Updated: Mar 13, 2022
29 years old patient - LT AKA and multiple complex fractures in RT foot bones
First, the patient was asked to lift his non-prosthetic leg from the first to the second stair, to practice a single leg stance on his prosthesis. After a few rehearsals, the PT instructs the patient to use only one handrail for assistance.
The PT instructs the patient to lift his leg to the third stair while using both handrails. This requires the patient to manage a longer single leg stance and increases range of motion in both legs. Again, after a few rehearsals, the PT instructs the patient to remove one hand from the handrails.
Second, the patient was instructed to lift his leg from the first to the second stair, to practice a single leg stance on his prosthesis, while facing sideways. He looks down to compensate with his vision for his lack of sensation in his legs. Due to pelvic weakness the patient tends to ‘lean’ over his hip’s joint ligaments, rather than activate his Glutes (Glut Med specifically). When the PT instructs him to use only one hand on the handrail, this tendency increases, and his shoulders shift left.
The PT instructs the patient to use both hands on the handrails, and lift his leg to the third stair. This requires him to shift his weight over a wider distance, and extend the time of single leg stance on his prosthesis. The patient looks down again to compensate for his lack of sensation, and again the PT instructs him to avoid it. During the exercise he shifts his shoulders left further and further, which can indicate weakness in the muscles around the hip and pelvic. When the PT instructs him to put only one hand on the handrails, his leaning to the left is exaggerated.
Patient’s description: The patient is 29 y.o after a car accident. LT Above Knee Amputation (AKA). Multiple complex fractures in RT foot bones and RT Fibula fracture that led to RT ankle lack in ROM. The RT foot was re-constructed in a slight supine, which makes the patient bear more weight on the foot’s lateral side. Skin grafts in the right foot led to allodynia, hyperalgesia, and sensitivity to friction and pressure.