Fitting the Artificial Hand and Training for Use

The role of the physiotherapist in training

Physiotherapy team: Mr. Andrew Babu, Asha Susan, Aejaz Sheriff, Edwin Jeba

Preoperative Assessment & Training

In the case of non-traumatic amputations, it may be possible to plan and impart physiotherapy before the surgery. Such training will help to prepare the patient for post-operative condition, the fitting of the prostheses and result in faster and better use of the artificial hand.

The physiotherapist must assess the following:

• Range of Movement - The physiotherapist must examine the range of movement of the limb above the planned level of amputation. For example: Scapulothoracic, Shoulder & Elbow movements
• Muscle Strength - The strength of the muscles must be tested and strengthening exercises may be prescribed. Again the following muscles must be noted: Scapulothoracic, Shoulder & Elbow muscles
• Sensation - The use of surrogate sensory feedback must be kept in mind and accordingly trained
• Positioning - Teach correct positioning of residual limb in anticipation of the surgery

Post Operative Physiotherapy Assessment

Following the amputation surgery the physiotherapist must assess the residual limb for the following:

• Muscle strength
• Sensation in the Residual limb- check for total absence, hypoaesthesia and hyperaesthesia
• Residual limb length - Above Elbow, Below Elbow
• Scar, Skin condition including Skin Graft if any
• Residual limb shape, Circumference, Swelling
• Pain, Phantom Limb sensation
• Arterial pulses - Brachial artery (BE)
• Muscle tightness/contractures

Post operative Physiotherapy Training

After the post-operative assessment the physiotherapist trains the patient in preparation for the prosthesis fitting. The following issues are important:

• Residual limb hygeine
• Desensitisation, if necessary, using: Percussion, weight bearing into different textures, massage, tapping, rubbing, vibration, limb wrapping
• Residual limb shrinking & shaping as necessary using: Elastic bandage, Elastic shrinker
• Strengthening & Endurance Exercises
  • Pulley system and sandbags
    
    
  • Video: pulley system for strengthening
• Biofeedback for interactive training of muscle for strength, range, etc.
  • Train muscles used for control Switches
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  • Isolation of muscle contractions
  • Isometric contraction training of specific muscle group

Prosthetic Phase

During the prosthetic fitting phase the physiotherapist works closely with the prosthists. The following points should be kept in mind:

• Evaluation of Prosthesis Comfort, fit of the harness and Socket
• Satisfactory operation of all components
• Check for skin ulceration and redness
• Above Elbow - Range at shoulder
• Video: examining range of movement
• Flexion 90º , Abduction 90º , Extension 30º
• Elbow flexion - should reach mouth
• Carry weight of 5kg with the prosthetic hand
• Video: Lifting objects with the prosthesis
• Training given according to vocational need