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LEARNING OBJECTIVES
Describe the components of transtibial and transfemoral prostheses, including advantages and disadvantages of alternative components and materials.
Explain the distinctive features of partial foot, Syme’s, knee and hip disarticulation prostheses, and bilateral prostheses.
Outline the maintenance program for prosthetic components.
Conduct static and dynamic evaluation of transtibial and transfemoral prostheses.
Summarize the physical therapist’s role in management of individuals with lower-limb amputation.
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 play an important role in the care of individuals with lower- and upper-limb amputations. To replace the absent part of the leg or arm, patients are often fitted with a prosthesis. In the broadest sense, prostheses also include dentures, titanium femoral heads, and plastic heart valves. A prosthetist is a health care professional that 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. Men are more likely to sustain amputation because of vascular disease and trauma. Among younger adults and adolescents, trauma is responsible for most amputations. 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 limb (LL) because many more people have lost a portion of the LL, as compared with the upper limb (UL). 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 LL amputation, physical therapists have the major role in assisting the person to regain function. LL prostheses will be described, together with a program for training patients in their use. For patients with UL 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 forming a peg leg to support a transtibial (below-knee) amputation limb was known in antiquity. Today, most individuals with LL amputation are provided with a prosthesis because function with one LL can be limited compared with two.
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The principal LL prostheses are partial foot, Syme’s, transtibial, and transfemoral as well as knee and hip disarticulations. 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 ...