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rehabilitation protocol

Basic rehabilitation protocol in a low resource setting

Pre- and post-rehabilitation cycles for lower extremity amputee patients

The table below suggests a relatively normal recovery cycle for uncomplicated patients. For more complex cases, additional sessions will be required based on individual case assessments.


Session (1) assessment => decision:

A No Fitting => Go to Table & View After Prep AB Fitting Start directly after surgery => Go to Table & View BC Fitting Start with Healed Stump when Ready => Go to Table & View CD Post Fitting => Go to Table & View D________________________________________________________________________________________

End result and procedure/goal number of sessions Contents [1][2][3] No fittings maintenance of a good stump; prevention of complications up to 6(1) assessments[4]; dressing(2) walker donation and training; dressing (pt education); positioning and mobilization of stumps; scar treatment; Transfer (3) walker training; all (2) focus on independence (pt education) (4) similar to (3), but more independent (5) care of residual limbs: hygienic skin care automatic massage (6) previous session A review of the reassessment [4] B Fitting surgery directly pre-installed rehabilitation Up 6(1) Assessment[4]; Dressing(2) Walker donation and training; Dressing; Positioning and careful movement of the stump until the wound has healed, then proceed to (3) below (after wound closure) C Assemble after wound closure Pre-assembled rehabilitation up to 6(1) assessments[4]; Bandaging(2) Walker donation and training; Bandaging; Stump positioning and mobilization; Scar treatment; Desensitization; Transfer(3) Walker training; All(2) Emphasis on independence; Initiation of weight bearing on stump; Strengthening (classical and functional, eg football) (4) Like (3) but more independent (5) caring for residual limbs [5]: hygienic skin care automassage; continue like (4) (6) Previous meeting review reassessment [4] D FittingPost-fitting rehabilitation [6] [7 ] 6(1) first assessment with prosthesis[4]; static exercises; handling prosthesis (putting on & doffing); caring for prosthetics and stumps [5] (2) continue (1); transfer of weight on parallel bars; gait training with a walker (3) static balance exercises; simple transfers; continuation of gait training (4) Dynamic Balance Exercises; Advanced Transfers; Advanced Gait Training; Obstacle Courses (5) Like (4); Start of physical activity (6) Reassessment of previous session overview [4]

The most important cited references can be downloaded for free as a pdf booklet. They outline the entire amputation and assembly process. They also provide guidance and ideas for rehabilitation activities and are essential to all physiotherapists, occupational therapists and rehabilitation worker. It is also a good idea to give or loan them to patients and caregivers who are interested and able to read English.



References will automatically be added here, see adding references tutorial.

  1.  World Health Organisation (WHO). The rehabilitation of people with amputations, 2004. http://www.posna.org/news/amputations.pdf (accessed 14 May 2014)
  2.  Demey Didier. PT Training Manual – Physiotherapy for patients with lower limb amputation. Handicap International, 2010.
  3.  Broomhead et al. Evidence Based Clinical Guidelines for the Managements of Adults with Lower Limb Prostheses. 2nd Edition. London: Chartered Society of Physiotherapy, 2012. Full version: http://www.csp.org.uk/sites/files/csp/secure/bacpar_amputee_rehab_guidelines_2012_1.pdf (accessed 17 May 2014)
  4. ↑ Jump up to:4.0 4.1 4.2 4.3 4.4 4.5 4.6 Gailey RS et al. The Amputee Mobility Predictor: an instrument to assess determinants of the lower-limb amputee ability to ambulate. Arch Phys Med Rehabil 2002;83:613-27.
  5. ↑ Jump up to:5.0 5.1 State of Queensland (Queensland Health). Caring for your stump. http://www.health.qld.gov.au/qals/docs/stump_care.pdf (accessed 14 May 2014)
  6.  International Committee of the Red Cross et al. Exercises for lower limb amputees, gait training. http://www.icrc.org/eng/assets/files/other/icrc_002_0936.pdf (accessed 14 May 2014)
  7.  Rau et al. Short-term effect of physiotherapy rehabilitation on functional performance of lower limb amputees. Prosthetics and Orthotics International 2007;31:258-270

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