Lower-Limb Amputee Rehabilitation

In the pre-prosthetic phase the goals of rehabilitation are to maintain range and strength, control pain and promote wound healing (Esquenazi & DiGiacomo, 2001). Contractures are common in amputees as a result of pain, decreased mobility, bed rest and positioning (Andrews, 1996). In particular, transtibial amputees are at a greater risk of knee flexion and hip flexion contractures, and transfemoral amputees are more likely to develop hip flexion, abduction and external rotation contractures (Spires, Kelly & Davis, 2013). Contractures of the intact limb can also occur with prolonged bed rest (Esquenazi & DiGiacomo, 2001).

 

Contractures are of concern to amputee rehabilitation, as they may impact on prosthetic fitting, particularly if the degree of contracture is large (Spires, Kelly & Davis, 2013). Modifications can be made to the prosthesis to fit the contractures, however this may cause the prosthesis to weigh more and be bulkier (Spires, Kelly & Davis, 2013). Furthermore, contractures will impact on the patient’s gait pattern and lead to abnormal biomechanics, which can contribute to musculoskeletal issues as a result of greater stress on joints and soft tissues (Spires, Kelly & Davis, 2013).

 

Therefore, in order to prevent contractures, amputees are recommended to complete ROM exercises for all joints, especially the joint proximal to the amputation, several times a day (Esquenazi & DiGiacomo, 2001; Andrews, 1996). Transtibial amputees require a wheelchair stump support in order to be able to keep the knee extended and avoid the limb from hanging in a dependent position (Spires, Kelly & Davis, 2013). Additionally, the knee should be kept in extension when the patient is in bed (Spires, Kelly & Davis, 2013).

 

Similarly, when in sitting or supine position, a transfemoral amputee should take care to position their hip in neutral rotation and adduction (Spires, Kelly & Davis, 2013). Furthermore, resting in prone for periods of time will also help to limit time spent in hip flexion (Spires, Kelly & Davis, 2013). This stretch should be included among other stretches as part of the patient’s exercise program to ensure maintenance of ROM (Esquenazi & DiGiacomo, 2001).