Lakhasly

Rehabilitation aims to maximize amputee independence and efficient gait, considering physical capabilities, amputation level, psychological state, pre-amputation function, medical conditions, and patient expectations. Rehabilitation, starting 5 days post-surgery, crucially involves gait analysis—observational comparison of the amputee's gait to expected patterns, identifying deviations to inform program development and using outcome measures to monitor progress. Pre-prosthetic exercises (lower limb, residual limb, abdominal, and back strengthening) improve range of motion and muscle strength, preventing prosthetic gait deviations. A shifted center of gravity post-amputation complicates prosthetic adaptation. A systematic review [4] confirmed the effectiveness of gait training (overground, treadmill-based, with various interventions) to improve gait asymmetry and biomechanics. Exercises should be adapted for transtibial/transfemoral amputations and prosthetic knee function (initially locked knee or focusing on center of gravity).

The aim of the rehabilitation is :
To aid the amputee to gain independence at the highest level they can, with the
most efficient gait possible. The assessment must take into account the
physical capabilities, level of amputation, psychological status, pre-amputation
function, existing medical conditions and the patient’s
expectations. Rehabilitation should begin 5 days post-surgery [1]. A crucial
element of constructing a rehabilitation programme is sound gait analysis. This
will largely be observational. Validated outcome measures are available to aid
goal setting and measure function.
Gait analysis consists of observation of the gait, which should occur from all
angles. Knowledge of normal gait patterns for the prosthetic and nonprosthetic user is required to help analysis of movement. On observation of the
gait,the assessor compares the function of the amputee to expected patterns
of gait and look for deviations[2]. Analysis of the gait pattern will help
determine why these deviations are occurring. This will then help to formulate
the rehabilitation programme, which includes the correction of the deviations.
Outcomes measures can be used to monitor progress[2].
Amputees should perform pre-prosthetic exercises to help maintain ROM and
improve muscle strength in the lower limb and residual limb in preparation for
using the prosthetic limb. Abdominal and back exercises should also be
considered to help trunk control and reduce back pain. Pre-prosthetic limb
exercises can help prevent the occurrence of prosthetic gait deviations[3]
Due to the loss of the limb,the amputee will automatically shift their centre of
gravity over the foot of the non-prosthetic side. After an amputation,there will
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be a period of time where the amputee is without a prosthesis. This is due to
the timeframe of the assessments required to decide if the provision of a limb
is appropriate. During this period the amputee will become familiar with the
shifted centre which will increase the difficulty of reorientation of the centre of
gravity once they receive a prosthetic limb[3].
The authors of a systematic review study reviewed 18 manuscripts to evaluate
the evidence on gait training interventions in patients with lower limb
amputations, in order to guide both research and practice.[4] They found that
gait training is needed due to improve asymmetry, change in biomechanics, and
related secondary consequences after an amputation. Both overground and
treadmill-based rehabilitation was included for review. Their results showed
that the following interventions are effective in improving gait: overground
training (with verbal, manual, or psychological awareness interventions),
treadmill-based training both as a supplement to overground, as a home
exercise, or on its own with visual feedback or with body weight support. [4]
The following exercises can be used for patients with either transtibial or
transfemoral amputations and should be adapted as necessary, depending on
the component. The prosthetic knee function could influence the exercises. If
possible start with a locked knee or teach the patient to keep their centre of
gravity on the prosthesis to keep it from bending when weight-bearing.
Different prosthetic knees have different functions and specific ways to teach
the patient. This page will give you the basics that can be used with every
patient, with links at the bottom of the page to more specific rehab. You can
also search on Google or YouTube for the specific company or prosthetic
components information.