Prosthetic Fitting after
Characteristics of amputated limb
which can functional well in prosthesis
Well padded by soft tissue
Non adherent scar
Greatest bone length
Prosthetic Rehabilitation Following
Phases of Rehabilitation
Acute Post Surgical Phase
Pre- Prosthetic Phase
Prosthetic Prescription and Fabrication
Prosthetic Training Phase
Functional & follow up Phase
Amputation Surgery to Suture
Promote wound healing
Control incisional and
Maintain joint(s) ROM
Promote positive nitrogen
Mobilize entire body
Promote Wound Healing
1-A superficial skin defect can usually be closed adequately
with a Split –thickness skin graft (STSG).
2-Full –thickness defect over bony prominence is better
handled with full –thickness coverage (either with local
flap, pedicle flap, or free island flap).
Physical therapy can enhance wound healing and reduce
associated complication (such as development of
hypertrophic scar) through using low level laser therapy
(LLLT) (Helium neon laser therapy and or Gl-Al-Ars), with
following treatment protocol;
Control Incisional and Phantom
1-It is a natural part of any surgical procedure
where skin subcutaneous tissue, nerve and
muscles have been cut .It usually goes away
when swelling reduced and healing occurs.
2-Incisional pain should be controlled with
adequate amounts of narcotic preferably given
intravenously on regularly prescribed dose basis.
This is usually helpful for the first three
postoperative days. Subsequently oral analgesic
should be adequate if there are no other sources
of significant pain
Control Incisional and Phantom
1-This is a pain in the missing or amputated part of the
limb. It varies tremendously from person to person .It
can include burning, tingling, squeezing and cramping,
shocking, and shooting description.
2-Phantom pain should be explained to the patients
since they occur in the early postoperative period.
3-The patient should expect that phantom pain
sensation and phantom limb changes and usually
diminished, and may be become long term problem.
4- Use of oral pain medication for significant phantom
pain has not usually produced adequate pain reduction
over period of time exceeding one week.
Control Incisional and Phantom
This is sensation or feeling in the part of the
limb that has been removed. it include itching ,
tingling , warmth, cold, cramping , constriction ,
movement, and any other imaginable sensation ,
and all persons with limb loss experience some
Rresidual limb pain:-
This kind of pain occurs in what is left of
your natural limb after the amputation, as the
residual limb always is more sensitive than other
parts of body.
Maintain Joint ROM &Strength
1-Positioning is an important part of a patient's exercise program. It
is done to prevent shortening of soft tissue and joint(s)
contractures, that can result from ;
(i) Soft tissue shortening .
(Ii) Muscle imbalance.
(iii) Protective withdrawal reflex.
(iv) Faulty position.
3-If possible patients with an amputation should lie prone
intermittently to enhance hip and knee extension, however care
should be taken to avoid over stress on cardiovascular system
during assuming this position.
4-The positioning program should emphasize active or active
assistive ROM of the joint (s) proximal to the amputation.
5-Elevation of residual limb on a pillow can lead to the development
of hip flexion contracture and so should be avoided.
Lying supine: make sure that hips and knees are
straight, the patients should lie on a firm surface
and avoid pillows under the residual limb. The legs
should be held close together.
Lying prone; pillow should be avoided under the
hip and the hip should be kept straight, and the leg
close together. The patients should lie prone or on
wither side for up to 15 minutes, four times a day.
This position will extended the hip and knee
Side lying; the hip should be kept in a neutral position. The patient should not sleep with large pillow between the legs or
under the back .Pillow in these positions enhance hip flexion and abduction.
Sitting: when sitting patients should use a sliding
board or other firm surface under the residual limb
to promote knee extension.
1-The exercises program is designed individually and
includes ROM, exercises, isometric, isotonic, and
endurance activities, and these dependent largely on
2-This exercise should not produce more than mild
discomfort and put less stress on suture line,
otherwise stop exercises.
3-The hip extensor, abductors and knee extensor and
flexors are particularly important for prosthetic
4-Strengthening exercise for upper extremity muscles
of shoulder depressor, elbow extensor, wrist extensor,
and hand flexor should encouraged, with general
strengthening program for trunk and abdominal
5-The program should emphasize active or active
assistive ROM of the joint (s) proximal to the
amputation, at 1st to 2nd day postoperative.
6- Active motion of all proximal joints through the full
ROM should be obtained by 10 -14 days following
amputation unless grafting procedure precludes
7-Gentle isometric exercises can be started at the 5th
* A brief repetitive isometric exercises (BRIME), regimen is
an extension of the original isometric .A patient with an
imputation may use this regiment which consists of up to 20
Each held for 6 second (Why?).
A 20 seconds rest after each contraction is recommended
Rhythmic breathing during the contraction is recommended
* Multiple angle isometric exercises should be performed.
8- Isotonic exercises can be encouraged at 7 -10 days
9-Program of muscle contraction and joint motion (8-10
repetition for 3sets) should be repeated several time daily (4-6
times), and once when adequately performed no need for
10-These exercises help to
(i)-Reduce edema, and promote healing.
(ii)-Maintain joint ROM,
(iii)-Prevent contracture and correct existing
(iv)-Allow early mobility self care and
(v)-Maintain muscle strength, and kinesthetic
sense of residual and phantom limb, which can
later be used in prosthetic training
Exercises for post-burn amputation
*Lie supine on firm matters,
with towel placed under the
residual limb; the residual
limb is pressed firmly into
the towel, raising the
buttocks off the resting
*Bridging: lie supine with
sound knee 90degrees of
flexion, with foot is pushed
down into the resting
surface. The residual limb
should be raised until both
hips are of equal height.
* Lie prone; lift the leg off
the mat, at time with knee
*Lie side on amputated side, with towel under the residual limb. The sound limb rested
in pillow, stool in front of residual limb. The residual limb is depressed down on the
*Lie side on sound side, raising the residual limb, with weight around the distal tibia.
*lie supine with rubber banding around the distal end of both limb, the patients pulls
the residual limb away from sound limb.
*Straight leg rising
*Short arc quad sets
*Lie Prone; the patient is prone
with towel under the residual limb.
the distal residual limb is pushed
into the towel , and extended the
*Lie supine, with a towel under
the residual limb, the patient
pulls back into the towel, slightly
bending the knee.
*Lie prone and flex the knee
Pre-Ambulation Exercises Program
Parallel Bar and Ambulation Activities
Returning Parallel Shift
Stepping Activitie Lateral
Forward s Weight
Push up Hiking
Walking with crutches
(For persons with single leg amputations
First move the crutches forward about (30 cm).
Step forward with your residual
limb/prosthesis. Land it between your crutches.
Lift your natural limb and step to, or past the
Going up stairs:
Step up with your natural limb first. Then bring
your crutches and residual limb/prosthesis up.
Going down stairs:
Don’t hop. Move your crutches down first, then
step down with your residual limb/ prosthesis.
Lastly, step down with your natural limb.