Definition:
An unfinished functional replacement for an amputated limb fitted and aligned in accordance with sound biomechanical principles, which is worn for a limited period of time to accelerate the rehabilitation process
Advantage of Early Prosthetic fitting
Early Prosthetic Fitting: A procedure in which a preparatory prosthesis is provided for the amputee immediately after removal of the sutures.
- Early prosthetic fitting plays a significant role in a rehabilitation success. The prompt and correct application of compression to the residual limb, together with appropriate therapy have a positive impact on the individual’s rehabilitation process.
- 2.As a temporary fitting, emergency prosthesis is a useful mean to bridge the period between early and definitive fitting. It is frequently used for several weeks or months until the stump has stabilized before the permanent prosthesis is provided.
- 3.A trial fitting can serve to objectively determine when and whether the individual will regain the ability to stand upright and walk.
Considerations
- Emergency Prosthesis must allow to put upright an amputee as soon as possible after scarring of the stump and to prepare for the definitive prosthesis.
- It must allow production of a large number of prosthesis in a short time, such as after natural disaster, in a context of war or post conflicts.
- The technique of Emergency Prosthesis makes it possible to manufacture the socket with out a positive casting mould.
1.The prosthesis takes into consideration:
2.Speed and carry out simplicity of fabrication
3.Minimum equipment required
4.Reliability
5.Price
6.Weight
Physiotherapy for Emergency Prosthesis
The preparation of the stump before fitting remains a preliminary and essential stage.
The therapy goals following amputation are:
1. Stump shaping
2. Desensitization
3. Skin mobility
4. Maintaining good range of motion, preventing or reducing contracture
Stump Shaping
What is stump? The stump is the bone and surrounding muscle tissue left after amputation. Another term is residual limb.
The length of the stump is determined by the length of the bone where the cut is made and the quantity of the skin and muscle tissue left to cover and protect the bone.
Elastic wraps work best for stump shaping. Some times a stump “ Shrinker” is used in place of wrapping after the incision is well healed.
What is a stump shrinker? A sturdy elastic cone shaped sock that pulls on over the stump and applies pressure. It replaces the elastic wrapping.
When do we begin wrapping?
Wrapping should begin on day after the surgery or as soon as possible. We must be very careful not to wrap it directly on the wound if it is not healed. This may cause infection. The wound should be protected by a clean bandage. Then the wrapping is done over this. Wrapping may be needed daily for years.
Desensitization
Decreasing or lessening sensitivity.
The stump often is very sensitive following surgery. There are different techniques for desensitization.
• At the beginning you can tell your patient to gently touch their stump with firm pressure just after amputation. Take care that don not put their hands directly on the wound. A bandage or dressing may be placed over the incision before beginning the desensitization techniques.
• Once they can tolerate the gentle touching, you can try brushing with soft cloth. Pressure can increase as the patient can tolerate it.
• When they can tolerate the gentle brushing with soft cloth, you may then begin gentle tapping of the skin. Intensity can increase as the patient can tolerate it.
Caution: Be careful not to interfere with the healing in the acute (early ) phase before stitches are removed and the incision is completely healed. Begin after this phase.
Skin Mobility
• Skin mobility
We are talking about the skin around and over the incision. We also are talking about the skin over the bones of the stump. It is important not to allow this skin to become stuck by scar tissue to the underlying bone. This restricts normal skin movement over this underlying bone. Why is this a problem? This causes abnormal pressure and rubbing of this skin and bone against the inside of the socket of the prosthesis.
• How do you keep the skin mobile?
Over the bone:
Use your thumbs to press down gently but firmly and move the skin in small circles over the underlying bone. Move the skin over the bone. Be certain that you are not just rubbing over the skin!!!
Around an incision:
Use your thumbs, one on each side of the incision, and move the skin side to side, and around in circles, making sure to move the skin over the tissue underneath. Make certain that you are not just rubbing the skin!!!!
Caution: Do not begin before the incision is healed Do not push too hard.
This can be done only when the wound is closed and well closed!! You do not want to open it.!!!! It is usually healed three or four weeks after the surgery. Ask the doctor if your are not sure.
Maintaining Good Range of Motion, Preventing or Reducing Contractures
• What are the causes of contractures?
Contracture happens when tissues around an articulation become stiff. It could be the muscles, joint capsule, tendons, skin, etc.
• Pain may prevent patient from moving and may cause patients to adopt bad postures. A good example is when a patient with an above knee amputation keeps his limb flexed on a pillow to protect it. He can have difficulty to extend his hip later.
• Another cause of contracture is an imbalance in muscles strength. Because some muscles are cut during the amputation, those muscles can become weaker and stronger muscles can then pull harder and keep the limb always in an abnormal and tightened position For example, if the hip adductors are weakened, the hip abductors may pull the leg into a resting position of abduction more easily.
Common contractures in standing
Guide Lines for fabrication of Emergency / Temporary Trans Tibial Prosthesis
Components
Prosthetic foot
Emergency kit
Socket
Suspension belt
Fabrication of Socket
Tools/ Equipment & Raw material Quantity Unit
1 Surgical Gloves 3 pair
2 Cotton cap 3 Pc
3 Plastizote (6mm) 50x30 Cm2
4 Glue 100 Gm
5 Paper cup 1 Pc
6 Glue brush 1 Pc
7 Cellofene 1 Roll
8 Scissor 1 pc
9 Knife 1 pc
10 Indelible pencil 1 pc
11 Powder talc 50 Gm
12 Dynacast roll 5 pc
13 Basin 1 pc
14 Oscillating cutter 1 pc
Fabrication of Socket
Measurements:
1. Take measurements from the amputated side from patella tendon to the distal end of the stump while the patient is seated with knee flexed at 90 degree.
2. Measure the circumference of the stump at the level of patellar apex, distal end of the stump and mid of the stump.
Remarks: This technique of manufacturing does not use the principle of casting, Measurements taken are used to follow the stump up to stabilization.
3. Take the measurements of the healthy leg from patella to ground.
4. Take the size of healthy foot for the choice of prosthetic foot.
5. Measure the heel height of the shoes which will be used by the patient.
Preparation of Stump
• Slip the cotton stockinet on to the stump.
• Mark the wt:sensitive areas i.e.
Fibular head
Tibial crest & tubrosity
Stump end and any other bony prominence
• Cut 6mm plastizote according to the mentioned areas. Chamfered and then glue these patches. On the stump glue 12mm plastizote.
• 12mm plastizote, 10 cm wide and length according to the circumference of the stump at the patella level + 5cm extra, is to be glued on the level of patella and condyles.
Modeling of the socket
• Wrap the dynacast roll on the stump. The application of the dynacast band should be done by exerting a light tension.
• Apply pressure at the wt. bearing areas and give shape to the patella.
• Ensure maximal cohesion between the layers, to smooth the socket with moist gloves.
• Let it dry for 10 min.
Further Procedure
• Release of the cast
• Check socket
• First try on the amputee
• Division of the socket
• Assembling
• Alignment
• Application of belt.
• Fitting of the prosthesis to the patient.
• Gait training
The person with Emergency / Temporary Trans tibial prosthesis
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