How to prepare an adult user for prosthetics. Part 2

In the previous block we discussed the general preparation of the body for prosthetics. Now we proceed to the limb requiring a prosthesis.

Let us repeat that immediately after amputation, the key role is played by caring for the stump, prevention and treatment of contractures (limited movements), and measures aimed at elimination of oedema. All these factors are of high importance in deciding whether or not a prosthesis can be installed and when; so they should not be neglected. If you have not been advised on bandaging before, contact Motorica so that we can assess the situation now and teach you how to care for the limb.

The “homework” can be divided into two blocks of activities. Let's start with the simpler one — self-massage. We are often asked whether people with upper limb disabilities need a general massage? There is no clear-cut answer to this question, since certain medical procedures can be recommended only after an in-person examination and a detailed study of health specifics. A proper body massage cannot cause any harm; however, you must remember that it is not suitable for effective muscle training. This requires active movements.

Nevertheless, we still recommend doing an unassisted arm massage “at home”. Such a massage helps prepare for wearing a prosthesis, decrease the size of the arm by reducing swelling, improve blood supply, and therefore, the growth and “frost resistance” of the limb.

The massage should be done several times a day.

• Stroking: lightly stroke with your palms the entire surface of the arm from its lower part to the upper part, twice for 7-10 seconds.
• Rubbing: rub the arm gently with your palm until the tissues become slightly warm; this procedure should be not longer than 10 seconds. Repeat the stroking procedure.
• Kneading: gently knead the arm with your fingers. The procedure lasts on average 30 seconds; after kneading, be sure to repeat the stroking procedure. The total duration of the kneading is 2-5 minutes. Then, repeat the rubbing procedure.
• Vibration: relaxing light patting for 5 to 10 seconds. After that, repeat stroking. You can do this massage yourself, without outside help.

The second block consists of specialized training of the muscular strength of the limb. This can be combined with physical exercises or performed separately — the choice is yours. Prior to exercises, consult with your doctor/orthopedic traumatologist or physical therapy doctor to get admitted to training.

If you are doing exercises beyond the training, you must first warm up. Warm-up exercises may include active rotations of the limbs in all planes, tilting the torso and head forward and backward, right and left, flexing of all joints, etc. The equipment required is forearm weights and resistance bands (also called rubber bands).

The weights are selected depending on the current state of muscle tissue. The weights have to be tried on — put them on below the elbow bend and make sure that it does not slip off when actively swinging the arm. You should feel the weight, which cannot be too heavy, though. It is important that you are able to perform 20 active elbow flexions and extensions, feeling mild to moderate fatigue after all repetitions.

Resistance bands are usually sold in sets. Within one set, they vary in the degree of resistance: one rubber band is more difficult to stretch than another. We recommend purchasing the set, since during the training you will be able to determine which band is more comfortable now, and later, in course of the training, you can make the task more difficult by using a tighter band.

• Elbow flexion and extension with a weight — 20 repetitions (with shoulder along the body).
• Elbow flexion and extension with a weight — 20 repetitions (with shoulder abducted from the torso at 90 degrees).
• Elbow flexion and extension with a weight — 20 repetitions (with shoulder raised vertically upward). The pace is medium; flexion should be done during inhaling, and extension — during exhaling. Block 2 — exercises with resistance bands (do not require wearing of weights)
• Flexion and extension of the most proximal joint with resistance — 20 repetitions.

What does proximal mean? For example, if you have a hand, the rubber band is thrown over the palm, and the other end is fixed on any stationary object / held by a partner. Bend the hand against the rubber band resistance.

Then, throw the rubber band over the back of the hand — bend the hand against the rubber band resistance. After that, we train the elbow joint in the same way. If you have no wrist joint, train the elbow joint. The principle is the same: flex and extend the elbow joint against the rubber band resistance. The pace is medium; flexion should be done during inhaling, and extension — during exhaling.

It should not hurt! If you experience pain or severe discomfort, stop the training and consult a specialist.

It is important to make using your prosthesis a habit, just like washing your hands before eating or brushing your teeth before going to bed; so, wear the prosthesis regularly. At first, the optimal regime is 40 minutes to 1.5 hour daily. Gradually, the usage time of the prosthesis should be increased, for example, by 20–30 minutes a day.

It is best to practice using the prosthesis in normal everyday household activities. Even if the prosthesis is not currently working, it is still on the arm and provides load bearing. Therefore, at first the prosthesis can be used passively.

It is important to understand that the prosthesis will always play a supporting role — that is, if the second hand is preserved and it is not busy with any task, it will always be easier and more convenient for you to take an object with it. This is normal and common practice. However, this does not mean that we cannot focus on working with the prosthesis during training. An example of such training is available through the link. By training the hand with a prosthesis, you significantly expand your skills in controlling the device and then, in everyday situations, you will be more confident in connecting the device to activities.

In addition, there are bimanual activities — those that require the use of two hands; for example, to carry a tray. It is in these activities that the use of a prosthesis becomes especially relevant, and all the acquired skills can be used.

At the very end of the tutorial — in the Annex — we will offer you approximate areas for training with a prosthesis. If you are undecided about the start, you can proceed with tasks from the Annex.

It is better to put off the prosthesis before you get tired of training, because when attention decreases, it becomes more difficult to pick up and hold objects, and failures cause irritation. Therefore, it is optimal to finish at the moment of success and switch to another activity, having put off the prosthesis.

In addition, the arm in the prosthesis may swell slightly for 2-3 weeks after prosthetics. This situation is normal, as the body needs to get used to the new load. Observe if any redness occurs on your arm. Light marks from the prosthesis do not require special attention.

However, you should not feel pain, and there should be no abrasions or blisters. If such a problem occurs, please contact us and we will decide together what is the best course of action.

The prosthesis must be used in accordance with the recommendations in the operating manual. However, this does not prevent breakage. A prosthesis, like any technical device, can fail.

Let's take the following analogy: can a man break his arm? Yes, it is possible. If he “violates the rules of operation” of his body, for example, by air-dropping without a parachute, the chance is definitely higher. However, one may get injured in everyday life without any extreme sports — for example, by accidental fall while going grocery shopping.

The same thing may happen with a prosthesis — there is always a chance of breakage. The difference is that if someone’s arm is broken, it will be put in plaster, and it is likely that the fracture will be accompanied by pain. With a prosthesis, everything is simpler: it is sent for repair free of charge for the user and returned already restored. Therefore, please do not try to “protect” the prosthesis against all dangers — it will be much more correct for your health to actively use the device while understanding that breakage is possible, but not critical. It is not advisable to carefully store a prosthesis on a shelf, intact and useless.

In the first days or 1-2 weeks after receiving the prosthesis, people often ask themselves: “Why did we read so many recommendations,if it's all so simple?” The fact is that most often our nervous system first perceives the prosthesis as a new and interesting gadget, which triggers our inner “researcher”. This is exactly what we were striving for when creating the prosthesis. However, there is one downside — any “toy” can become boring. In the same way, a kid asks for a new phone when the old one still works quite well. However, with a prosthesis this happens faster, since it also requires work from muscles and the brain.

Here we come to the crisis of the first weeks. After one, two or sometimes three weeks, the nervous system is already saturated with new impressions with the prosthesis, but the habit of using it has not been formed yet. It is often during this period that the prosthesis is laid on the shelf.

Now, everything is in your hands — it is important to keep the motivation. Remember the health aspects and the inevitability of success with regular training.

In addition to the crisis of the first weeks described above, seasonal difficulties can be distinguished as well. They are especially acute in winter, since in the cold period the use of a prosthesis is often associated with certain specifics. Let's look at the most common ones.

1. The prosthesis does not fit through the sleeves of outerwear. Indeed, most manufacturers strive to make the sleeves of their jackets as narrow as possible so that the wind does not blow inside the clothing. This makes wearing the prosthesis much more difficult. Our first recommendation is to try putting an ordinary plastic bag over the prosthesis when putting on outerwear. Later, when the hand has already passed through the sleeve, the bag can be pulled out and removed. This simple life hack will improve sliding and facilitate the movement of the prosthesis in the sleeve. An alternative option is suitable for needlewomen — you may sew a zipper or clasp into the sleeve. Regular folks who do not have a sewing machine or special skills can turn to a tailor shop. Although, the easiest way for the future is to try on new clothes with the prosthesis immediately when buying them, and choose depending on how easy it is to put on the prosthesis.
2. The arm with the prosthesis gets colder. It is important to understand that the blood flow and innervation (location of nerves) in an arm requiring prosthetics are usually different from those in a conditionally healthy hand. This is why one hand often gets colder than the other. In our experience, the prosthesis does not make this situation worse. However, if you feel discomfort in cold weather, remember that you can put a mitten or glove on the prosthesis.
3. Concerns that snow will get on the prosthesis. This is not critical — the cyber-man's hand can withstand even worse things!

What to do during the crisis of the first weeks, seasonal or any other crisis? The answer is simple — call Motorica and we will help.