Early Rehabilitation Training for Patients with Transfemoral

Amputation before Wearing Prosthesis

Lu Bai

School of Biomedical Engineering, Capital medical university, Beijing,100069, China

Keywords: Transfemoral Amputation, Rehabilitation, Deformity Prevention, Prosthetic Adaptation.

Abstract: Due to trauma and disease, the number of patients with transfemoral amputation is increasing year by year.

Exploring early rehabilitation methods for transfemoral amputation is becoming more and more important.

After finding the problems and consulting multiple documents, I found several methods for the problems.

Early rehabilitation training can not only meet the appearance needs of patients with transfemoral

amputations, but also provide preliminary preparations for patients before wearing prostheses. It can also

prevent or reduce the occurrence of deformities, and reduce training obstacles and training time for patients

when wearing prostheses.

1 INTRODUCTION

The number of amputations caused by trauma or

disease is increasing year by year. The amputation

will not only bring personal and physical trauma to

the individual, but it will also deal a heavy blow to a

family. Although early rehabilitation treatment and

prosthetic adaptation can help amputees return to

society early and resume activities of daily living as

soon as possible. However, due to the limited medical

level in some places, or the failure of family members

to contact the rehabilitation team in time, many

patients have deformities of the residual limbs due to

various reasons after amputation, and also due to the

need for physical mechanisms to compensate, which

cause the uninfected side disease (Xu 2018).

Therefore, in order to better fit the prosthesis and

meet the needs of patients for appearance, it is

necessary to prevent or reduce the deformity of the

residual limb. It is hoped that early functional

exercises can improve the convenience of patients to

adapt to prostheses and reduce the occurrence of

deformities. In this way, more amputees can get better

prosthetic fit and appearance satisfaction in the

future.

2 REHABILITATION AFTER

TRANSFEMORAL

AMPUTATION

The entire process of amputation should be

accompanied by the full participation of the

amputation rehabilitation team. The rehabilitation

team includes the amputee himself, doctors, nurses,

physiotherapists, occupational therapists, prosthetics,

social workers, family members, psychological

counselors, etc (Carroll 2006). In the entire process

of amputation, each worker performs their own job

function to help the amputee recover early, complete

the fitting of the prosthesis, and finally return to

society. In patients with a transfemoral amputation,

due to different amputation planes, unbalanced

muscle strength and poor posture, patients often

cause flexion and abduction deformities, and the

higher the amputation plane, the more obvious the

deformity is, as is shown in figure 1. When the thigh

stump has deformities, it will be difficult to make and

fit the prosthesis in the later stage. Early rehabilitation

training can avoid or reduce the formation of

deformities, which can not only bring the greatest

beautification of the appearance to the patient, but

also reduce the pain of the patient in the later

prosthetic fitting training.

Amputation is not only a destructive but also a

reconstruction and repair operation, which creates a

good residual value condition for the installation of a

104

Bai, L.

Early Rehabilitation Training for Patients with Transfemoral Amputation before Wearing Prosthesis.

DOI: 10.5220/0011187600003444

In Proceedings of the 2nd Conference on Artiﬁcial Intelligence and Healthcare (CAIH 2021), pages 104-108

ISBN: 978-989-758-594-4

prosthesis. Lower limb amputation requirements: the

residual limb has good weight-bearing capacity, can

walk after wearing a prosthesis, and the residual limb

after the amputation must have power, which is a

functional residual limb. A prosthesis is an orthopedic

device used outside the body that compensates for the

loss of the function and appearance of the limb.

Figure 1: Above knee amputation deformity.

2.1 Stump Stereotype

The ideal residual limb plays a very important role in

the late prosthetic fitting. The ideal residual limb

should achieve: (1) Proper length; (2) The residual

limb has normal joint movement, good muscle

strength, and no contracture deformities; (3) The

residual limb is covered with moderate soft tissue,

without tenderness, bone spurs, or neuroma, (4) and

the disabled no swelling of the limbs, good skin

condition, moderate skin tension, no adhesions, no

ulcers, no sinuses. After amputation or repair of the

residual limb, the soft tissue of the residual limb

undergoes greater trauma, and causes such as

capillary rupture can lead to edema. With time

passed, the edema can be slowly absorbed without

complications such as infection. Wrap the elastic

bandage in time after the operation to help reduce the

swelling and shape of the residual limb. As is shown

in Figure 2, use the eight-character winding method

when winding, follow the principle of tightening

down and loosening up, 30-40 minutes each time,

relax 2-4 times a day, and continue bandaging at

night. After amputation, the patient's affected limb

stump is wrapped and shaped with a medical elastic

bandage, which can not only reduce the pain of the

phantom limb, but also facilitate the shaping of the

limb stump, shorten the time to install the prosthesis,

and it is of great significance to improve the patient's

quality of life (Deng 2012).

2.2 Functional Training before

Assembly

Before the prosthesis is assembled, in order to

achieve the ideal rehabilitation effect, the patient

needs to undergo systematic rehabilitation training.

Through training, patients can restore physical

fitness, improve cardiopulmonary function,

strengthen muscle strength, maintain or improve joint

mobility, and make adequate preparations for wearing

prostheses.

Early Rehabilitation Training for Patients with Transfemoral Amputation before Wearing Prosthesis

105

Figure 2: Horoscope bandage wrapping

2.2.1 Strength Training

In patients with thigh amputations, due to the

different amputation planes, the reduction in the

number of muscles that control a certain movement

will be different, resulting in unbalanced muscle

strength and deformity. The common deformity after

thigh amputation is flexion and abduction. Therefore,

in order to prevent the appearance of this deformity,

muscle strength training should be added early after

the amputation to strengthen the muscle strength on

the side with insufficient muscle strength. For

abduction deformities, the muscle strength of the

adductors of the thigh should be increased; for flexion

deformities, the muscle strength of the hip extensors

should be increased. Muscle training can help

patients improve muscle strength and better control

the position of the residual limb (Xiao 2016). Early

functional exercise can be combined with physical

factor therapy, which can effectively relieve the

patient's stump pain and enhance the patient's stump

muscle strength (Dilinuer 2020).

2.2.2 Range of Motion Training

For hip joint function disuse syndrome and long-term

immobilization, the joint deformity, contracture, etc.

caused by the limitation of joint range of motion, the

effective traction of the joints of the patient, and

encourage the patient to actively move, in order to

effectively improve joint function (Bao 2015).

2.2.3 Balance Training

Due to amputation, the body's center of gravity often

changes, causing the body to compensate and appear

unstable. Suspension training can strengthen the

body's core muscles, thereby improving the stability

of the patient's trunk and pelvis, strengthening the

core control ability, and enhancing the patient's

walking stability and balance ability (Sun 2019). It

can be prepared for the later adaptation of the

prosthesis.

2.2.4 the Placement of Residual Limbs and

the Prevention of Deformities

In addition to unbalanced muscle strength, patients

with thigh amputation can also cause deformity due

to abnormal posture. Therefore, after amputation, you

should pay attention to the placement of the residual

limb to avoid too high a residual limb for a long time,

which increases the possibility of flexion deformity;

or put something (such as a pillow, cushion, etc.)

between the legs to increase the possibility of

abduction deformity.

The correct posture of amputee patients which is

shown in Figure 3 include: (1) In the supine position,

lying on a hard board with the two legs tied together,

and the pelvis should be kept in a horizontal position;

(2) In the uninvolved side lying position, the affected

limb should be up and healthy. Side down, keep the

affected limb in a naturally straight posture; (3) In the

prone position, keep the hips flat on the bed with your

legs close together. It is best to sleep on your prone

for 1 to 2 hours a day; (4) When sitting, the body

Stands upright, with the center of gravity between the

legs, and the legs of the amputee patient are brought

together.

In the daily rest process, you can use

elasticbandages to tie the residual limb and the

healthy side together. Pay attention to controlling the

normal body posture, the size of the effective binding

area, the length of the effective arm, the binding time

and the amount of force applied. It can avoid other

problems caused by the occurrence of control

deformities.

CAIH 2021 - Conference on Artiﬁcial Intelligence and Healthcare

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Figure 3: Schematic diagram of thigh muscles.

Figure 4: Good stump placement.

3 CONCLUSIONS

Due to the frequent occurrence of accidents and the

impact of diseases, the number of patients with thigh

amputations is increasing year by year, but

postoperative muscle atrophy, stump deformity, and

stump pain are prone to occur, which affects the

patient's prosthetic fit and quality of life.

Early Rehabilitation Training for Patients with Transfemoral Amputation before Wearing Prosthesis

107

At the same time, it effectively prevents and

alleviates the occurrence of deformities, which not

only provides aesthetics for patients, but also

provides convenience for the production and wearing

training of prostheses that are adapted in the later

stage. Early rehabilitation training after amputation

plays a very important role in shaping the residual

limb, restoring function, and preventing deformity. It

is worthy of promotion by clinical and rehabilitation

teams.

ACKNOWLEDGEMENTS

Thanks to the teachers from the Department of

Prosthetics and Orthopedics of the China

Rehabilitation Research Center for their teaching and

guidance on the content of this article. Thanks to

Professor Dario Farina from Imperial College

London for explaining to me the related content of

bionic limbs online, which enriched my vision. Thank

you from the thesis teacher for your guidance on my

writing. Thank you from the thesis teacher for your

guidance on my writing.

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