Walking training guide for thigh prosthesis

A thigh prosthesis is a tool used to load the body weight to assist the unaffected leg in stepping out. When adjusting the alignment of the thigh prosthesis for this purpose, special attention should be paid to how to make the foot of the thigh prosthesis step out normally, and basic gait training should be done.

(1) When walking with a prosthetic thigh, you must first step out of the healthy leg

It is easier to use the unaffected leg to take the load and step out the prosthetic leg first. When using the side load of the thigh prosthesis, it is difficult to lift the unaffected leg, even for one second. The action of stepping out of the unaffected leg is not a step-out action of the lower limb but an action of pushing the pelvis forward. (3) The purpose of stepping forward with the unaffected leg is to push the pelvis forward Patients who wear thigh prostheses for the first time will tuck their buttocks and lean forward when stepping out of the unaffected leg. For this reason, the patient should be instructed not to just step forward with the lower limbs, but to push the pelvis forward. Therefore, the patient is asked to press the stump against the back wall of the socket, and while maintaining this position, take the first step with the unaffected leg. Stepping out of the unaffected leg is to move the body forward, forming a chain movement of the lower limbs and trunk. Simply stepping out your lower limbs will not achieve the walking effect. (4) "Advancing the pelvis is to make the thigh prosthesis have a certain extension angle." When the thigh prosthesis forms an extension angle of 15 degrees, the residual limb also reaches the maximum extension angle within the socket, and at the same time, the body weight support line moves toward the toes. In order to move the weight support line between the heel and metatarsal (German style) toward the toes, the extensor muscles of the residual limb must have the force to maintain the extended position of the prosthetic knee joint, and at the same time, the abductor muscles of the residual limb must be used to control the pelvic sinking. To exert these two muscle forces of the residual limb in the socket at the same time, good fixation between the residual limb and the socket is required, which directly affects the effect of the thigh prosthesis. This is indispensable when studying the fit and alignment of thigh prostheses, and is also a key point that needs to be paid attention to during gait training with thigh prostheses. Whether the person wearing a thigh prosthesis is mentally stable is also related to this. Therefore, you need to pay attention to the following points when training:

aThe high slope you feel when you step over your toes b. Push your toes hard as if you are going to burst your socks. c Lift the heel and do not let the prosthetic leg float These actions occur during the weight-bearing period. At the moment when the load on the toes moves to the healthy limb, the stability of the posture depends on whether the walking cycle can be maintained balanced. The patient himself will feel uneasy during these movements. (5) “Thigh prostheses are not for walking.” The advancement of the thigh prosthesis begins with the swing phase of the prosthesis. Extend the residual limb to the maximum angle. Do not make a forward movement but try your best to lift the loaded toe off the ground. Let the prosthetic limb perform a vibrator swing and then move forward. During amputation, the flexor muscles are not damaged and can maintain normal function, so the flexor function can be used when the prosthesis is extended. To control the swinging movement of the vibrator, the residual limb needs to be trained. When the stepped prosthesis reaches an appropriate angle with the pelvis, the heel contact uses the action of the extensor muscles to keep the knee joint stable, quickly landing the foot and allowing the body weight support line to quickly move to the distal end of the foot. This state is the key to maintaining the posture of the prosthetic limb in the extended position so that it can move forward normally, thereby forming a normal walking cycle. In order to stabilize the knee joint when the heels are grounded, the rubber elastic ring can be softened in the early stages of training. Gait training for thigh prostheses is carried out according to the above five methods. In the initial stage, do standing training first.

 

When training in the standing position, you can perform the following sequence. a Have the patient stand with his back against the wall and repeatedly step out the unaffected leg. (Training for the healthy leg) b Let the ankle joint of the prosthetic leg that is stepping out do a dorsiflexion movement, that is, the sole of the foot strikes the ground. (Prosthetic leg training) c There are several points that need to be noted when practicing these two movements repeatedly. When the healthy leg and prosthetic leg step out, the pelvis moves forward. If you master the control method of the extensor muscles of the residual limb when the ankle joint is dorsiflexed, you can train the movement of the healthy leg to the prosthetic leg. Remember that the thigh prosthesis is not just for walking. When you step out with the healthy leg, the stride length of the prosthetic leg will be shorter than that of the healthy leg. Once you get used to this kind of walking, you will feel that the prosthetic leg is shorter than the healthy leg. The result of this kind of gait practice will be a stable stride with the same stride length of both legs.

 

Let me reiterate several key points of gait training with thigh prostheses. a The thigh prosthesis is used to bear weight. b When walking with a prosthetic thigh, you must first step out of the healthy leg. c. Step forward with the unaffected leg and push it forward toward the pelvis. d. Pushing the pelvis forward is to allow the prosthetic leg to form a 15-degree extension angle. At this time, the heel of the foot lifts the load on the toes. e The thigh prosthesis is not for walking. The stride length of the unaffected leg is smaller, and the sole of the foot taps the ground.