PP06 - Week Five

Introduction

This week we are going to delve into all aspects of post-fitting rehabilitation. This includes exercises programmes, first-fitting and gait training such as weight bearing and balance, co-ordination and endurance, functional activities and advanced gait training skills.

You can see the online version of the week four email here.

In the video below Leslie Muller from the ICRC introduces the topics of the week (Note - watching this video is optional).

Objectives for this week

At the end of this week you should be able to:

  1. Have a good knowledge about how to don and doff a TT and TF prosthesis and how to teach it to your patients.
  2. Have a good understanding on how to manage prosthetic socks during the post-fitting rehabilitation process and how to teach the patient when to add or remove socks.
  3. Understand the importance of post-fitting rehabilitation and have a good idea about exercises to improve range of motion, strength, balance, coordination, agility and endurance in order to improve patient's physical and functional status and maximise prosthetic use.
  4. Have a good knowledge of gait training exercises, understand their purpose and the importance of a good progression. 

Topic 1: Post-fitting rehabilitation

The aim of this topic is to provide an overview of post-fitting rehabilitation, what type of exercises to use to improve a patient's functional outcomes and enhance all physical demands required for prosthetic use. 

  1. Much of the post fitting rehabilitation continues with similar exercises to those that we learned about in week three. Find out about the overall aims of the post-fitting management of the amputee by reading this page in Physiopedia.
  2. Find out more about post fitting rehabilitation from the ICRC PGA Manual pages(pages 104-111)
  3. Read chapter 10 in Engstrom to find out more about  gait re-education and prosthetic functional activity (pages 268-276)

Topic 2: Socks, Liners, Donning and Doffing

Donning a prosthesis refers to the application of a prosthetic device, doffing refers to the act of removing a prosthetic device. The aim of this topic is to gain knowledge of socks and liners and the process of donning and doffing a prosthesis. 

  1. Prosthetic socks are simple, relatively inexpensive and critically important. Learn why by reading this article.
  2. Learn more about prosthetic socks and liners by reading this article
  3. Read WHO Manual page 101-103 on managing prosthetic socks
  4. You will need to teach your clients about prosthetic care.  Take a look at these articles:
  5. There are many different types of prostheses available and the process of donning and doffing each is different. You will individually need to become familiar with the types of prosthesis that you use but these videos below provide some insight into donning and doffing socks, liners and prosthetics:
Donning and doffing socks and liners All you need to know about socks
How to don and doff a TT prosthesis Using a sleeve to don a TF prosthesis

Topic 3: Prosthetic rehabilitation

The aim of this topic is to enable you to have a good knowledge about prosthetic rehabilitation including gait training and what type of exercises to propose to your patient to allow him to walk in the most efficient manner possible, to reduce energy expenditure and to correct gait deviations.

To start watch this short interview with Dr Robert Gailey where he gives some tips for this phase of rehabilitation (optional).

  1. Read an overview of Prosthetic rehabilitation in Physiopedia
  2. We must understand the importance of gait training. This is a handy article from the Amputee Coalition.
  3. It's always useful to have some ideas for exercises that you might use when rehabilitating the individual with amputation.  The following resources will give you lots of ideas:

Quiz

You are not assessed on this quiz, it is designed for you to test your knowledge on the topics this week.

Have a go at the quiz for week five

Case Study

Watch this video:

Find out more about Osama (alternative text document if you can't watch the video)

Discussion

Go to the Discussion Forum and add responses for the three discussion activities below. Please post your discussions as a comment in the relevant discussion thread that will be set up

  1. Let's talk about donning and doffing! In your practice what do you check before donning a prosthesis? What are the important things to educate your clients in when donning and doffing?
  2. Tell us about the post-fitting rehabilitation process in your context.  What does the process involve? How much time on average does post-fitting rehabilitation take? How often do you see your clients? What factors influence the time taken for rehabilitation?
  3. In relation to the video case study, what do you think about the progression in the gait training of Usama? Do you think it is exhaustive?

Optional: Explore other resources

The following resources are optional for you to read/view but will further expand your knowledge on this week's topics:

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The Rehabilitation Series for Lower Extremity Amputees

Free access to these three text books has kindly been provided by Robert and Ann Gailey for the duration of the course:

  1. Prosthetic Gait Training For Lower Extremity Amputees
  2. Balance, Agility, Coordination and Endurance For Lower Extremity Amputees
  3. Stretching and Strengthening For Lower Extremity Amputees

Alternatively you might be interested in having your own copy of the books.

Buy PDF version of all three books for £4.99 direct from Physiopedia

Additionally you might be interested to purchase the complementary DVDs direct from Robert and Ann Gailey.

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Prosthetic Gait Analysis for Physiotherapists

This is the course textbook from ICRC which will be available to all participants of the course.

Access the book here!

Alternatively you might be interested in having your own copy of the book.

Download your own FREE copy here

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Therapy for Amputees

This course textbook has kindly been provided by Elsevier and will be available to all participants of the course for FREE for the duration of the course.

Access the book here! (this will be made available for free for the duration of the course)

Alternatively you might be interested in having your own copy of the book.

Buy with 20% discount by clicking here!!

Buy PDF version for £4.99 direct from Physiopedia