Prosthesis : it is Amputation: it the device is the removal held on the Role of of a bodyAmputation 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) 2.6:1LEVELS 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 prosthesisTwo 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 limbTranstibial 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 feetProsthetic 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 managementPre-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 trainingStrengthening exercises Bed mobility and transfers
Post-operative managementThe 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 stageAmputees suffering from peripheral vascular disease anddiabetes 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 equipmentAmputees caused by trauma or malignancy have followingtreatment 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 strokescomplications Phantom limb pain Deep vein thrombosis local Neuroma Knee contractures