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Old 10-30-2006, 10:11 PM   #1
Court Wing
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Hey all,
I now have a client in NYC that is a Below the Elbow (BE) amputee and we are currently using a kettlebell. Does anyone have experience training this population and could you offer me any suggestions or warnings? Would appreciate your help and time.

Thanks,
Court.
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Old 10-31-2006, 08:50 AM   #2
John Tuitele
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For starters, don't do what your avatar does.

In 20 years of PT, I've never treated a BE amputee, lots of below knee and above knee, so this is a fairly rare condition. Limb loss incidence is, according to Amputee Coalition of America, 5 per 1000 to begin with. Information from them at http://www.amputee-coalition.org/publications.html

What does the physician (surgeon or physiatrist) say in terms of precautions so you don't rip up what they so carefully glued down ? How long is the remaining forearm past the elbow? The client is grasping the kettlebell with elbow flexion, right? Pretty smart, but I'm wondering what kind of abrasion is taking place if the bell handle slides up and down the stump.

Shoulder motion is going to be altered in a big way. I would listen for any comments about shoulder pain on the involved side and alter the exercises to steer clear of impingement issues.

Stump ends can experience skin breakdown - pretty common early after surgery when the prosthesis is fitted, so I'd scale and progress slow on loading the end of the amputation.

Does the client have a prosthesis? Another resource would be the physical therapist who treated him/her in the hospital as well as the CPO (Cert. Prosthetist/Orthotist) who may have fitted the device.

What an interesting situation......email me direct at jt57dpt05@gmail.com if I can help brainstorm with you.
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Old 10-31-2006, 10:15 AM   #3
Court Wing
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Thanks for your quick response, John.
It seems I gave a mis impression, he is only missing one arm; the right arm's still there and works just fine. I guess I'm more concerned about torso imbalances developing from predominantly working the right side and that generating some kind of torsion on the spine...any suggestions?

Thanks for the help.
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Old 10-31-2006, 05:18 PM   #4
Ronald Coleman
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I have been a below the elbow amputee, 4 inches, for nearly 10 years. I do not have torsion on the spine. I agree with John, ask your client to ask his physiatrist, physical therapist, or prosthetist about possible limitations. I use BB and DB. The owner of this prosthetic company TRS, Inc. built a prosthetic arm for a powerlifter who benches several hundred pounds. He is fairly easy to get in touch with.
http://www.oandp.com/products/trs/
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Old 10-31-2006, 05:21 PM   #5
Yael Grauer
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I haven't, but I believe Angela Hart spoke about teaching rowing to a one-armed amputee on the CF Live broadcast.
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Old 10-31-2006, 07:06 PM   #6
John Tuitele
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This is interesting.

I get that the right arm is intact and all good - he is using the kettlebell with the right arm or the amputated side?

Left arm is amputated below the elbow - how long is the forearm on the left?

One idea: have you considered using a Versadisc or half foam roll or bosu trainer under the amputated limb for pushups?


(Message edited by jt57dpt05 on October 31, 2006)
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Old 11-01-2006, 12:27 PM   #7
Court Wing
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Right arm is fully present and left arm is pretty mangled, from what I can see, and apparently there is no lat remaining on the left side. There is maybe 4" of forearm left, but overall there seems to an actual loss of musculature in the left arm. Not currently doing any work on the left side, only the right.
I like the Bosu/foam roller assist idea; was also planning to teach him OAPU progressions ala Pavel's "Naked Warrior".

(Message edited by Court_Wing on November 01, 2006)
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Old 11-01-2006, 07:27 PM   #8
John Tuitele
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OAPU progressions are ?

I was thinking about a strap for grasping with the forearm for pullups, but if the lats aren't present, that's going to be a real challenge. How about the hanging slings that people use for hanging "knee ups" - can he hold static body weight with those?

I really like the suggestion of contacting the TRS for ideas....
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Old 11-02-2006, 04:07 AM   #9
Fiona Muxlow
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This year I started training a girl who is not an amputee but was born basically without her left arm. She has a small left hand which she can use for simple taskes ,such as holding her car keys but not no more than about 2lbs of weight and no elbow.
Her right arm is fine. In the past she had been restricted to machine based weights. Now she is learning how to snatch and C&J, and loving it.
She is actually an ex-paralymic swimmer she medaled in two paralympics and a world titles but is now retired and while there is some diference between her delt and pec development here spinal alinement is fine.
I won't post her photo here but you can see her every now and again on the CrossFitNQ Blog

Dislocating my own shoulder mid last year probaly helped me to understand better what can actually be done when you only have one arm.

Modifications, not she has only been doing CrossFit for about 2 months and does group workouts

*KB all single arm work.to start off she used a 5 kg DB but i have had I had a 11lb kettle bell made up for her to use for swings ect as she dosen't have the double hand control.

*Skipping/Double under = Tuck jumps

*Pushups = Single arm pushups on knees

*Pullups= Bodyrows with feet on ground

*Cleans/Snatchs = Single arm dumbell work

Im trying to get special a oar made for her so she can use the C2.

If in doubt of something i simply ask her how she would do it, Having been born with only one arm she has the advantage of never having had the use of two. So far back squats and medicine ball cleans are the only thing we haven't got her to do, but dare i say it .....squat machine and light dumbbells are a good sub. And when we do sledge-hammer work on the tractor tyres she swings a weighted mallet.

Hope this helps
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