Treatment cycle - Leg prosthesis
Our Treatment Circle shows you at a glance all the different steps involved in the fitting process for your orthotic device at the Ottobock Competence Centre. Here you find detailed information of what to expect of our services before, during and after your fitting.
The ultimate goal in all our Competence Centres is to restore your mobility, which includes increasing your level of independence and maximising your quality of life. In order to achieve this you will be supported by your interdisciplinary rehabilitation team consisting of physicians, therapists, prosthetists/orthotists as well as your family and friends. The whole process can take a couple of months depending on various factors amongst others your own motivation and participation.
A personal interview and thorough physical examination are carried out at the beginning of each fitting.
Before your amputation surgery you have a personal interview and several thorough physical examinations with your doctor. Tests done there include blood analysis, X-ray of your lungs as well as checks of your heart and circulatory functions. Your doctor informs you in detail on what happens during and after the amputation and you have the opportunity to ask all questions relevant to you. Our advice is to take notes beforehand so you do not forget to ask anything that seems important. Nevertheless, you can still address follow-up questions since doctors are obliged to explain the processes and procedures to you even several times.
In case of a traumatic accident you will naturally get the consultation with your doctor after the surgery. We at Ottobock want to get involved in the rehabilitation process as early as possible, so that our prosthetists can answer your questions and give you an impression of what to expect during the rehabilitation process. Furthermore, we are happy to cooperate with your doctors to achieve the best possible results for you. All you have to do is to call your local Ottobock Competence Centre prior to the surgery and we will arrange an appointment.
We know that having an amputation is a major change in your life. However, you do not have to carry this burden alone. Your treatment team supports you in case of occurring problems and answers all your questions. Do not feel ashamed to talk about your fears – your treatment team is skilled to handle this situation and also offers psychological counselling. The earlier you seek support, the better, since overcoming mental conflicts and fears contribute to a rapid healing and regaining your quality of life.
Throughout our long history we experienced a positive impact resulting from dialogues between amputees. Talking to other amputees lets you get new insights on how other amputees deal with the situation. Moreover, you can get valuable advice on how to live with a prosthesis, the fitting process and how others handle their prostheses in everyday life. Your doctors, therapists and prosthetists help you to get in contact with local peer support groups.
Immediately after the amputation the focus is laid on the healing of your residual limb so you can start therapy as soon as possible. It is likely that you will have a drain in your residual limb right after the amputation to drain fluids and blood out of the wound.
To find the best prosthetic solution for you your prosthetist will conduct a personal interview and thorough physical examination in your local Ottobock Competence Centre. This is where your personal needs are being determined.
Therapeutic measures follow with the purpose of preparing you for a prosthetic fitting.
An initial swelling of the limb tissue after the amputation is expected. This is a normal, healthy reaction to the surgery and usually subsides after a few weeks. In the meantime, the wound needs to be dressed for your prosthetic leg fitting and the swelling needs to be reduced. This is done to prevent a pronounced residual limb oedema as it delays wound healing and it also takes longer for the residual limb to reach its final shape, so that the fitting with your leg prosthesis would be protracted. The oedema therapy and application of special creams ensure the scar tissue to remain soft and supple while simultaneously becoming resilient which is essential for wearing a prosthesis.
When the wound dressing or residual limb plaster is removed, compression dressings are applied using a special bandaging technique. This promotes the circulation in your residual limb, reduces pain and helps to improve the healing of the scar as well as the shaping of the residual limb. In the first few days and weeks after the surgery, your residual limb is bandaged by your therapist or nursing staff. This somewhat elaborate compression with elastic bandages has the advantage that the dressing can be individually adapted to your residual limb and amputation level. Later the nursing staff or your doctors can show you how to put the compression bandage on yourself. You have to wear the compression dressing all the time until the residual limb heals. As soon as everything is healed, you can try to sleep one night without the dressing after consulting your doctor, prosthetist or therapist. If the residual limb exhibits pronounced swelling again the next morning, compression therapy has to be continued.
Next to elastic bandages, silicone liners are another compression option. Silicone liners are available in standard sizes but can also be custom-made. The liner exerts even pressure on your residual limb, bringing it into the correct shape, while the elastic, skin-friendly silicone makes the scar soft and supple. Your prosthetist will give you further information on how to correctly wear and clean your silicone liner.
Immediately after the surgery you might not be able to turn around in bed by yourself, therefore nursing staff will shift your position several times a day to help prevent bedsores. This also allows you to find a position free of pain and reduces your risk of flexion contractures, which is a limiting in range of motion at the hip or knee that could hinder your rehabilitation. Your positioning in bed should be done in such a way that the muscles and joint closest to the residual limb do not shorten or stiffen. How to correctly position yourself will be shown to you by your doctor or therapist.
Starting with the therapy is a critical step towards regaining your mobility. Your team consisting of prosthetists, doctors and therapists creates a tailor-made therapy programme for you. We advise you to start therapy as soon as possible after the surgery to strengthen your muscles. One of the first exercises that your doctors and therapists should practise with you is to correctly transfer from bed to a wheelchair. This will make your time during rehabilitation much easier. Your doctor or therapist will also show you other therapy exercises to optimally prepare you for your prosthetic fitting.
This will make your time during rehabilitation much easier. Your doctor or therapist will also show you other therapy exercises to optimally prepare you for your prosthetic fitting.
The muscular training functions as a preparation for your muscles to wear a prosthesis. The training consists mainly of exercises to strengthen your torso, arm and leg muscles as well as stretching and balancing exercises. The training can be performed with light weights and therapy bands from a lying, sitting or standing position. The residual limb should also be included in the training. For a successful fitting your active participation is crucial. Your therapist will show you the exact exercises.
3. Fitting recommendation
This is where you learn which prothesis is most suitable for you and which personal objectives should be pursued.
Your prosthetist at the Ottobock Competence Centre considers all the factors that influence the selection of a suitable leg prosthesis for you. These include your physical condition and health, the amputation level, your motivation and the demands you place on the prosthesis as well as your professional and private environment. The options offered to you by Ottobock’s modern prostheses meet the requirements of daily life. Your prosthetist bases his suggestions on the Mobis® system which enables him to choose the best prosthetic components individually for you. Generally your prosthesis fulfils the function of restoring your mobility and independence, preventing posture problems as well as balance impairments and prevents excessive strain of your sound leg.
The prosthetist takes your individual body measurements.
For us at Ottobock regaining your mobility means you can rely on the support of your leg prosthesis in all your daily activities. You need to be able to control the prosthesis during each movement phase to fully benefit from its functions and to enjoy smooth movement patterns. Therefore, the component connecting your residual limb with the leg prosthesis, known as a socket, needs to fit you just like a good shoe. This is why we use full-contact sockets that give you more control and result in a better functioning of the whole prosthesis. To ensure the correct fit of the socket as well as the whole leg prosthesis it is essential to take detailed measurements of your residual limb and body. This is why Ottobock constantly develops new improved measurement methods which are used in our Competence Centres worldwide. Depending on the condition of your residual limb we employ digitally based methods or use plaster cast to take your individual body measures as precisely as possible.
Fabrication of your custom prosthesis follows.
Using your individual measurements your prosthetist produces a one-to-one model of your residual limb which is the basis for manufacturing a thermoplastic interim socket. After having determined all prosthetic components your prosthetist assembles a complete artificial leg and aligns it accordingly.
During the fitting, the prosthetist adapts the prosthesis to your individual needs.
Your prosthetist will decide whether an interim leg prosthesis is necessary in your case based on your individual needs, wishes and the condition of your residual limb. Due to the fact, that the interim socket is made from a thermoplastic material it allows your prosthetist to react to volume fluctuations in your residual limb and to make sure the socket is perfectly comfortable for you. You will wear the interim prosthesis for early standing and walking exercises which has a positive influence on the healing and shaping of your residual limb. The interim prosthesis consists of all the parts that your final leg prosthesis comprises of – the prosthetic foot, a knee joint where applicable, adapters and the socket. You may need to visit your local Ottobock Competence Centre several times for adjustments to be implemented. We know that this might be perceived as a tedious process, nevertheless be patient in this stage of your fitting as it determines the perfect fit of your final leg prosthesis. After no more volume fluctuations occur in your residual limb the suitability of the prosthetic components as well as your interim socket is evaluated. When everything is to your satisfaction your final leg prosthesis will be manufactured.
When a comfortable fit of your socket has been achieved after several trial fittings and all prosthetic components have been selected carefully your final leg prosthesis can be assembled. The prosthetic alignment process can vary from patient to patient depending on your body posture and height. Be assured that your prosthetist advises you on the best prosthetic solution for you. Once your final leg prosthesis is ready additional trial fittings with your prosthetist follow to check the prosthetic alignment and to precisely adapt the prosthesis to your needs. At this stage your prosthesis can also be equipped with a custom silicone cover.
Here you learn how to correctly handle the prosthesis in daily life.
To ensure an optimal synergy between the prosthetic technology used and our therapeutic expertise a therapist will accompany you during your rehabilitation process in your Ottobock Competence Centre. Nevertheless, most of your rehabilitation programme will take place in a specialised clinic. Therefore, we at Ottobock would like to have as much contact with the clinic as possible to support you during your rehabilitation. The purpose of your rehabilitation is for you to train wearing your leg prosthesis with the ultimate goal to provide you with maximum mobility and independence.
The starting point of your rehabilitation training depends on the condition of your residual limb. The rehabilitation phase begins when the wound on your residual limb has healed properly which can take up to 6 months after the amputation. Depending on your individual circumstances the training will be done with your interim or final leg prosthesis. You can directly influence the success of your rehabilitation through active participation as well as high levels of motivation and self-confidence.
During rehabilitation you learn how to care for your residual limb and scar yourself. Your therapists will guide you and provide you with valuable advice. To prevent rough and scaly skin you should wash your limb with mild soap (e.g. Derma Clean) twice a day. The skin should then be dabbed dry thoroughly and a special cream should be applied that is designed to care for highly stressed skin. We recommend you to use Derma Prevent and Derma Repair to avoid chafing of the skin and to keep it soft and supple. Putting on your leg prosthesis right after washing your limb might be a bit difficult since warm water causes the limb to swell slightly. In order to prevent infections you should pay special attention to folds of your skin and scar contractions. Look out for skin injuries, pressure points and blisters which require medical treatment. To see the back side of your residual limb more comfortably you can make use of a mirror. The flexibility of the scar can be enhanced by gently stretching and massaging it.
Your sound leg is subject to greater strain as your residual limb initially cannot support a lot of weight. Therefore, you should also inspect your sound leg to detect minor injuries which might become infectious. In this case please consult your doctor for an appropriate treatment. Additionally, you should not walk, stand or transfer to a wheelchair barefoot to avoid any injuries. It is best for you to wear comfortable shoes with insoles if needed, wool or cotton socks that absorb perspiration with a cuff that does not disrupt your blood circulation. Your socks should be changed on a daily basis to prevent infections and should not have wrinkles when wearing them.
During rehabilitation you will also learn how to correctly put your leg prosthesis on and take it off which is also known as donning and doffing. There are various ways to don a leg prosthesis depending on the prosthesis itself and on the characteristics of your residual limb. Taking your individual circumstance into consideration your therapist will show you the best solution for you to handle your leg prosthesis confidently.
After you know how to handle your prosthesis you learn how to stand up and sit down. The precise exercises depend on the components used in your prosthesis and will naturally be shown to you by your therapist. Users with below knee (transtibial) amputations should try to put weight on both legs when sitting down which is a significant relief for the sound side and helps to prevent premature excessive strain problems. C-Leg® and Genium® knee joints enable above knee (transfemoral) amputees to balance their weight on both legs for the same reason.
Gait training focuses on balance and coordination exercises, the strengthening of your pelvis and upper body muscles as well as weight bearing exercises on the prosthetic side. The exercise programme is individually designed and takes your needs as well as your prosthetic fitting into consideration. Gait training begins once you feel comfortable and confident in handling your prosthesis. You can positively influence the gait training by strengthening your muscles for a stable body posture in advance. During the training process you will first learn how to walk between parallel bars. Your walking aids will then gradually be reduced for you to walk independently. You are supported in making this transition by learning to use correct walking techniques. Depending on your prosthetic fitting you will also learn how to employ special techniques that enable you to walk on ramps and stairs.
8. Quality check
Together with the rehabilitation team you discuss to which extent you can cope with the prosthesis.
A team consisting of your therapist, prosthetist and ideally your doctor will finally approve your leg prosthesis using a Dartfish video analysis software to analyse your gait pattern, implementing final adjustments and recording your progress. Before you leave you will be handed a treatment outcome report for your documentation as well as a user manual for your prosthesis including all important information on how to use your leg prosthesis in everyday life.
The Ottobock Competence Centre maintains continuous contact with you.
Ottobock regards itself as a long-term partner for you to master the challenges that you decide to tackle. This is why, even after your successful fitting, adjustment period and rehabilitation your local Ottobock Compentence Centre still remains in contact with you. We recommend you to visit us for regular check-ups so we can determine if adjustments need to be made and can implement these. To continue training at home we created the app “Fitness for amputees” which features exercises to enhance your strength and endurance as well as coordination and balance. Download the app free of charge for iOS and Android devices.