Hi,
I'm David Lawrence and in this video I'm going to talk about and show you how to
get up out of a chair and how to lower to a chair with a prosthetic limb.
Transferring from sit to stand with a unilateral prosthetic device is focused on
getting that leg underneath you in a stable position as quickly as possible.
So what you always want the patient to do is scoot forward in the chair,
get about halfway out of the chair into a stable position. Then, exactly,
bring that prosthetic back so the heel is slightly off the ground and you've got
the weight mainly on the toes. Now she's in a position, lower level.
What I want this patient to do is keep one hand on the chair,
one hand up on the walker,
lean her nose over her toes as she does press down into the ground on the
prosthetic side and push all the way up to stand.
You'll notice that the end of that motion,
her knee really popped back into extension.
That's because she was actively pushing on the back of that leg to bring it into
extension. It's just what you want to do.
As soon as that knee reaches full extension, you have a stable position.
If she doesn't reach full extension,
that knee's going to be very unstable and she might take a step and lose her
balance right off of the first step. When a patient goes to sit,
we want to make sure she has the most stable position possible.
So the first thing she's going to do come back to the back of the chair so she
can feel the chair on her legs, reach back with one hand to grab it.
As she begins to sit, keep weight in that leg.
As she reaches back now for the chair and finishes that sit,
she keeps one hand up, one hand down,
so she's living in stability in both worlds until she's really committed to the
seat and then she can bring her hand back. She brings the hand back too quickly,
loses her balance forward, she can fall. If she doesn't reach back in the chair,
slides away from her. She doesn't have control and she can fall.
So all of these are prevention of fall.
The next transfer is just sit to stand without an assistive device as a patient
gains strength.
What a lot of patients do is do 90% of the work with their remaining limb.
The problem with that is over time arthritis, other issues of wear and tear,
can wear on this leg. And I always say to patients,
if you're going to wear out one of these two legs you want to wear out this one
because we can replace it.
So you want to do as much work over here as you possibly can.
So that you're preserving some of the effort on the opposite side.
So first thing to do is scoot forward in the chair about halfway,
bring that prosthetic back so that knee's into a position where the heels off
the ground low into toe load and she's going to now think about as she's getting
up,
not just standing up as she's standing up using her backside muscles to press
into that back wall,
the socket and she's going to press into that back wall till she's all the way
vertical. So start to push up press into the back wall. Press, press, press,
press, press, press.
So she really feels that like press back into position as she's pressing back,
the leg is actually helping her stand, so it kind of lifts her up in the air.
What does that do?
It takes a percentage of weight off of her sound side and puts the leg into a
stable position.
If you stand up into a position where that leg doesn't come into a full
extension on your first step, it might buckle on you. So in this position,
what a lot of people tend to do is do all the work over here, press, stand up.
This leg stays into a position where it's not fully locked.
So at any time this leg can still bend out from underneath her.
So you always want to be in a position where she ends up standing with that leg
level or behind and that knee fully locked out.
Now if we're going to sit on a patient who's gained a lot more stability,
doesn't need a supportive surface or or a walker to hold on to,
there's two ways to sit. We're going to assume, she has a microprocessor knee,
but we're gonna assume she doesn't just has a mechanical knee.
So what she's going to have to do on a mechanical knee is get it to unlock and
in most of those knees that is going to occur from stepping back slightly to
create toe load. As you get toe load, press that knee forward, feel it release,
grab the chair and sit back. All right,
so basically what she's doing and doing all the work over here,
but she has to unlock that knee before she goes to sit or she'll have a peg when
she's trying to sit down.
So at this point we're looking at a patient who has advanced skills and really
wants to learn to sit utilizing the hydraulics of this microprocessor to its max
potential. Why? Take some of the pressure off the opposite leg. Again,
whenever possible we want to wear out the prosthetic, not the other leg.
So what she's going to focus on here is as she begins to bend that knee.
Her natural tendency is to sit back and put all the weight on her right leg.
So we're going to ask her at this point in time to try to,
as she feels the knee bend,
keep the weight on that knee and sit right down into the heel of that prosthetic
side so you can very go press right down to the heel thick, thick, thick,
and feel some thickness or resistance back from that knee.
So we're gonna try it again.
Get a little bit thicker and a little bit slower when you come down. So,
at this point in time, we're going to have her bend that knee,
keep her weight on it,
press down into it and the thicker or harder she presses into it,
the thicker the knee should become and that gives her resistance and she rides
the hydraulic down to the chair.
Thanks for watching and we hope that you found this helpful.
This video is part of a series on prosthetic interventions ranging from managing
the residual limb after amputation to running with a prosthesis.
We encourage you to view our other videos in this series and to share them as
well.
You can find them on our YouTube channel at YouTube.com/MissionGait .
To stay up to date on our latest content,
click the link in the corner to subscribe and be sure to like comment and share
this video.