Below Elbow

Amputation
Group Members: Dave-Ann Alves, Majel De
Coteau, Demi Guevara, Chaz-Anthony James, Alex
Lawson, Divina Mahtani, Cayanna Peart, Laura-Lee
Seales
General Considerations for Exercise
● Level of amputation/fraction of limb remaining
● Handedness of the patient
● Psycho-Social status of the Patient
● Sensitization and pain
● Pre/co-existing conditions eg OA
● Healing process ie swelling, incision site
● Condition of skin and presence scar tissues
● Meds being taken
● Pre-Morbid AROM
● Phantom Limb.
Exercises Unique to the Area (Early post-
amputation)
● Control phantom pain ● Manage wound healing
○ With healthy skin: biofeedback or ○ Non-adherent dressing and
TENS sterile bandages
○ Acupuncture ○ Plaster of Paris kept in place 5-7
○ Vibration Therapy days post-op
○ Ultrasound ● Addressing scar tissue
○ Analgesics ○ Ultrasound
○ Mirror Therapy ● Edema Control
○ Sensory overload
○ Interferential current
○ Wrap limb in figure of 8
Exercises Unique to the Area (Early post-
amputation)
Exercises Unique to the Area (Early post-
amputation)
● Passive ROM of residual limb
○ Implementing a position schedule to minimize contracture formation
○ Moist heat followed by stretching of shoulder and forearm muscles
throughout their ranges
● Desensitization/Sensory Reeducation
○ Swedish Massage
○ Patient places limb into different surfaces (rice, clay, silk,cotton)
● Sound limb Care
○ Daily skin inspections
○ Skin cleansing
○ Minimizing Negative Environments. Eg dry skin
Exercises Unique to the Area (Early post-
amputation)
● Patient Education
○ Independence in wrapping and bandaging techniques so limb can fit
prosthesis
● Muscle strengthening of shoulder girdle and contralateral extremity
○ Isometric holds
 Management Unique to the Area (Mid
rehab- preparation for prosthesis)
This phase usually occurs 2-3 weeks post-
operative
● Shaping of the residual limb: massage,
figure 8 bandaging
● Desensitization of the residual limb
● Strengthening:
○ Bicep curls ○ Shoulder IR and ER
○ Tricep kickbacks ○ Chest press
○ Shoulder Abduction ○ Lat pulldown
○ Shoulder flexion+extension ○ Rows
Goals of Preprosthetic Management
● Residual limb shrinkage and shaping
● Residual limb desensitization
● Maintenance of normal joint range of motion
● Increasing muscle strength
● Instruction in proper hygiene of the limb
● Maximizing independence
● Orientation to prosthetic options
● Exploration of patient goals regarding the future
Progression of Exercises
● Focus on more functional exercises
○ Punching
○ Writing and Eating (training them to use non-
dominant hand if necessary)
○ Dressing, Brushing teeth, etc.
○ Supination + Pronation
● Stretching
○ Windmills
○ Wall Pec Stretch
○ Tricep Stretch
● Progress Exercises from Mid-Rehab
○ Increase weight/ band thickness
○ Increase the number of reps.
Key muscle Groups needed
● Biceps
● Triceps
● Rotator Cuff
● Deltoids (anterior, middle and posterior fibres)
● Brachioradialis
● Pectoralis major
● Pronator Teres & Supinator (For long transradial amputations)
Thank you!