Bracing/Artificial Limbs


The medical term for an artificial limb is a prosthesis.  Prostheses are prescribed and used by patients with traumatic amputations as well as congenital limb deficiencies (born without part of a limb).  The most common type of prosthesis prescribed is a custom below knee prosthesis.  A prosthesis is most commonly prescribed by a physiatrist.  A prosthesis is made by a prosthetist.

Immediately following amputation surgery, the rehabilitation to maximize prosthetic use can make a significant difference in a patient’s mobility and functional outcome.  Immediately following surgery, a post-operative prosthesis, sometimes referred to as an IPOP (immediate post-operative prosthesis) serves as a “football helmet” for the below knee amputee stump.  It protects the amputation site as more than half the patients with a new below the knee amputation forget that they have the amputation and/or fall just because of loss of balance and damage the surgical wound site within the first two weeks after amputation.  This protective cap helps prevent injury from occurring.  More importantly, an IPOP will help shape and form the residual lower limb in a cylindrical fashion.  This is akin to having an orange juice can suction effect while trying to remove the orange juice that is only partially thawed.  In other words, a 100% surface contact is what helps hold an artificial limb in place much more so than any type of suspension strap.  Therefore, healing the residual limb into the shape of a cylinder is very important.  The avoidance of a “dog-eared” appearance or out-pouching of the bottom left and right stump is important.  If a dog-eared appearance occurs, this means that there are air pockets just above them and this creates a source of friction and pistoning with an ill-fitting prosthesis that will not be used effectively by the amputee.

A person with a below knee amputation uses approximately 33%-40% more energy than a person without a below the knee prosthesis.  A unilateral above knee amputation requires much more energy consumption in the order of approximately 66% more energy consumption to ambulate in comparison to a person without such an amputation.  Therefore, a person with an above knee amputation or bilateral below knee amputations or greater will need a wheelchair for longer distance mobility.  Wheelchair prescription is also part of the specialty of physiatry.

The medical term for a brace is an orthosis.  An orthosis is medically defined as a device applied to the external surface of the body to improve function.  The most common type of orthosis prescribed for a person with a lower limb disability is an ankle-foot orthosis.  This is also referred to as an AFO.  An AFO is commonly prescribed for a person with foot drop due to a traumatic peroneal nerve injury (a branch of the sciatic nerve) or for a person with a stroke.  There are different types of orthoses (braces) that are made custom by an orthotist as prescribed by a physiatrist for diagnoses commonly also including spinal cord injuries and traumatic brain injuries.  Often weakness, paralysis and spasticity require bracing.  Plastic componentry is much more common than metal componentry but unstable joints can often require metal joints to help stabilize the joint.  The best brace for a patient is one that has minimal weight, is easy to don (put on) and doff (take off) and helps normalize the patient’s function.  Lower limb bracing, in general, is more commonly prescribed than upper limb bracing.

In regard to the issue of artificial limbs and bracing, Dr. Hennessey in particular has published four book chapters on bracing, including one in each of the his field’s international standard textbook editions of physical medicine and rehabilitation entitled Physical Medicine and Rehabilitation, edited by Randall Braddom, M.D., and published by Elsevier in London, England.

Medicolegal issues in regard to bracing, artificial limbs and gait (walking) abnormalities can be very well addressed by Dr. Hennessey and Dr. Kozakiewicz.