The three factors of artificial limb wearing comfort: socket, alignment and rehabilitation training
After patients and prosthetists choose the most suitable prosthesis for the patient, what they are most concerned about is whether they can return to their pre-amputation living standards after wearing the prosthesis. Obviously, according to the current technical level, it is difficult for a prosthesis to fully exert all the functions of a normal physiological limb. It can only compensate to the maximum extent for most of the functions of the lost limb. Whether the prosthesis can maximize its function, I think the most important thing depends on three points:
First, the socket
The degree of fit of the socket is directly related to the production level of the prosthetist. The socket is the most important component of the prosthesis. It is in direct contact with the residual limb, supports the weight of the human body, and controls the movement of the prosthetic limb. The comfort of wearing a prosthesis depends entirely on the fit of the socket. The socket is an important structure that affects the wearing comfort and function of prosthetic limbs. Full contact and maximum stump load-bearing are requirements for sockets in modern prosthetic limb fitting. The stump load-bearing realizes the load-bearing of the residual limb bones. It has the physiological effect of preventing decalcification (passive osteoporosis).
In pediatric amputees, it can also stimulate growth of the residual limb. Weight-bearing and movement are the most fundamental functions of lower limb prostheses. The reliable "connection" between the residual limb and the socket ensures the realization of the function of the prosthetic limb. Any slight "pseudo-joint" activity and "piston movement" between them will hinder the amputee's control over the prosthesis, thereby reducing the stability of standing and walking and increasing the patient's energy consumption. Full contact between the residual limb and the socket helps achieve the goal of a strong connection between the residual limb and the socket. Full contact requires that the residual limb can at least be in contact and be able to withstand a certain amount of pressure.
Second, the alignment of the prosthesis
Prostheses are worn on our bodies, just like normal limbs. In addition to supporting the body weight, various forces will act on our prostheses. In order to meet the most basic walking needs, reduce the patient's discomfort during wearing and the patient's gait after wearing the prosthesis, the prosthesis needs to be aligned. The entire alignment process of the prosthesis is divided into three steps:
- The first step is to align the workbench. We know that the current prosthetic limb is assembled by a combination of the socket, joints, and foot plates through connectors, leg tubes, etc. According to the specific performance of the prosthetic limb and the patient's data, the alignment that needs to be performed during this assembly process is called workbench alignment.
- The second step is called static alignment, which requires the patient to put on a prosthetic sample and make fine adjustments to the prosthetic limb that has been assembled and aligned on the workbench while standing still. This step is to make the prosthesis better match the patient's own limbs and body condition, and make some inspections and adjustments based on the alignment of the workbench, such as checking whether the load-bearing is reasonable; checking whether the patient can maintain balance when wearing the prosthesis; after the patient puts on shoes, whether the height of the prosthesis and the angle of the prosthetic foot are reasonable, etc.
- The third step is called dynamic alignment, which means that after the patient wears the prosthesis and walks, appropriate adjustments are made based on the patient's gait, whether there is pain in the patient's residual limb, whether the suspension is appropriate, etc. Alignment is a relatively complex process that requires constant adjustments, which involves some knowledge of sports biomechanics. Young technicians need to constantly explore and master skills to quickly understand the cause of the patient's abnormal gait and make corresponding adjustments in a timely manner. This is very important for patients to have a good gait.
Third, rehabilitation training after wearing prosthetics
Whether the function of the prosthetic limb can be maximized, in addition to some preliminary work before wearing it, the quality of rehabilitation training can directly affect the patient's usage habits and gait. When amputee patients wear prosthetic limbs for rehabilitation training in the early stages, they cannot directly perform gait training. They need to undergo 2-3 days of standing weight-bearing training to allow the residual limb to slowly adapt to the feeling of weight-bearing and promote further shaping of the residual limb.
Wearing a prosthetic limb to walk is a huge test for the patient's physical fitness. For patients with lower limb amputation, the higher the amputation level, the higher the energy the patient consumes when walking wearing the prosthetic limb. Therefore, rehabilitation training is not only about training the skills and usage of the residual limb and prosthetic limb, but also cannot ignore the training of the unaffected limb and core muscle strength. After completing standing weight-bearing training, some balance training is generally performed to exercise the patient's balance ability, center of gravity transfer ability, ability to get up after a fall, etc. Afterwards, walking training on balance bars, walking training with crutches, and how to go up and down stairs and up and down ramps will be conducted. Patients in need will also receive some gait training in special environments. Until I can walk independently.
After you find a prosthetic limb that suits you best and do the three most important things to make the prosthetic limb function well, you will definitely be able to live the life you want.
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