Therapy and training after lower limb amputation
Prosthetic care solutions
For amputees, there are different care solutions depending on the amputation level. The higher the amputation of the leg, the more complex the fittings and components are. A higher level of ampuation means less muscle function and requires more training to use the prosthesis correctly. The different prosthetic components like foot, knee, hip joint, as well as components of the socket and adapter are individually selected for the amputee.
After the operation the patients has to get prepared for everyday life with and without a prosthesis. There are four stages within the rehabilitation process.
Post-operative therapy
Early therapy contributes to greater treatment success, and ideally begins even before the amputation. Directly after the surgery the focus is on oedema therapy, initial mobilisation and scar care. more
Pre-prosthetic therapy
Appropriate exercises strengthen the muscles so that contractions can be avoided. more
Prosthetic training
After the patient receives her/his prosthesis, the focus is handling the individual prosthesis and the relevant musculature and gait training. more
Amputation level
The term amputation level describes the place where a body part or extremity is removed. In addition to the other factors, the amputation level is primarily used to choose a suitable artificial limb in each case. The amputation level is established by the doctor before the operation and is based on the reason for amputating e.g. an infection or a disease process. In some cases a missing extremity is already congenital or amputations must be carried out preventively in order to preserve surrounding tissue.
Click on the numbers, to find information about each level of amputation.
This amputation takes place below the femur condyles or above the tibial plateau. Residual limb can either be muscular or have substantial soft tissue, which would offer adequate loading capacity. Other advantages compared to a transfemoral amputee are the long lever arm when walking and a reduced risk for a contracture of the hip flexor muscles.
This can also be referred to as an above knee amputation. Ideally a longer leaver arm is preferred, as it enables the patient to walk with more ease.
Hip disarticulation
With this type of amputation, the acetabulum remains intact. The prosthesis is then controlled by the movement of the pelvis and the activity of the trunk muscles.
Hemipelvectomy
Here, the sacrum and the pelvis remain intact, whereby the supply is very similar to the hip disartculation. The control of the prosthesis also takes place via the movement of the pelvis and the activity of the trunk.
This amputation level is also called below knee amputation. The amputation is performed through an incision of the tibia and fibula, the length depends on the injury of the tissue.
In the area of the foot more than 12 different amputation levels are known. One of the most common reasons for foot amputation is diabetes type 2. The amputations can range from the forefoot, midfoot to the heel and also can affect the talus. In most cases, the amputee is treated cosmetically.
The components of a prosthesis
With regard to the type and amount of the amputation, different components are needed. There is a large selection of components which differ in many aspects, e.g. material, construction, manufacturing, and functioning.
Each transfemoral prosthesis consists of a socket, a knee joint and a foot, which are connected by the so called adapters. Some amputees prefer to have a cosmetic cover so that the prosthesis appears more naturally. In case of an hip amputation also a prosthetic hip joint is needed to preserve the function of the hip. If the amputation level is below knee, no prosthetic knee joint is needed.
- Prosthetic socket
- Suspension system and liner
- Adapter
- Prosthetic knee joint
- Prosthetic foot
The prosthesis socket represents the connection between the amputee's residual limb and the other prosthetically used components. Each socket is manufactured individually by the orthotist and prosthetist professional using high-quality materials such as carbon, silicone and lamination resin.
The production and the accuracy of fit are essential for the later suspension of the socket at the residual limb, so that the amputee can walk safe and comfortably and does not have the feeling that the socket is falling off his or her limb.
The suspension system and the liner decribes the connection between the residual limb and the prosthetic socket. It guarantees that the socket does not slip off the residual limb while walking.
There are so called mechanical suspension systems and also suspension systems based on negative pressure (vacuum). Suspensions mostly work together with a certain liner. Based on the requirements of the end user certain liner-suspension-combinations bring a higher benefit.
The prosthetic knee joint plays an important role in transfemoral amputees. The knee joints differ depending on whether it is for example a mechanical, pneumatic or microprocessor-controlled knee joint. All knee joints are individually adjusted by the CPO (Certified Prosthetist and Orthotist) and offer the amputee various functional advantages in use.
The prosthetic foot has a very high influence on the stability and safety of standing, walking and comfort. The O & P professional selects the foot according to the user's everyday activities and the amputee's gait. Feet in the heel can differ in stiffness as well as in the dynamics or stability of the forefoot.
The adapters on a prosthesis ensure that the positioning of the prosthesis is correct. The rotation adapter additionally offers the amputee a better handling of his everyday activities, e.g. when putting on and taking off his trousers.
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