Rehabilitation, Prosthetics and Orthotics
Core rules
- Rehabilitation begins early and is goal-directed: pain control, range of motion, strength, mobility and participation.
- Amputation level affects energy cost and prosthetic potential; transtibial amputation generally requires less energy than transfemoral.
- Prosthetic fitting depends on residual limb healing, shape, sensation and patient goals; prosthetic knees vary from mechanical to microprocessor-controlled.
- Orthoses can immobilize, correct, offload or assist; examples include AFO for foot drop, TLSO for spinal support and CROW boot for Charcot.
- Spinal cord rehabilitation addresses bladder, bowel, skin, spasticity and pressure areas, not walking alone.
Worked example
A 40-year-old with a traumatic transtibial amputation wants to return to work. Reasoning: optimize residual limb shape and wound healing, provide compression, fit a total-surface-bearing socket, train gait and balance, and address prosthetic maintenance and work demands.
Traps
Do not prescribe an orthosis without a functional goal. Do not ignore skin breakdown from a poor socket. Do not equate rehabilitation with passive exercises only.
Key points are listed separately.