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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, ankle disarticulation, knee and hip disarticulation prostheses, and bilateral prostheses.
Describe the form and function of upper limb prosthetic devices.
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 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 years 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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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 lower limb amputation, physical therapists have the major role in assisting the person to regain function. Lower limb and upper limb prostheses will be described, together with a program for training patients in their use. Read Chapter 22, Amputation, of this text for more information about amputations and postoperative rehabilitation.
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A prosthesis is the artificial device that replaces an anatomical structure, while the term prosthetic is an adjective used to describe the device (e.g., prosthetic limb). Therefore, when instructing a patient to walk with their artificial limb, you would say “Please walk with your prosthesis” or “Please walk with your prosthetic leg” and not “Please walk with your prosthetic.” Additionally, since not all individuals underwent amputation, the term individual with limb loss is preferred to amputee. For those born with congenital deficiency, the term limb difference should be used.
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LOWER LIMB PROSTHESES
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The principal lower limb prostheses are partial foot, ankle disarticulation (Syme), transtibial, and transfemoral as well as knee and hip disarticulations. The purposes of lower limb prostheses are to (a) restore as much function as possible, particularly in walking, and (b) ...