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Prosthesis : it is
             Amputation: it
                                the device
             is the removal
                                held on the            Role of
                of a body
Amputation                     residual limb       physiotherapy
               extremity by
                               and helps in        in amputees:
                trauma or
                               locomotion,
                  surgery.
                                    etc.
Incidence : 132/100000
                      : male:female (trauma) 9.2:1
                                    (disease) 2.6:1

LEVELS OF AMPUTATION
                                                                   principles




                                                   General
                                                                                      Surgical
                                          - Save as much limb length
                                                                                 - use of torniquets
                                           - Retain maximum bone
                                                                                - Avoiding neuroma
                                                 -avoid scars
                                                                                    - Skin flaps
                                                                                 - Bone resection




   Causes          congenital    Trauma              Infection           vascular            neuropathic
Etiology                                                 Indications
• Trauma                                                  Loss of blood supply
• PVD                                                       to limb
• Congenital limb                                         Uncontrolled infection
   deficiency                                             Chronic foot or ankle
• Tumors                                                    injury that cannot be
                                                            salvaged




                                         Posterior
              Surgical principles                                            Closed by suturing
                                    dissection should   Fibula cut shorter
 procedure      should kept in                                                 layers of tissue
                                     be longer than         than tibia
                    mind                                                          together
                                         anterior
Transtibial prosthesis

Two types:
• PTB prosthesis
• Joint corset prosthesis




    Type of PTB:
    RSC or Removable Supracondylar
    SCSP or Supracondylar Suprapatellar
    Suspension Sleeve
Components of a transtibial prosthesis
                          •   Tanstibial socket design
                          •   Pressure tolerant areas of the residual limb
                          •   Pressure intolerant areas of residual limb




Transtibial socket
• Hard socket
• Prosthetic socks
• Soft liner
• Other interfaces
• Flexible socket in rigid frame

                                          Suspension mechanism
                                          • Sleeve suspension
                                          • Supracondylar suspension
                                          • Cuff suspension
                                          • Waist belt and anterior strap
                                          • Suction suspension
                                          • Thigh lacer and side joints
                                          • Additional design and suspension variation
Progression from temporary to definitive
                      prosthesis
                      • Endoskeletal finishing
                      • Exoskeletal finishing
                      • Prosthetic feet




Prosthetic alignment
• Bench alignment
• Static alignment
• Dynamic alignment and gait
   analysis

                               Evaluation of prosthetic fit
                               • Initial evaluation
                               • Special test: look and see test
                                               powder test
                                               ball of clay test
                                               lipstick test
Physiotherapeutic management




Pre-operative               Post-operative
• Assessment
• Strength training


               Pre-prosthetic          Post-prosthetic
               • Assessment            • Gait training
               • Stump                 • Stump
                  strengthening          handling
               • Stump training
                  for prosthesis
Pre-operative management

   It involves the assessment and training, both physical and
   psychological, of the patient that is undergoing amputation.

                     Training involves:
                     • Breathing exercises
                     • Strengthening exercises
                     • Mobilization exercises
                     • Bed mobility
                     • Transfers
                     • Stabilization exercises
                     • Wheelchair training
                                                    Wheelchair training




Strengthening exercises
                                    Bed mobility and transfers
Post-operative management
The aims of treatment are:
• Prevention of joint contracture
• To strengthen and mobilize unaffected leg
• To strengthen and co-ordinate the muscles controlling the
  stump
• To strengthen and mobilize the trunk and retrain balance
• To teach the patient to regain independence in functional
  activities
• To control oedema of the stump and commence early
  ambulation
• Re-education of sensation in healed stump
• Successful discharge into community
Oedema control can be done by following methods:
• elevation and exercise
• Bandaging
• Shrinker socks
• Rigid dressing
• Intermittent pressure machines
• PPAM aid: pneumatic post amputation mobility
  aid
Post-operative stump training
•   Exercise
•   Massage
•   Pressure
•   Mobilization
•   strengthening




               PPAM aid for pressure tolerance
               training
Prosthetic stage
Amputees suffering from peripheral vascular disease and
diabetes have following aims of treatment:
• To attain optimal gait pattern
• To maintain safety
• To improve functional ability
• To ensure steady progress
• To supply correct walking equipment

Amputees caused by trauma or malignancy have following
treatment aims:
• To attain optimal gait pattern
• To progress quickly
• To return to normal functional activities, including recreational
   interest.
Gait training
•   Goals of gait training
•   Gait re-education
•   Consideration for gait in transtibial
    amputation
•   Gait abnornalities




                                            Progression out of
                                            the parallel bar
Angina



                          Chest infection

                general

                          Heart attacks



                              strokes

complications
                          Phantom limb
                              pain


                            Deep vein
                            thrombosis
                 local

                            Neuroma


                              Knee
                           contractures
Project ppt

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Project ppt

  • 2. Prosthesis : it is Amputation: it the device is the removal held on the Role of of a body Amputation residual limb physiotherapy extremity by and helps in in amputees: trauma or locomotion, surgery. etc.
  • 3. Incidence : 132/100000 : male:female (trauma) 9.2:1 (disease) 2.6:1 LEVELS OF AMPUTATION principles General Surgical - Save as much limb length - use of torniquets - Retain maximum bone - Avoiding neuroma -avoid scars - Skin flaps - Bone resection Causes congenital Trauma Infection vascular neuropathic
  • 4. Etiology Indications • Trauma  Loss of blood supply • PVD to limb • Congenital limb  Uncontrolled infection deficiency  Chronic foot or ankle • Tumors injury that cannot be salvaged Posterior Surgical principles Closed by suturing dissection should Fibula cut shorter procedure should kept in layers of tissue be longer than than tibia mind together anterior
  • 5. Transtibial prosthesis Two types: • PTB prosthesis • Joint corset prosthesis Type of PTB: RSC or Removable Supracondylar SCSP or Supracondylar Suprapatellar Suspension Sleeve
  • 6. Components of a transtibial prosthesis • Tanstibial socket design • Pressure tolerant areas of the residual limb • Pressure intolerant areas of residual limb Transtibial socket • Hard socket • Prosthetic socks • Soft liner • Other interfaces • Flexible socket in rigid frame Suspension mechanism • Sleeve suspension • Supracondylar suspension • Cuff suspension • Waist belt and anterior strap • Suction suspension • Thigh lacer and side joints • Additional design and suspension variation
  • 7. Progression from temporary to definitive prosthesis • Endoskeletal finishing • Exoskeletal finishing • Prosthetic feet Prosthetic alignment • Bench alignment • Static alignment • Dynamic alignment and gait analysis Evaluation of prosthetic fit • Initial evaluation • Special test: look and see test powder test ball of clay test lipstick test
  • 8. Physiotherapeutic management Pre-operative Post-operative • Assessment • Strength training Pre-prosthetic Post-prosthetic • Assessment • Gait training • Stump • Stump strengthening handling • Stump training for prosthesis
  • 9. Pre-operative management It involves the assessment and training, both physical and psychological, of the patient that is undergoing amputation. Training involves: • Breathing exercises • Strengthening exercises • Mobilization exercises • Bed mobility • Transfers • Stabilization exercises • Wheelchair training Wheelchair training Strengthening exercises Bed mobility and transfers
  • 10. Post-operative management The aims of treatment are: • Prevention of joint contracture • To strengthen and mobilize unaffected leg • To strengthen and co-ordinate the muscles controlling the stump • To strengthen and mobilize the trunk and retrain balance • To teach the patient to regain independence in functional activities • To control oedema of the stump and commence early ambulation • Re-education of sensation in healed stump • Successful discharge into community
  • 11. Oedema control can be done by following methods: • elevation and exercise • Bandaging • Shrinker socks • Rigid dressing • Intermittent pressure machines • PPAM aid: pneumatic post amputation mobility aid
  • 12. Post-operative stump training • Exercise • Massage • Pressure • Mobilization • strengthening PPAM aid for pressure tolerance training
  • 13. Prosthetic stage Amputees suffering from peripheral vascular disease and diabetes have following aims of treatment: • To attain optimal gait pattern • To maintain safety • To improve functional ability • To ensure steady progress • To supply correct walking equipment Amputees caused by trauma or malignancy have following treatment aims: • To attain optimal gait pattern • To progress quickly • To return to normal functional activities, including recreational interest.
  • 14. Gait training • Goals of gait training • Gait re-education • Consideration for gait in transtibial amputation • Gait abnornalities Progression out of the parallel bar
  • 15. Angina Chest infection general Heart attacks strokes complications Phantom limb pain Deep vein thrombosis local Neuroma Knee contractures