Prosthetic Phase (2) Flashcards
what is an important part of rehab
gait training
assists in pulling all skills together (balance, strength, prosthetic control)
how do we begin gait training
begin with parts of gait (partial practice)
work towards whole skill
ground practice
good for specific skills like balance and prosthetic control
treadmill practice
works to pull skills together
good for long term conditioning and home use for “lifelong care”
sequencing of gait training
balance exercises
weight shift
control
ambulation
endurance (treadmill)
what should gait training include
hills, ramps, inclines
hills, ramps, inclines
lateral ascent/descent
lateral ascent/descent
beginner
intermediate
expert
beginner lateral ascent/descent
intact side always facing uphill
uphill: w/ sound side leading
downhill: with prosthetic side leading
intermediate lateral ascent/descent
zig zag/diagonal
expert lateral ascent/descent
face hill and negotiate
verbal cue for pt to decline
difficult to do step over step if steep
goals at the end of prosthetic phase
be independent in
-donning and doffing
-exercises
-ambulation w/ or w/o an AD
-ADL activities
main differences b/w K1 and K2
obstacles navigated in daily life
ability/need to be limited community ambulatory
variable cadence is not required at either of these levels
what does the pt need to advance from K1 to K2
obstacle training
improvement of physical limitation
gait specific training
what must training for K1-2 include
obstacle training
curbs, stairs, uneven surfaces, inclines/declines
general rules of training –> K1 to K2
up with good
large inclines/declines benefit from the ability to step-step upwards
reciprocating downstairs possible but not necessary (TT)
what should we consider –> K1 to K2
ROM
strength
balance
gait
ROM –> K1 to K2
hip
prone extension
knee extension
promote manual techniques
contract relax
encourage full ROM, esp extension
promote manual techniques –> ROM –> K1 to K2
joint mob of hip and knee, sacrum and L/S
hip anteriorly to get into extension, posteriorly to have femoral head sit back in the socket
strength –> K1 to K2
hip extensors, ABD
for TT: knee extensors
balance –> K1 to K2
prosthetic leg stance phase
balance progression
biofeedback
gait –> K1 to K2
pelvic initiation
step length (increase it)
“breaking” the knee joint (control TT, TF)
main differences b/w K2 and K3
ability/need to be an unlimited community ambulator
variable cadence is required
what does the pt need to advance –> K2 to K3
previous rehab program (strengthening, stretching, balance)
addition of gait focus
addition of gait focus –> K2 to K3
components (quality of gait, step length, cadence variation, gait speed)
putting it all together
how are ADs and K-levels determines
physicians
prosthetist
PT
physicians –> AD and K level
must be in their notes
recommendation from PT
recommendation from PT –> AD and K level
fxnal capabilities and long term prognosis
prosthetist –> AD and K level
AMP
notes to MD
PT feedback
PT –> AD and K level
recommendations
notes are critical
AMPPro
K1 –> K2
no w/c to the MD visit
K2 –> K3
no walker to MD visit
