Date of Award

5-2024

Document Type

Thesis

First Advisor

Steven Halcrow

Keywords

Transtibial amputations (TTA), Pre-prosthetic, residual limb management, prosthetic gait training.

Abstract

Introduction: Transtibial amputations (TTA) impose significant functional difficulty on those who undergo the procedure. Physical therapy is one of the resources that can be used to maximize a patient's outcomes following surgery. Physical therapists play a vital role in the improvement of strength, functional mobility, and independence following a TTA. This report covers the outpatient physical therapy evaluation and treatment of a patient status post-TTA. The purpose of this case was to identify different treatments, considerations, and outcome measures, that can be used when treating a patient with a TTA.

Case Description: The patient is a 66-year-old male who is status post-L TTA. He has a past medical history of diabetes, hypertension, obesity, and was a former smoker. This patient was seen in an outpatient physical therapy clinic for post-TTA management.

Intervention: The patient was seen two days per week for a total of eight weeks. The initial four weeks would focus on pre-prosthetic strengthening, balance training on his unaffected limb, and residual limb management. The remaining four weeks would be oriented towards higher level balance training and gait training with the prosthetic.

Outcomes: Following PT intervention, the patient was able to increase his gait mechanics with a prosthetic and demonstrate improved bilateral knee and hip strength, and balance.

Discussion: Through evaluation and treatment of this patient, it was determined that pre-prosthetic strengthening and balance exercises on the unaffected limb are an effective initial intervention to maximize functional outcomes before the final prosthetic fitting. It was also determined that prosthetic gait training exercises that challenge stability led to improved balance as measured with the Berg Balance Scale and timed single-leg stance. The interventions provided to this patient resulted in improved functional outcomes and mobility both before and after receiving the prosthetic.

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