Overview Functional Training

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Exercises with Therapist

1. Sitting2. Standing up vs. Sitting down3. Standing4. Stance phase ( Static and dynamic )5. Swing phase6. Gait Evaluation7. Walking level ground8. Advanced Exercises9. Stairs10.Ramps

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1. Sitting

• Sitting position

• Abduction and adduction

• Start tapping with wrench on soundside, then the prosthetic side.

- Heel- Metatarsale I- Metatarsale V

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2. Standing up vs. sitting down

Standing up

• Load on both sides

• Move a litte

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2. Standing up vs. sitting down

Sitting down

• Load on both sides

• Move a litte

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3. Standing

• Straight Standing in parallel in bars

• Tripod in standing position, starttapping with wrench on sound side,then the prosthetic side.

- Heel- Metatarsale I- Metatarsale V

• Feel the socket / connect to theground

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3. Standing

Training in standing position in parallel bars

Stance

• Orientation of the COM (Center ofMass) over the base of support.Symmetrical load both legs

• Maximize the displacement of COM• Full prosthetic load• Posture (head!)

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3. Standing

Weight Shifting

• The amputee must learn to displacethe COM over the base of support

• COM is ± 5 cm in front of S2

• A-P transfer• M-L transfer• A-P / M-L on Airex Pad

*combine with proprioceptivefeedback

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4. Stance Phase

Stepping Up Exercise

• Stance shifting weight• Stance shift weight to prosthetic side

/ load prosthesis / contract m.gluteus max and hamstrings

• Stance shift weight / load prosthesis/ contract m. gluteus max and m.hamstrings / sound side toe load

• d. c plus step up; stretching trunk onprosthetic side

• Learn the users to feel andlead/control the movements

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4. Stance Phase

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4. Stance Phase

Theraband Exercises

Theraband on sound side:• Short, fast movements to induce

muscle recruitment• Hip movements:

- Extension- Abduction- Adduction

Theraband on prosthetic side:• Strength, power

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4. Stance Phase

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4. Stance Phase

Ball Exercises

• Ball underneath the sound foot• Difference between small and large ball• Support of the parallel bars

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4. Stance Phase

Loading Response

• Coordination: bring stump fromextension in flexion,

• Feel/experience the resistance,• Functional use in gait, down the

stairs.

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4. Stance Phase

Dynamic prosthetic load

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5. Swing Phase

Pelvic Progression

1. In parallel bars, in step position, both hands support, sound side foot infront.Move pelvis prosthetic side forward/ rotate and let prosthesis flex at theknee.Control the movement of the pelvis ,no pressure, only lead the pelvis inthe right direction

2. As 1, when the movement is correct, then put some pressure on thechrista/ A.S.I.S of the pelvis and with same technique let it rotate forwardwith knee flexion at the end.

3. As 2, but step forward on prosthesis.

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5. Swing Phase

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5. Swing Phase

Start of Walking

4. As 3, one hand support

5. As 4, with walking forwards out ofthe parallel bars, hands support onthe shoulder of physiotherapist.

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6. Gait Evaluation

5 Questions you need to ask yourself to achieve a comfortable Gait

1. Stepping- Can I balance over my prosthesis and take a slow, long stride with the sound limb?

2. Balance- Do I feel my body weight shifting equally over each foot?

3. Knee flexion- Am I achieving equal knee flexion from both legs?

4. Step length- Am I taking an equal step length with each leg?

5. Arm swing

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6. Gait Evaluation

6 Major Deteminants of Gait

1. Transverse Rotation of the pelvis2. Lateral Tilting of the Pelvis3. Lateral Displacement of the Pelvis4. Knee Flexion5. Hip Flexion6. Knee Ankle Interaction

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6. Gait Evaluation

Pelvic Movements

• Rotation- The pelvis rotates during walking. It

rotates forwards with the swingingleg. Normal pelvic rotation is about4°.

- The opposite shoulder and arm willmove forwards with the swinging leg,so that balance is maintained.

• Pelvic dip- The pelvis dips on the side of the

swinging leg. Normal pelvic dip isabout 5°.

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6. Gait Evaluation

Pelvic Movements

• Lateral displacement- The pelvis and trunk move from side

to side during walking, as weight isshifted from one leg to the other.

- Normal lateral displacement is 40 -50mm.

• Vertical displacement- The body rise and falls during

walking.- Normal vertical displacement is less

then 50 mm.

Mid stance Double support

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7. Walking

Pelvic Progression

• Manual unilateral resistance in swingphase of sound side and prostheticside

• Walking with resistance- Manual resistance- With theraband- Always start with sound side

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7. Walking

• Changing Speeds- Accelerate by taking a slightly longer step- Trunk and arms assist with balance- Maintain equal width between feet

• Turning- Take shorter but equal length steps- Start the turn with the hip

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8. Exercises for Advanced Users

• Forward Cup Walking- slowly raise sound leg to 90º flexion in

hip and knee, then slowly return footfloor.

• Lateral Cup Walking

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8. Exercises for Advanced Users

• Side Stepping- Try to maintain pelvis and hips even

when weight is taken on prostheticside.

• Braiding

• Ball Roll- Roll tennis ball forward with sound

side, with or without support, and stepforward to follow it

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9. Stair Descent

• Use handrail

• Prosthetic side first

• Foot position 2/3-1/2 (“hang footover step”)

• Load prosthetic heel

• Feel the resistance

• In flexion on prosthetic side, moveknee forward against appliedresistance

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9. Stair Descent

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10. Ramps

Ramps Ascent

• Take shorter steps

• Use prosthetic toe

• Take pelvis and ascent in samerhythm. Resistance is given in thestance phase

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10. Ramps

Ramps Descent

• Take shorter steps

• Try to control your speed in everysituation

• Put hand on prosthetic knee anduser bents knee with resistance. Useshoulders of physiotherapist forsupport

Exercises transfemoral amputees without prosthesis

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Static Gluteal Contractions

• Lie on your back• Keep both legs straight and close together• Squeeze your buttocks as tightly as possible• Hold for 5 seconds• Repeat ……..times

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Hip Flexor Stretch

• Lie on your, preferably without apillow

• Bring your thigh towards yourchest and hold with your hands

• Push your opposite leg down flaton the bed

• Hold for 30-40 seconds, thenrelax

• Repeat…….times

• Repeat the above with the otherleg

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Hip Hitching

• Lie on your back• Keep both legs flat on the bed• Hitch one hip towards you on one

side and push away on the other(shortening one side and stretchingthe other)

• Hold for 3 seconds• Repeat…….times

• Repeat on the other side

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Bridging

• Lie on your back with your arms atthe side

• Place a couple of firm pillows orrolled up blankets under your thighs

• Pull in your stomach, tighten yourbullocks and lift you bottom up offthe bed

• Hold for 5 seconds• Repeat …..times

• To make this exercise more difficult,place your arms across your chestas shown in the picture

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Hip Flexion and Extension

• Lie on your side• Bend the bottom leg• Lift your top leg slightly• Bend your thigh fully towards your

chest• Push your leg backwards as far as

you can• Repeat …….times

• Try not to let your hips roll forwardsor backwards

• Repeat the above with the other leg

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Hip Abduction in Side Lying

• Lie on your side• Bend the bottom leg• Keep hips and top leg in line with

your top leg up• Slowly lift your top leg up• Slowly lower• Repeat ……times

• Try not to let your hips rollforwards or backwards

• Repeat the above with the otherleg

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Hip Extension in Prone Lying

• Lie flat on your stomach• Lift your leg off the bed as far

as you can• Be sure to keep hips flat on

the bed and do not roll yourbody

• Hold for 5 seconds, slowlylower

• Repeat …….times

• Repeat the above with theother leg

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Hip Adduction with Resistance

• Sit with both legs out in front off you• Place a pillow or rolled up towel between

your thighs• Squeeze your legs together• Hold for 5 seconds• Repeat …….times

• This exercise can also be performed whensitting in a wheelchair or at the edge off thebed

Exercises transfemoral amputee

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Exercises transfemoral amputee

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Side-to-side pelvis shift

Place your feet approximately 10 cm apart and shift your pelvis slowly from left to right and back again. Feel how your weight is shifting from one foot to the other.

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Stepping Up

Move your weight slowly over the prosthetic leg, then push your residual limb into the socket and place the sound side foot on the step. Feel your full weight loaded on your RHEO KNEE. Try to control your balance on the prosthetic side using the muscles around your hip.

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Stepping Forward

Step forward with your sound side foot, actively loading your weight onto the prosthetic side. Focus on your balance over the prosthesis as you move forward and backward.

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Walking

Practice walking while your prosthetist or physiotherapist gently restrains your pelvis on the prosthetic side. This increased resistance during the exercise will help give you more forward momentum. When walking, this will produce a longer and more natural stride

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Figure - 8 - walking

Place rubber cups on the floor and walk in a figure of eight or make gentle turns. Concentrate on the roll-over movement of the prosthetic foot and feel how smoothly the RHEO KNEE is flexing.

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Walking with sticks

Using sticks can help improve your trunk rotation and balance as you get used to the RHEO KNEE. Actively loading the prosthesis (putting your weight on to it) and generating a smooth roll-over of the prosthetic foot will enhance your forward momentum.

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Sitting Down

Place the prosthetic foot slightly forward, then put your weight on the RHEO KNEE and keep it there until you can gently bend it (the prosthetic knee). The resistance – or braking power – you can feel helps you to sit down slowly.

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Walking downstairs

Hold the handrail(s) and place the rear half of the prosthetic foot on the step. Practice putting weight on the prosthetic side and gradually move the pelvis forward. By loading the RHEO KNEE like this, you will produce the resistance needed to get you down to the next step smoothly.

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Walking down a ramp or slope

Hold the handrail(s) and take short, evenly-paced steps. Loading the RHEO KNEE will produce the resistance needed to walk down the ramp in a controlled way.

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