Getting Up Off of the Floor: Floor to Stand Transfer for Bilateral Amputees- Prosthetic Training:Ep9

Summary

In this instructional video, David Lawrence demonstrates safe techniques for individuals with bilateral prosthetic limbs to get down to and up from the floor. He covers initial steps, transitioning to a hands and knees position, and leveraging furniture for support during the process. The video emphasizes the importance of taking time, checking prosthetics for alignment, and using proper body mechanics to avoid injury. It also addresses the challenges faced when falling in public and the need for self-assistance over hasty help from others.

Takeaways

• 🧍‍♂️ Practice getting down to the floor safely first to ensure you can also get up safely.
• 🛋️ Start practicing on a low surface like a sofa or mat table to simulate a safe environment.
• 🔄 Bring the close leg back and roll the hips to slide off the sofa into a kneeling position.
• 🐛 Crawling on prosthetics is possible and can be a method to move if getting up is difficult.
• 🛑 After falling, take a moment to assess your condition and ask bystanders for space to get up independently.
• 👀 Check prosthetic feet orientation before attempting to stand to ensure they are properly positioned.
• 🦶 Reset prosthetic limbs if necessary before attempting to get up to avoid further injury.
• 💪 Get to a position of power by being on all fours to prepare for standing up.
• 🛋️ Use a higher surface like a sofa to help with the process of standing up by leveraging it for support.
• 🚶‍♂️ For higher-level patients, straighten one prosthetic to create a stable base and shift weight to stand.
• 🤝 Direct traffic when people want to help, instructing them not to pull but to provide stable support.
• 👥 Remind patients to communicate their needs to bystanders and not to rush the process of getting up.
• 🔄 For below-knee amputees, the process of getting down and up involves similar steps but with attention to the integrity of the prosthetic suspension.
• 🚑 In case of a fall with no surface to hold onto, the process is more strenuous and requires more energy and effort.

Q & A

What is the primary focus of David Lawrence's video?

The video focuses on demonstrating and explaining how individuals with bilateral prosthetic limbs can safely get down to and up from the floor.

Why is it important for bilateral amputees to learn how to get down to the floor safely?

It is important for bilateral amputees to learn this skill so they can perform tasks on the floor safely at home and also know how to get up from the floor if needed.

What is the recommended starting position for practicing getting down to the floor with prosthetic limbs?

The recommended starting position is on a low surface like a sofa or a mat table, with the patient facing the direction they will roll back towards.

How does the process of getting down to the floor begin for a bilateral amputee?

The process begins by bringing the close leg back, rolling the hips onto the sofa, and sliding backwards into a position on the knees.

What is the term used to describe the position where the patient is on their hands and knees?

This position is referred to as the 'position of power'.

Why is it suggested to not rush to get up after falling flat on the back?

It is advised not to rush to get up to allow the heart rate to stabilize and to assess the situation, ensuring that the prosthetic limbs are correctly positioned before attempting to stand.

What should a bilateral amputee check after falling and before attempting to stand up?

They should check the orientation of their prosthetic feet to ensure they are facing the ceiling, which indicates that the prosthetics are properly positioned.

How can a bilateral amputee with weak strength get up from the floor without using their arms?

They can get up by angling towards a surface like a sofa, getting their hips up on it slightly, and then rolling and pressing up into a seated position.

What is the benefit of being able to crawl on prosthetics for a bilateral amputee?

The ability to crawl on prosthetics is beneficial as it allows the patient to move towards a higher surface, which can provide more leverage for getting up.

What advice is given to people who want to help a bilateral amputee who has fallen?

The advice is to let the amputee direct the assistance, not to yank or pull on them, and to stand nearby ready to offer stable support as needed.

What is the main concern when a bilateral below-the-knee amputee kneels on prosthetics with a sleeve suspension?

The main concern is that the front wall of the prosthetic may press into the rubber, potentially cutting a hole and causing loss of vacuum control.

How can a bilateral amputee ensure they have a stable base when standing up from the floor?

They can ensure a stable base by straightening out one prosthetic leg completely, shifting their weight towards it, and then locking out the other prosthetic leg.

What is the purpose of the video series on prosthetic interventions mentioned by David Lawrence?

The purpose of the video series is to provide a range of information and techniques on managing the residual limb after amputation and using a prosthesis for various activities, including running.

Outlines

00:00

🦿 Safely Getting Down and Up from the Floor with Bilateral Prosthetic Limbs

David Lawrence introduces a tutorial on how individuals with bilateral prosthetic limbs can safely lower themselves to the floor and rise back up. He emphasizes the importance of practicing this skill for situations at home or when a transfer to the floor is necessary. The process involves starting on a low surface like a sofa, using the close leg to roll back, sliding off the sofa onto the knees, and then transitioning to a hands and knees position. Lawrence also covers the ability to crawl on prosthetics and the correct way to get up from a lying position, including checking the prosthetic feet orientation and resetting if necessary, moving to a 'position of power', and using the sofa to assist in standing up without putting pressure on the prosthetics.

05:02

🤔 Dealing with Falls and Anxiety with Bilateral Amputees

The second paragraph focuses on the psychological and practical aspects of falling and getting up with bilateral prosthetics. It discusses the common scenario of falling in a crowd and the associated anxiety and rush to stand up. Lawrence advises taking time to recover and directing bystanders on how to assist properly without causing harm. He demonstrates the process of getting up without external support, starting from a stable base, shifting weight, and using the prosthetics to stand up. The paragraph also covers the importance of checking the prosthetics for any issues after a fall and the potential complications with different types of suspension systems in prosthetics.

10:05

📚 Comprehensive Guide on Prosthetic Interventions and Resources

The final paragraph serves as a conclusion and a call to action for further learning. It mentions that the video is part of a series on prosthetic interventions, covering a range of topics from managing residual limbs to running with a prosthesis. The paragraph encourages viewers to watch other videos in the series, share them, and subscribe to the YouTube channel for updates. It also invites viewers to interact with the content through likes, comments, and shares.

Keywords

💡Bilateral amputee

A bilateral amputee is an individual who has lost both of their limbs, typically referring to legs in this context. This term is central to the video's theme as it focuses on techniques for such individuals to safely get down to and up from the floor using prosthetic limbs. The script describes various maneuvers and safety considerations for bilateral amputees, such as starting on a low surface and ensuring their prosthetics are correctly positioned before attempting to stand.

💡Prosthetic limbs

Prosthetic limbs are artificial replacements for missing limbs. In the video, they are essential for the mobility and independence of the bilateral amputees. The script demonstrates how to use these prosthetics for tasks such as getting down to the floor safely and getting back up, highlighting the importance of proper alignment and functionality of the prosthetics during these processes.

💡Transferring

Transferring, in the context of the video, refers to the act of moving from one position or surface to another, particularly for individuals with physical limitations. The script outlines specific techniques for bilateral amputees to transfer from standing to sitting on the floor and vice versa, emphasizing the importance of safety and control during these movements.

💡Position of power

The 'position of power' is a term used in the script to describe a stable, all-fours position that provides a strong base for the individual to push off from when getting up from the floor. This position is crucial for the video's theme as it is a common starting point for various techniques shown to help amputees rise from the ground using their prosthetics.

💡Safety

Safety is a primary concern throughout the video, as it discusses methods for bilateral amputees to perform floor transfers without risking injury. The script repeatedly advises against rushing and emphasizes checking the prosthetics for proper alignment and functionality before attempting to stand, ensuring that the individual is secure and stable in their movements.

💡Crawling

Crawling is mentioned in the script as a potential method for a patient to move if they are having difficulty getting up. It is an alternative means of locomotion that can be used by individuals with prosthetics to navigate short distances or reach higher surfaces, showcasing adaptability in mobility for bilateral amputees.

💡Blood pressure

Blood pressure is the force exerted by circulating blood on the walls of blood vessels. The script advises individuals to take time to stabilize their blood pressure after a fall, as a rapid change in position can cause dizziness or lightheadedness. This is particularly important for individuals with prosthetics, who may need to adjust to changes in posture more carefully.

💡Vacuum control

Vacuum control refers to the seal between the prosthetic socket and the residual limb, which is crucial for the fit and function of the prosthetic. The script warns that kneeling on prosthetics with certain types of suspensions could compromise this vacuum, leading to potential issues with the prosthetic's fit and the individual's mobility.

💡Residual limb

A residual limb is the remaining part of a limb after an amputation. The video series, of which this script is a part, covers a range of topics including managing the residual limb after amputation. Although not explicitly detailed in the script, the proper care and management of the residual limb are essential for the fit and function of prosthetics, which is a broader theme of the video series.

💡Pin suspension

Pin suspension is a type of prosthetic fitting mechanism that uses a pin to attach the prosthetic socket to the residual limb. The script mentions it as a non-issue for kneeling on prosthetics, suggesting that this type of suspension is robust and less likely to be compromised by the pressure exerted during such movements.

💡Elevated vacuum

An elevated vacuum is a type of prosthetic suspension that creates a vacuum seal between the prosthetic socket and the residual limb. The script warns that this type of suspension might be at risk if the individual kneels on the prosthetics, as the pressure could potentially damage the vacuum seal, affecting the fit and function of the prosthetic.

Highlights

David Lawrence demonstrates methods for bilateral amputees to safely get down to and up from the floor.

Starting on a low surface like a sofa or mat table is recommended for practicing transfers.

Bilateral amputees can roll their hips and slide backwards to get onto their knees.

Crawling on prosthetics is a viable option for mobility on the floor.

When fully on the floor, it's advised to take a moment before attempting to stand up.

Checking the orientation of prosthetic feet is crucial before attempting to stand.

Achieving a 'position of power' on all fours facilitates easier standing.

The importance of not rushing to stand and the potential need for readjusting prosthetics after a fall.

Using a sofa or mat to assist in standing by angling and rolling towards it.

For those with more strength, a method to stand without leaning on an object is presented.

The strategy for standing involves straightening one prosthetic leg and shifting weight before locking out the other.

The psychological aspect of falling and the anxiety it can cause in public spaces.

The importance of directing help from bystanders and not allowing them to pull or yank during standing.

Practicing with a partner to ensure stability and gradual release of support.

For below-the-knee bilateral prosthetics, the process of getting down and up from the floor is detailed.

The risk of damaging the prosthetic suspension when kneeling directly on the floor.

The video concludes with a reminder of the importance of technique and safety when using prosthetics.

Transcripts

Hi, I'm David Lawrence,

and in this video I'm going to talk about and show you how to get down to an up

off of the floor with bilateral prosthetic limbs.

For working with a bilateral amputee,

getting transferring to the floor and from the floor.

The first thing really want to practice is how to safely get down to the floor.

That's also so they can practice getting up,

but also at home if they need to get on the floor to get to something they know

a safe way to do that. Where do you want to do it? Start on a low surface.

Something like a sofa or a mat table like this.

Put the patient in a position where they're facing. Try to bring the,

the close leg, the direction they're going to go back towards them.

Yeah.

Here you go.

He's going to bring his other leg over the top and simply roll his hips on the

sofa. So we still got all his weight on the sofa. From here,

he can just slide backwards.

So we just basically slides off the sofa into a position where he's on his

knees.

From there Robert I'm going to have you turn and get to your hands and knees

and you'll notice in this position,

Robert can actually crawl on the prosthetics.

That's really important because if a patient needs to get up and they're having

a hard time getting up,

knowing that you can crawl half a mile you had to to get to a higher surface,

it is possible. But from there Robert,

and have you come all the way down onto your back.

There you go.

And what I like to tell the patients is what I want to simulate here is the

actual full wipe out. You have completely gone down, flat on your back.

The first thing you want to do when you get up is don't rush to get up.

Give yourself a second. Your heart's beating hard.

Give yourself a second to kind of get your bearings right and if there's people

around you tell them, "Please just let me do this.

I'll let you know if I need some help." But the first thing that Robert's going

to do is get up to a sitting position, but don't stand up.

Look at his feet and make sure both prosthetic feet are facing the ceiling.

If they're not,

that means something may have come loose and that may have been when he fell or

because he fell. So at this point he wants to look at that.

If something isn't straight,

he needs to reset his prosthetic and try to get it on straight. If it is,

the next thing he needs to do is get to the position of power.

And that's basically getting to all fours.

So Robert's going to take one leg and cross over the other,

turn over to his hands and knees and he's into a position of power.

Again, here he could crawl, he could get himself someplace,

but let's say Robert's quite weak and he's gonna have a hard time pressing

himself up. So even your lowest level patient can get to here,

get their hands up on the sofa and nothing else. Get up on his knees. Like this.

Pressure down into the prosthetic socket is no different if you're kneeling or

standing. So in the sockets, the patient doesn't worry,

it's not going to feel different. It's the same pressure.

But getting his head up allows him to kind of equalize his blood pressure a

little bit and not feel so much pressure on his head from being in head down

position. If he feels okay about that,

the next thing he's going to do is get closer to the mat or as close as he can

on a bit of an angle to the sofa,

kind of angling towards me a little bit and as much as possible,

he's going to get his hips up on the sofa just a little,

and then roll towards away from there.

You go and press right up into a seated position. At that point,

Robert never had to stand up, never had to lift himself off the ground.

He let the sofa do the work. From here he's just doing a sit to stand transfer.

So if our patient has fallen,

but they have a little more strength to really push themselves up,

I'm going to show you how to now get fully up from position where he may not

have something to lean on or lay on, but just something to hold onto.

So first thing patient's going to sit up,

he's going to look at his legs to make sure his feet are facing the ceiling.

If that looks good,

he's going to cross his leg over and get to the position of power,

which is onto all fours. And this position, again, he could crawl,

kneel on these prosthetics, any length that he needs to,

if he can get his hands to a higher position. Again,

it just lets him kind of stabilize for a second.

From there to get up what Robert wants to do is straighten out one prosthetic

completely. So he has a full stable base.

Shift his weight towards that prosthetic while he locks out the other prosthetic

brings them in and kind of walks him right up underneath him.

So if a patient's standing getting down to the floor,

one of the benefits or or that Rob points out on a bilateral above knee amputee

is the hamstrings are not connected.

So if Robert wants to get down to the floor, he can simply,

go ahead and demonstrate Robert, lean forward, put his hands on the floor.

From that position,

he can bend those knees and ride the hydraulic down into the base position and

come all the way down to the floor. Now if Robert's going to get up,

and again at a higher level, what he's going to do is the same principle,

get himself to the power position, which is on all fours,

cross that leg over. So it's uncrossed when you get to your all fours.

From here, Robert's gonna lock out one leg, shift his weight to it,

lock out the other leg,

pushes weight back to the prosthetics and come up to standing.

So one of the biggest things is most times people fall,

they fall in a crowd and there's people around. So there's anxiety,

there's fear, there's I want to get up as fast as possible.

So always remind folks that take their time and then also direct traffic.

So many people are going to want to help and they'll usually come up and say,

Hey, I can help you grab onto their arm and pull on them or yank them different

directions. Really important if you train the patient well,

patient as a patient needed to say to that, people around you,

"Please just stop. Don't yank on me. I can do this. Don't go away.

Stand here near me. But let me tell you what I need.

Please don't pull on me cause I have a technique." So Robert,

I'm going to have you come around to your position of power that you would

normally do.

Now from here, Robert wants to get up.

All I want to do is be close to Robert and stand as stiff and as stable as

possible.

So if Robert needs my help he can put his hand on me to come up.

But at the same point he can find stability. The mistake.

A lot of people make the help as they quickly. Then once he's up, break loose,

I want to keep my hand on Robert until he,

lets go of me now you notice I didn't have to pull up much when he lets go with

me and feels more stable, I'm good.

But if it he's just got up and his heart's still beating and I let go of him

quickly. He could easily lose his balance and fall again.

So if we're practicing getting off of the floor with bilateral prosthetics below

the knee. The process here is first how to get down to the floor safely.

So at home you're going to have a patient pick a surface like a sofa or

something that's fairly low. Scoot themselves forward on that sofa.

Bring the close leg back, a little bit,

lot of weight on the hands and she's just going to slide down onto her knee.

That way she's not very far but gets right down onto her hands and knees.

From there I want her to come all the way down on her stomach and then her back.

There you go.

She's in a position as if she had the full wipe out the complete wipe out I'm on

the ground down and out.

The first thing that patient wants to do is don't rush to get up. Take a time,

a second to just let your heartbeat kind of calm down for a second.

If there's people around you let them know just I'm good. No problem.

I'm going to sit up here,

I'm going to look at my legs and this is the first thing.

Look at her feet to make sure they're straight up in the air. If they are,

you know the prosthetics are on,

but when she fell she may have twisted and dislodged or the prosthetic partially

came off so she'll want to re-donn that prosthetic before she gets up or she may

find something broke. If something did break,

she's going to need to let someone know she's going to need a lot of help to get

up and she'll need a wheelchair or something cause you won't be able to walk on

the prosthetic. If we're in this position though, they're facing the ceiling.

I just want Carol scoot away from me a little bit.

Cross her left leg over the right, turn. As she cross turns,

her legs become uncrossed, which is in the position of power,

which is on all fours. From this position,

she could crawl anywhere she needed to to get to a surface higher than her.

Higher surface will really give her more power to get up.

So let's assume we have a surface here.

You're going to turn towards this surface,

get your hands up on the surface and then as quickly as possible,

get your head upright and just take a few deep breaths because as soon as her

head's up higher,

her blood pressure can kind of start to stabilize a little bit and not have so

much pressure in her head. Once she's there,

she's going to bring one leg into a position into a high kneeling. There you go.

Once she's stable, lean forward into the mat.

Press in hard as she presses the other leg out straight.

As soon as it gets straight,

lean back into it a little bit because it's locked out and step back.

There you go. And then bring both feet into a stable position.

Once she's stable, she can come around, have a seat. All right,

let's say our patient's fallen and now they've got themselves to the position of

power but there's nothing around the grab onto so it has to try to stand up out

in the middle of the parking lot.

This takes a lot more energy and a lot more effort.

To do it though the mechanism starts the same.

Pick that right foot up and bring it forward.

Get it into a good stable position wherever she feels good about it.

Hands and on the ground.

Weight forward as she tries to straighten out her back leg. There you go.

And the press her way back into it. Hand on the knee and pressed upright.

Push up tall, push up tall, push up tall.

There you go.

Not easy to do.

So when we're transferring with bilateral below the amputation or even single

below the knee amputation, the concern is always this top wall.

You can kneel on prosthetics, no problem. If you have a pin suspension,

this is a a non issue.

If you have a sleeve suspension of some sort of elevated vacuum,

you can certainly do this.

The problem will be when this front wall presses into that rubber,

it's likely to cut a hole in it. If it does an elevated vacuum,

you've lost some of your vacuum control, so know, if you need to get up,

that's what you're going to need to do the exact same way.

There's only way to get up, but at that point in time, once you're up,

you have to know that likely as the legs may have some pistoning or some slip

because you've lost some of your vacuum.

Thanks for watching and we hope that you found this helpful.

This video is part of a series on prosthetic interventions ranging from managing

the residual limb after amputation to running with a prosthesis.

We encourage you to view our other videos in this series and to share them as

well.

You can find them on our YouTube channel at YouTube.com/MissionGait .

To stay up to date on our latest content,

click the link in the corner to subscribe and be sure to like comment and share

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