AK TRAINING SERIES

Hip Extensor/Hamstring

Have amputee lift prosthesis up as high as they can

Place hand on the back of the socket

Have them push down and try to drive heel into the floor

Hip Flexor/Quadriceps

Bend prosthetic knee from behind and grab at ankle

Have amputee push forward

Spotter release hold at the ankle once they give good push to see if leg goes into full extension

You may need to use a spotter, a wall, or the parallel bars as a form of balance support.

You may also need to stand on a 2-4 inch step on the side you are not working for clearance of the floor.

So begin swinging your leg backwards, then forwards in an arc like a pendulum motion.

Building up the intensity of the swing requires a stronger push on the front and back walls of socket

A physical therapist can help you perfect this movement by standing on the side of you, placing their hands on the socket (avoid placing your hands in the knee joint) and gently giving a push backwards and forwards.

After some practice you'll be doing this on your own

This exercise will help you to develop where your foot is in space without having to always look down.

Stand in between the parallel bars with the prosthetic foot behind you and begin to flex your hip/push on front wall of the socket and start moving your leg into swing phase.

About half way through the swing phase motion stop pushing on the front part of the socket and make an aggressive push on the back wall of the socket.

By pushing on the back wall of the socket you activated your hip extensors and hamstrings to bring the prosthesis back down to the ground.

Remember it is an aggressive push on the back wall of the socket activating those hip extensors, which after typically weak post amputation.

WHAT TO WATCH FOR

Are they striking or floating the leg

Are they leaning back

Are they sitting back

Are they shifting weight to the prosthetic side

Are they able to bend the knee (what knee unit is it?)

Does the knee buckle at point of heel strike

Does the leg rotate too much (internal or external)

ASSISTING 

Physical therapists can assist the movement by placing their hands on the socket; avoid the knee hinge, and aggressively push backwards to assist the hip extensors in striking the ground.

BEGINNER GOAL: 3 sets of 5

INTERMEDIATE GOAL: 3 Sets of 12

ADVANCED GOAL: 4 sets of 15

I WORK MAY WAY UP TO 5 SETS of 25

As a beginner, this exercise will fatigue the muscles in the hip and residual limb very quickly

This exercise has been called a "targeting" one.

Take pieces of masking tape and place them on the ground in front of you and to the sides of you.

Create a marker to stand on with the sound side.

Make the pieces of tape big for beginners.

The physical therapist will now number each piece of tape 1 to however many are on the floor.

They then will call out each number in order as you go through the grid performing the Heel Strike exercise.

After becoming more advanced, call the numbers out of order and eventually make the markers on the floor smaller and smaller to further increase proprioception.

This exercise will help get rid of some bad habits like vaulting (rising up too much on the sound side). We start to introduce heel striking from the grid to an actual part of walking.

By taking small "baby" steps in the length of the parallel bars, practice a continuous heel strike exercise.

Taking those small steps with both the prosthetic side and the sound side will not allow the vaulting action to take place.

Physical therapists can again assist by standing on the side and putting their hand on the socket area and push backwards to assist the hip extensors and hamstrings in achieving a quick heel strike.

Measuring out a 10 ft. distance: 

Beginners will complete 3-5 baby steps for every 5 ft.

Intermediate levels will complete 5-10 baby steps for every 5 ft.

Advanced will complete 10-15 baby steps for every 5 ft.

This exercise is one that will increase your stance time while walking on your prosthesis and force the knee to have to bend.

Take a short step with your prosthesis and a long step with you sound leg.

Do the opposite: a short step with the sound limb and a long step with the prosthesis.

Place your prosthesis on a short step.

Try using a Reebok step in between the parallel bars or a stairwell with handrails that you can reach with both hands.

Push really hard on the back wall of the socket to force the leg into full extension.

This is teaching someone to lead with their prosthetic leg.

If the person does not have the strength in the extensor muscles to push back, the prosthesis will buckle.

Spotting is very important for beginners.

This will help build strength for escalating stairs and curbs

A physical therapist can help in two ways:

One way is to push cradle backwards and the socket forward to assist the extensors.

Another method would be to hold the prosthetic foot that is on the step from turning side to side.

This side to side motion is happening because the AK amputee is not putting enough weight on the prosthesis.

By holding the foot, you are giving them security in only having to control the prosthesis with the hip extensors and hamstrings.

What to watch For when assisting?

Are they using the other leg to push up/jump up?

Is the knee ending in full extension or is it slightly bent or buckling?

Do they need a lot of assistance from spotter?

Are the in the end position have both feet are equal or is the sound side slightly behind?

Beginners: Can usually accomplish a 2-4 inch step with assistance

Intermediate: 4-8 inch step; moderate to no assistance

Advanced: 12 inches and above with no assistance

Pretend that the step is a curb now.

Start by heeling striking onto the higher height as it is close

Then put curb at far end of the parallel bars. Walk down parallel bars and target the curb. Practice doing the exercise by taking normal steps-baby steps-odd steps BUT always targeting the curb!

STEPPING OVER

Start with one inside parallel bars

I work up to 4 to 6 inside parallel bars --Increasing the amount of half round foam rollers works on stepping over and limits space in between to plant feet. Great targeting exercise.

We use the balance beam for strength training and targeting. By walking heel to toe with no space will encourage the amputee to bend their knee as they are doing the exercise. If they do not bend their prosthetic knee they might circumduct their gait. Staying on the beam is a challenge.

Add a second beam and have one foot one each beam. Great for bilateral amputees. 

Practice normal walk and baby steps. 

Spotter wraps t-band around AK side (midway length of residual limb), and holds from behind as amputee  powers through walking gait.

Use heavy resistance t-bands.

When the bands come off, the AK amputee will feel like the prosthesis is super light and now be able to walk  much quicker and stronger.

One important note is that you want to make sure the person is bending the knee on the prosthesis side while the t-band is attached.

Beginners: Start inside parallel bars (10 Ft.) ---If the knee cannot bend (locking knee) I still do the exercise.

Intermediate: Turn around and walk back (20 Ft.) This is the real beginning for most people

Advanced: Work up to 50 Ft., adding 10 Ft. more at a time

If the knee cannot bend (locking knee) I still do the exercise

REBOUNDER

This is heel striking into mat

Hit center of mat

Set up grid work

Make sure they shift weight onto prosthetic side after striking it

The feeling is like trying to push into the mat

Work sound side too, but not by striking it, just stepping onto mat

TEST OF WEIGHT SHIFT

After amputee hits mat with heel strike, have them hold position for 5 seconds

Spotter try and move prosthetic side in all different directions

If the foot moves then they are not shifting enough weight and holding the shift onto mat

Are they leaning back?

With spotter in the front, the amputee will step out with prosthesis then bend the knee until the foot is flat on the ground and hold

  Ways to evaluate and set goals:

Distance: from the toes of the back foot to the heel of the front foot that we can measure

4 inches for a beginner

8 inches for a intermediate

12 inches higher for advanced

Remember to combine Lunges with the Odd Steps exercise to create more difficulty by adding targeting to the mix

Sitting in a Chair and Squats

Have the amputee sit in a chair

Do they collapse into the chair?

Do they lift prosthesis off the ground

to sit in the chair?

Recommended 4 exercises:

Total Gym Squats

Leg Press machine

Squatting using ball

Stand Up Squats inside the Parallel Bars

When Spotting The Person

Amputee’s foot is positioned about half way off the front of the squat stand

This allows amputee to squat down into 90 degree angle

Foot (HEEL) stays in contact with leg platform (might need to hold foot for beginners to prevent heel rising or rotation)

Position hand on top of the knee joint to assist downward and upward movement to bring leg from Flexion to Extension

A good test and great workout

The right candidates/ A very advanced workout

Have amputee walk as fast as they can

NOT ON TREADMILL for beginners

Tests prosthetic control

Reinforces “Push & Pull” socket training

Mark out distance up to 50 feet

The Amputee Walking School is now available 

ITunes

https://itunes.apple.com/us/app/amputee-walking-school/id1131471787?ign-mpt=uo%3D4

Google Play Store

https://play.google.com/store/apps/developer?id=Amputee%20Walking%20School&hl=en