Special Population: Limb Loss and Prosthetic Devices

1. Presentation by: Lauren Grosse, Jak Kesselring, Meghan Allen Special Population:Limb Loss and Prosthetic Devices

2. What is it? How does it happen? • Limb Loss by amputation has many different categories Some of the most common are: Symes: Forefoot or midfoot BK – Below the Knee (transtibial) AK- Above the knee(transfemoral) BE – Below the Elbow (transradial) AE – Above the Elbow (transhumoral) Unilateral – one side Bilateral – two sides Most common to hear. “He has a bilateral transtibial amputation” which is both legs, below the knee. Over half of all amputations in the U.S. are performed on people who have been diagnosed with diabetes.

3. What are the concerns or special considerations? What makes requirements different than normal? • Well for #1- THEY ARE MISSING A LIMB therefore activities will have to be modified in order to be courteous of the amputation. Many patients prefer to have their “stump” called a Residual Limb. This is the PC term. • Therapists have to take into account that having a prosthetic can cause problems with gait, balance, coordination, pain control, skin irritants, swelling and infections.

4. Other considerations • Lower limb amputees have a higher energy expenditure that directly relates to the level of amputation. A unilateral transfemoral amputee uses more energy than a unilateral transtibial amputee. This is directly correlated to the height of the amputation. Oscar Pistorious

5. Would you max test? • Same preliminary safety measures/testing as for normal individuals should be performed prior to testing. • Different types of amputations require different methods for max testing. • Rehabilitation level and/or experience with their prosthetic(s) also should be assessed.

6. How Would You Test?—Max Tests • Arm ergometer, might not achieve actual max • One-legged cycle ergometer • Regular cycle ergometer (with accommodations) • Treadmill test (with accommodations)

7. How Would You Test?—Other Tests • Several weight training analyses are possible. Extra supervision or assistance may be necessary. • Testing for performance with newly-fitted prosthetics • Gait analysis • Functional testing for ADLs • Balance and flexibility testing

8. FITT for Aerobic Exercise • Goal is to increase cardiovascular fitness, endurance of all limbs, ease of movement, and ADL’s • Four to seven days per week • 40 – 80% HRR, 11-16 RPE • 30 – 60 minutes per session but may build up to this gradually • Yoga and swimming are great activities for exercise and rehabilitation

9. FITT for Resistance Training • Important for increasing strength in all limbs and specifically the core muscles • Two to three days a week • 60 – 80% 1 RM (rep maximum) or weight allowing for 8 repetitions • Should perform at least 2 upper-body exercises, 1 core, and 2 lower body

10. Flexibility and Special Considerations • After every exercise session and at least once a day to promote flexibility and increase range of motion • Each stretch should be preformed slowly and be held for 25 seconds each • Special considerations when designing an exercise plan include: lower energy expenditure, increased chance of skin breakdown and infection, and overuse

11. The End Sources: 1) http://www.amputee-coalition.org2)http://www.ncbi.nlm.nih.gov3) http://www.amputee-coalition.org/limb-loss-resource-center/4)www.prostheticsexperience.wordpress.com5) http://ptjournal.com6) http://oandplibrary.org