Lesson 1Residual limb examination: skin integrity, scars, neuroma signs, swelling, limb volume variability and measurement techniquesThis section focuses on residual limb examination, emphasizing skin inspection, scar mobility, neuroma signs, edema, limb volume fluctuation, and standardized measurement techniques to support safe loading, socket fit decisions, and long-term tissue health.
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 outlines functional mobility testing for transtibial users, including TUG, 6-minute walk, stair negotiation, and sit-to-stand measures, with guidance on test setup, safety, interpretation, and documenting change across 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 explains balance and proprioception testing, covering clinical tools such as Berg items, single-leg stance, and Limits of Stability, plus optional instrumented measures, to quantify fall risk and guide targeted balance training.
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 explains how to collect a focused history for transtibial prosthesis users, covering surgery details, prosthetic use, pain patterns, daily activities, participation goals, and psychosocial aspects that influence rehabilitation outcomes and adherence.
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 reviews joint range of motion and muscle length testing relevant to transtibial amputees, emphasizing hip, knee, and gastrocnemius–soleus length, contracture risk, testing positions, and implications for 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 addresses assessment of assistive devices and environments, including cane or walker fit, home and workplace demands, community terrain, and transportation needs, to ensure safe mobility and realistic rehabilitation planning.
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 covers systematic visual assessment with and without the prosthesis, focusing on global posture, pelvic alignment, limb length, contractures, spinal curves, and compensatory strategies that may affect comfort, gait efficiency, and long-term joint health.
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 details muscle strength testing protocols for key muscle groups, including hip abductors and extensors, knee extensors, core stabilizers, and the contralateral limb, using manual testing and dynamometry to guide exercise prescription.
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 presents a structured gait analysis framework, using observational checklists for stance and swing, step length, stance time, and foot clearance, and links common deviations to potential prosthetic or physical causes and treatment priorities.
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 details prosthetic-specific checks, including socket fit, suspension function, pressure distribution, alignment cues, foot behavior, and sock or liner management, to distinguish prosthetic issues from physical impairments during assessment.
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
