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1

What is the most common place for a sore to develop on the transtibial amputee?

anterior distal tibia

2

What is the most common place for a sore to develop on the transfemoral amputee?

lateral distal femur

3

How is knee extension maintained throughout stance phase?

alignment
type of components (knee, foot)
patient

4

Alignment phases

bench
static dynamic

5

Bench alignment:

foot selection
knee selection
sagittal plane
coronal plane
transverse plane

6

Foot selection:

length of foot
heel durometer
heel height

7

Knee selection

functional level of amputee
sound side strength
strength of UE

8

Sagittal plane

TKA alignment (promotes knee stability)
flexion in socket (allows even stride length of sound side)

9

Coronal plane

height
M-L placement of the knee and foot
adduction angle

10

Transverse plane

toe out
knee rotation

11

Four factors of gait:

patient
prosthetic alignment
socket fit
rehab teamwork

12

Purpose of sock:

position limb in the socket

13

System challenged for sitting upright:

Trunk stability
Sitting balance
Sitting endurance

14

Treatment option for sitting upright:

Trunk Rhythmic rotation
Resisted trunk flexion & extension
Sitting endurance progression
Balance pad/sit disc/bosu sitting
Rhythmical stabilization: pushing into the sound leg (knee or hip to force the patient to use the prosthetic leg.
Rest ball (against wall) behind patients head while in sitting have the patient maintain the position

15

Treatment for sitting reach:

PNF
Cone reaching
Cane trunk twist
Plyoball tosses with trunk reaching
Wand reaches

16

Exercises for chair to chair transfer:

Dips for UE strength
Scooting and pivoting on mat
Seated prosthetic weight bearing
Sitting balance on unsteady surface
Planning for task is a problem for many of these patients because of preexisting conditions

17

Treatment for arises from chair:

Weight shifts/Rocking/Nose over toes
Partial wall squats
Triceps pushups
Stand against resistance on non-involved leg or trunk resistance
Leg press single leg
Step by step Processing/organizational skills

18

Treatment for standing balance:

Side to side/forward and back weight shifts
Diagonal weight shifts
Rhythmic stabilization in standing
Perturbation in standing
Standing on a 2X4, Airex pad, tilt board,

19

Treatment for single leg stance:

Patient stands on prosthesis
Non-involved Foot on step
Foot on air ex pad
Foot on foam roller
Foot on mini basketball
Movement of non-involved leg while on any of the above noted surfaces.
Ball toss, chops and lifts

20

Treatment ideas for standing reach

Forward and backward shift
Arms swings up and back
Standing against wall
Heavy ball swings
Standing ball throws

21

Nudge test treatment

Ankle strategies
• Hip strategies
• Step Strategies
Rhythmic stabilization
Forward and backward
shift arms up and back
Standing against wall
heavy ball swings
Standing ball tosses

22

Treatment ideas for eyes closed and picking objects off the floor

Partial Squats
Partial golfers lift
Lunges
Cones pick-up off the floor
Weighted ball pick-up off the floor

23

Treatment for sitting down:

Resisted sit-stand
Partial wall squats
Wall slides
Sit squats
Eccentric gluts, hamstrings, quads, gastroc

24

Treatment for initiation of gait

Pre-gait activities
P-bars walking
Multi-directional stepping
Stop and go walking
Ramp Walking
Stool stepping exercises
Ball rolls
Restoration of transverse rotation of the pelvis
Resisted gait
Resisted hip extension/flexion

25

Treatment ideas of step continuity

Side walking
Braiding
Stop and go walking
Cup walking
Resisted Knee Ext/Flexion

26

Turning treatment idea:

Turn training
Braiding
Cup walking

27

Treatment ideas for variable cadence

Match therapist speed
Walking to the beat of music
Musical Chairs?
Odd Steps with variable length on each leg based on grid or therapist instructions

28

Treatment ideas for step over obstacle

Single leg stance on prosthetic with opposite leg movements
Hip flexor and hip extensor work in standing
Step over cones
Aerobic steps
Grid work

29

Treatment ideas for stairs:

Stool stepping
Wall squats
Lunges
Squats
Eccentric lowering
Glut activities
Spot the patient at the foot and with socket