What is the physiotherapy treatment for below knee amputation?
Physiotherapy for a below knee amputation would really depend on
the age and reason of condition which lead to the amputation. First
lets us look at a young patient who had the amputation due to
trauma. First physiotherapy would be aimed at assisting with the
healing of the incision on the stump, then the desensitasation of
the stump. Also there should be treatment to give the brain new
input so it is able to recognise the new end of the limb. Then
treatment would be to strengthen all the main muscles in the
remaining part of the leg. So the muscles around the hip and the
muscles of the thigh would be strengthend . The important ones
would be the knee extensors, the knee flexors, the hip extensors
and flexors and the hip abductors. The treatment must ensure that
the patient has full range of all movemnts and does not develop a
bent knee, as pain often makes the patient hold the knee in a bent
position so stretching is important. Treatment is also provided to
keep swelling in the stump to a minimum. The patient would also be
taught wheelchair mobility, transfers and independent activities of
daily living, this would be asssited by an Occupational Therapist.
The patient would also be taught trunk strengthening and core
stability to help with balance, balance on one leg would also be
taught. When the patient got the prosthesis ( the artificial leg)
the patient would be taught how to walk and how to walk without a
limp. Stump care is also very important and would be addressed by
the Physio and nursing staff. Finally for good rehabilitation the
patient should relearn how to go back to work or to school and
continue to have hobbies.
If the patient was older with diabetes some of this work would
be too much so it would be decided if the patient wanted to walk
again or live in a wheel chair. Healing of the incision would be
more of an issue and maintaining the stump would also be an issue.
Much more patient eduction is needed. The patient may be taught all
the same things but in a less aggressive fashion. If the patient
was to live in a wheelchair then pressure relief and positioning
would be an important part of the rehabilitaton. Some treatment for
phantom pain may also be needed. The patient will need to practise
such things as getting into and out of bed, on and off toilet etc.
With older patients the relatives also need teaching and sometimes
have to help with putting on the leg or helpng the patient transfer
get in and out of car, in and out of a bathtub and even change
dressings.