Amputee Strengthening: Preparing for Your Prosthesis- Prosthetic Training: Episode 5

Summary

In this instructional video, David Lawrence introduces a series of pre-prosthetic exercises tailored for amputees, focusing on range of motion, motor activation, and strength. He emphasizes the importance of maintaining full joint mobility over strength, utilizing modified closed-chain exercises for functional impact, and tailoring exercises to gait-specific goals. The exercises progress from post-operative activation to advanced strength training, aiming to prepare patients for future prosthetic use and enhance their gait cycle efficiency.

Takeaways

• 🏋️ Pre-prosthetic exercises are categorized into postoperative, basic, and advanced levels, focusing on range of motion, motor activation, control, and strength.
• 🔄 Range of motion is prioritized over strength in pre-prosthetic exercises to prevent limitations in the gait cycle and future functional activities.
• 🔗 Modified closed chain exercises are recommended for their functional impact, using body weight effectively and safely post-surgery.
• 🚶 Exercise prescription should be gait specific, targeting muscle and joint movements that align with the patient's walking goals.
• 🛌 Post-operative exercises start with bed mobility, teaching patients to roll and transfer safely using their residual limb.
• 🤏 Motor activation exercises for the glutes and adductors are crucial for preventing contractures and ensuring proper muscle function during the gait cycle.
• 🧘 Basic level exercises progress to motor control, using variations of towel rolls or foam rollers to engage muscles like the glutes and abductors in a manner that mimics walking movements.
• 🏋️‍♂️ Advanced exercises increase difficulty by incorporating body weight and resistance, preparing the patient for the demands of walking with a prosthetic.
• 🤲 Core strength and control are integral, with exercises promoting pelvic rotation and stability to support a smooth gait cycle.
• 👥 Bilateral amputees require special attention to full hip extension for energy-efficient ambulation and the prevention of contractures.
• 🔄 For bilateral amputees, exercises emphasize the activation of extensors and adductors to counteract common contracture issues and enhance prosthetic control.

Q & A

What is the main focus of the pre-prosthetic exercises discussed in the video?

The main focus of the pre-prosthetic exercises is on range of motion, motor activation, motor control, and advanced exercises that transition the patient into strength work.

Why is range of motion considered more important than strength in the initial stages of pre-prosthetic exercises?

Range of motion is more important because maintaining full range through the joints allows for stronger functional activities and exercises in the future, whereas strength with limited range can limit the gait cycle and is difficult to improve later on.

What are the three primary concerns when establishing pre-prosthetic exercises according to David Lawrence?

The three primary concerns are: 1) Range of motion is more important than strength, 2) Modified closed chain exercises provide the greatest functional impact, and 3) All exercise prescription should be gait specific, tailored to the patient's future goals.

How do modified closed chain exercises benefit the patient in the context of pre-prosthetic training?

Modified closed chain exercises use body weight as resistance in a safe and effective way, allowing the muscles of the lower extremity to work best as they would in a closed chain, even though the foot is absent.

What is the significance of gait-specific exercises in the pre-prosthetic training regimen?

Gait-specific exercises are designed to target the muscles and joint angles that are used during walking, ensuring that the patient's training is directly relevant to their functional goals, such as walking with a prosthesis.

Can you explain the first post-operative exercise mentioned in the video and its purpose?

The first post-operative exercise involves the patient rolling to the sound side from a supine position, supporting the residual limb, and moving it through flexion and extension. The purpose is to maintain hip joint lubrication and mobility, which is crucial for bed mobility and future gait.

What is the purpose of activating the gluteal muscles post-operatively as described in the video?

Activating the gluteal muscles helps to ensure future range of motion and strength needed for the gait cycle, keeps the hip joint functioning, and helps to inhibit tight hip flexors, which are commonly problematic post-amputation.

How do the adductor muscles play a role in the post-operative exercises, and why are they important?

The adductor muscles are targeted to prevent abduction contractures, which are common issues for amputees. By activating these muscles, the exercises aim to counteract potential contractures and maintain proper functioning during the gait cycle.

What is the progression from basic level exercises to advanced exercises in the context of the video?

The progression involves moving from exercises that focus on motor activation and range of motion to those that emphasize motor control and strength. For example, starting with towel rolls for activation and moving to using body weight for resistance in more advanced exercises.

How do the exercises for bilateral amputees differ from those for unilateral amputees, as discussed in the video?

Exercises for bilateral amputees place a greater emphasis on full hip extension range of motion, stabilization, and the development of strength and power in the muscles, as these are crucial for successful ambulation without assistive devices or high energy costs.

What is the importance of prone positioning for patients with amputations, as highlighted in the video?

Prone positioning is important as it closely resembles erect standing, helps to reduce stiffness from prolonged supine bed rest, and is essential for working on hip extension, which is critical for energy-efficient ambulation.