Chapter 7: Lower Extremity Prosthetic Management

OBJECTIVES

At the end of this chapter, all students are expected to:

1. Describe the factors that mitigate for or against prosthetic fitting.

2. Recognize major gait deviations that may be exhibited by individuals walking with a transtibial or transfemoral prosthesis.

3. Describe the critical components of the prosthetic training program.

4. Compare and contrast the training program for an individual with a transtibial or transfemoral prosthesis.

Physical Therapy students are expected to:

1. Analyze the fit of any prosthesis.

   1. Perform an appropriate prosthetic check out.

2. Establish a physical therapy diagnosis and functional goals for an individual with a transfemoral or transtibial prosthesis.

3. Develop a plan of care for any individual with a transfemoral or transtibial prosthesis.

4. Implement an individualized prosthetic training program for anyone with a transtibial or transfemoral prosthesis.

5. Delegate and supervise physical therapist assistants in the implementation of selected aspects of the prosthetic rehabilitation program.

Rehabilitation programs for individuals who have undergone an amputation are very variable.

The service person who sustains an injury in a service-related activity is quickly evacuated to the nearest medical center and receives continuous and complete medical services throughout the rehabilitation phase. In Iraq and Afghanistan, wounded soldiers are evacuated to Germany, often within a few hours of injury, and transferred to Walter Reed Medical Center or Brooks Army Medical Center when stabilized for complete medical, surgical, and rehabilitative care. They are fitted with state-of-the-art prostheses and receive rehabilitative care until complete independence for all daily and leisure activities is achieved. Many complete part of their rehabilitation at the Center for the Intrepid, a modern outpatient rehabilitation facility on the campus of Fort San Houston and described later in this chapter. Some are able to return to active military duty.¹ Individuals in the civilian population may also receive continuous care from injury to rehabilitation depending on location, finances, age, cause of amputation, and the proximity of a comprehensive medical center or an in- and outpatient rehabilitation center. In many instances, unfortunately, particularly for older individuals, the surgeon who performs the amputation may not refer the patient for comprehensive care. The patient may eventually be sent to a prosthetist for prosthetic fitting and may never be seen by a physical therapist or may be referred to physical therapy long after the prosthesis has been fitted and the person has developed energy-consuming gait deviations. Ideally, the same continuity of care available to the military member should be available ...