Preparation for lower limb prosthetics – consultation and rehabilitation

Preparation for using the prosthesis

After amputation of a limb, there is pronounced swelling of the stump and adjacent tissues. As prescribed by the doctor, the stump is bandaged to create moderate compression.

Correct position of the stump

While still in the hospital, you need to ensure a physical activity regimen appropriate to your general condition: physical therapy will help maintain muscle tone and mobility in the joints. Initially, most patients believe that a comfortable and painless position of the body and stump is correct. However, experience shows that this is not always the case! It is in no case recommended to keep the stump in a bent state constantly. From time to time, it is also necessary to carry out measures to prevent or treat hip joint contracture: with amputation above the knee, we recommend lying on your stomach for 30 minutes two to three times a day. The head should be turned to the side opposite the amputation. This procedure is designed to stretch the hip flexor muscles and maintain the amplitude of extension in the joint.

A hard mattress is another precaution. It does not allow the pelvic area to "sink" while lying on your back, which can lead to excessive pelvic flexion and the development of contractures.

Correct position of the stump while sitting

In the initial stage after amputation, you may need a wheelchair. It is necessary that the cushion on the seat is hard. This helps prevent the formation of spinal deformities. To prevent increased swelling and contractures, the stump must be bandaged.

Early compression therapy

Follow your surgeon's instructions regarding the healing of the stump. Early application of an elastic bandage to the stump has a number of positive effects. It relieves swelling and prevents venous stasis, promotes stump formation, provides skin protection, reduces problems with excess tissue and reduces phantom pain. The bandage is applied in a figure eight (diagonally), ensuring that the elastic bandage is stretched to approximately two-thirds of its maximum stretch. After loss of elasticity, the bandage should be replaced.

For a thigh stump, bandages 10-15 cm wide are used. For a lower leg stump - 8-10 cm wide. Each round of the bandage overlaps the previous one by approximately half the width of the bandage. The distal pressure (at the end of the stump) should be greater than the proximal pressure (for the lower leg, the popliteal fossa, for the thigh - the groin). The bandage should always end at the lymph nodes above the swelling and should be clean and dry, smooth and without wrinkles. Elastic bandages are washed with mild soap and dried in the shade without hanging on a towel to maintain their elasticity.

There are also standard-sized compression covers and silicone or gel liners that are more comfortable to wear and are more likely to stay in place and not slip off. However, they are indicated for cylindrical stump shapes. For stumps of complex shape (club-shaped, with excess or deficiency of soft tissues), they are difficult to choose and it is more advisable to use elastic bandages. If after applying the bandage there is a feeling of numbness, pulsation, coldness, it is necessary to remove it and re-apply it with less tension.

Additional compression therapy

It will be possible to start primary prosthetics when the stump volume stops rapidly decreasing and stabilizes for a long time. Until then, it is necessary to continue compression therapy. Our specialists will show you how to properly monitor this. At the first stage of prosthetics, you will walk on the prosthesis for a short time (for example, during fitting sessions), then you should continue to wear compression bandages or liners throughout the day. As soon as you start using the prosthesis on a permanent basis, additional compression therapy will no longer be needed.

Stump and wound care

Persons with amputated limbs should be aware that sweating may increase over the entire surface of the stump while using the prosthesis. If you maintain good hygiene, such problems occur much less often. Follow these recommendations:

• - wash the stump daily with mild soap
• - avoid leaving the stump in water for too long
• - after hygiene procedures, be sure to dry the stump with a towel, paying special attention to folds and allowing the skin to air dry completely.

This means that the best time of day for hygiene procedures is in the evening.

Wearing a prosthesis on a wet stump can damage the skin. If you have reduced surface sensitivity of the stump skin, you should know that you need to be careful to avoid abrasions, cuts and other damage.

The stump should be inspected daily for signs of pressure, vascular and mechanical changes (a mirror may be useful). It should be noted that alcohol, cream, oil balms, and medications should not be used on the surface of the stump without a doctor's recommendation, as they can cause dermatitis.

Independence and self-care

You must be able to perform the dressing yourself, or know how to instruct someone to do it, and how to check its quality, care for the stump, bandage the stump, and perform exercises to prevent contractures.

Muscle training

Preparatory training is aimed at strengthening the muscles of the trunk, namely the abdominals and back, as well as the preserved limbs. Strengthening exercises can be performed with light loads or a rubber band from lying, sitting, or standing positions. Exercises are also necessary for the stump.

Stretching the muscles of the stump area

The muscles and joints around the stump need to be stretched. Maintaining or restoring the amplitude of movements in all joints is very important for full development and symmetrical walking on a prosthesis.

Strengthening the muscles of the healthy leg

You should also focus on restoring range of motion in all joints to avoid contractures. To enhance your training, you may want to have a physical therapist assist you during the exercises to provide additional resistance.

Strengthening the muscles of the stump

As recommended by your doctor, you should begin exercises to strengthen the muscles of the stump in the days following surgery.

For example, you can hold both thighs together with a towel and try to spread them apart. This exercise is aimed at increasing the strength of the muscles that abduct the thigh.

You can strengthen your inner thigh muscles by squeezing a pillow or ball with your hips.

Strengthening your core muscles

Your core muscles play a crucial role in learning to walk with a prosthesis. You should prepare them before you receive your prosthesis.

To perform the first exercise, sit on a chair without leaning against the back, alternately move your arms up and down, and breathe deeply. This exercise helps to straighten the chest and improves blood circulation.

Another exercise is called the “bridge”. Lie on your back, bend your healthy leg at the knee, and extend your arms down on both sides of your body. Raise your pelvis and create a straight line from your shoulders to your knees, then lower yourself back down.

Using the prosthesis

Correct putting on and taking off

Putting on and taking off your prosthesis is very important in your daily life. At first, your relatives can help you. However, your main goal is to learn how to do it yourself.

There are many different ways to put on a prosthesis, depending on its type and the characteristics of your stump. Our specialists will teach you the most suitable method for you.

Prosthesis care

Your prosthesis needs to be cared for and washed daily. To remove skin particles and sweat, wipe the inside of the receiving sleeve with a damp cloth. A clean inner surface of the sleeve will help avoid skin irritation.

When using the liner, please ensure daily care according to the instructions for use!

How to sit down and stand up correctly

Once you have learned how to take off and put on your prosthesis, you should move on to learning how to sit down and stand up correctly with your prosthesis.

The necessary exercises depend on the set of prosthetic components and your physical condition. Modern prosthetic models allow for significant relief of the work of both the healthy side and the spinal column, which, in turn, helps prevent problems associated with excessive fatigue and asymmetry of the load.

Learning to walk

Guidelines in learning

Once you learn to "feel" the prosthesis, you can move on to learning to walk.

Goals:

• • Improve coordination and balance.
• • Ensure even weight distribution between the limbs.
• • Keep your pelvis and upper body anatomically correct.
• • Walking safely with a prosthesis.

You should also continue to strengthen your muscles, as good physical fitness and strong muscles are necessary to maintain a stable posture while walking.

Walking on a flat surface

The first step will be to learn how to properly transfer your body weight when walking between parallel bars. It is important to learn to rely not only on your hands and good leg. You must learn to distribute your weight on the prosthetic limb as well.

Once you have learned to walk on the uneven bars, you can move on to walking with the support of crutches or a walker. Over time, it is necessary to gradually reduce the use of assistive devices. This is achieved through a combination of training in proper walking technique and strengthening the muscles of the body.

One of the main tasks is to master a symmetrical energy-saving gait. The specialist will monitor your gait and suggest ways to correct any errors that may occur while walking. In the future, following the recommendations, you will learn to walk correctly and take care of yourself on your own.

Walking on an inclined surface and stairs

In everyday life, you constantly encounter various obstacles, for example, going down and up stairs when going outside or on ramps.

The components of your prosthesis will determine the way to overcome certain obstacles, since different knee modules are characterized by different mobility capabilities. In addition, the correct position of the foot or the use of handrails can significantly help in overcoming obstacles.

Training on uneven surfaces

You should learn to walk freely on uneven surfaces. To this end, you and your rehabilitation therapist should pay special attention to outdoor training.

For example, walking over obstacles of varying density, height, and width is a good challenge.

During the training, you will learn to independently and confidently overcome all the main everyday difficulties of movement.

How to get up on your own after a fall

An important exercise using your new prosthesis is learning how to get up from the ground correctly after falling or lying down.

You will master safe inclinations and special lifting techniques.

This will help you learn to lift objects from the ground or move them. According to your physical capabilities, you will learn to get up from the ground with the help of crutches, a chair or without outside help.

The key to success in the rehabilitation process is your active participation as an amputee. Positive motivation and a high level of self-confidence can make a big contribution. The rehabilitation process does not focus only on the healthy limb and prosthesis, but also on the overall functioning of the body.

Patients with amputated limbs should be constantly monitored (examine the amputated limb). There is a control examination to identify possible problems in time, consider repair issues or other issues.

It is forbidden to use the prosthesis in case of:

• • pustular infections of the skin of the stump;
• • mismatch of the volume of the prosthesis receiving sleeve with the parameters of the stump;
• • violation of the prosthesis attachment elements;
• • the appearance of redness of the skin from excessive pressure.

The prosthesis must be kept clean, especially the receiving sleeve, to avoid stump diseases.

It is necessary to wipe the receiving sleeve with a damp cloth and then with a dry cloth every day after using the prosthesis.

After that, the prosthesis must be left in a dry place (no closer than 1 meter from a heat source).

The prosthesis must be stored in a dry room, protected from direct sunlight at room temperature.

The prostheses must be protected from direct sunlight and contact with petroleum products (gasoline, kerosene, etc.).