Programming for Lower Limb Amputation
An estimated 1.9 million individuals in the United States have experienced an amputation. The majority are lower limb amputations (LLA) and are the result of vascular diseases such as type II diabetes or peripheral vascular disease.
Trauma is the second leading cause of lower limb amputation. Trauma may result from accidents causing severe crush injuries or ischemia, chemical and electrical burns and frostbite.
Curative treatment of tumors and treatment of congenital deformities account for the remaining number. There is a distinct difference between individuals requiring LLA resulting from vascular disease versus trauma.
The majority of individuals requiring LLA resulting from the vascular disease are over age 55 and their amputations are primarily the result of complications occurring from Type II diabetes or atherosclerosis.
Those individuals with LLA resulting from trauma, tumors or congenital deformities are under the age of 50. Understanding the classification is important as individuals with vascular amputations will inevitably have multiple system dysfunctions. The primary purpose for exercise management in this population is to slow the pathogenesis of the underlying metabolic disease.
Exercise management for the non-vascular amputee is similar as it would be for a nondisabled person. That is, to develop an exercise program to reduce the risk of developing secondary disabilities such as cardiovascular disease, diabetes, hypertension, and obesity. Additionally, a number of LLA regularly participate in sports and endurance events.
Lower leg amputees fall into one of a number of different classifications depending on the location of their amputation.
Symes amputation occurs at the midfoot. Transtibial occur below the knee, transfemoral are above the knee and a hip disarticulation is a removal of the leg at the hip joint.
The effects of exercise on individuals with LLA will depend on the remaining volume of exercising muscle mass.
Individuals with bilateral transfemoral amputations will be limited by the muscle mass and work capacity of the upper body musculature. Those individuals with transtibial amputations that select a mode that utilized their remaining lower body, trunk, and upper body musculature will have a similar response as nondisabled individuals. In fact, given the opportunity to train and utilize performance prosthetic devices some individuals may even make it to the Olympic games.
In general, individuals with LLA can follow the same exercise programming as the rest of the population.
Individual’s with LLA should use a mode of exercise that will maximize their remaining muscle mass to produce improvements in cardiovascular fitness and not cause breakdown of the skin on the residual limb or overuse injuries. Flexibility exercises are important to minimize the potential for knee flexion contractures in the transtibial amputee and hip flexion contractures in the transfemoral amputee. Joint contractures cause a significant increase in the energy cost of walking with a prosthesis.
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