Lower-Limb Amputee Rehabilitation

The anatomy of amputated limb is important to consider in rehabilitation, as the level of amputation involved will determine the loss of specific joints, muscles and tendons (Spires, Kelly & Davis, 2013; Tintle et al., 2010). These changes to muscle length and bulk will subsequently impact on muscle strength and risk of contractures, which will thus affect the biomechanics of gait (Murphy, 2013). In order to preserve the function and length of the soft tissues, a myodesis may be performed during surgery to suture the muscle to bone (Tintle et al., 2010).

Transfemoral amputee patients are at a greater risk of hip flexion and abduction contractures due to the loss of muscle attachment sites and the imbalance of hip abductor and adductor muscles (Murphy, 2013). Shorter residual limbs have a greater likelihood of developing contractures (Murphy, 2013). Additionally, a hip flexion contracture will also affect the patient’s gait as the gluteus maximus is consequently placed at a mechanical disadvantage, which will further impact on the patient’s ability to extend their hip during stance (Murphy, 2013).

Transtibial amputee gait is often less affected than transfemoral amputees as the knee joint is preserved (Tintle et al., 2010). Transtibial amputees will have decreased plantarflexion power as a result of the loss of attachment sites of the gastrocnemius-soleus complex (Murphy, 2013). There will also be loss of proprioceptive feedback, particularly from the ankle joint and associated muscles, which will further impact on gait (Moirenfeld, Avalon, Ben-Sira, & Isakov, 2000).