Wieder gehen! Eine Informations-Initiative zum Thema Fußheberschwäche

Contacts and TMR Centers

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Birgit Bischof & Agnes Sturma, physiotherapists

Why does therapy play such a key role in the TMR fitting process?

The therapist accompanies the TMR patient and subsequent TMR prosthesis user throughout the entire rehabilitation process. The goal is to teach the patient to use the TMR prosthesis, with each muscle controlling a specific prosthesis movement. This requires a structured concept that is adapted to the individual training progress of the patient:

Clinical assessments are carried out in preparation for the operation and the patient is physically prepared for surgery according to his/her physical constitution. Immediately after the TMR surgery, when the reinnervation of the transferred nerves takes place, the healing process is supported by conventional post-operative measures. The reinnervation process is simultaneously facilitated by mental training, which promotes the patient’s ability to visualise the movement. The better the patient is prepared mentally, the faster and easier the subsequent signal training for the reinnervated muscles will be. The signal training is done muscle by muscle. Apart from defining the best electrode position, this also requires a new movement which the user thinks of and with which each muscle can then be individually activated. The muscle and signal training improves the user’s control over his/her muscles and thus allows for reliable control of the prosthesis. After all the muscles that have been operated on have been activated separately, the actual prosthesis training starts.

How do you manage to keep users motivated over such a long period of time?

As part of the TMR process, the patient needs to have a great deal of initiative and self-motivation from the very start. It is also important to give the patient thorough information regarding the time frame, the entire TMR process and the benefits of therapy and rehabilitation in advance with respect to controlling the TMR prosthesis later on. Therapy involves the setting of many small goals. Accomplishing these individual goals motivates the patient through the entire rehabilitation time.  We also design the individual therapy units to be as varied as possible, customised to the personal requirements of the TMR patient.

How many hours a day/week does a TMR user have to train?

The time required for therapy and training may differ greatly from patient to patient, and may also change over the course of rehabilitation. Specific therapy starts while the nerves are still healing, which accelerates the subsequent training process. It can generally be assumed that the most intense and thus also most time-consuming training will be necessary between months six to twelve after TMR surgery. Weekly training (ideally with the therapist) is recommended during that time. An additional at-home programme can be designed individually.

What does the everyday cooperation between the surgeon, prosthetist and therapist involve?

This interdisciplinary cooperation, particularly between the surgeon, prosthetist and therapist, is of enormous importance for successful rehabilitation in the TMR process. Even the pre-operative information and patient advisory sessions as well as the further planning of the procedure are carried out in joint team meetings. Each expert contributes his/her expertise in order to plan the TMR surgery, surgical corrections of the residual limb, rehabilitation and various prosthetic solutions as well as the ongoing course of care for the patient individually.

All professional groups involved meet jointly and regularly during the rehabilitation process. At these meetings, the current status of the patient is discussed and further steps are planned. Well into the rehabilitation process, for example, during socket design, the prosthetist and therapist work together with the patient.

What kind of feedback have you received from TMR users?

After all the time we spend with TMR users, we are always particularly happy to receive positive feedback, such as:

“...I wear my TMR prosthesis every day. Thanks to the prosthesis, I can continue running my bakery and really chip in.”