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application and correct pressure of the various bandages. The initial swelling (edema) decreases rapidly but edema usually
lasts from six months to a year so expect lots of changes in your limb and prosthetic socket.
When the residual limb has healed and is relatively stable in size and shape, you will be measured for a final prosthesis.
As soon as your stump is healed, you will be instructed in stump wrapping. This is necessary to prevent swelling and
properly shape the stump. The stump is shaped by wrapping an elastic bandage around the stump using just the correct
amount of tension and pressure. The limb is usually rewrapped every two to three hours in order to allow the stump to be
exposed to fresh air and to adjust the bandage's tension.
e. Pre-prosthetic exercise program:
The object of an exercise program is to insure that you have the best physical ability you are capable of in order to
operate the prosthesis safely and to walk efficiently.
If you do not use a part of any limb for a month or so, it may change so much it may never be useful again. The muscles
literally shrink to almost nothing while the tissues which connect the muscles to the bones (ligaments and tendons) will
shrink to match the shortest length they can be. Thus, if you keep your knee bent for a month or so, the tissues will shrink
up (called a contracture) and may never be able to stretch out again. You will have to learn how to avoid these kinds of
problems and to strengthen your residual limb so that it can take on the task of using the prosthesis when you are ready.
Walking with a crutch will probably be your first "functional" activity. You may have to start walking between two
parallel bars until your balance has improved enough for you to safely use crutches. Muscle strength and endurance are
important. The exercise program will be developed especially for you depending on your current condition and problems
as well as your needs. Resistive exercises, pulley and mat exercises, push-ups, sit-ups, balancing, hopping independently
on the unaffected limb, and crutch exercises are important to increase your confidence, strength, endurance, and especially,
safe control of the prosthesis.
f. Prosthetic training
(1) The initial "training" artificial limb: The artificial limb you will use to walk or assist you to grasp items is called a
prosthesis. Soon after amputation most people are fitted with a training or trial prosthesis. This is a very simple device to
use so you can walk normally or carry out many of the functions of your hand. A typical pylon (training prosthesis) was
shown in Figure Five. As soon as the residual limb is stable (measurements are unchanged for about two or three weeks),
an expert in making and fitting artificial limbs (called a "prosthetist") will measure you and build a prosthesis to your exact
needs and shape. Modern prostheses may be made from a variety of materials or combinations of materials. The best
choice of materials for your prosthesis is determined by many factors. For someone who wants to engage in vigorous
sports, material strength is an important consideration. For a frail individual, the weight of materials might be a greater
concern. Your prosthetist can help you decide on the materials most suitable for the construction of your prosthesis. The
process begins by creating a plaster mold of your residual limb; then a plastic socket for the limb is created from the
mold. This socket is then fastened temporarily to an adjustable temporary leg for beginning of training in walking.
Adjustments may have to be made occasionally before the leg is finished.
Please note that you can not bear weight on the end of your residual limb! If you did, the bone at the bottom of the stump
would crush the skin flap and destroy it. Your foot is probably eight to ten inches long by three or so wide. The bone at the
bottom of the stump is probably less than an inch by an inch. The weight is simply too concentrated for the skin to be able
to take it.
(2) Steps and timing: It takes time to learn to use any kind of a prosthesis. You must be patient and learn each step in the
process. Skimping on time and rushing now will slow down your eventual recovery and cause you considerably more pain
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