Question
At what point are patients getting their first prosthetic limb? Are there any limitations or precautions for exercise and balance training?
Answer
Patients are generally getting their first limb, or rather, we are starting the first limb, around the time of suture removal. That can be anywhere between 3 and 6 weeks. It will depend on how fast the patient is healing, what their healing potential is, how fragile their skin is, and co-morbidities. I have had a patient where I have taken a chance on making a leg early because of their other issues. I had one man who could not use a bed pan for urination. He was having a lot of problems. It came down to catheterized or getting a prosthetic limb even though he was not 100% ready for the limb. We decided to take a chance. Every case is going to be individual, but generally speaking, we like to see the patient for the impression right around the time that the sutures are coming out, and the doctor has cleared them.
Limitations for exercise and balance training will be based on any co-morbidities including cardiovascular problems, wound sensitivity, or skin breakdown/friable skin. It is a “take it as you see it” approach. I tend to be a little bit more aggressive, because you never really know how far you can go until you have gone there. For example, patients will come in my office with a walker, and I can see that they can walk with a can. Am I going to just throw the walker out and give them the cane? No, I will demonstrate to them that they can hold on with one hand in the parallel bars, and then I will send them back to the therapist and say to them, “Hey I think you are ready. Let’s move along.”
