Prosthetic Assignment

looking at our patient with the left, above the knee

amputation and a right below the knee amputation.

There are several gait deviations noted.

The first one I noted, was a decrease step length

on the right, secondary to a decrease stance time on

the left.

There also appeared to be limited in reflection with the

left prosthesis abducted and sir conducted gate on the left,

as noted by a wider base of support on the

left, lower extremity is planted.

I also noted a right trampling when she was in

los stance.

LTD left arm swing was noted, although this is likely

due to the use of a lobster and touch on

the right side.

Also a note there was limited hip extension on the

rate, a positive right from Gatlinburg, difficulty with turning and

difficulty with the initiation.

Patient causes of these gait deviations can include weak hip

abductors, weak hip flexors or balance, a lack of sensation

secondary to the amputation and use of a prosthesis on

both sides.

Lack of trust in the transfer moral prosthesis, global hip

weakness, habit and slow gait speed.

Prosthetic causes could include the poor fit of the prosthesis,

the prosthesis being too long inadequate reflection with the trans

femoral prosthesis and inadequate or faulty suspension.

These reasons will require consult with the process as far

as an impact on mobility and self care.

This patient may struggle with a wide range of things,

such as difficulty with emulating on uneven surfaces, stepping up

onto curbs, are stepping over small objects on the floor,

difficulty with stairs at home may be an issue if

she has them, or maybe an issue just in the

community, difficulty with her standing balance would impact her ability

to cook to clean, to do laundry as well as

many other household chores or activities.

Her sit to stand transfers and floor transfers may also

be impacted due to her potential weakness, lack of sensation

and poor balance or her treatment plan.

There are three key areas that need to be tackled.

The first would be bound streaming ideas for this include

weight shifts for bounds and increased confidence in her prosthesis

to bear weight, especially the trans femoral prosthesis.

This would he performed in standing in a regular stance

as well as on the diagonal single leg stance exercises

would also be beneficial for this patient, starting with seeing

how she does standing on one leg with a solid

surface in front of her for safety and doing this

exercise on both sides would be a good starting point

progressions could include motivations as well as standing on phone,

dynamic balance measures such as the tug and the FDA

would also be beneficial for this patient as the tug

incorporates six assistants and turns, and the FDA includes a

wide variety of stepping variation for strengthening and program would

include sideline abduction and trendy Ellenberger exercises to target the

weak hip abductors.

We would also incorporate standing marches, step ups, squats and

lunges to target weak hip flexors, incorporating some aerobic exercise

into her program would also be beneficial to improve her

endurance and cardiovascular fitness For this.

The new stuff for the stationary bike would be good

options for.

Finally, for gait training, we would want to incorporate high

intensity gait training R.

R. P levels of 14 to 19 in order to

improve gait speed and endurance with this patient practicing overground

with directional changes, sidestepping and stepping over small objects will

help improve the patient's ability to be a more successful

angular. Later practicing stairs as well would be a good

progression to allow her to become more functionally independent.

In a systematic review that I found 18 studies on

different methods of gait training were reviewed.

This review stated that overground gait training with manual and

verbal cues was beneficial for improving outcomes with this population.

This is something that would be important to incorporate into

treatment sessions with this patient, something important to keep in

mind with the systematic review, however, was that it was

noted that there needs to be more uh studies done

on this population so that we know more solid results

on.

Prosthetic Assignment

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