amputee with fixed flexion deformity

[neuron]

Hi,
my client (female) 65 years with BKA and right knee fixed flexion deformity (FFD) @final 20 degrees. client bilateral hip has 4/5 muscle strength and good trunk control in parallel bar but while training with walking frame trunk flexion is predominant and client not able continue due to fear of falling?? . client wish to walk again but due to family situation not able to get prosthesis . anyone has idea how to proceed with this case ?

neuron

[emad]

N,

First of all is there pain ?
I can NOT understand how do you rehabilitate/walk training a patient with amputation without prosthesis .

By the way i have a patient the same as yours and furthermore have weakness?hemiparesis of one side and amputation of the other side .

Cheers
Emad

[nari]

Neuron,

Here we trained amputees to regain optimal balance first, in // bars and/or walking frame. Yours will have to learn slowly, to practise standing balance to overcome the forward flexion. Provide a safe environment for practise (which is why // bars can help) and then remove her from that environment, as she regains some balance.

Those who were not going into a prosthesis, for whatever reason, learn to walk with elbow crutches. I am not sure of the reasons why your client is not proceeding to a prosthesis, but assume it is financial and the fact that the FFD is definitely fixed.

If the patient is motivated, elbow (Canadian) crutches are quite sufficient to enable them to go most places independently.

If they are unmotivated, then they may never walk. Inspire her as much as you can...good luck!

Nari

[neuron]

N,

First of all is there pain ?
I can NOT understand how do you rehabilitate/walk training a patient with amputation without prosthesis .

By the way i have a patient the same as yours and furthermore have weakness?hemiparesis of one side and amputation of the other side .

Cheers
Emad
Hi emad,
thank you for your reply. but amputees who is preparing for prosthetic fitting( pre- prosthetic training) we usually train them with walking frame/crutches or even high rollator walking frame inorder to meet thier daily tasks. So as my client also been trained with walking frame to meet her daily tasks demands.

Hi nari,
Thank you for your suggestions but iam afraid to say that my client is an elderly woman 65 years old. do you still think elbow crutches is a good choice?? . i am out of musculo-skeletal practice for many years!!!!
regards
neuron

[nari]

Hi neuron,

It depends on the 65 year old. If she is nervous and anxious, crutches of any sort may be risky. But I have seen 80 year olds use Canadian (elbow ) crutches with ease. If she lives with stairs, they can be a better option than a frame. If not, it is distinctly possible for her to be quite mobile with elbow crutches. Depends how comfortable she feels with either walking aid.

65 years is not elderly! ;)

Worth trying both once she has gained a sense of balance. If she cannot get her balance and reduce some of the forward flexion - her mobility will be really challenged. Good luck!

Nari

[emad]

Neuron , Is that your real name ? Just a Thought you do not have to answer !!!

Good to see discussion around amputees here ,my patient still has not recieved her Prosth. so that we are just working to address her weakness ,pain and balance .
I agree that balance and safety is the first priority.


Cheers
Emad

[neuron]

Neuron , Is that your real name ? Just a Thought you do not have to answer !!!

Good to see discussion around amputees here ,my patient still has not recieved her Prosth. so that we are just working to address her weakness ,pain and balance .
I agree that balance and safety is the first priority.


Cheers
Emad
Hi emad,
neuron is not my name i like this name probably coz my intrest in neurology well my real name is suresh. Well my client her main issues is financial!!! we are trying to get maximum financial support but sometimes it's been a tricky issue to deal with .......
Thanks nari for your suggestions
regards
neuron

[Daniel Silva Cordeiro]

Hello Neuron,
A great advantage of his patient, is to have a dominant leg in the amputation transtibial with preservation of the knee. An attempt for decrease of the pattern of deformity of the stump, is the prolongation of every subsequent chain and PNF (to contract / relax) in the knee articulation. Because he is afraid of walking with prosthesis?; he fell?; Is he amputated bilateral?

Hugs

Neuron

[maryannalyn]

Neuron.