PPAM AID - PNEUMATIC POST AMPUTATION MOBILITY AID Sheila Hughes 2008

Original design was by Professor Little from RPA in Comprised an inflatable air splint with a rigid aluminium frame and a telescopic shank and a SACH foot In 1982 Bonner in the USA trialled a air leg which had an inner air bag that was placed over the stump and an outer fibreglass shell.Again it had a metal shank and a SACH foot.

Research Dept at Roehamton Hospital London combined the two designs and added their own touch. Their mobility aid comprises an aluminium frame with a rocker foot, a small inner bag which is placed over the distal stump and an outer stump sleeve which extends into the groin.

Used for transtibial and transfemoral amputees Use same aluminium support frame but different stump bags Cannot be used for bilateral amputees

Partial weight bearing aid only Used primarily in the parallel bars Some patients can progress to crutches but never used with sticks

Can be used from approx 7 days post-op, dependent on initial wound healing Accurate documentation of wound progress is essential Never used if wound is infected or if wound is dehiscing Can be applied over stump dressings,stump shrinkers, bandages or over trousers

Method Pump a small amount of air into the inner bag Turn it inwards to form a shallow cup which is then placed on the end of the stump The larger outer stump sleeve is then slipped over the inner cushion and placed with the top end in contact with the patients groin.

A rigid frame is then placed over the outside of the bag Need to leave at least 2 inches between the top of the frame and the top of the outer bag.

The webbing is placed at the bottom of the frame to support the distal end of the outer sleeve. The rocker foot should be in a position such that the remaining limb is slightly shorter Place strap over opposite shoulder and attach to frame.

Support the frame whilst inflating The outer bag is inflated to 40mmHg for walking On weight bearing there will be some shortening and some adjustment may need to be made to the length.

Worn for mins initially and then the stump must be examined Gradually build up wearing time Whenever the patient is sitting the outer sleeve must be deflated a little and the leg elevated to prevent the circulation being compromised

Benefits Psychological boost Patient is upright and weight bearing Provides total stump contact Aids in oedema reduction Can give some indication about whether or not they will be prosthetic users Can be reused for other amputees

Drawbacks Lack of knee flexion/extension when mobilising Can introduce gait deviations eg. circumduction. More apparent with transfemorals. Initial stages are time consuming