Lesson 1Residual limb examination: skin integrity, scars, neuroma signs, swelling, limb volume variability and measurement techniquesThis section concentrates on examining the residual limb, stressing skin checks, scar mobility, neuroma indicators, swelling, volume variations, and reliable measurement methods to ensure safe loading, socket fitting, and sustained tissue health over time.
Skin color, integrity, and breakdown riskScar location, adherence, and mobility testsPalpation for neuroma and nerve tendernessEdema patterns and soft tissue consistencyCircumference and length measurement methodsMonitoring limb volume changes over timeLesson 2Functional mobility testing: timed up-and-go (TUG), 6-minute walk test, stair assessment, sit-to-stand measuresThis section describes functional mobility tests for transtibial users, covering timed up-and-go (TUG), 6-minute walk test, stair handling, and sit-to-stand evaluations, with advice on setup, safety, analysis, and tracking improvements during rehabilitation.
Timed Up and Go test setup and scoringSix-Minute Walk Test proceduresStair ascent and descent performanceSit-to-stand and transfer assessmentsUse of assistive devices during testsLesson 3Balance and proprioception testing: clinical tests (Berg Balance Scale items, single-leg stance, Limits of Stability) and instrumented measuresThis section covers balance and proprioception assessments, including clinical tools like Berg Balance Scale items, single-leg stance, and Limits of Stability, along with optional device-based measures, to assess fall risks and direct balance training programmes.
Static standing balance observationsBerg Balance Scale item selectionSingle-leg stance and tandem stance testsLimits of Stability and weight shiftingInstrumented balance and sway measuresLesson 4Structured history-taking: surgical history, prosthetic history, pain characteristics, activity goals, and psychosocial factorsThis section guides focused history collection for transtibial prosthesis users, including surgery details, prosthetic experience, pain descriptions, daily activities, participation aims, and psychosocial elements affecting rehabilitation success and compliance.
Key surgical details and amputation etiologyPrevious prosthetic use and device changesPain type, intensity, triggers, and patternsActivity level, vocational and sport goalsPsychosocial context, mood, and supportLesson 5Joint range of motion and muscle length testing relevant to transtibial amputees (hip, knee, ankle/gastroc-soleus length)This section examines joint range of motion and muscle length tests for transtibial amputees, highlighting hip, knee, and gastrocnemius–soleus assessments, contracture risks, testing positions, and effects on gait and prosthetic alignment.
Hip flexion, extension, and rotation rangeKnee flexion and extension measurementGastrocnemius–soleus length assessmentStandardized goniometry positioningImpact of contractures on gait and fitLesson 6Assistive device and environmental assessment: cane/walker use, workplace demands, uneven terrain challengesThis section evaluates assistive devices and environments, covering cane or walker suitability, home and work requirements, community terrain, and transport needs to promote safe mobility and practical rehabilitation planning in Namibia.
Cane and walker selection and fittingHome layout, hazards, and accessibilityWorkplace physical demands and tasksCommunity terrain and outdoor challengesTransportation and public transit accessLesson 7Observation and static postural assessment with prosthesis on and off (pelvic alignment, limb length, contractures)This section involves systematic visual checks with and without the prosthesis, focusing on overall posture, pelvic alignment, limb length, contractures, spinal alignment, and compensatory habits impacting comfort, gait efficiency, and joint health long-term.
Posture with prosthesis donned and doffedPelvic tilt, obliquity, and rotation checksApparent and true limb length comparisonDetection of hip and knee flexion contracturesSpinal alignment and compensatory posturesLesson 8Muscle strength testing protocols for hip abductors/extensors, knee extensors, core and contralateral limbThis section specifies muscle strength testing methods for essential groups like hip abductors and extensors, knee extensors, core muscles, and the opposite limb, employing manual tests and dynamometry to inform exercise recommendations.
Hip abductor strength testing methodsHip extensor and gluteal strength checksKnee extensor and quadriceps assessmentCore stability and trunk strength testsContralateral limb strength comparisonLesson 9Gait analysis framework: observational checklist (stance/swing symmetry, step length, stance time, foot clearance), identifying prosthetic-related deviationsThis section offers a structured gait analysis approach using checklists for stance and swing symmetry, step length, stance duration, and foot clearance, connecting common deviations to prosthetic or physical issues and prioritising treatments.
Standardized observational gait checklistStance phase symmetry and stabilitySwing phase, foot clearance, and timingStep length and cadence comparisonsCommon transtibial gait deviationsLinking deviations to likely prosthetic causesLesson 10Prosthetic-specific checks: socket fit assessment, suspension performance, pressure mapping basics, alignment cues, prosthetic foot response, socks/liner fit and volume managementThis section covers prosthetic-specific evaluations, such as socket fit, suspension effectiveness, pressure patterns, alignment indicators, foot performance, and sock or liner adjustments, to differentiate device problems from physical limitations in assessments.
Static and dynamic socket fit assessmentSuspension system function and pistoningPressure-sensitive and tolerant area reviewVisual and functional alignment indicatorsFoot rollover, heel response, and stabilitySock ply, liner fit, and volume strategies
