patient to spend more time in the prone posture, you can prevent hip flexion
contracture.
 To be properly positioned, avoid resting on your side and keep the residual limb extended at the hip and knee.
 With a walker at first, then crutches, begin your balance training before moving on to your mobility training.
 Before moving on to the prosthetic, begin strengthening the remaining limb.

FOREARM PROSTHESIS

INTRODUCTION
Devices used to replace a lost bodily part, typically limbs, are known as prosthetics. Typically, people who have had amputations utilise prosthetics.

CAUSES OF FOREARM AMPUTATION:
Vascular damage
Frost bite
Compartment syndrome
Thermal burns

SYMPTOMS:
Ache from a phantom limb
Swelling
Muscle deconditioning
Sensory loss

PHYSIOTHERAPY MANAGEMENT:
After 48 hours following surgery, rehabilitation can begin.
-Massage techniques are utilised to enhance healing and minimise swelling.
Rehabilitation is divided into three stages:
1. The postoperative period (0-7days)
2. The preparatory stage (1-6 weeks)
3. Prosthetic rehabilitation (6 weeks and thereafter)
Phase following surgery:
-Breathing exercises
-Boosting the strength of the muscles in the upper limbs
-Massage techniques
-TENS for pain from phantom limbs Phase before a prosthetic:
-Pays special attention to preventing complications following surgery, as well as strengthening and preparing the patient for prosthesis.

REHABILITATION WITHOUT PROSTHESIS

INTRODUCTION
• In the rehabilitation of an amputee, physical therapy will be crucial and will be focused on:
-Teaching common transfers including stair and bed transfers as well as toilet transfers
-Increasing muscle flexibility and strength
-Teaching students how to use walking sticks and other mobility aids
-Increasing physical stamina and upper body power
-Increasing independence through practical pursuits
-Reaching your physical potential to the fullest -Improving ones quality of life.

REHABILITATION
-Workouts to increase flexibility and strength.
-Gait retraining using crutches
-Training wheelchair techniques
-Exercises to increase physical fitness.
– Soft tissue manipulation helps relieve pain and stiffness.
-Coordination and balance strategies to help with transfers and daily tasks.

PROSTHETIC REHABILITATION

INTRODUCTION
• A multidisciplinary rehabilitation team should preferably be involved. The physical rehabilitation process is often overseen by a physical therapist. The goal of rehabilitation is to help the amputee achieve the highest level of independence while using the most effective gait possible. Prior features, pre-existing medical conditions, and patient expectations should all be considered. Rehabilitation should begin 5 days after her surgery. A robust gait analysis is an important component in designing a rehabilitation program. Most of it will be observational. It is possible to measure features and create targets with validated result measurements.

EXERCISES
The following exercises are for both transfemoral amputees and transfemoral amputees and should be adjusted based on the component. The function of the knee prosthesis may affect movement. If possible, start with a locked knee or teach the patient to maintain a center of gravity on the prosthesis to prevent the prosthesis from buckling under load. Different knee prostheses perform differently and are taught differently to patients.
Exercises in prosthetic rehabilitation
Exercises for prosthetic limb rehabilitation Lateral weight shifts, forward and backward weight shifts, stepping on stairs/stools, balance boards, throws and catches, ball rolling, stepping, single leg stances using resistance bands, kicking balls, gait retraining, Specific gait retraining Addressing some issues during gait re-training.

HOW DOES AMPUTEES REHABILITATION HELP IN RECOVERY?

Amputation is the surgical removal of a bodily extremity due to Trauma. Everyone who loses a limb might find it to be an overwhelming event. You need a team-based professional strategy to assist you in adjusting to life without your limb. Physiotherapists are essential to the rehabilitation of those who have undergone amputations.

There are two basic categories of causes for becoming an amputee, though there may be others.
Trauma occurs when a limb sustains severe injury in an accident and cannot be preserved due to its blood supply or structural integrity.
Vascular disease, if it is severe, may cause a decrease of blood flow to the leg following prior medical treatment, which may need amputation.

Less common causes for amputation include, tumours, infection, as a pain control method or due to congenital reasons.

Physiotherapy Pre- Operation

A physiotherapist can offer the following services before non-emergency amputation:
Exercises before surgery to preserve muscle strength and range of motion

Information about what to anticipate in terms of recovery after surgery.

Physiotherapy Post- Operation

Many interventions can be offered by a physiotherapist to help with post-operative rehabilitation.

Therapy options include massage to ease discomfort, speed up the healing process, and ease tension in the muscles surrounding the stump or the opposite limb, where issues may develop as a result of overuse brought on by compensatory behaviour.

Phantom limb discomfort and phantom sensation can be treated with acupuncture and electrical stimulation.

When the patient is still in bed rest, exercises are performed to reduce stiffness in other joints and build strength.

The physical therapist will do a preliminary evaluation that takes into account the patient's pre-amputation expectations, lifestyle, and medical conditions.

Assessments and therapies will always consider the degree of amputation, the social setting, the physical (stump healing), and the psychological healing (emotional and cognitive).

In order to gain maximal independence safely within the patient's limitations, the physiotherapist will then develop a therapy plan in coordination with the patient.

WHAT ARE THE REHAILITATION PROCEDURES CARRIED OUT ON AMPUTEES WHILST IN HOSPITAL AND AFTER DISCHARGE ?

Rehabilitation in a hospital

A physiotherapist will teach you various exercises to do while lying in bed during your hospital stay. They will also teach you transfers, which include how to get in and out of bed, onto a wheelchair, and onto and off of the toilet.

While Still Hospitalized

You will keep up a workout regimen to keep your other limbs strong and to build the muscles around your stump.

At this point, they would also start to focus on gait, offering any necessary walking supports.

Upon hospital discharge, rehabilitation

As soon as two weeks after surgery, you can be allowed to leave the hospital.

Maintaining your fitness regimen is crucial.

Even though each physiotherapy treatment plan is unique, the following would often be included in physiotherapy intervention programs:

Amputee strengthening program which could including a variety of exercises:
Isometric
Isotonic
Isokinetic
Manual
Active upper and lower limb extremity strengthening
Functional exercises for the upper and lower limbs
Pre-gait training exercises
Weight bearing and balance exercises
Pelvic and trunk exercises
Gait training

Techniques for managing and preventing injuries

You will also be evaluated for an artificial limb if necessary (prosthesis).

The physiotherapist will instruct you in donning (putting on your prosthetic) and doffing if a prosthesis is judged necessary (taking off your prosthesis).

Bethany Navajeevan Physiotherapy Clinic
& Rehabilitation Centre

'Learn to Heal' with Care & Compassion