special subjects
Leg Amputation Rehabilitation
Introduction
Before amputation, the physician describes to the patient the extensive postsurgical rehabilitation program that is needed. Psychologic counseling may be indicated. The rehabilitation team and the patient decide whether a Overview of Limb Prosthetics or a wheelchair is needed. (See also Rehabilitation teaches ambulation skills; it includes exercises to improve general conditioning and balance, to stretch the hip and knee, to strengthen all extremities, and to help patients tolerate the prosthesis. Because ambulation requires a 10 to 40% increase in energy expenditure after below-the-knee amputation and a 60 to 100% increase after above-the-knee amputation, endurance exercises may be indicated. As soon as patients are medically stable, rehabilitation should be started to help prevent secondary disabilities. Older patients should begin standing and doing balancing exercises with parallel bars as soon as possible. Flexion contracture of the hip or knee may develop rapidly, making fitting and using the prosthesis difficult; contractures can be prevented with extension braces made by occupational therapists. Physical therapists teach patients how to care for the residual limb and how to recognize the earliest signs of skin breakdown. 