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INTRODUCTION

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LEARNING OBJECTIVES

  1. Describe the components of transtibial and transfemoral prostheses, including advantages and disadvantages of alternative components and materials.

  2. Explain the distinctive features of partial foot, Syme's, knee and hip disarticulation prostheses, and bilateral prostheses.

  3. Outline the maintenance program for prosthetic components.

  4. Conduct static and dynamic evaluation of transtibial and transfemoral prostheses.

  5. Summarize the physical therapist's role in management of individuals with lower-limb amputation.

  6. Analyze and interpret patient data, formulate realistic goals and outcomes, and develop a plan of care when presented with a clinical case study.

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Physical therapists are concerned with the care of individuals with lower- and upper-limb amputations. Patients are often fitted with a prosthesis to replace the absent part of the leg or arm. In the broadest sense, prostheses also include dentures, titanium femoral heads, and plastic heart valves. A prosthetist is a health care professional who designs, fabricates, and fits limb prostheses.

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The major causes of amputation are peripheral vascular disease, trauma, malignancy, and congenital deficiency. In the United States, vascular disease accounts for most leg amputations, particularly among patients with diabetes.1 Individuals older than 60 constitute the largest group of people with amputation. Trauma is responsible for the majority of amputations in younger adults and adolescents. Men are more likely to sustain amputation because of trauma and vascular disease. Bone and soft tissue tumors are sometimes treated by amputation, with adolescence the period of peak incidence. Congenital deficiency refers to the absence or abnormality of a limb evident at birth.

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This chapter focuses on the lower extremity (LE) because many more people have lost a portion of the LE, as compared with the upper extremity (UE). Physical therapists are key members of the rehabilitation team, working with prosthetists, physicians, occupational therapists, and others to foster the patient's welfare. For individuals with LE amputation, physical therapists have the major role in assisting the person to regain function. Lower extremity prostheses will be described, together with a program for training patients in their use. For patients with UE amputation, physical therapists may play a lesser role, cooperating with occupational therapists, depending on the administrative organization of the health care facility.

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Historic records confirm that the concept of replacing a missing limb is very old. A forked stick that formed a peg leg to support a transtibial (below-knee) amputation limb was known in antiquity. Today, most individuals with LE amputation are provided with a prosthesis because function with one LE is very different from maneuvering with two.

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The principal LE prostheses are partial foot, Syme's, transtibial, and transfemoral, as well as knee and hip disarticulation. The physical therapist should be familiar with their characteristics and maintenance, as well as the rehabilitation of patients fitted with these devices.

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PARTIAL FOOT AND SYME'S PROSTHESES

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The purposes of partial foot prostheses are to (1) restore, as much as possible, ...

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