amputation mean to cut a part of your limb to avoid infection or spread of infection in your rest of body

1. LECURE NO.2
21/5/2022
AMPUTATION

2. PRE PROSTHETIC TRAINING PREOPERATIVE
• Counseling: prosthetic rehab program
• Psychological support
• Exercises
1. Active range of motion exercises
2. Conditioning exercises of non amputee extremities
3. Muscle strengthening of bilateral upper & lower limbs
• Manual muscle testing
• Skin care
• Transfer& ambulation with assistive devices
• One leg gait with assistive devices
• Self care & ADL
• Patient & family assessment about vocational & avocational
activities.

3. POST OPERATIVE
• Counseling for prosthetic fitting and care
• Healing of incision
• Pain control
• Preparation of residual limb
• L.Limb 6-10 wks
• Positioning of stump
• ROM in proximal joints of amputated limb
• Strengthening of L.limb muscles glutei, hamstring, quads etc.
• Mobility
• ADL
• Endurance exercises to avoid cardiovascular problem of post
amputee of vascular origin
• Psychological support 25-30% depression
• Financial resources of the patient
Prosthetic fitting and gait training (3-6weeks)

5. CAUSES OF AMPUTATION

6. COMPLICATIONS
• Short stumps
• Contracture
• Edema
• Improper skin grafts
• Redundant tissues and Adductor roll
• Dermatological problems
• Phantom pain

8. To maintain a good shape and good position of the
stump for fitting Prosthesis.
Ensure uncomplicated woundhealing
Control oedema
Maintain ROM (prevent contracture)
Maintain muscle strength
Desensitization
Skin mobility

9.  Stump Positioning /Shapes/types
 Stump weight bearing
 Stump bandaging
 Pre prosthetics excercise
 Phantom pain/Desensitized
 Skin mobility/scar mobilization
 Contracture
 Transfer
 PATIENT EDUCATION

10. STUMP SHAPES
CYLINDRICAL CONICAL BULBOUS
Stump evaluation :
shape, volume, length, osteophyte (spur), distal
padding.

11. IDEAL STUMP
Cylindrical shape
(preferred)

12. IDEAL POSITING OF STUMP ON WHEEL CHAIR

13. POSITIONING OF STUMP

15. STUMP WEIGHT BEARING

16. PRONE LYING

18. BANDAGING
Reduce oedema
Stimulate the blood circulation
Protection of the stump
Assist to get an ideal shape

20. Wrong bandaging

21. FIGURE OF EIGHT BANDAGING
 1. Pressure is greater distal than proximal
2. Smooth and free of wrinkles
3. Reapplied regularly
4. 24 hours per day

22. STEPS OF TRANSFEMORAL AMPUTATION BANDAGING

23. STEPS OF TRANSTIBAL
AMPUTATION BANDAGING

24. SHIRNKERS
•Sock like garments knitted of heavy rubber reinforced cotton.
•Conical in shape.
•Available variety of sizes.

25. ACTIVITIES OF DAILY LIVING ADLS
• Reacher
• Long handles mirror to
inspect the wound
• Sponges shoe horn
• Dressing stick
• Socks aids

27. EXERCISE PROTOCOL
 10 s contraction
 10 s rest
 10 repetitions
 10 exercises
 10 times per day

28. MOBILIZATION AS SOON AS POSSIBLE
• Increase local circulation to improve
wound healing
• Stimulate the cardio vascular
system
• Keep good muscle power
• For a good emotional and physical
condition

29. STRENGTHEN MUSCLES
strengthen muscles that oppose contracture
• Hip and knee extensors
• Abductors
• Arm strengthen for transfer and mobility
• Wrist
• elbow extensor
• scapula stabilizers

30. EXERCISE
Selected muscle groups need attention in
preparing the amputee for future gait
activities.
• The preparation of all extensor muscles predominate
in providing postural control and stabilization for the
gait support phase.
• The flexor muscle group, mainly responsible for
initiating swing, also requires exercise practice.

31. ISOMETRICS EXERCISES
Quadriceps contraction

32. BALANCE, COORDINATION & ENDURANCE

33. Active exercises to stimulate the blood circulation/ muscle training

34. Active exercises to stimulate the blood circulation/ muscle training
HIP ADDUCTOR Gluteus Medius Gluteus maximus
MUSCLES

35. Active exercises to stimulate the blood circulation/ muscle training

36. ABDOMINAL CONTRACTION

37. UPPER EXTREMITY
STRENGTHNING

38. THERABABND RXRECISE

39. ROLLING ACTIVITIES

40. PHANTOM PAIN DESENSITIZED
TEACHNIQUES

41. PHANTOM PAIN

43. TYPES OF SCAR
KELOID
NORMAL

44. SCAR MOBILIZATION

45. DERMATOLOGICAL PROBLEMS
• Folliculitis
• Allergic dermatitis
• Break down of scar

46. CONTRACTURE

47. Elbow flexion contracture Abduction and flexion
contracture of shoulder

48. CONTRACTURE REDUCING EXERCISE

49. TRANSFER

50. TRANSFER

51. SITTING BALANCE

52. Forward Backward Transfer
Side Transfer with board

53. PIVOT TRANSFER

55. POST
PROSTHETICS
REHABILITATION

57. TO IMPROVE STATICAND DYNAMIC BALANCE
TO NORMALIZEDTHE GAIT PATTERN
TO IMPROVE DUALTASKING
BALANCE TRAINING ON STABLE AND ALTERED BASE OF SUPPORT
BALANCE TRAINING IN STANDING
IMPROVE GAIT PARAMETERS INCLUDING SWING AND STANCE PHASES
ON BOTH LOWER LIMBS.