Start of osseointegration (click) prosthesis rehabilitation
AOFE Clinics collaborates with the Aardenburg Military Rehabilitation Centre in Doorn. Rehabilitation starts 3-6 weeks after surgery, depending on bone quality and ingrowth. You may be advised to start rehabilitation later than discussed with you prior to surgery. This health care will be coordinated with you individually.
Muscle pain a limiting factor for physical therapy
Muscle pain due to limb loss is a major limiting factor for progress in rehabilitation. Especially in people with an osseointegration prosthesis in the upper leg, the gluteal and stump muscles are severely weakened after years of socket use. When walking with an osseointegration prosthesis, the stump muscles must be fit and strong to stabilise the leg prosthesis. This muscle building during rehabilitation may be accompanied by a lot of muscle pain. The rehabilitation team will guide you through this and, if necessary, prescribe painkillers or adjust the pace of rehabilitation. Muscle pain in the stump occurs particularly when crutches are phased out. Sometimes it is necessary to take a rehabilitation break when pain is a limiting factor for gait training without walking aids.
Leg prosthesis – alignment and adjustment
Leg prosthesis adjustment is an important aspect of rehabilitation and depends on the rehabilitation phase. AOFE Clinics works with the prosthesis maker at Aardenburg Military Rehabilitation Centre in Doorn.
Stoma care instructions
The experience expert of the AOFE Clinics osseointegration team will go through the instructions for stoma cleaning with you and give you tips for the materials and devices that you can use. The rehabilitation doctor is present at the rehabilitation session every week and can prescribe stoma products if necessary in case of stoma irritation.
Duration of rehabilitation
For Dutch patients, rehabilitation takes about six weeks for lower leg osseointegration (click) prosthesis and 12 weeks for an upper leg osseointegration (click) prosthesis. The rehabilitation doctor will discuss progression with you and the team in mid-term evaluations and tailor the rehabilitation content and duration to you. Non-Dutch patients will undergo four weeks of rehabilitation for lower leg osteointegration prosthesis and six weeks for upper leg osteointegration prosthesis. Additional prosthesis rehabilitation will be prescribed if required in the respective home country.
Upper leg osseointegration (click) prosthesis rehabilitation protocol (standard)
Week 1: Increasing prosthetic load.
- Leg prosthesis fitting and alignment including connector instructions.
- With the leg prosthesis constructive loading using a scale up to 100% of body weight.
- Exercises for hip mobility, strength, training, for trunk, buttock and stump muscles.
- Stoma care instructions and pain management instructions.
Weeks 2 and 3: Walking in the bridge.
- Standing and balance training
- Walking training: different walking patterns (sideways, backwards, stopping and turning).
Week 4 to 6: Walking training with crutches.
- Basic walking training with crutches in 3-point gait and 2-point gait.
- Climbing stairs.
- Walking training on uneven surfaces.
Week 7 to 11: advanced walking training (optional).
- Walking training without walking aids.
- Walking training with inclines, obstacles, and double tasks.
Upper leg osseointegration (click) prosthesis rehabilitation protocol (adapted). Indication for adapted protocol is on the advice of the surgeon
Week 1-6 : Increasing prosthetic load to a maximum of 50% of body weight.
- Leg prosthesis fitting and alignment including connector instructions.
- With the leg prosthesis constructive loading using a scale up to 50% of body weight.
- Standing and balance training.
- Walking in the bridge and walking with crutches in a 3-point gait.
- Exercises for hip mobility, strength training for trunk and stump muscles.
- Stoma care instructions and pain management instructions.
Week 7-9: Increasing leg prosthesis load to 100% of body weight.
- With the leg prosthesis constructive loading using a scale up to 100% of body weight.
- Standing and balance training.
- Walking in the bridge and walking with crutches in a 3-point gait.
- Walking training: different walking patterns (sideways, backwards, stopping, turning).
Week 10 to 12: Walking training with crutches.
- Basic walking training with crutches in 3-point gait and 2-point gait.
- Climbing stairs.
- Walking training.
- Walking training on uneven surfaces
Week 13-17: Advanced walking training.
- Walking training without aids.
- Walking training with inclines, obstacles, and double tasks.
Lower leg osseointegration (click) prosthesis rehabilitation protocol
Week 1: Build up leg prosthesis load.
- Leg prosthesis fitting and alignment including connector socket.
- Build up to 100% of body weight with leg prosthesis using scale.
- Exercises for hip mobility, strength training for torso, buttock and stump muscles.
- Stoma care instructions and pain management instructions.
Week 2: Walk in the bridge.
- Standing and balance training.
- Walking training: different walking patterns (sideways, backwards, stopping and turning).
Week 3: Walking training with crutches.
- Basic walking training with crutches in 3-point gait and 2-point gait.
- Walking stairs.
- Walking training on uneven surfaces.
Week 4: advanced walking training.
- Walking training without aids.
- Walking training with inclines, obstacles, and double tasks.
