Overview Functional Training

Overview Functional Training

Exercises with Therapist 1. Sitting 2. Standing up vs. Sitting down 3. Standing 4. Stance phase ( Static and dynamic ) 5. Swing phase 6. Gait Evaluation 7. Walking level ground 8. Advanced Exercises 9. Stairs 10. Ramps 10/29/2015 29

1. Sitting Sitting position Abduction and adduction Start tapping with wrench on sound side, then the prosthetic side. - Heel - Metatarsale I - Metatarsale V 10/29/2015 30

2. Standing up vs. sitting down Standing up Load on both sides Move a litte 10/29/2015 31

2. Standing up vs. sitting down Sitting down Load on both sides Move a litte 10/29/2015 32

3. Standing Straight Standing in parallel in bars Tripod in standing position, start tapping with wrench on sound side, then the prosthetic side. - Heel - Metatarsale I - Metatarsale V Feel the socket / connect to the ground 10/29/2015 33

3. Standing Training in standing position in parallel bars Stance Orientation of the COM (Center of Mass) over the base of support. Symmetrical load both legs Maximize the displacement of COM Full prosthetic load Posture (head!) 10/29/2015 34

3. Standing Weight Shifting The amputee must learn to displace the 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 proprioceptive feedback 10/29/2015 35

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 on prosthetic side Learn the users to feel and lead/control the movements 10/29/2015 36

4. Stance Phase 10/29/2015 37

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 10/29/2015 38

4. Stance Phase 10/29/2015 39

4. Stance Phase Ball Exercises Ball underneath the sound foot Difference between small and large ball Support of the parallel bars 10/29/2015 40

4. Stance Phase Loading Response Coordination: bring stump from extension in flexion, Feel/experience the resistance, Functional use in gait, down the stairs. 10/29/2015 41

4. Stance Phase Dynamic prosthetic load 10/29/2015 42

5. Swing Phase Pelvic Progression 1. In parallel bars, in step position, both hands support, sound side foot in front. Move pelvis prosthetic side forward/ rotate and let prosthesis flex at the knee. Control the movement of the pelvis,no pressure, only lead the pelvis in the right direction 2. As 1, when the movement is correct, then put some pressure on the christa/ A.S.I.S of the pelvis and with same technique let it rotate forward with knee flexion at the end. 3. As 2, but step forward on prosthesis. 10/29/2015 43

5. Swing Phase 10/29/2015 44

5. Swing Phase Start of Walking 4. As 3, one hand support 5. As 4, with walking forwards out of the parallel bars, hands support on the shoulder of physiotherapist. 10/29/2015 45

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 10/29/2015 46

6. Gait Evaluation 6 Major Deteminants of Gait 1. Transverse Rotation of the pelvis 2. Lateral Tilting of the Pelvis 3. Lateral Displacement of the Pelvis 4. Knee Flexion 5. Hip Flexion 6. Knee Ankle Interaction 10/29/2015 47

6. Gait Evaluation Pelvic Movements Rotation - The pelvis rotates during walking. It rotates forwards with the swinging leg. Normal pelvic rotation is about 4. - The opposite shoulder and arm will move 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 is about 5. 10/29/2015 48

6. Gait Evaluation Pelvic Movements Lateral displacement - The pelvis and trunk move from side to side during walking, as weight is shifted from one leg to the other. - Normal lateral displacement is 40-50 mm. Vertical displacement - The body rise and falls during walking. - Normal vertical displacement is less then 50 mm. Mid stance Double support 10/29/2015 49

7. Walking Pelvic Progression Manual unilateral resistance in swing phase of sound side and prosthetic side Walking with resistance - Manual resistance - With theraband - Always start with sound side 10/29/2015 50

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 10/29/2015 51

8. Exercises for Advanced Users Forward Cup Walking - slowly raise sound leg to 90º flexion in hip and knee, then slowly return foot floor. Lateral Cup Walking 10/29/2015 52

8. Exercises for Advanced Users Side Stepping - Try to maintain pelvis and hips even when weight is taken on prosthetic side. Braiding Ball Roll - Roll tennis ball forward with sound side, with or without support, and step forward to follow it 10/29/2015 53

9. Stair Descent Use handrail Prosthetic side first Foot position 2/3-1/2 ( hang foot over step ) Load prosthetic heel Feel the resistance In flexion on prosthetic side, move knee forward against applied resistance 10/29/2015 54

9. Stair Descent 10/29/2015 55

10. Ramps Ramps Ascent Take shorter steps Use prosthetic toe Take pelvis and ascent in same rhythm. Resistance is given in the stance phase 10/29/2015 56

10. Ramps Ramps Descent Take shorter steps Try to control your speed in every situation Put hand on prosthetic knee and user bents knee with resistance. Use shoulders of physiotherapist for support 10/29/2015 57

Exercises transfemoral amputees without prosthesis

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 10/29/2015 71

Hip Flexor Stretch Lie on your, preferably without a pillow Bring your thigh towards your chest and hold with your hands Push your opposite leg down flat on the bed Hold for 30-40 seconds, then relax Repeat.times Repeat the above with the other leg 10/29/2015 72

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 stretching the other) Hold for 3 seconds Repeat.times Repeat on the other side 10/29/2015 73

Bridging Lie on your back with your arms at the side Place a couple of firm pillows or rolled up blankets under your thighs Pull in your stomach, tighten your bullocks and lift you bottom up off the bed Hold for 5 seconds Repeat..times To make this exercise more difficult, place your arms across your chest as shown in the picture 10/29/2015 74

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 forwards or backwards Repeat the above with the other leg 10/29/2015 75

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 roll forwards or backwards Repeat the above with the other leg 10/29/2015 76

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 your body Hold for 5 seconds, slowly lower Repeat.times Repeat the above with the other leg 10/29/2015 77

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 when sitting in a wheelchair or at the edge off the bed 10/29/2015 78

Exercises transfemoral amputee

Exercises transfemoral amputee 10/29/2015 93

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. 10/29/2015 94

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. 10/29/2015 95

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. 10/29/2015 96

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 10/29/2015 97

Figure - 8 - walking Place rubber cups on the floor and walk in a figure of eight or make gentle turns. Concentrate on the rollover movement of the prosthetic foot and feel how smoothly the RHEO KNEE is flexing. 10/29/2015 98

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. 10/29/2015 99

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. 10/29/2015 100

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. 10/29/2015 101

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. 10/29/2015 102

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