SPECIAL POPULATION:LIMB LOSS AND

PROSTHETIC DEVICES

Presentation by: Lauren Grosse, Jak Kesselring, Meghan Allen

What is it? How does it happen? Limb Loss by amputation has many different categories

Some of the most common are:

Symes: Forefoot or midfoot BK – Below the Knee (transtibial) AK- Above the knee (transfemoral)BE – Below the Elbow (transradial) AE – Above the Elbow (transhumoral)Unilateral – one sideBilateral – two sides

Most common to hear. “He has a bilateral transtibial amputation” which is both legs, below the knee.

Over half of all amputations in the U.S. are performed on people who have been diagnosed with diabetes.

What are the concerns or special considerations? What makes requirements different than normal?

Well for #1- THEY ARE MISSING A LIMB therefore activities will have to be modified in order to be courteous of the amputation. Many patients prefer to have their “stump” called a Residual Limb. This is the PC term.

Therapists have to take into account that having a prosthetic can cause problems with gait, balance, coordination, pain control, skin irritants, swelling and infections.

Other considerations Lower limb amputees have a

higher energy expenditure that directly relates to the level of amputation. A unilateral transfemoral amputee uses more energy than a unilateral transtibial amputee. This is directly correlated to the height of the amputation.

Oscar Pistorious

Would you max test? Same preliminary safety

measures/testing as for normal individuals should be performed prior to testing.

Different types of amputations require different methods for max testing.

Rehabilitation level and/or experience with their prosthetic(s) also should be assessed.

How Would You Test?—Max Tests

Arm ergometer, might not achieve actual max

One-legged cycle ergometer Regular cycle ergometer (with

accommodations) Treadmill test (with accommodations)

How Would You Test?—Other Tests Several weight training analyses are

possible. Extra supervision or assistance may be necessary.

Testing for performance with newly-fitted prosthetics

Gait analysis Functional testing for ADLs Balance and flexibility testing

FITT for Aerobic Exercise Goal is to increase

cardiovascular fitness, endurance of all limbs, ease of movement, and ADL’s

Four to seven days per week 40 – 80% HRR, 11-16 RPE 30 – 60 minutes per session but

may build up to this gradually Yoga and swimming are great

activities for exercise and rehabilitation

FITT for Resistance Training Important for increasing strength in all

limbs and specifically the core muscles Two to three days a week 60 – 80% 1 RM (rep maximum) or

weight allowing for 8 repetitions Should perform at least 2 upper-body

exercises, 1 core, and 2 lower body

Flexibility and Special Considerations After every exercise session and at least

once a day to promote flexibility and increase range of motion

Each stretch should be preformed slowly and be held for 25 seconds each

Special considerations when designing an exercise plan include: lower energy expenditure, increased chance of skin breakdown and infection, and overuse

The End

Sources: 1) http://www.amputee-coalition.org 2)http://www.ncbi.nlm.nih.gov3) http://www.amputee-coalition.org/limb-loss-resource-center/ 4)www.prostheticsexperience.wordpress.com5) http://ptjournal.com 6) http://oandplibrary.org