**10. Rehabilitation**

The main aim of rehabilitation followed by a lower limb amputation is to restore daily activities by means of gait. In order to acquire full accomplishment the patient

*Prosthetics for Lower Limb Amputation DOI: http://dx.doi.org/10.5772/intechopen.95593*

must be trained psychologically to obtain physical performances without any hindrance (**Figure 8**).

Donning- Initially the patient is demonstrated with fitting step. Initial fitting refers to the very first time the individual wears the prosthesis and stands, during which; patient should be stable enough to overcome disappointment about amputation and get adjusted to the prosthesis. Any discomfort should be immediately reported to the prosthetist. It is considered as the initial communication between prosthetist and the patient which will be followed by gait training.

Doffing- The patient is likely advised to sit down and remove the socket by slipping it off from the residual limb. After removal instruct the patient to check for any signs of ulcer or skin breakdown [8].

### **10.1 Prosthetic gait training**

1.**Contents of training**: It takes several months so provide the patient with a detailed menu for the entire program from basic to advance. This will anticipate the patient about their progression and helps in self motivation. The menu can be classified into three sections:

A.*Preparation for prosthetic gait training*


#### B. *Basic training for prosthetic gait*


#### C. *Advanced training for prosthetic gait*


#### 2.**Residual limb changes**

Explain about socket fitting and how it may change as the limb matures. As gait training progresses edema of the residual limb will be reduced, and it may fluctuate between morning and evening. Educating the patients about self management post discharge regarding adjustment of the fitting and maintaining hygiene.

#### 3.**Adjustment of the lower limb prosthesis**

Instruct patients about the alignment of the prosthesis which varies according to the weight loaded during gait. Educate them to adjust accordingly to avoid pain.

#### 4.**Daily Life after the Gait Acquisition**

Provide the patient with a complete rehabilitation program.

*Precautions in daily life*

Even though there is a rehabilitation team supporting and encouraging the patient still it is difficult for the patient to overcome certain circumstances. Therefore, it is the patient's capability to withstand and progress further with continuous use of prosthesis by maintain body weight and residual limb related problems.

#### **11. Discussion**

All types of prosthesis are well explained with their application and advantages. Each prosthesis has its own uniqueness and the patient will be well rehabilitated with those prosthesis. Not all the patients are permitted into rehabilitation stage. It depends on factors like age, built of the patient, involvement of the limb (bilateral or unilateral), Psychology of the patient, socio-economical status of the patient. A multi- specialist Rehabilitation team has to be set to rehabilitate the Amputee.

#### **11.1 Biomechanical principles of prosthesis and gait in prosthetic leg**

The gait cycle which consists of two stages will also be termed as walking cycle. Initial contact is the first step in the starting point and the end point in every gait cycle. A single gait cycle has two phases. The stance phase and the swing phase. The stance phase is the initial step in which the foot contact starts followed by other steps in the ground. The stance phases contribute about 60% of the gait cycle and the swing phase contributes about 40% of the gait cycle. The swing denotes the single leg support in which the foot is off the ground.

The pattern of gait in subjects with prosthesis will present an altered gait pattern. Here the foot contact on the ground and the weight distribution on the foot is the key factor to be noted. The foot contact will occur on the heel in such a way the walking cycle will be as natural as possible. In this situation the sole of the foot will contact the ground and the weight is transmitted to the foot. Thus, the selection of foot component and the knee joint must be proper. This is because this will have an influence on the subject's gait when he turns on to the next phase [9].

During swing phase, the knee function is so important so that the mobility on the knee joint performing both flexion and extension facilitating the foot transition from plantar flexion to dorsiflexion i.e toe elevation. This will prevent the subject from stumbling and subsequent fall.

The residual limb must be placed on the socket which provides rigid and stable attachment to the limb. This aids control over the subject's limb during walking. The prosthesis socket can be divided into 3 parts. The top region of the socket is known as seating face. The central part of the socket is the primary control area. The function of the central part is to ensure correct movement and restrain it in the PA direction during walking. The last part is the distal socket end. This part will transfer only 10% of the subject weight to avoid abnormal weight transfer and this will cause subsequent damage to the soft tissues. The socket must be able to transfer the load thereby it ensures good stability of the subject's gait with better control [10].

During standing, there will be a stretching of gluteus medius muscle. This will maintain the pelvis in a balanced position. For a subject with lower limb amputation this pelvis position is taken care by the prosthetic socket. In a transverse oval socket of transfemoral prosthesis, the pressure on the distal femur end increases and the

#### *Prosthetics for Lower Limb Amputation DOI: http://dx.doi.org/10.5772/intechopen.95593*

body is excessively bending aside to reduce the pressure. It is a non-physiological load transfer, as the load is transferred through the tuberosity of the ischium which reduces the arm of the exerted force and the overturning moments are increased.

If there is any problem in procedure of construction and principles in aligning the prosthesis, there will be an abnormal deviation that may develop during gait. This gait deviations uses more energy expenditure during walking. Once this is practiced as a routine, may result in over use of certain muscle groups which also causes muscle imbalance.

In most cases, the improper construction of the transfemoral prosthesis and transtibial prosthesis includes


Thus, if there is an improper prosthetic fitting, there will be pain and altered muscle activity during execution of the normal daily activities. This pain may cause lateral asymmetry of the body which is due to incorrect length of the prosthesis or incorrect selection of the prosthetic component. This wrong construction can lead to abnormal force transmission, overloading the various muscles involved and also damage to the soft tissues which may affect the integration of the stump function.
