Situation: Was working with a pt whom had undergone a left transtibial amputation and had previously been fitted with a supracondylar suspended patella tendon bearing prosthesis. As a result of ongoing issues withk suture line healing the pt had been having trouble with the fit of prosthesis causing compromise to skin integrity. It was therefore decided that the pt was going to be fitted with a prosthesis with thigh suspension to decrease the load through the distal residual limb.
Task: Get pt walking in new prosthesis and perform observational gait analysis on her pattern.
Action: As the pt had already undergone gait retraining exercsises on her original prosthesis and her residual limb had become accustomed to bearing weight, we started with some simple walking in the parallel bars.
Result: Pt was able to walk independently in the parallel bars with minimal support from the upper limbs. Stance phase was decreased on the prosthetic limb and the pt walked with an antalgic gait pattern, flexing the trunk laterally towards the prosthetic limb in stance phase. Increased lateral trunk flexion and overall antalgic gait pattern was attributed to decreased strength and control of hip abductors of the residdual limb and pain that was reported over femoral condyles on weight bearing. As a result we aimed to optimise the number of socks to reduce pain and but allow the best fit in the socket and also give the pt exercises to improve hip control.
Evaluation: Overall I think I performed well in the gait analysis part of the task. Where I could have improved was with the exercise prescription and planning part. I thought I'd give my pt exercises to improve hip abduction control and so prescribed her with standing hip abduction when standing in her contralateral limb. As one of the physios correctly advised me, it would probably be more appropriate to get the pt to stand on the prosthetic limb and maintain hip control when abducting and hitching the contralateral limb. This exercise is more specific to the situation where the pt is experiencing her decreased pelvic control i.e. when standing on her prosthetic throughout the gait cycle.
Strategies: Think about the situation when the pt experiences an impairment and prescribe exercises to be as specific to that situation and context.
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment