An amputation of your lower leg below your knee is called a trans-tibial amputation but is commonly referred to as BK (below knee) amputation. Rehabilitation after this type of surgery involves physical therapy, occupational therapy and working with a prosthetist.
Evaluation After Amputation
Under the direction of your surgeon, your physical therapist will evaluate your overall health conditions and will assess your capabilities after your amputation. This assessment will include the strength of your muscle groups, the range of motion in your knee, the sensation you feel, your level of mobility and your balance and coordination. Your prosthetist will work with you to create an artificial limb, a prosthesis, that is best suited to your individual lifestyle and physical needs. An occupational therapist may be part of the rehabilitation team depending on your vocation.
Your therapists will also provide you with education on proper skin care of your residual limb, techniques to prevent your knee from contracture, the condition of being in a flexed position all the time, fall prevention techniques and overall body conditioning.
Physical Therapy
Your physical therapist will work with you to develop a pre-prosthetic exercise program designed to prepare you to walk with a prosthesis; but you will first learn how to balance your weight over your good limb. This is typically done through the use of parallel bars and progressive exercises until you attain balance and coordination on one leg. You will learn how to place the center of your body mass over the foot of your residual leg and will advance to side-to-side and forward/backward exercises until you feel safe with your balance and coordination.
Gait Training
For a healthy person with a below-the-knee amputation, learning to walk with a normal gait is very achievable. Your therapists will help you understand the influence of your gait mechanics on your ambulation and stability. This includes the length and width of your stride, how you tilt and rotate your pelvis when you walk, how you flex and extend your knee and the impact of not having an ankle and foot for flexion and extension. Your therapist also evaluates how you swing your arms and use your trunk. By assessing these factors your therapist and your prosthetist can design and fabricate a prosthesis that will enable you to perform to the best of your ability.
Sensation in Your Residual Limb
Most amputees feel phantom limb sensations. Additionally, the contact of your limb inside the prosthetic socket will create sensory pressure feedback that allows you to better control your prosthetic limb. This feedback helps you to regulate how pressure is placed on your prosthesis to give you control of your artificial limb as you walk. You will master stepping activities such as ascending and descending stairs and maneuvering on uneven surfaces. Walking backwards or rotating your body on your prosthetic limb will be additional challenges your therapist will help you to accomplish confidently.
If You Cannot Use a Prosthesis
If you cannot use a prosthesis due to other medical conditions or for other reasons, your therapist will train you in the use of assistive devices such as crutches, walkers and wheelchairs. The therapist may focus on one-legged assisted ambulation or recommend full time use of a wheelchair.
References
- "Atlas of Amputations and Limb Deficiencies"; Physical Therapy; Gailey, R. and Clark, C.; 2004
- "Care of the Combat Amputee"; Gait Analysis and Training of People With LImb Loss ; Wilken, J. and Martin, R.; 2009
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