Preparation for upper limb prosthetics – consultation and rehabilitation

Preparation for using a prosthesis

The first therapeutic actions begin immediately after amputation. The wound is treated, as well as its preparation for wearing a prosthesis. Immediately after the healing of the surgical wound, the process of prosthetics and rehabilitation begins.

Treatment of edema

After surgery, as a rule, swelling of the stump tissues occurs. The occurrence of edema is a normal reaction to the operation. The swelling will go away within a few weeks.

Before the stitches are removed, only a bandage is applied to the stump.

In the initial stages, it is forbidden to put pressure on the stump.

In order to be able to assess the reduction of swelling, it is necessary to constantly measure the volumetric dimensions of the stump.

If severe swelling remains on the stump for a long time, this means that the wound is healing worse and thus increases the time for preparing for prosthetics.

Body position

Immediately after the operation, the correct position and placement of your body is very important. It is necessary to reduce muscle contractions and in this case the swelling will subside faster.

If possible, the elbow should be placed in an extended position. Under no circumstances should the elbow be kept in a bent or elevated position, such as on a pillow, for a long time, as this will cause the muscles to contract and make it more difficult to move the stump in the future.

Perform movements with the stump several times a day in the shoulder and elbow joints.

To facilitate the performance of these exercises, you can use a towel or bandage. This way you can prevent the loss of mobility of your joints.

During this period of treatment, you need to contact a therapist or rehabilitation specialist so that they can show you the exercises that you need to perform at this time.

Early compression therapy

After the operation, you will immediately be put on a bandage on your arm, which must be changed periodically. After that, as a rule, compression therapy using a compression bandage begins. The exact time for this stage of treatment should be determined by your doctor. The main goal of this therapy is to reduce swelling of the stump and speed up the preparation time for future prosthetics. Compression therapy improves blood circulation, which reduces pain and forms a scar faster.

For compression therapy, an elastic bandage is wrapped around the stump, or a silicone liner or compression stocking is used.

In case of impaired blood circulation and sensitivity, the bandage or liner must be checked regularly and replaced if necessary.

Compression bandage

With the help of a compression bandage, pressure on the stump can be dosed daily, or even several times during the day. The density of the bandage should be maximum at the end of the stump and decrease towards the body. To wrap the bandage on the stump, elastic bandages are used that are fixed with a shepherd. To prevent the stump from being excessively tightened by the bandage and to reduce pain, the bandage should be applied by a doctor or other specialist. Otherwise, if it is impossible to involve a specialist, you must be able to and know how to bandage the stump correctly.

Silicone liner

Unlike bandages, you can work faster with a silicone liner and it will be more convenient, but you need to take into account the individual size. Liners come in different sizes, so you can choose the right one for you.

To create uniform compression over the entire surface of the stump, when putting on the liner, make sure there is no air at the end of the liner. Using a liner may increase sweating over the entire surface of the stump. If you maintain good hygiene, such problems occur much less often.

Follow the following 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; the skin should air dry completely.

Further compression therapy

If the stump volume remains stable and unchanged for a long time, you can begin the process of preparing for prosthetics. Until then, you need to maintain constant compression.

If in the initial stages of prosthetics you use the prosthesis only for short periods, then at other times you need to wear a compression bandage or liner. Once you start using the prosthesis constantly, additional compression is no longer necessary.

Skin and scar care

After amputation, the skin on the stump is often more sensitive. To alleviate these sensations, you can use a soft brush or a rubber ball with spikes, running them over sensitive skin areas. This increases its resistance. Later, you can also rub the stump with a towel or a regular sponge.

In addition, after the wound heals, hygienic treatment of the stump is important. The first priority is to wash the stump daily with warm water and soap, as well as use special creams.

Scar treatment

In most cases, the amputated wound heals within 3-4 weeks, after which a scar forms.

From the very beginning, you should constantly massage the scar and lubricate it with a special cream. This is done so that the scar tissue remains soft and mobile. This is important for the future use of the prosthesis, because with proper ongoing care you can minimize the feeling of pain during movements in the stump socket.

Early compression therapy also influences the proper formation of the scar. Full-surface compression combined with a silicone liner is one of the best solutions for preventing excessive scar tissue growth.

Phantom Pain and Mirror Therapy

Mirror therapy, or phantom-impulsive gymnastics, is aimed at improving blood and lymph circulation;

accelerating regeneration and repair processes;

prevention of such postoperative complications as phantom pain, swelling, muscle atrophy

of the operated limb, improving muscle tone of the healthy limb, self-care skills, and psycho-emotional state.

Mirror therapy allows you to reduce the intensity, frequency, and duration of phantom pain.

For this therapy, you need a mirror that is located near you so that the healthy limb is reflected in it and a sense of visual control over both limbs is formed. Looking in the mirror at a certain angle, you should see yourself as if you have two limbs.

In the process, you may experience such side effects as emotional and painful, nausea, dizziness, increased sweating, rapid heartbeat, etc. You should inform your physical therapist about this and take a break from the session, because all these symptoms indicate fatigue.

It is recommended to conduct mirror therapy sessions at least once a day, lasting from 15 to 45 minutes.

To facilitate independent exercise with the help of mirror therapy, it is recommended to perform the following exercises:

Exercises for the fingers:

1. Simultaneous clenching of the fingers into a fist – unclamping;

2. Alternately clenching the fingers into a fist – alternately unclamping;

3. Simultaneously abducting the thumb, index, ring finger and little finger from the middle finger;

4. Alternately abducting the thumb, index, ring finger and little finger from the middle finger;

5. Simultaneously bringing the thumb, index, ring finger and little finger to the middle finger;

6. Alternately bringing the thumb, index, ring and little finger to the middle finger;

7. Simultaneously connecting the index, middle, ring and little fingers with the pad of the thumb;

8. Alternately connecting the index, middle, ring and little fingers with the pad of the thumb;

9. The palm lies on the table, the fingers are slightly spread; alternately raising the fingers above the support and then lowering them; raising – lowering is done by only one finger, while all the others should be tightly pressed to the table;

10. The palm lies on the table, the fingers are slightly spread; simultaneously raising the fingers above the support and then lowering them;

11. Transferring objects, such as cubes, pencils, etc. into a container (this can be a cup or a tray);

12. Sorting objects;

13. Performing tasks on a task board near a mirror (lacing, buttoning, etc.) •

Exercises for the elbow joint:

1. Flexion – extension;

2. Pronation – supination;

3. Performing sliding movements using rollers on wheels or slippery surfaces.

Exercises for the shoulder joint:

1. Flexion – extension;

2. Pronation – supination;

3. Abduction – adduction;

4. Performing circular movements.

Self-care

After an upper limb amputation, the problem of dressing yourself often arises. Even despite the presence of a large number of relatives who are always ready to come to your aid, you need to learn how to dress and undress yourself.

Putting on underwear

The process of putting on underwear is carried out in the following ways:

- In the initial standing position: with one hand, hold the panties in the center in front, alternately push first one and then the other leg into the holes, and holding them by the elastic, pull the panties up. If the belt is twisted, gradually straighten it with one hand and give it the necessary position;

- In the initial lying position: sit on the bed, legs do not hang down. Hold the panties with your hand, as in the previous version, alternately push your half-bent legs into the holes and pull the panties up to the level of the upper third of the thigh. Then you need to lie on your back, bend your legs at the knees; resting your feet on the surface of the bed, lift your pelvis, tearing it off the bed, and pull the panties up, adjusting their waistband with your hand from all sides.

Putting on pants

You can put on pants in the same way. If the button on the waistband is an obstacle, then sports pants are preferable. But with a little effort, after a few workouts you will be able to do the button with one hand. To do this, you need to do the following:

The index finger is placed near the button, pushing the trouser bar to the button;

The thumb is placed on the inner surface of the trousers under the button;

The middle finger is placed on the loop from above and smoothly enters the loop, heading towards the index finger, which is located near the button;

The index and middle fingers meet in the loop that is stretched over the button;

At this moment, the thumb pushes the button forward, pushing it through the loop of the fastener. That's it! The trousers are fastened. All you have to do is grab the zipper with your thumb and forefinger and pull it up.

Putting on women's underwear

Since during military operations, amputations are performed not only on men, but also on women: servicemen, volunteers, and civilians who were injured, let's consider the option of putting on a bra with one hand. To do this, you need to:

Put the bra on yourself with the clasp in front, with the cups facing up — to the back;

Go to the outer corner (the one that protrudes) of the wall or cabinet, place the side of the clasp that has the hooks against your stomach, and lean sideways against the corner so that the bra is firmly clamped between you and the corner;

With one hand behind your back, grab the other edge of the clasp that has the loops, and pulling it over your stomach, hook the loops onto the hooks. When fastening, pay attention to choosing the row of loops that is necessary for a comfortable fit of the bra;

After that, you can move away from the corner, twist the bra with the clasp towards your back, straighten the cups to the desired position, and put the straps on your shoulders. It is worth noting that this principle of fastening the fastener is advisable to use when wearing jackets and sweaters with zippers.

Putting on T-shirts

The following method is used to put on T-shirts:

The T-shirt is laid out on the bed so that the front of the product is at the bottom;

We put our hand inside the T-shirt so that it goes into the corresponding sleeve;

Placing the entire T-shirt on the shoulder, we find the back edge of the collar and fix it with our fingers;

We gather the back of the T-shirt with pleats (accordion) and press it to the edge of the collar;

We hold the entire structure above our head, carefully pushing it through the collar;

We straighten the T-shirt on the shoulders, tucking it into the pants if necessary.

Zippers

To put on sweaters with The following algorithm is followed for fasteners:

We put on the jacket on the side of the amputation;

Taking our hand behind our back, we put our hand into the corresponding sleeve and adjust the jacket on our shoulders;

So that the sleeve of the amputated limb does not interfere (in the case of a high level of amputation), we need to turn it out and fix it from the inside under a T-shirt or bra;

To fasten the zipper, we fix one strip using the outer corner, and we put the second element of the fastener into the groove;

We pull the “tail” of the fastener in front and up to fasten it completely.

Putting on socks

To put on socks yourself with one hand, you can use a specially designed device. It consists of two parts: a flexible plastic semicircular shape, lined with fabric (usually terry), which allows you to fix the sock on the base and prevent it from slipping while putting it on, and two straps attached to the sides of the holder. The length of the straps reaches about a meter, which allows you to conveniently use this device without even bending over. To put on a sock with one hand, you need to:

Place the holder in front of you so that the solid side of its semicircle is directed downwards, and the end rests on your stomach;

Take one sock, fold it (accordion) and put it on the holder with a movement towards you so that the heel is at the bottom;

Holding the straps with your hand, put the holder on the floor;

We push our toes inside the sock, while pulling the straps towards us and upwards, pushing our foot inside the sock.

The job is done - the sock is in place. If it is located awkwardly, you need to adjust or remove the sock from your foot and repeat the procedure again. This way, you can wear not only socks, but also stockings.

Prosthetics

After an upper limb amputation, a person is provided with two
types of prostheses of different functionality, namely:

- cosmetic and working;

- with traction control and working.

Military personnel:

- cosmetic and with an external energy source (in particular, with increased functionality);

- with traction control (with combined traction control) and with an external energy source (in particular, with increased functionality).

A well-made prosthesis according to individual needs provides mobility, independence and self-confidence, and also ensures good body balance of its owner. If you do not like the aesthetic appearance of the prosthesis or it is not functional enough, you should look for another variation of the prosthesis that you will be satisfied with.

Before you start using your prosthesis, you should work out a wearing schedule with your physical therapist. The initial time of wearing the prosthesis should be 15-30 minutes with constant monitoring of the condition of the stump skin to detect excessive pressure and/or its uncomfortable position in the stump receiver. After removing the prosthesis, it is necessary to carefully examine the stump for redness and areas of rubbing. Normally, these adverse reactions should pass within 15-20 minutes after removal. If the recovery time of the stump skin is more than 20 minutes, it is necessary to inform the medical staff and contact the prosthetist for assistance in modifying the prosthesis. The position of the stump in the stump receiver should be monitored especially carefully by those who have impaired sensitivity in the stump. If there are no such problems with the stump skin, the prosthesis can be worn for 30 minutes three times a day. A week after starting to use the prosthesis, you should wear it all day. Record the results of monitoring the condition of the stump skin and the time of using the prosthesis in a notebook to identify problem areas and agree on a schedule for wearing the prosthesis. Before starting to use the prosthesis, it is necessary to determine your expectations from its use. You should not set unrealistically high goals. Make a list of the actions and everyday skills that are most important and necessary for you now. This will allow you to orient the medical staff working with you and make the rehabilitation process purely individual. You should not expect that the prosthesis will be able to fully functionally replace the amputated limb. In reality, when performing everyday skills, the prosthesis is able to perform about 30% of the total number of tasks. Unilateral amputation of a limb automatically makes the healthy limb dominant (this especially applies to the hand). For example, a prosthesis can perform the function of rough grasping, holding and stabilizing objects, while the healthy hand will perform more complex and coordinated movements.

Prosthesis training

You should tailor your prosthesis training to your needs. Important factors include your experience, physical endurance, individual preferences and personal learning pace.

During training, pay attention to your overall body position, as well as how you feel. Pay special attention to:

• Posture;

• Coordination of movements and balance;

• Strengthening the muscles.

Stretching the stump muscles

The muscles and joints adjacent to the stumps - the elbow and shoulder joints - should be stretched regularly. If you can only move the joint actively with difficulty, you can also perform passive movements, helping yourself with a towel. It is important that your joints maintain or restore maximum mobility in all directions.