1.12 Amputations

Amputations can be classified into two categories – acquired amputation and congenital amputation. The amputation is acquired if one has a limb removed by operation; it is congenital if the child is born without a limb.

Congenital amputations are classified according to the site and level of limb absence. When an amputa­tion is performed through a joint, it is referred to as a disarticulation.

Medical Treatment. Medical treatment involves the design of a prosthetic appliance. The purpose of the prosthetic device is to enable the individual to function as normally as pos­sible. The application of a prosthetic device may be preceded by surgery to produce a stump. .After the operation the stump is dressed and bandaged to aid shrinkage of the stump. Following the fitting of the prosthesis, the stump must be continually cared for. It should be checked periodically and cleaned to pre­vent infection, abrasion, and skin disorder.

The attachment of a false limb early in a child's development will encourage the incorporation of the appendage into natural body activity more than if the prosthesis is introduced later in life.

Prosthesis Training. Amputees must develop skill to use prostheses; effec­tive use demands much effort. Training should be di­rected toward daily living skills such as eating, drink­ing, dressing, and recreational skills that can be taught in physical education. Prostheses often result in problems of ambulation. These problems vary with the specific level of amputation.

Gait Training. Most gait deviations result from problems with the alignment of the prosthesis. Deviations may include rotations of the foot at heel strike, unequal timing, side walking base, abducted gait, excessive heel ride, instability of the knee, excessive knee flexion, hyper-extension of the knees, excessive pronation of the foot, foot slap, and rotation of the foot with continu­ing whip.

Persons with amputations below the knee can learn ambulation skills well with a prosthesis and training. Persons with amputation above the knee but below the hip may have difficulty in developing effi­cient walking gaits. Amputations at this level require alteration of the gait pattern. Steps are usually short­ened to circumvent lack of knee function.

Aids may be designed to assist prostheses of the legs or the arms. Assistive devices may be used to aid lo­comotion when the legs are debilitated. Some assis­tive devices are canes and crutches. A major problem for students who use canes and crutches is the need to learn balance to free one hand for participation in activity. Use of the Lofstrand crutches, which are an­chored to the forearms, enables balance to be main­tained by one crutch. This frees one arm and enables participation in throwing and striking activities.

Although it is difficult to substitute for the human hand and fingers, it is possible to achieve dexterity with the use of a utility arm and split hook. These aids enable the use of racquets for paddle games if both arms are amputated. Persons who have lost a single arm can play most basic skill games and partic­ipate in more advanced sports activity without modi­fications. Special devices can be built by an orthotist to fit into the arm prosthesis to hold sports equip­ment such as gloves.

Therapeutic Treatment. Amputees are often exposed to beneficial exercise through the use of the prosthesis. Exercises should be initiated to strengthen muscles after a stump heals. Training also enhances ambulation, inhibits atrophy and contractures, improves or maintains me­chanical alignment of body parts, and develops gen­eral physical fitness.

Authorities agree that children with properly fitted prostheses should engage in regular physical educa­tion activities. Amputees have considerable potential for participation in adapted sports and games. There are opportunities for persons with prostheses to par­ticipate in official sports competition.

There are several adaptations of physical activity that can be made for children with impaired ambu­lation. For these children the major disadvantages are speed of locomotion and fatigue to sustained activity. Some accommodations that can be made are short­ening the distance the player must travel and de­creasing the speed needed to move from one place to another.

Physical fitness of amputees should be an impor­tant part of a physical education program. Strength and flexibility and power of the unafflicted limbs are important. Furthermore, Lasko and Knorph stress the importance of developing and maintaining the amputees' level of cardiovascular efficiency.