Hi, I'm David Lawrence,
and in this video I'm going to talk about and show you how to get down to an up
off of the floor with bilateral prosthetic limbs.
For working with a bilateral amputee,
getting transferring to the floor and from the floor.
The first thing really want to practice is how to safely get down to the floor.
That's also so they can practice getting up,
but also at home if they need to get on the floor to get to something they know
a safe way to do that. Where do you want to do it? Start on a low surface.
Something like a sofa or a mat table like this.
Put the patient in a position where they're facing. Try to bring the,
the close leg, the direction they're going to go back towards them.
Yeah.
Here you go.
He's going to bring his other leg over the top and simply roll his hips on the
sofa. So we still got all his weight on the sofa. From here,
he can just slide backwards.
So we just basically slides off the sofa into a position where he's on his
From there Robert I'm going to have you turn and get to your hands and knees
and you'll notice in this position,
Robert can actually crawl on the prosthetics.
That's really important because if a patient needs to get up and they're having
a hard time getting up,
knowing that you can crawl half a mile you had to to get to a higher surface,
it is possible. But from there Robert,
and have you come all the way down onto your back.
There you go.
And what I like to tell the patients is what I want to simulate here is the
actual full wipe out. You have completely gone down, flat on your back.
The first thing you want to do when you get up is don't rush to get up.
Give yourself a second. Your heart's beating hard.
Give yourself a second to kind of get your bearings right and if there's people
around you tell them, "Please just let me do this.
I'll let you know if I need some help." But the first thing that Robert's going
to do is get up to a sitting position, but don't stand up.
Look at his feet and make sure both prosthetic feet are facing the ceiling.
If they're not,
that means something may have come loose and that may have been when he fell or
because he fell. So at this point he wants to look at that.
If something isn't straight,
he needs to reset his prosthetic and try to get it on straight. If it is,
the next thing he needs to do is get to the position of power.
And that's basically getting to all fours.
So Robert's going to take one leg and cross over the other,
turn over to his hands and knees and he's into a position of power.
Again, here he could crawl, he could get himself someplace,
but let's say Robert's quite weak and he's gonna have a hard time pressing
himself up. So even your lowest level patient can get to here,
get their hands up on the sofa and nothing else. Get up on his knees. Like this.
Pressure down into the prosthetic socket is no different if you're kneeling or
standing. So in the sockets, the patient doesn't worry,
it's not going to feel different. It's the same pressure.
But getting his head up allows him to kind of equalize his blood pressure a
little bit and not feel so much pressure on his head from being in head down
position. If he feels okay about that,
the next thing he's going to do is get closer to the mat or as close as he can
on a bit of an angle to the sofa,
kind of angling towards me a little bit and as much as possible,
he's going to get his hips up on the sofa just a little,
and then roll towards away from there.
You go and press right up into a seated position. At that point,
Robert never had to stand up, never had to lift himself off the ground.
He let the sofa do the work. From here he's just doing a sit to stand transfer.
So if our patient has fallen,
but they have a little more strength to really push themselves up,
I'm going to show you how to now get fully up from position where he may not
have something to lean on or lay on, but just something to hold onto.
So first thing patient's going to sit up,
he's going to look at his legs to make sure his feet are facing the ceiling.
If that looks good,
he's going to cross his leg over and get to the position of power,
which is onto all fours. And this position, again, he could crawl,
kneel on these prosthetics, any length that he needs to,
if he can get his hands to a higher position. Again,
it just lets him kind of stabilize for a second.
From there to get up what Robert wants to do is straighten out one prosthetic
completely. So he has a full stable base.
Shift his weight towards that prosthetic while he locks out the other prosthetic
brings them in and kind of walks him right up underneath him.
So if a patient's standing getting down to the floor,
one of the benefits or or that Rob points out on a bilateral above knee amputee
is the hamstrings are not connected.
So if Robert wants to get down to the floor, he can simply,
go ahead and demonstrate Robert, lean forward, put his hands on the floor.
From that position,
he can bend those knees and ride the hydraulic down into the base position and
come all the way down to the floor. Now if Robert's going to get up,
and again at a higher level, what he's going to do is the same principle,
get himself to the power position, which is on all fours,
cross that leg over. So it's uncrossed when you get to your all fours.
From here, Robert's gonna lock out one leg, shift his weight to it,
lock out the other leg,
pushes weight back to the prosthetics and come up to standing.
So one of the biggest things is most times people fall,
they fall in a crowd and there's people around. So there's anxiety,
there's fear, there's I want to get up as fast as possible.
So always remind folks that take their time and then also direct traffic.
So many people are going to want to help and they'll usually come up and say,
Hey, I can help you grab onto their arm and pull on them or yank them different
directions. Really important if you train the patient well,
patient as a patient needed to say to that, people around you,
"Please just stop. Don't yank on me. I can do this. Don't go away.
Stand here near me. But let me tell you what I need.
Please don't pull on me cause I have a technique." So Robert,
I'm going to have you come around to your position of power that you would
normally do.
Now from here, Robert wants to get up.
All I want to do is be close to Robert and stand as stiff and as stable as
possible.
So if Robert needs my help he can put his hand on me to come up.
But at the same point he can find stability. The mistake.
A lot of people make the help as they quickly. Then once he's up, break loose,
I want to keep my hand on Robert until he,
lets go of me now you notice I didn't have to pull up much when he lets go with
me and feels more stable, I'm good.
But if it he's just got up and his heart's still beating and I let go of him
quickly. He could easily lose his balance and fall again.
So if we're practicing getting off of the floor with bilateral prosthetics below
the knee. The process here is first how to get down to the floor safely.
So at home you're going to have a patient pick a surface like a sofa or
something that's fairly low. Scoot themselves forward on that sofa.
Bring the close leg back, a little bit,
lot of weight on the hands and she's just going to slide down onto her knee.
That way she's not very far but gets right down onto her hands and knees.
From there I want her to come all the way down on her stomach and then her back.
There you go.
She's in a position as if she had the full wipe out the complete wipe out I'm on
the ground down and out.
The first thing that patient wants to do is don't rush to get up. Take a time,
a second to just let your heartbeat kind of calm down for a second.
If there's people around you let them know just I'm good. No problem.
I'm going to sit up here,
I'm going to look at my legs and this is the first thing.
Look at her feet to make sure they're straight up in the air. If they are,
you know the prosthetics are on,
but when she fell she may have twisted and dislodged or the prosthetic partially
came off so she'll want to re-donn that prosthetic before she gets up or she may
find something broke. If something did break,
she's going to need to let someone know she's going to need a lot of help to get
up and she'll need a wheelchair or something cause you won't be able to walk on
the prosthetic. If we're in this position though, they're facing the ceiling.
I just want Carol scoot away from me a little bit.
Cross her left leg over the right, turn. As she cross turns,
her legs become uncrossed, which is in the position of power,
which is on all fours. From this position,
she could crawl anywhere she needed to to get to a surface higher than her.
Higher surface will really give her more power to get up.
So let's assume we have a surface here.
You're going to turn towards this surface,
get your hands up on the surface and then as quickly as possible,
get your head upright and just take a few deep breaths because as soon as her
head's up higher,
her blood pressure can kind of start to stabilize a little bit and not have so
much pressure in her head. Once she's there,
she's going to bring one leg into a position into a high kneeling. There you go.
Once she's stable, lean forward into the mat.
Press in hard as she presses the other leg out straight.
As soon as it gets straight,
lean back into it a little bit because it's locked out and step back.
There you go. And then bring both feet into a stable position.
Once she's stable, she can come around, have a seat. All right,
let's say our patient's fallen and now they've got themselves to the position of
power but there's nothing around the grab onto so it has to try to stand up out
in the middle of the parking lot.
This takes a lot more energy and a lot more effort.
To do it though the mechanism starts the same.
Pick that right foot up and bring it forward.
Get it into a good stable position wherever she feels good about it.
Hands and on the ground.
Weight forward as she tries to straighten out her back leg. There you go.
And the press her way back into it. Hand on the knee and pressed upright.
Push up tall, push up tall, push up tall.
There you go.
Not easy to do.
So when we're transferring with bilateral below the amputation or even single
below the knee amputation, the concern is always this top wall.
You can kneel on prosthetics, no problem. If you have a pin suspension,
this is a a non issue.
If you have a sleeve suspension of some sort of elevated vacuum,
you can certainly do this.
The problem will be when this front wall presses into that rubber,
it's likely to cut a hole in it. If it does an elevated vacuum,
you've lost some of your vacuum control, so know, if you need to get up,
that's what you're going to need to do the exact same way.
There's only way to get up, but at that point in time, once you're up,
you have to know that likely as the legs may have some pistoning or some slip
because you've lost some of your vacuum.
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
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