Have you ever wished you could better understand the “Greek” being spoken by the professionals in your prosthetic office? This glossary of prosthetic terms will not only increase your knowledge, but could also help you explain what you are feeling during the fitting process.

PROSTHETIC TERMINOLOGY

A

Abduction:  Motion of body part away from mid-line of body.

Adduction:  Motion of body part toward mid-line of body.

Adherent Scar Tissue:  Scar tissue formed in the healing process which sticks to underlying tissue such as muscle or bone.

AK:  Above knee amputation; also known as transfemoral amputation.

Alignment:  Position of prosthetic socket in relation to foot and knee.

Amputation:  The loss or absence of all or part of a limb.

Anterior:  Front; as in front portion of a shoe or foot.

B

Bilateral Amputee:  A person missing either both arms or both legs; a double amputee.

Biomechanics:  Applying mechanical principles to the study of how the human body moves.

BK:   Below-knee amputation; also known as transtibial amputation.

Body Image:   The awareness and perception of one’s own body related to both appearance and function.

C

Check or Test Socket:   A temporary socket, often transparent, made over the plaster model to aid in obtaining proper fit and function of the prosthesis.

Contracture:  Tightening of muscles around a joint which restricts the range of motion.

Cosmesis:   The outer, aesthetic covering of prosthesis. Usually made of foam or rubber-like material and covered with a cosmetic skin or hosiery.

D

Definitive Prosthesis:   A replacement for a missing limb or part of a limb which meets accepted check-out standards for comfort, fit, alignment, function, appearance, and durability.

Disarticulation:   An amputation through a joint; commonly the hip, shoulder, knee, ankle, elbow, or wrist.

Distal:   The end most distant from the central part of the body. For example, the distal part of the femur (thigh bone) is the end down by the knee. The opposite of distal is proximal.

Donning and Doffing:   Putting on and taking off the prosthesis, respectively.

Dorsiflexion:   Pointing the toe/foot upward, toward the body.

Durometer:   Means different “density” or strength.

E

Edema:   A local or generalized condition in which the body tissues contain an excess of fluid.

Energy Storing Foot:   A prosthetic foot designed with a flexible heel. It is designed with a spring that stores energy when weight is applied to it and releases energy when the amputee transfers weight to the other foot.

Extension Assist:   A method of assisting the prosthetic limb to “kick forward” on the swing-through phase to help speed up the walking cycle.

F

Femur:   The thigh bone.

G

Gait Training:   Learning how to walk with your prosthesis or prostheses.

H

Heel Strike:   The moment when the heel makes contact with the floor at the end of the swing-through phase.

Hemi-Pelvectomy (HP):   An amputation where approximately half of the pelvis is removed.

Heterotopic Ossification (HO):  Formation of true bone within extraskeletal soft tissues.

Hip-Disarticulation (HD):  Amputation which removes the leg at the hip joint, leaving the pelvis intact.

Hydraulic:   Used in reference to knee joints and provides controlled changes in the speed of walking.

I

Ischium:   The lower portion of the hip bone (ischial tuberosity) that protrudes from your pelvis; also known as the “sitting” bone.

K

Knee-Disarticulation:   Amputation through the knee joint.

L

Lateral:   To the side, away from the mid-line of the body.

Liner:   Used for suspension, comfort and protection of the residual limb. These liners may be made of silicone or gel substances.

M

Medial:   Toward the mid-line of the body.

Multiaxial Foot:   Allows inversion and eversion and rotation of the foot, and is effective for walking on uneven surfaces.

N

Negative Pressure:   Vacuum. In relation to prosthetics, elevated negative pressure is used to provide superior interface with skin and tissue which increases comfort, control and proprioception of the prosthesis.

Neuroma:   The end of a nerve left after amputation which continues to grow in a cauliflower shape. Neuromas can be troublesome, especially when they are located in places where they are subject to pressure from the prosthetic socket.

O

Orthotics:   The profession of providing devices to support and straighten the body.

P

Phantom Pain:   Pain, which seems to originate in the portion of the limb which has been removed.

Phantom Sensation:   The normal “ghost image” of the absent limb. May feel normal at times and at other times be uncomfortable or painful.

Pistoning:   Sometimes called “milking”. The term used when your liner stretches, resulting in your residual limb slipping up and down inside the prosthetic socket.

Plantar Flexion:   Means the toe is pointing down, toward the sole of the foot. Almost like pushing the gas pedal down and simulating that position or alignment.

Ply:   Thickness of prosthetic sock. The higher the ply number, the thicker the sock.

Posterior:   The back side of the body or part in question.

Proprioception:   The sense of the orientation of one’s limbs in space.

Prosthetics:   The profession of providing functional restoration of missing human parts.

Prosthesis:   An artificial part of the body.

Proximal:   Nearer to the central portion of the body. For example, the proximal end of the femur is part of the hip joint. The opposite of proximal is distal.

Proximal Femoral Focal Deficiency (PFFD):   A congenital anomaly where the proximal femur is lacking in completeness.

Pylon:   A rigid tube between the socket or knee unit and the foot that provides a weight bearing support shaft for a prosthesis.

R

Ramus:   The front, middle portion of the pubic bone (in the groin area).
Range of Motion: The amount of movement a limb has in a specific direction at a specific joint, such as your hip or knee.

Residual Limb:   The remaining portion of a limb after amputation, also called the “stump.”

Revision: Surgical modification of the residual limb.

S

Shrinker:   A prosthetic reducer made of elastic material and designed to help control swelling of the residual limb (edema) and/or shrink it in preparation for a prosthesis.

Stance Control:   Device with an adjustable brake mechanism to add stability to prosthetic knee unit.

Stance Flexion:   Mimics normal knee flexion at heel strike.

Swing-Phase:  Prosthesis moving from full flexion to full extension. Usually used in reference to prosthetic knee units.

Symes Amputation:   An amputation through the ankle joint that retains the fatty heel pad portion and is intended to provide end weight-bearing.

V

Vacuum:   (see Negative Pressure)

Exercise is important for everyone, but for amputees it is especially so.  A strong core and higher stamina will enable you to complete your daily tasks more easily, and walk longer distances without tiring.  The following article not only provides you with info to help you begin a safe exercise program after amputation, it also addresses the fears that might be keeping you from getting started.  In the coming weeks I’ll be adding more info on exercise and recreational sports you may be interested in trying.

Exercise is for Everybody

by Kate R. Shult, M.S.

What separates those who are inactive from those who exercise? Is it that non-exercisers have more diseases, physical disabilities, or time constraints? Consider what the real reason might be: Fear fear of injury or medical problems, fear of the unknown, and fear of failure. Overcoming these very human fears is a process that starts with a safe exercise plan and ends with the continued successes of meeting personal fitness goals.

Close to 60% of Americans are inactive, even though the message to exercise becomes louder every year. What separates those who are inactive from those who exercise? Is it that nonexercisers have more diseases, physical disabilities, or time constraints? No. I believe there is more to it. Let’s level the playing field and consider what the real reason might be: Fear fear of injury or medical problems, fear of the unknown, and fear of failure. Overcoming these very human fears is a process that starts with a safe exercise plan and ends with the continued successes of meeting personal fitness goals.

Conquering the fear of injury or medical problems

Ken B. came to me at the request of his doctor. Ken is an above knee amputee, has diabetes, and received a kidney transplant a few years ago. Ken has put on considerable weight over the past years. He confessed that he would not have come on his own. Exercise scares him because he does not know what to do and he is afraid he will hurt himself.

An initial health screening is recommended before participating in a new exercise program. This is especially true if a person has been inactive, has a known cardiopulmonary, metabolic, or musculoskeletal disorder, or is a male 45 years and older or a female 55 years and older. The health screening should include a health history and a physical examination. At the very least, the doctor should be informed if someone is interested in becoming more active. The doctor may also have some recommendations on how to keep exercise safe.

Most exercise-induced injuries result from doing too much, too fast or from doing something above a person’s present skill level. Here are tips on how to avoid falling into these traps.

Conquering fear of the unknown

Ken has been exercising for two weeks now. He thinks he is comfortable following his prescribed exercise program, but he hasn’t gained the confidence to make modifications in his program.

How often, how hard, and how long should someone exercise? An easy way to answer this is to talk about the F.I.T. Principle. F.I.T. stands for frequency, intensity, and time of exercise. A F.I.T. prescription will change as a person becomes a more seasoned exerciser. For beginners, start with approximately three sessions a week on nonconsecutive days. Keep the exercise intensity low-to-moderate. Make sure it’s possible to pass the “talk test” while exercising, being able to talk comfortably with an exercise partner. Keep in mind that many people drop out of exercise because they perceive it as being too hard or painful.

During the first four to eight weeks of exercise, intensity should be down and enjoyment up.

Finally, let’s look at how long each exercise session should last. Start off with short sessions, letting the body adapt gradually. Make it a goal to progress up to 20 consecutive minutes of exercise during the initial four to eight weeks. Interval training is one way for beginners to work on endurance and take necessary rest breaks. Another way to increase endurance gradually is to add two to three minutes of exercise each session, until one reaches the 20 minute goal.

Start each exercise session with a low intensity warmup. Slow walking or cycling, along with light stretches, will help “wake up” the body and mind, get blood flowing and decrease chances for injury. Repeat this process at the end of each session to help pump blood back into the upper torso and decrease muscle soreness.

Make sure to include muscle strengthening exercises in the routine. Increasing muscular strength will make activities of daily living easier and exercise more enjoyable.

Ken is doing five-minute intervals of bike riding with one minute of rest in between. He does a total of four to five intervals, depending on how he feels. Gradually, he will increase his riding time and decrease his rest time until he can reach the 20-minute goal.

Frequency: Approximately three times a week.

Intensity: Low-to-moderate.

Time: Work up to 20 consecutive minutes.

Ken has been experimenting with the bike. He likes to ride with his prosthesis and now carries an Allen wrench in order to adjust his foot to the pedals. He wants to conquer the treadmill next.

Deciding which mode of exercise is best depends on the availability of equipment and facilities, present skill level, and likes and dislikes. I encourage people to keep it simple when they start out. Treadmill walking and stationary cycling (arm or leg) are excellent ways to build endurance and to begin adapting to exercise with a prosthesis. Swimming is another activity that many amputees enjoy: the key word is enjoy. Take time to do a little investigating into exercise classes offered through the local YMCA, Arthritis Foundation, and city recreation departments. Call local exercise sites and ask about handicap accessibility. For home exercise, consider an exercise video for amputees. Another excellent resource is the Home Exercise Guide For Lower Extremity Amputees by Robert S. Gailey, M.S. Ed., P.T.

Conquering fear of failure

Failure occurs when we set our goals too high. I believe that overcoming small hurdles is the way to make it over the mountain. If initial fitness goals are realistic, measurable, and obtainable, success will result. Focus goals on the behavioral changes that are likely to occur during the first four to eight weeks of exercise. Accept any physiological changes, such as a decrease in body fat or blood pressure, as a bonus.

Behavioral changes:

    * Increased sense of mastery and accomplishment.
    * Increased self-esteem.
    * Feeling energized.
    * Better sleep at night.
    * Conquering fear.

Make sure new plans are not too ambitious. Is driving 30 minutes to get to an exercise class realistic? Is club membership affordable? If it appears that a plan is too ambitious, come up with one that will work. Don’t get set up for failure. Gather support from family and friends. Who knows, it may motivate them to start an active life, too. Turn over a new leaf and make exercise a positive experience as well as a lasting one.

Exercise Resources

Home Exercise Guide for Lower Extremity Amputees
Robert S. Gailey, M.S. Ed, P.T.
Ann M. Gailey, M.S., P.T.
Sandra L. Sendelbach, M.S., P.T.

Seat-A-Robics: Exercise for the Disabled
(708) 831-4007 voice/fax
Chairobics
Cherly Spessart, BSN, RN
1-800-610-4270

Aerobics for Amputees
Produced by DS/USA
1-800-610-4278

Nancy’s Special Workout: For the “Physically Challenged”
Nancy Sebring, OTR
1-800-610-4278

Flex-ercise
Produced by Flex-Foot, Inc.
1-800-233-6263 ext. 23

About the Author
Kate Shult completed her M.S. in exercise physiology at the University of Tennessee. Presently a clinical exercise physiologist at the U.T. Medical Center, she handles a diverse caseload, and has also designed and implemented a kidney transplant rehab program. Certified by the American College of Sports Medicine, Kate has spent the past 10 years lecturing, training, and educating in the health and fitness field, and is the UTMC Heart at Work coordinator.