prosthesis in below knee amputation and gait training

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