Pre-Prosthetic Phase of Rehabilitation
The period between the surgical amputation and the fitting of an artificial limb (prosthesis) is referred to as the pre-prosthetic phase of rehabilitation. The goals of treatment during that time are:
- Promote healing of the involved limb. Proper healing of the wound is essential for preventing infection, and for ability to eventually wear a prosthesis. Often patients come out of surgery with a rigid cast or dressing to assist with keeping the swelling down and provide for the initial shaping of the stump. Careful attention must be paid to the healing of the wound as well as ongoing skin care.
- Reduce swelling and prepare limb for prosthetic fit. In order for the prosthetic limb to fit properly and for the patient to be able to use it for daily tasks the swelling must be kept to a minimum. As the wound heals, therapists will work with the patient to wrap the stump with elastic wraps or stockings that minimize swelling and shape the stump for the best fit possible into a prosthetic limb.
- Improve strength, endurance, and range of motion: Being able to use
- Prevent stiffness in the joints remaining.
- Facilitate independence prior to arrival of prosthesis.
- Enhance daily living skills.
- Facilitate coping skills for both patient and family.
- Provide education regarding skin care and prosthesis usage
- Assist in prosthesis prescription and fit.
- Facilitate desensitization of involved limb. After limb amputation, an area of hypersensitivity can develop along the healed surgical incision. This can make wearing a compression bandage painful as well as interfere with prosthetic use. Special desensitization exercises can help decrease this uncomfortable sensation. The technique involves the gradual advancement of texture and pressure application to the hypersensitive area. To begin, lightly rub a smooth textured material across the hypersensitive site. Once the sensation becomes comfortable, advance the texture as well as the pressure applied. Desensitization should be performed throughout the day. Texture advancement is as follows: Silk, Cotton, Velvet, Corduroy, Wool
- Pain control as needed. Phantom pain describes a painful sensation that can occur in a limb that is no longer present due to trauma or surgical amputation. It is often described as a shooting or burning type pain. The sensation can be constant for some people, but intermittent for others.
Prosthetic Program Goals
- Provide instruction in proper prosthesis use for walking, transfers, and activities of daily living
- Facilitate community re-entry
- Provide patient and family with education regarding proper skin care
- Instruct patient in proper prosthesis donning and doffing
- Provide instruction in prosthesis use and maintenance
Prosthetic Training Provided
- Education on shrinkage device use
- Reinforcement of residual limb (stump) skin care
- Range of Motion activities and positioning
- Education on progressive strengthening exercises of all extremities. Goal is to improve strength of all muscles to their maximum in preparation for prosthetic training. Active exercises progressing to resistive exercises including a variety of concentric, eccentric, and isometric therapeutic exercises
- Reinforcement of bed mobility skills - patient must be independent moving in bed in all directions
- Mobility on floor training - patient must be able to move in all directions on the floor
- Wheelchair mobility indoor and outdoor
- Education and reinforcement on transfers at all levels
- Balance and coordination exercises
- Endurance training
- Reinforce content of Home Exercise Program to patient, family or caregiver, as necessary
- Fitting of prosthesis
- Education to patient on appropriate use of prosthetic socks
- Education on skin care
- Education for proper independence in application and removal of prosthesis
- Activities of Daily Living Skills with the prosthesis
- Transfers training to all surfaces wearing the prosthesis
- Balance and gait training with prosthesis outdoor and indoor: stairs, ramps, curbs, elevators
- Family training, as necessary
- Reevaluate ambulation skills periodically and "upgrade" assistive device as applicable.
The rehabilitation of the person with limb loss is a complex process and period of training to learn how to function using the prosthesis, with the aim of being independent in all the activities of daily living, vocational and avocational activities. The final aim is to live, in the way of life which the person used to live before the amputation.
The purpose of physical therapy is to empower the person with an amputation to develop the best level of physical and emotional function that can be achieved. The rehabilitation program should be design to restore a meaningful quality of life through return to function in the family, community and workplace. We should focus not only on the prosthesis but on the individual amputee.