After a lower limb amputation, first use of a prosthesis is an important step in prosthetic leg rehabilitation for the person's return to daily life. Gait training is a structured process that aims to enable safe and balanced movement with a prosthesis. All applications are carried out in line with the specialist physician's assessment and medical report, accompanied by a physiotherapist and a prosthetist-orthotist.
Basic Skills with a Prosthesis
For a user getting used to their first prosthesis, the priority is to acquire the basic skills needed for daily life. These skills include:
- Putting on and taking off the prosthesis correctly
- Carrying, cleaning and caring for the prosthesis
- Developing balance, coordination and muscle strength
- Reorganizing activities of daily living (ADL)
- Gait training
Help from a relative may be useful at the beginning of the process; however, the ultimate goal is for the person to be able to use and care for their prosthesis on their own.
Putting On and Taking Off the Prosthesis
One of the first skills new users need to learn is putting on and taking off the prosthesis. The method used varies according to the type of prosthesis and the condition of the residual limb. Different socket and liner combinations and different attachment techniques may be used for below-knee (transtibial) and above-knee (transfemoral) levels. The appropriate technique is planned individually.
Gait Training
When a new prosthesis is fitted, a gait training program adapted to the selected components is started. At this stage, it is essential for the user to gain confidence in the new prosthesis, regain balance and understand how the prosthesis functions. Understanding how the prosthetic foot works is especially important for below-knee users, and how the prosthetic knee works for above-knee users.
The gait cycle consists of the stance phase, in which weight is placed on the leg, and the swing phase, in which the leg moves forward in the air; the stance phase makes up the larger part of the cycle. New users may often encounter asymmetries such as a shorter stance phase on the affected side. For this reason, control of the stance phase is usually a good starting point in training. Exercises that can help build strength and confidence include:
- Balance and weight shifting: Getting used to the prosthesis by shifting weight back and forth from the unaffected side to the affected side.
- General strengthening: Developing balanced whole-body posture with a focus on the trunk and the affected leg.
- Standing up and sitting down: Mastering these movements by distributing the load evenly on both sides.
- Stance phase practice: The habit of putting equal load on both sides at the start of each step.
- Activities of daily living: Increasing real-life confidence by repeating frequently performed movements.
Assessing Progress
Successful rehabilitation is a process that returns the person to daily life and work. To measure progress, it is helpful to compare mobility before and after amputation. Validated, standardized assessment tools are frequently used in the clinic:
- Performance-based tests: Tools such as the Amputee Mobility Predictor (AMPPRO/AMPnoPRO), the Four Square Step Test and the Timed Up and Go (TUG) test measure the current level of mobility and improvement after training.
- Patient-reported outcomes (PRO): The Activities-specific Balance Confidence (ABC) scale, the PLUS-M mobility questionnaire and the EQ-5D-5L quality-of-life scale are used to assess the person's own perception.
These tools help monitor the process objectively by considering different dimensions such as balance, coordination, risk of falling and quality of life together.
This content is for informational purposes; for diagnosis and treatment, you should consult your physician.
