Page 2 P H Y S I O T H E R A P Y  DECEMBER, 1971

IN T R O D U C T IO N

M O D U LA R  PROSTHESES A possible Extension o f the T raditional Physical Therapy
Role in the m anagem ent o f Amputee P atients.

J O A N  M . W A L K E R , B .P .T ., N .Z .R .P ., D ip . T .P ., 
S c hool o f  M edical R ehabilitation, 800 Sherbrook S tre et, 

W innipeg, 2, Canada.

Physical th era p y  has a vital role to play in the re h a b ilita ­
tio n  o f  a m p u te e  p a tie n ts. A n a m p u te e  p a tie n t n o rm ally  has 
a  len g th y  perio d  o f  c o n ta c t w ith physical th era p y  while 
w aitin g  fo r fitting o f  the final o r definitive lim b. T h is fitting 
is no rm ally  delayed until m a x im u m  s tu m p  sh rin k a g e  has 
been achieved. W h a t c a n  the th e ra p ist d o  to  assist in re d u c ­
ing this p e rio d ?  W h a t can  be d o n e  to  reduce the tedious 
repetitive exercise p ro g ra m m e  necessary d u rin g  th is period 
to im p ro v e  a n d  th en  m a in ta in  an  a d e q u a te  level o f  fitness, 
p a rtic u la rly  in re la tio n  to the s tu m p  m u sc u la tu re ?  C an the 
m o d ern  th era p ist in sm all c en tres a w ay  fro m  close c o n ta c t 
w ith a p ro sth e tist e n la rg e  the tra d itio n a l physical th era p y  
role to help p ro v id e  a b e tte r service fo r a m p u te e  p a tie n ts ?

A t th e  M a n ito b a  R e h a b ilita tio n  H o s p ita l all a m p u te e  
p a tie n ts receive daily, a n d  o fte n  tw ice daily, tre a tm e n t on 
th e  Jo b s t P e rip h era l C o m p ressio n  U n it in a d d itio n  to  the 
tra d itio n a l p ro g ra m m e  o f  stu m p  b a n d ag in g . P a tie n ts also 
receive tre a tm e n t o n  th is U n it p rio r to c astin g  fo r  a socket 
by th e  p ro sth e tist. T h e re  is a need for a co m p re h en siv e  
clinical stu d y  to  d e te rm in e  exactly th e  effect the use o f  the 
Jo b s t u nit h a s on s tu m p  sh rin k a g e  o ver a perio d  o f  tim e 
a n d  in different age groups.

T ra d itio n a l exercise p ro g ra m m e s, p a rtic u la rly  fo r the 
g e ria tric  a m p u te e  p a tie n ts a re  best rep laced  w ith p r o ­
g ra m m es involving n o rm al activities using a  prosthesis, 
a n d  exercising the stu m p  m uscles in a fu n c tio n a l m anner. 
Im m e d ia te  p o st-o p e ra tiv e  p la ste r o f  p a ris fitting allow s 
early  re -e d u c atio n  o f g ait a n d  pra ctic e  o f  fu n c tio n a l a ctiv ities; 
how ever, this te c h n iq u e  has n o t alw ays p roved successful. 
T he use o f  m o d u la r pro sth e se s, as described in th e  follow ing 
tw o  article s, allow s th e  p a tie n t to  c om m ence train in g  w ith 
a p ro sth e sis fro m  th e  tim e o f  rem oval o f su tu re s a n d  can 
th u s p rovide a m ea n s o f  re d u cin g  the need fo r lengthy 
exercise p eriods in the tra d itio n a l form .

M o d u la riz a tio n  can  p ro v id e  fo r a n  ex te n sio n  o f  the 
tra d itio n a l th era p y  role in the m an a g em e n t o f  a m p u te e  
p a tie n ts as well as re d u cin g  th e  o verall length o f  the re ­
h a b ilita tio n  p eriod. T h is ex te n sio n  o f  role c o uld p ro v e  m ost 
effective for th e ra p is ts w o rk in g  in sm aller c en tres w here 
re sid en t p ro sth e tic  services a re  a b se n t. A th e ra p is t tra in e d  in 
the use o f  m o d u la r p ro sth e se s can  n egate th e  need for a 
p ro sth e tist to  trav e l a ro u n d  th e  c o u n try  seeing p a tie n ts a nd 
c a n  e n ab le  th e  p ro sth e tist to d e v o te  his time to  c o n stru c tio n  
o f  pro sth e se s. A ltern a tiv e ly , a n  a m p u te e  p a tie n t in a sm all 
c e n tre  need n o t travel to the larg e r c en tres for fitting o f  a 
p ro sth e sis. Physical th e ra p ists h ave the necessary k n o w ­
ledge a n d  skill a n d , w ith fu rth e r train in g , c o uld a ssu m e  the 
task  o f ta k in g  th e  negative p la ste r o f p aris m o u ld  fro m  w hich 
the p ro sth e tist will m a k e  the definitive socket. T h is w ould 
m ea n  th a t on ly  th e  negative m o u ld  a n d  th e  final socket 
travels. In the o u tly in g  c entres the p re fa b ric a te d  c o m p o n e n ts 
c o uld be k e p t in th e  physical th e ra p y  d e p a rtm e n t a n d  be 
assem bled by the physical th e ra p is t w h o  is also cap a b le , 
fo llow ing train in g , o f  m a k in g  alig n m en t c h anges as required.

T h is w riter is n o t p ro p o sin g  to  “ ta k e -o v e r” n o rm al 
d u ties o f p ro sth e tists, b u t is suggesting th a t m o d u la riz a tio n  
o f  p ro sth e se s m ay e n ab le  a g re a te r n u m b e r o f  a m putee 
p a tie n ts to  be p ro v id ed  w ith im p ro v e d  service a t low er cost 
to  e ith e r the p a tie n t o r  th e  social service involved.

The fo llow ing articles on M o dular Prostheses were 

produced especially f o r  publication in the S o u th  A frican 

Journal P h y sio th e rap y  b y  k in d  arrangem ent o f  M iss 

Joan W alker, B .P .T ., N .Z .P .P ., Dip. T.P ., fo rm e rly  

lecturer at the Sub -D ep a rtm en t o f  P hysiotherapy, 

U niversity o f  W itwatersrand.

A modular Hip Disarticulation Prosthesis o f  the 
Winnipeg type.

R
ep

ro
du

ce
d 

by
 S

ab
in

et
 G

at
ew

ay
 u

nd
er

 li
ce

nc
e 

gr
an

te
d 

by
 th

e 
P

ub
lis

he
r 

(d
at

ed
 2

01
3.

)