Basic rehabilitation protocol in a low resource setting or conflict/disaster context: Amputation

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Pre- and post-fitting rehab cycle for patients with a LL-amputation

This table is a suggestion for a relatively normal rehab cycle of patients without complications. For more complex cases additional sessions will be necessary based on case-by-case-evaluation.

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Session (1) assessment => decision:

A no fitting
B fitting after preparation start directly after surgery
C fitting after preparation start with healed stump
D postfitting
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Final outcome & procedure / objectives	Nr of Sessions	Content
A No fitting Maintenance of a good stump;  Prevention of complications	up to 6	(1) assessment; bandaging (2) donation of mobility aids & training; bandaging (pt education); positioning & mobilization stump; scar treatment;  (3) training with mobility aid; all of (2) with focus on independence (pt education) (4) like (3) but more independence (5) taking care of the stump: hygiene, skin care, automassage (6) roundup of previous sessions

B Fitting
Pre-fitting rehabilitation directly after surgery Up to 6 sessions 1 assessment; bandaging
2 donation mobility aids and training; bandaging; positioning & careful mobilization of stump, until wound is healed then continue with 3 below (after wound closure)
C Fitting
Pre-fitting rehabilitation after wound closure Up to 6 sessions 1 assessment; bandaging
2 donation mobility aids & training; bandaging; positioning & mobilization stump; scar treatment; desensitization; transfers
3 training with mob.aid; all of 2 with focus on independence; start weightbearing on stump; strengthening (classical & in function eg football)
4 like 3 but more independence
5 taking care of the stump: hygiene, skin care, automassage; continue like in 4
6 roundup of previous sessions
D Fitting
Post-fitting rehabilitation 6 sessions 1 static exercises; handling prosthesis (put-on/off); taking care of prosthesis & stump
2 continue with 1; weight shift in parallel bars; gait training with mob.aid
3 static balance exercises; simple transfers; continue gait training
4 dynamic balance exercises; advanced transfers; advanced gait training > obstacle course
5 like 4; start sports activity
6 roundup of previous sessions

References

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