A close family friend indicated that she spoke with someone who recently got a prosthetic leg, and was taken aback at the challenges of adjusting. As well, a client who recently came in for care services, was somewhat distraught at the issues now being faced, having gotten the new leg. Unfortunately, restoring a patient’s ability to perform everyday activities only begins with the fitting of the prosthesis. For lower limb amputees, gait analysis and training, are the necessary next steps to ensure restoration, and maintain comfort and function.
Is Prosthetic Training Required?
You may be ready to begin using a prosthetic leg once your amputation wound heals. However, the process of adapting to the loss of a limb, and placing your weight on a prosthesis can take some time. In conjunction with a prosthetist, a physical therapist will help you return to your former lifestyle, as seamlessly as possible.
Re-educating and preparing the body to walk with a prosthesis is crucial, before an amputee’s ability to walk with a prosthesis can be appropriately evaluated. The majority of gait deviations (the way you walk) that are observed initially, are due to a lack of, or being in the process of, gait training. In my experience, these deviations are most often corrected through therapy, as against a wrench. When the person has achieved optimal gait through training, then the prosthetist and physical therapist can come together to fine tune the prosthetic alignment.
You won’t be fitted for a prosthesis until your swelling is under control, and you are strong enough to begin gait training, or learning to walk
with it. Once you begin gait training, you will practise walking with a temporary prosthesis, as the size of your residual limb stabilises. Your gait should never alter to fit your permanent prosthesis, but the prosthesis should be fitted to your individual gait. At the beginning of gait training, your therapist will help you practise standing on your prosthesis, with support from parallel bars. Eventually, you’ll start walking slowly with the parallel bars, and progress to a stabiliser, such as a cane or walker.
Abnormal posture can be observed by greater sway, and more weight bearing toward the intact limb. Leg-length discrepancy, is a major cause of concern for persons with lower-limb amputations, because it can lead to many secondary physical conditions. People who use a prosthesis that is the same length as the intact limb, have fewer incidences of back pain, and are able to create a more symmetrical step length. Yet, patients often ask that the prosthesis be made shorter. Careful consideration, and patient education, may reduce the long-term risks this may pose. Leg-length discrepancy can appear as a lateral trunk bend, and can relate to chronic complications, and referred joint disruption of the ankle, knees, hip, and lower back. A significant discrepancy is to cause symptoms of functional scoliosis, chronic back pain, knee, and hip pain in the intact limb.
Strength and Balance
It can be difficult for some users to accurately explain, what they perceive when they stand or walk. It is up to the clinician to recognise optimal gait with a given device, so that he or she can identify departures from the standard; determine their causes; and correct them when possible. Furthermore, proper user education can help to reduce the long-term effects of secondary conditions associated with prosthesis use. Exercise and symmetrical walking practice can reduce disuse atrophy; increase strength symmetry; and reduce loading in general. This practice should not be avoided because of fear of high impact.
Exercises to strengthen your upper body, such as bicep lifts, will also be emphasised by your physical therapist. You will need upper body strength, to transfer in and out of a wheelchair; or to propel yourself with a wheelchair or walker, as you learn to use your prosthesis. Having plenty of upper body strength, is also important to compensate for lack of a second leg, during activities such as pushing yourself up into a sitting position in bed.
A major part of going through physical therapy with your prosthesis, is learning how to live a normal life, despite the loss of a limb. Your physical therapist will aid you in doing functional exercises, to ease you into day-to-day home and work life. You will practise activities such as: walking up and down stairs; handling uneven walking surfaces; going from a sitting position into a standing position; putting on clothing; and reaching for objects above your head. Your therapist may also give you a list of “homework” exercises, to hasten your progress.
Due to the compensatory factor, often callus builds up on the other foot, and is best managed by a podiatrist; therefore ensure regular review appointments to monitor tissue viability, along with other assessments. Monitoring can lead to possible prevention, so it is important to follow up and comply as directed. Losing a limb can be quite traumatic for some, so expert advice is advisable, to deal with the psychological aspect. It is a team approach, it is a process, it is an initial change in lifestyle, but it is achievable!
Your feet mirror your general health . . . cherish them!