Phone: 866-782-6258

The Right Time for a Prosthetic Limb

John Rheinstein, CP, FAAOP

September 24, 2014



At what point are patients getting their first prosthetic limb?  Are there any limitations or precautions for exercise and balance training?


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.”  

john rheinstein

John Rheinstein, CP, FAAOP

John Rheinstein is a board certified prosthetist with 20 years experience practicing in New York City with Hanger Clinic. He received his board certification in prosthetics from Northwestern University Medical School’s Prosthetics & Orthotics Center at the Rehab Institute of Chicago. He is a fellow of the American Academy of Orthotists and Prosthetists and is the chair of the Lower Limb Prosthetic Society.

John has specialized experience with active, proximal level, and upper extremity amputation patients as well as immediate post-operative care.  He is the co-inventor of the patented Aircast Air-Limb post-operative prosthesis. John is active in research and patient care applications of new products.  He presents at academic and medical institutions, teaches continuing education courses to prosthetists, and trains prosthetic residents.  He recently won the Hanger Award for Pioneering Innovations.

Related Courses

Fabrication of a Training AFO
Presented by Jennifaye V. Brown, PhD, PT, NCS
Recorded Webinar


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Course: #3119Level: Advanced2 Hours
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Research indicated that in inpatient rehab "The largest percentage of time in physical therapy sessions was spent on gait activities" (Jette, et al., Physical Therapy, 2005; 85(3): 238-248, p. 241). Ankle foot orthotics (AFOs) are not issued in inpatient rehab due to the costs and interim interventions such as stabilizing the foot with an ace bandage are not adequate. Facilities do not have access to pre-fabricated AFOs or electrical stimulation units now being used as walking aides to replace AFOs. Focused rigidity casting is widely used in the orthopedic population and can be applied to the neurologic population. This course will provide insight on the use of focused rigidity casting to fabricate training an AFO. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

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Presented by Jennifaye V. Brown, PhD, PT, NCS
Recorded Webinar


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Course: #2946Level: Intermediate2 Hours
  'I enjoy orthotic information and gaining knowledge in this area'   Read Reviews
Very little research exists documenting the practice and evidence of the physical therapist’s role in recommending an ankle foot orthosis (AFO). The comprehensive examination should be patient-centered and collaborative in nature with the orthotist, but is often absent in rehabilitation practice. This course will review components of a physical therapy AFO examination as presented in the literature and provide evidence of what should be included, deleted or modified based patient impairments, social determinants of health and the presenter's experiences in AFO fabrication. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

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  'It was good to be reminded that many people have traumas to some degree and how to approach it as a clinician during your treatment sessions'   Read Reviews
Acute and chronic trauma is very prevalent in the United States, and have been tied strongly to adverse health behaviors and outcomes. This course provides the rehabilitation professional with an overview of the physiology of trauma, as well as practical tools to work with patients who are experiencing trauma. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

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Presented by Jill Seale, PT, PhD, NCS
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Jill Seale, PT, PhD, NCS
Course: #3489Level: Intermediate2 Hours
  'Very practical - thanks'   Read Reviews
This course will provide participants with essential tools for determining appropriate orthotic management with an ankle-foot orthosis (AFO) based on detailed gait analysis. Evidence-based orthotic interventions will be presented and participants will have opportunities to see orthotic examples and practice application of information through video/paper cases. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Static Splinting Series
Presented by Kirsten Davin, OTD, OTR/L, ATP, SMS
Recorded Webinar


Kirsten Davin, OTD, OTR/L, ATP, SMS
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  'This course is very informative, descriptive and practically oriented for me in my clinical practice'   Read Reviews
The static splinting 4-course series consists of an overview of the history of splint fabrication, the advances in the splinting and orthotics arena, and an anatomical review of key structures and landmarks. A detailed demonstration of wrist orthotics is presented as well as radial gutter/thumb spica splints, dorsal and volar wrist cock-ups, functional position with an intrinsic plus modification option, hand-based thumb spica, finger gutter and MP joint blocking splints. The application and use of a spring finger extension splint, oval 8 splints as well as static progressive finger flexion and extension splints are included.Finally, the fabrication of a footplate for external fixator application, the application of lower extremity splints and orthotics as well as splinting considerations for specific diagnoses including burn injury occurs in part 4.

Please note: This course series is comprised of the following individual recordings: #4018, #4020, #4022, and #4024

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