Early therapy contributes to greater treatment success, and ideally begins even before the amputation. Once the residual limb wound has healed, the rehabilitation phase as such begins a few weeks after the operation - this is called the pre-prosthetic therapy. In most cases, inpatient or outpatient rehabilitation will take up to six months. In the video above, you can see therapy measures that you can apply to your patient.
Anamnesis after amputation
In order to get a status about the clinical picture of the patient, it is necessary to make an anamnesis, which assesses the physical as well as psychological parameters and gives you an impression of how mobile the patient is. In addition, assessments provide information about the future care options for the fitting of the prosthesis.
During anamnesis the following aspects - among others - should be assessed.
Residual limb conditions
After the operation, many factors depend on good residual limb conditions. These include the length of the residual limb which is, among other things, decisive for muscular recruitment. Soft tissue supply and residual limb bedding also play an important role, as does the pain sensation of the residual limb. Pain is an important factor for a therapist to be able to assess when and to what extent a patient is able to work.
Especially with older amputees, other secondary diseases can develop and play an important role in component selection and therapeutic treatment. In addition to diabetes, stroke and cardiovascular diseases, osteoporosis and polyneuropathy can also occur. It is always important to keep in an interdisciplinary exchange with the doctor and prosthetist in order to receive and pass on important information.
The use of outcome measures for periodic patient assessment at designated time points is an increasingly important element of evidence-based practice. Using validated objective outcome measures throughout the rehabilitation process provides direct feedback to providers and patients regarding the efficacy of therapeutic interventions and progress towards established functional goals. The use of common data elements across healthcare institutions helps to standardize practice and improve the overall quality of healthcare delivery.
When choosing from the numerous outcome measures available, it is important to first select a measure that evaluates the construct of interest.
It is important that in addition to the intact side, the affected side (residual limb) and the trunk muscles are included in the exercises. The first therapeutic step of therapy is to ensure the loading capacity and mobility of the residual limb.
Because strong residual limb muscles allow better control of the prosthesis and thus contribute to a better gait pattern, we recommend that the respective training begins a few days after the surgery.
Try to keep in mind that it is also important to strengthen the torso as well as the legs.
The upper body muscles play an important role when learning to walk with a prosthesis. The goal is to achieve a posture that is as upright as possible. Patients should therefore be well prepared before being fitted with the final prosthesis.
Here are some examples for the training without prosthesis:
Stretching exercises for mobility/ physiological range of motion
To maintain or restore the maximum mobility of the joints and quickly get accustomed to standing and walking with the prosthesis, the muscles and joints around the residual limb must be sufficiently mobilized. Hip flexion can be minimized by adequate stretching and controlled isometric muscle activation.
A physiological range of movement of the hip joint allows the O&P professional to fabricate a prosthesis with a physiological socket position and a correct load line.
The following videos give you examples for stretching exercises.
Ottobock Fitness for Amputees App
Further ideas and more exercises you can find in the Ottobock Fitness for Amputees App.