First the residual limb wound has to heal properly. Once this healing process is complete after a few weeks, the rehabilitation phase as such begins. It usually takes up to half a year.
When you can begin with intensive rehabilitation is decided by your treatment team based on the progress of your recovery. In the rehabilitation phase, you are purposefully prepared for wearing a prosthesis. The goal is to provide you with maximum mobility and independence so that you can lead your life as normally as possible in the future. However, your active participation is crucial for the success of rehabilitation. Your motivation and level of self-confidence can make an important contribution as well.
Care of the residual limb
In the rehabilitation phase, you already care for your residual limb, the scar and also your sound leg yourself.
While the nursing staff and doctors took care of cleaning the wound and changing the bandages or dressings in the hospital, you take care of your residual limb, the scar and also the sound leg yourself in the rehabilitation phase. Ongoing intensive care will be essential so you can wear your prosthesis without complaints.
How do I properly care for my residual limb?
Your therapist will show you how to properly care for your residual limb. To prevent the skin from becoming rough and scaly, wash the residual limb with water and mild soap in the morning and evening (e.g. Derma Clean). Then dry the skin thoroughly or carefully dab it dry and apply a cream. Derma Repair and Derma Prevent are two products from the Ottobock care series developed especially to care for highly stressed skin, i.e. on the residual limb. The Derma Prevent cream for example helps prevent chafing by covering the skin with a protective coating, keeping it soft and supple.
If folds of skin or scar contractures have formed on the residual limb, these require special attention in order to prevent infections. Your rehabilitation team can advise you about this. During residual limb care, also look for skin injuries, pressure points and blisters. These require medical treatment. A mirror can help you examine the back of your residual limb. Regularly massaging and gently stretching the scar is another important element of residual limb care.
Note that putting on a prosthesis in the morning – immediately after washing – is often more difficult than usual, since warm water causes the skin on the residual limb to swell slightly.
Care of the sound leg
As long as the residual limb is not able to support a lot of weight after the amputation, the sound leg is subject to greater strain.
Regularly examine your sound leg as well, even for minor injuries. Since these too can become dangerous – especially in case of infections – any injury should be treated by a doctor immediately. After all, keeping your sound leg functional is essential. You should carefully cut your toenails regularly too. Many affected individuals visit a trained pedicurist for this.
A comfortable shoe that fits well is part of caring for the sound leg as well. Insoles may also be recommended. The choice of socks is crucial in addition to footwear: They should be made of wool or cotton, so that they absorb perspiration well, and the cuff should not be too tight so as not to disrupt blood circulation. Socks and stockings have to fit without wrinkles and should only be worn for one day. Otherwise perspiration results in the formation of salt deposits which can chafe the skin and lead to infections.
It is also important not to transfer to a wheelchair while barefoot. You should not stand or walk barefoot either – the risk of injury is too high. When you are lying in bed, you can put a padded support under the heel and ankle of the sound leg in order to prevent pressure points.
Walking with a prosthesis
Thanks to modern technology, various prostheses can be fabricated today for many different requirements. The prosthesis components selected for you therefore play a major role. Your training and exercise programme is tailored to these components. It is designed to build your confidence in using your prosthesis and to relearn everyday movement patterns.
Walking on level surfaces
Once you are generally confident in handling the prosthesis, actual gait training can begin. Improving balance and coordination, sufficient weight bearing on the prosthesis side and straightening the pelvis and upper body are the objectives.
You should also continue strengthening your muscles because strong muscles are essential for a stable body posture while walking.
First you learn how to shift your body weight and stand on one leg between parallel bars. Do not support all your weight with your arms and sound leg; use your prosthesis too. As soon as you can walk between parallel bars, unsupported gait training follows. The first objective is to gradually reduce the use of any walking aids you may require initially. This is achieved through a combination of correct walking technique, in addition to strengthening the torso musculature.
Avoiding gait deviations is part of all gait training exercises. At first your therapist is always at your side and offers help. Over time you will no longer need such assistance.
Secure walking on ramps and stairs
You will always encounter obstacles in daily life, e. g. curbs, stairs in the home, a ramp leading up to the garage and many more. The components of your prosthesis are crucial here, as different prosthetic knee joints require different walking techniques. For example, correctly positioning the foot or using the handrail play an important role.
What is known as an interim prosthesis is a transitional prosthesis fabricated for you by your orthopaedic technician. You wear it until you can be fitted with the final prosthesis.
An interim prosthesis helps you perform standing and walking exercises early on. Your orthopaedic technician also learns about your individual movement patterns, providing him or her with important information to select suitable prosthesis components for you. He or she then adapts the prosthesis socket and finally adapts the prosthesis precisely to your requirements.
Using the Prosthesis
With the support of your therapist, you learn how to use your prosthesis correctly. This includes how to put the prosthesis on and take it off, standing up and sitting down as well as balance and gait training. The functional capabilities of prosthesis components, such as prosthetic feet and prosthetic knee joints, can be very different. Selecting the prosthesis components carefully is therefore very important. These components and special training in their use are crucial in order to reach your individual therapy goal.
Correct donning and doffing
Putting the prosthesis on and taking it off independently is important for daily use. While your family may have to help you at first, being able to do this on your own is the goal.
There are various ways to put on your prosthesis, depending on the type of prosthesis and the characteristics of your residual limb. Your therapist will show you what is best for you.
You have already learned how to care for your residual limb, but the prosthesis also has to be cleaned and cared for on a daily basis. In order to remove perspiration and skin particles, wipe the inner socket of the prosthesis with a damp cloth.
A clean contact surface to the skin helps prevent skin irritation. If you wear a liner, please care for it daily according to the instructions for use.
Sitting down and standing up
Once you know how to put on the prosthesis and take it off, sitting down and standing up are the next everyday actions you will learn. The required exercises depend on the components used in your prosthesis. For example, it is possible to put weight on both legs while sitting down with a transfemoral prosthesis that includes the C-Leg® knee joint. This results in significant relief for the sound side, which helps prevent premature excessive strain problems.
You should also put the same amount of weight on both legs when sitting down and standing up with a transtibial prosthesis for the same reason.
Initial swelling of residual limb tissue is expected after the operation. This swelling is a normal reaction to the operation. It can be prevented by applying pressure over the entire surface.