The relationship between a therapist and a prosthetist is delicate, but has the potential to greatly impact patient care. Physical therapists first need to understand their realm of prosthetic rehabilitation in relation to the prosthesis in order to be a beneficial part of the team. Understanding that the prosthetic limb is considered a "work of art" to a prosthetist is key to developing a mutual respect between clinicians. Gait training sessions do not always have to be postponed due to prosthetic pain and a simple prosthetic evaluation could provide a great deal of information to the physical therapist and the patient. Understanding the evaluation will allow the therapist to contact the prosthetist with helpful information about potential issues while respecting the work of the prosthetist. The physical therapists' guide to prosthetic evaluation is included in the four following steps:
1. Evaluate the residual limb.
2. Assess the socket fitting.
2. Evaluate the static alignment.
3. Evaluate the dynamic alignment.
This blog post will delve into the first two components of the evaluation. Check back next week to learn more about the second two!
Evaluating or "reading" the limb: Ask the patient to remove the limb, any socks, and the liner to carefully inspect the residual limb. Check to assure that the skin is intact and does not have significant breakdown. Skin breakdown does not always mean that the gait training session has to be postponed. Literature has been published linking increased pressure with wound healing, but each patient is different. Contact with the patient's physician will allow for individualized care and monitoring of the skin to progress rehabilitation safely. Try to use your hands to duplicate the pain out of the socket. Provide circumferential tightness with distraction, as if your hands are the socket. If can duplicate the pain, then you will either rule out socket issues, or understand the exact origin of the pain.
Assess the socket fitting: Redness over weight bearing areas may indicate that the patient is sinking too deeply into the socket. Redness around the area touching the rim of the socket may indicate that the patient is not in the limb far enough. Discuss the importance of proper sock ply when gait training. The prosthetist may only see the patient in the limb for a short time, in which the limb shape may not change. A physical therapist is able to see the patient for increased amounts of time while rehabilitation progresses and limb changes occur. Use this time to teach the patient how to use socks to assure the best prosthetic fit possible.
Check back next week for an overview of the next two steps in the physical therapist evaluation of a prosthetic limb.