For new amputees, the road to recovery is filled with many challenges; tasks once considered routine take on a new level of complexity. The idea of "recreation" may not come up much in the early days, but as life begins to return to normal, amputees can start to focus again on activities that were an important part of their life before losing their limb – such activities as hiking, running, swimming, skiing, golf and even boxing! (More on that later.) There are also obvious physical benefits to being more active on a regular basis. In some cases, the amputee’s existing prosthesis may be suitable. In other situations, modifications or even a second prosthesis may be required.

Take to the hills

Hiking or trail walking can be a great way to exercise regularly without the need for much specialized equipment other than a comfortable, well-suspended prosthesis and hiking boots. With the introduction of so many gel/locking liners over the last five years, socket comfort and suspension have been dramatically improved and skin irritation should be a thing of the past.

For the transtibial amputee, the focus is on the type of prosthetic foot used. For walking on uneven ground, the amputee should choose a foot that offers multiaxial motion combined with energy return or dynamic response. This ensures that the foot maximizes contact with the ground at all times and offers a high degree of energy return to the user. Some models to consider in this category would be College Park’s Tru-Step and Ossur’s Vari-Flex.

The transfemoral amputee has to consider the type of knee unit, the choice of foot and how well the combination will perform as a unit. For many transfemoral amputees, walking on rough ground can increase the risk of stumbling so it is important to choose a knee unit that will allow some degree of recovery from such a stumble. Knee units to consider would be Endolite’s high-activity frame with adjustable hydraulic cylinder or The Ultimate Knee from Ortho Enterprises. The amputee can vary the amount of knee resistance with a simple adjustment of the knee unit.

In the Swim

A common misconception among new amputees is that it is no longer possible to go to the swimming pool or beach wearing a prosthesis. In fact, there are a number of "swim" prostheses to choose from, depending on the amputee’s needs.

The simplest swim leg is a lightweight, hollow (exoskeletal) construction with a waterproof, nonarticulating foot attached to the end. The prosthesis has drain holes at the top and bottom that allow the hollow center to fill with water to reduce buoyancy and then empty out when removed from the water. The prosthesis is normally suspended with a waterproof suspension sleeve. For a more sophisticated approach, a swim leg can incorporate an adjustable ankle unit such as the ActivAnkle from Rampro. This unit was invented by an amputee and allows full plantar flexion capability, making it much easier to kick and therefore increase propulsion. It can be attached to a conventional waterproof foot.

The transfemoral amputee, might consider a waterproof knee such as the 510 nylon knee from Aulie Devices. This knee is one of the few completely waterproof knees available and is an extremely versatile unit with adjustable hydraulic dampening and adjustable friction as standard.

Though most upper-extremity amputees can manage to keep afloat without any assistance, a swim prosthesis can be useful if swimming becomes a regular form of exercise. TRS, based in Colorado, has designed a freestyle swimming device that is particularly useful for the transradial amputee.

The design, which mimics a folding wing, reduces resistance during stroke recovery but flares open to provide maximum resistance during the power stroke. The device can be rotated to optimize various swimming strokes and styles. Though a relatively simple design, the overall effect can dramatically improve the user’s swimming technique.

FORE!

Golf has become one of the fastest-growing sports over the last 10 years and is a very popular pastime among upper- and lower-limb amputees. There are now several amputee golf associations around the country dedicated to helping amputees return to the sport - or even try it for the first time!

For the lower-limb amputee, the only major change required to the prosthesis would be the addition of a torque-absorption unit. This device allows amputees to turn their body while keeping the prosthetic foot in the correct position, giving them a more natural swing due to the amount of rotation provided by the unit. Both the Endolite and Century XXII units provide shock absorption as well as rotation.

For upper-limb amputees the choice is between learning to swing the club with one hand (a lot more difficult than it looks!) and using a specialized adaptive device attached to the prosthesis. The transhumeral amputee will almost certainly learn to swing with one hand but the transradial amputee may opt for an adaptive device.

TRS produces two versions of a golfing adapter for amputees. The Amputee Golf Grip is designed for people without a left hand. It can be positioned anywhere on the club grip and uses the "sound" hand’s gripping pressure to "lock" the device in place, preventing slippage and improving control. The Golf Pro is designed primarily for people without a right hand. It slips over the shaft of the club and then "jams" in place on the grip when pulled up. Plastic sizing rings can be enlarged to custom fit the user’s clubs. Both of these devices feature a unique, strong, flexible coupling, which duplicates the wrist action required for a smooth, controlled swing.

Back in the ring

It’s not every day that an amputee boxer visits the office and asks if you can help improve his boxing technique. Even more unusual was that Tim Welch’s (aka Titanium Tim) amputation was above-knee, on the right side. The main problem he encountered in the ring was preventing his Otto Bock 3R80 knee joint from collapsing when all of his weight was on the right side, and the prosthetic knee was flexed. After spending some time ringside, the prosthetist and the Research & Development Department of Fillauer, Inc., came up with a custom-made flexion limiter. This consisted of an anchor plate above- and below-knee, and an adjustable Dacron strap between the plates. The device was strong enough to withstand the considerable forces applied during a match, yet could be removed quickly and easily once the fight was over.

The days of wooden "pirate" legs and cumbersome prostheses that merely helped amputees move slowly from one spot to another are gone. Amputees today have the opportunity to live a relatively normal life. It’s not just about moving around anymore - it’s also about having fun in your life.

For more information on amputee recreational topics, contact the Amputee Coalition of America (ACA) toll-free at 1-888/AMP-KNOW (267-5669).

About the Author:

Arthur Graham, CP, has been living in the USA for the past five years. A graduate of Strathclyde University in Glasgow, Scotland, he currently works for New England O & P Systems in Westwood, Massachusetts. You may contact him at www.neops.com/

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