Rehabilitation, Prosthetics and Orthotics
What you must understand
Know the principles of rehabilitation: early mobilization, protected weight-bearing, range-of-motion versus strengthening phases, and functional outcome measures. Understand prosthetic components - socket design, suspension, knees, and feet - and the energy cost of amputation levels (transtibial < transfemoral < hip disarticulation). Be fluent in orthoses: AFO, KAFO, TLSO, and their indications. Understand the multidisciplinary team and the role of physiatry and therapy.
Traps in questions
- Higher amputation levels require more energy for ambulation; transfemoral amputation has significantly higher energy cost than transtibial.
- AFO is used for foot drop and ankle instability; KAFO for knee instability or quadriceps weakness.
- Prosthetic fitting requires a mature, well-healed stump with adequate soft tissue and bone coverage.
- Rehabilitation should begin early - delayed mobilization worsens outcomes.
- Outcome measures (e.g., DASH, KOOS, Harris hip score) are commonly tested.
Worked rule of thumb
For any amputation, consider level, energy cost, and prosthetic potential. A younger, motivated patient with a transtibial amputation has excellent functional potential; higher levels demand more energy and training.
Exam strategy
Questions often test the indication for a specific orthosis or the energy cost hierarchy - memorize the ladder.