One-way valve system + knee sleeve
How a below-knee amputee dons a prosthesis designed with a common socket and liner combination.
Educating your patient
Training with a prosthesis.
While your patient is getting used to their first prosthesis, much of your focus should be on helping them learn the basic skills they need for day-to-day life with lower limb loss. For example:
- Donning and doffing their new prosthesis
- Handling and cleaning their device
- Balance, coordination and strength-building
- Activities of daily living (ADLs)
- And of course, gait training
If the patient has a caregiver, it's important to involve them throughout the recovery, fitting and training process. They may assist the patient with their prosthesis at first, but the ultimate goal is for the patient to learn how to control and maintain their device themselves.
First steps
Donning & doffing a prosthesis.
One of the first skills new prosthetic users need to learn is how to put on and take off their prosthesis. There are multiple ways to do this, depending on the type of prosthesis your patient is using and the condition of their residual limb. The two examples below show common techniques — one for a transtibial (TT) user and one for a transfemoral (TF) user.
Pin liner shuttle lock system
How an above-knee amputee dons a prosthesis with a more complex but user-friendly socket configuration.
Step by step
Gait training.
Once a patient has been fitted with a new prosthesis for the first time, you'll want to start a gait training programme tailored to the components selected for their new prosthetic solution.
When your patient is getting used to a new prosthesis, it's essential for them to learn how to trust their new leg. Focus on helping them regain their balance and build their confidence: start by explaining the functionality of the new prosthesis and the everyday motion sequences it supports — especially the prosthetic foot for TT users and the prosthetic knee for TF users.
Since the gait cycle is approximately 60% stance phase and 40% swing phase, stance phase is often the best place to begin when training new users. Many may struggle with a new asymmetry in their gait — a noticeably shorter stance phase for their affected leg. To help them overcome that challenge, focus both on controlling stance phase initiation and understanding how the device will swing once it begins to move.
Here are some exercises that can help your patient build both their strength and their confidence in their prosthesis:
Balance and weight-shifting
Help your patient get comfortable with their new prosthesis by starting with simple back-and-forth movements from their sound side to their affected side.
Overall strengthening exercises
Focus on the user's torso and affected leg, but also on achieving a balanced full-body posture when standing and walking.
Standing up & sitting down
Help your patient master these seemingly simple movements by showing them how to consistently balance the load on both their sound and affected side.
Stance phase training
Have your patient practice putting an even load on both their sound and affected side during the start of every step.
Activities of daily living (ADLs)
Spend lots of time on your patient's most common activities to build real-world confidence.
Resources
Watch on Ottobock YouTube.
The playlist Kenevo Gait Training for Professionals shows exercises in different Ottobock Kenevo A, B and C modes.
Open the playlist on YouTubeOutcome measures
Assessing your patient's progress.
For most lower limb amputees, a successful rehab process is one that returns them to their everyday life and work.
For a physical therapist or prosthetist, evaluating a patient's progress towards that goal requires a good understanding of the patient's mobility both pre- and post-amputation. Before-and-after comparisons are still one of the most effective ways to document effective rehabilitation — for patients themselves, for your clinic and especially for payers.
Below is a collection of instruments frequently used to assess and measure multiple dimensions of your patient's progress during therapy.
Performance-based tests
Three validated, standardised, performance-based tests can be used to assess both current mobility levels and improvement after therapy and training. Each can be used with all mobility grades, with little equipment and in a short amount of time.
Amputee Mobility Predictor (AMPPRO/AMPnoPRO) Test
Measures the ambulatory potential of lower limb amputees with and without the use of a prosthesis. An effective way to evaluate patient mobility prior to fitting and predict the level of functionality a user will achieve.
4 Square Step Test
A clinical assessment of dynamic balance and coordination by measuring participants' ability to step over objects forward, sideways and backwards.
Timed Up-and-Go (TUG) Test
A widely-used test to assess mobility, balance, walking ability and fall risk — particularly in older adults.
Patient-reported outcomes (PROs)
Three patient-reported outcome questionnaires that can be used to gather patients' own perceptions of their progress. While PROs often involve subjective ratings, these tools can still provide valuable diagnostic information for clinicians.
Activities-specific Balance Confidence (ABC)
A 16-item, self-reported evaluation of patients' confidence in their balance while performing various activities.
PLUS-M (Prosthetic Limb User Survey of Mobility)
A self-reported instrument for measuring the mobility of adult lower-limb amputees, focusing on the ability to move intentionally and independently from one place to another.
EQ-5D-5L
A descriptive self-reported assessment focusing on five dimensions of patients' quality of life: mobility, self-care, usual activities, pain/discomfort and anxiety/depression.
More back to mobility topics
Continue exploring back to mobility.
Pre-amputation preparation
A step-by-step guide on what to consider and how to prepare your patients and their relatives for a planned amputation.
Learn more ›
Post-amputation recovery
Take the right steps to set your patients up for successful rehabilitation back to mobility.
Learn more ›Prosthetic fitting
Prepare your patients for their first prosthetic fitting and restoring their mobility. Plus learn more about the components of a prosthetic leg.
Learn more ›
Back to life and refitting
Supporting your patients to resume their daily activities with their prosthetic leg.
Learn more ›Advance your skills with Ottobock.
Are you looking to maximise the outcomes you can achieve with Ottobock products? Talk to our team about clinician training, products and resources that support gait rehabilitation.
Contact us