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SusanI

SUGGESTIONS FOR WALKING DOWN RAMPS?

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Hi Everyone,

Well, I'm three months out since my RAKA, and 7 weeks out since getting my first leg, which is a C-Leg. I am doing pretty well, all in all....going to Physical Therapy twice a week, still seeing my prosthetist every two weeks. I'm using a cane most of the time when my leg is on, and I've only fallen twice!

One thing that I noticed that I am pretty scared of having my knee give out when I go down any type of incline at all, even if it a very gradual one. Going up is a piece of cake, but going down scares me. My Physical therapist said that in her experience, this was true for a lot of people with amputations. I tried to take a cart down a ramp at a grocery store the other day, and I really got scared, as it was rolling and I felt out of control.......how will I ever do this???

What I'm wondering, is there any tips from those of you with more experience to going down ramps more easily, or is this one of those things that I will always have issues with???

(HELP!!!)

Best wishes to all,

Susan

PS off to Westminster Kennel Club in NYC with my Chocolate Lab and friend on Tuesday.........scared but going..........

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I had to deal with a fairly vicious downward slope just this morning! I took the advice of my physio. I used my stick to give me a little extra support, put my heel down (fairly definitively) and sort of fell forward onto my toe. It seemed to do the trick!

Hope this helps

Falstaff

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I can cope with gentle slopes but if they are too steep and/or slippery I find turning my leg/foot sideways helps. It is slow but safe.

Sue

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Sue, if it's any consolation, I'm a basic BKA who's two years out at this, and I STILL take ramps cautiously! They're one of those "challenging" things for MANY amps!

Don't know how it would work for an AK, but a couple of things that I find helpful: the "heel plant" Falstaff describes makes the walk "down" feel much closer to natural, for me... and if the ramp is long and wide enough, walking both ACROSS and DOWN at the same time (going down along a sort of gentle "S" path) seems to make things feel less steep.

And you're absolutely right: going UP is a piece of cake! I've joked with my leg guys that, if they could adjust my prosthesis so that I constantly felt as though I was walking up a slight incline, I'd be one happy camper!

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Hey Susan!

I'm sure if you ask a thousand amps, there's probably a thousand different variations. I'll throw mine in here and hope it's of some help. :)

First, C-LEG, wow! Heck of a leg for starting. You've got the "good stuff", so to speak. ;) I use a Mauch hydraulic and a Rheo microprocessor knee, similar to your C-leg. Currently, I'm using the hydraulic leg since I'm STILL battling with the MAS socket design. I decided to "pick my battles" so to speak and the Mauch is simple and predictable once you get a feel for it.Blah, blah, blah... :D

So, I'm headed down a ramp, hill, incline, etc. First, if the transition is very abrupt, I try to lead with my prosthetic side(I'm LAK). After my heel touches down, I sort of "ride" the hydraulic resistance down on that side. It's a very short "ride", but during it, I am pulling back (like walking on flat ground)to propel myself forward and at the same time, I am swinging my right leg forward and setting the heel down.

Riding the hydraulic down- it's a little strange at first. But, as your heel strikes, sort of imagine that you are going to sit on the back of your socket. As the knee gives resistance(your c-leg is basically a hydraulic knee with a brain) your butt cheek should "squat" :P in the direction of the heel of your prosthetic foot. But don't ride it too long. Notice how much you sound side bends and try to match it.

I hope I haven't confused you too bad. It took me a while to get this all down and then get the timimg of it all right. So, practice every chance you get. And, IMHO, don't be afraid of falling. The ground is right where it's been your entire life. Even if it seems to have gotten farther away! :blink:

Good luck!! :D

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Being a bk, I am sure that ramps are entirely different to us, than it is for an ak.... we have a little control.....not much and given the steepness of the incline is a whole other thing.....

The only thing that I can add to all of this is, if you find a place you can, practice.......... I used my wheelchair ramp for the better part of a year and a half.....I used it until that slope didn't bother me at all, and Cheryl is so right, going up is easier..

Would it help if you have your pt or hubby, or significant other,, someone, help you learn how to get up if you haven't had someone show you.... There is a trick to some of it... and I have found that once most people are sure that they would be able to get up, they are less afraid of falling....

But, Shane said it, the ground is always right where it's always been.....not really that far away...

I'd say at 7 weeks, your doing quite well.......

Higgy

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Hi Susan,

As Shane already stated everybody has there own way of doing things.

Here is a few of my suggestions that MIGHT help you.

Confidence & Trust of the leg where my main concerns.

How I got round these.

I think of my prosthetic limb as a tool and like all tools you have to lean how to master them to get the best out of them.

So Susan my suggestion to you is, practice practice & even more practice,

Get away from the limb centre; go to a nice open, grassy park or field with a slope on. (Not too steep to start with).

Take a blanket, food and drink with you, yes you are going to be there all day invite a friend along.

Now let’s start,

1) Stand at the top of the gradient, head up chest out, step out. Bad leg out first, very very small step, plant the heel down, & pull back, transfer weight over & swing Good leg through and place LEVEL with bad foot. (Remember to take breath).first step taken.

2) Keep repeating until you feel confident, use walking sticks if necessary.

When you are happy with that do ( 1) again only this time when you swing your good foot forward place it slightly in front of you false foot say (2 inches) again practice, practice, & more practice. When you are happy with this increase your step size. The smaller the step the easer it is to control the speed.

After a bit of time you will no longer be “step together step together” you will be step over step remember small steps is best to start with.

If you friend hasn’t already eaten all your food that you brought with you get them to film it on a camera, (if your working so should they) and whilst you are having a well deserved rest have a look at how you look, its surprising what you can learn by watching your self on film.

Steeper gradients I have found need slightly different techniques, you have a c leg so I believe that you can “ride” the hydraulics going down (like Shane stated)

If not try turning your toe in (it helps to keep the knee from collapsing). Control of your speed is of utmost importance if you start going to fast you will take a tumble, (that’s why I suggested nice soft grass to land on)

Really steep gradients try turning the whole leg inwards and go step together step together,

Really really steep gradients try turning your whole body to one side

Really really really steep gradients get easer as I treat the like walking down the stairs.

I guess that every body has there own way of getting round this , my way might not look that good but it enables me to go hiking up n down some pretty big hills with confidence,

I think that word confidence is what your post is all about, it is early days for you, you will master the gradients, it just takes a little time and soooooooooooooooooo much practise remember you are in charge of the leg not the other way around. I hope in some small way this helps…………. take care………Mick (now off to put plaster on blister that’s on my typing finger) :lol:

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Hey Susan!

I'm sure if you ask a thousand amps, there's probably a thousand different variations. I'll throw mine in here and hope it's of some help. :)

First, C-LEG, wow! Heck of a leg for starting. You've got the "good stuff", so to speak. ;) I use a Mauch hydraulic and a Rheo microprocessor knee, similar to your C-leg. Currently, I'm using the hydraulic leg since I'm STILL battling with the MAS socket design. I decided to "pick my battles" so to speak and the Mauch is simple and predictable once you get a feel for it.Blah, blah, blah... :D

So, I'm headed down a ramp, hill, incline, etc. First, if the transition is very abrupt, I try to lead with my prosthetic side(I'm LAK). After my heel touches down, I sort of "ride" the hydraulic resistance down on that side. It's a very short "ride", but during it, I am pulling back (like walking on flat ground)to propel myself forward and at the same time, I am swinging my right leg forward and setting the heel down.

Riding the hydraulic down- it's a little strange at first. But, as your heel strikes, sort of imagine that you are going to sit on the back of your socket. As the knee gives resistance(your c-leg is basically a hydraulic knee with a brain) your butt cheek should "squat" :P in the direction of the heel of your prosthetic foot. But don't ride it too long. Notice how much you sound side bends and try to match it.

I hope I haven't confused you too bad. It took me a while to get this all down and then get the timimg of it all right. So, practice every chance you get. And, IMHO, don't be afraid of falling. The ground is right where it's been your entire life. Even if it seems to have gotten farther away! :blink:

Good luck!! :D

Gee, Shane, I wish you lived closer so you could show me! You too Mick!!!

My prosthetist did adjust my hydraulic resistance, but now I think it's too tight. (he stood on my foot while I sat down) My therapist is going to take me outside once this cold weather breaks, and we are going to work on the incline (or rather decline) in front of the building, and she is going to check the resistance for me. I didn't even realize that the resistance was there, as my prosthetist is apparently doling out information slowly....doesn't want to overwhelm me with info. I was asking about the ramps and he mentioned the resistance.

Mick, it sounds like you are basically saying similar stuff to Shane, i.e. planting the heel down, & pulling back. I definately think that I will need to practice and practice, but it is helpful to know that there are ways to get down those inclines!

I appreciate everyone's feedback and support. I know I haven't been posting a lot lately, but it is so good to know that others have gone before me and know how to deal with this stuff!

:D

Thanks!

Susan

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Heel plant and commitment... that is it.... I do find that for a really steep slope...specially without a yielding knee... 'tacking sideways' is the quickest and most comfortable way... say if you're a right AK... down to your left is great... approach the slope diagonally until you have a comfortable yielding knee.

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Guest bearlover

I have no problem walking down ramps..Its the going up that is hard for me.. With stairs it's the going up. Coming down is much better. LBK 3.5 years

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I am a b/k, but always find going down a slope more difficult than going up. Think someone else mentioned it, but I generally, depending on the steepness, take the sideways approach.

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Damn you lot are always making me think.....stop it!! I had to actually go out and do this and think about it and damn near killed myself. I can't even walk while someone else chews gum so actually thinking about what I'm doing is a distraction in itself

What I do won't suit everyone but it suits me.

The grade of the ramp makes little difference to me, especially as I'm RBK(symes) so it's going to be way different for AK's.

I take fairly long strides. When my foot hits the ground I lock my knee hard and roll up and over my foot until my weight is forward of the leg on the ground, then I let my knee go and take my weight on the other leg with a locked knee as it hits the ground. No different for either leg.

Reminds me of a day when my youngest and I were Xmas shopping.

We hopped on an escalator (the type with just a moving belt and no steps) and as there was only one person ahead of us and he was quite a way ahead we started to walk down. Momentum got us and our strides became longer and longer and we were making a hell of a thump on the belt. The poor guy must have thought a whole tribe of people were coming down and he moved so fast to get off I actually thought he was going to jump off the side :lol:

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hello susan,

you just have a new leg for 7 weeks and want to be able to do all things well? :lol: will take some more time.

i use the c-leg as well. yielding is for going down slopes best thing, but you need much power in your stump. when slpoes are not so steep you can go longer "over the foot"...means normal, but need to "swing" in the knee then.

when it gets steeper, you have to let you fall in the knee...there you have to find out "your" setting. testing is for this on stairs a good place......just finde a good speed going down stairs then.

you will get confidence, when you use the leg all day. hopefully soon without your cane and then you will learn also the harder things.

for me the hardest thing is at the moment the decision when going over the foot or let me fall in the knee......

ciao thomas

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Heel plant and commitment... that is it.... I do find that for a really steep slope...specially without a yielding knee... 'tacking sideways' is the quickest and most comfortable way... say if you're a right AK... down to your left is great... approach the slope diagonally until you have a comfortable yielding knee.

I agree with Oneblueleg - I tackle slopes sideways. We went to Sun City for a few days and it is "disabled friendly". This directly translates to "many evil slopes".

I am a RAK, and I head down the slope leading with my arty leg (I use a Total knee - yours is much nicer and safer). I plant my arty foot sideways - toe pointing inwards. That way I can be relatively sure that the knee won't buckle when I step over with my real leg.

Slopes will almost always be a pain for us amps.

And by the way - you are doing incredibly well. I don't know if you can benchmark yourself against other amps at the moment (do you have new amps around you learning to walk?), but trust me, you need a huge pat on the back. Trolleys? Damn, you're going to be just fine!!!

:)

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@ ally and oneblueleg

walking with the c-leg, and i thing with the rheo is the same, is when going slopes down totally different. i know this from my time with the total knee. with the c-leg you don´t need to go sideways.....and you won´t start running the slopes down.

thats the advantage of such a "fancy knee". its not a good idea learning all other techniques which don´t use the skills of the c-leg, then you won´t need it.

in my opinion the c-leg is not a good leg for a beginner...too much skills. like driving a fast car, when you just have got your driving license. i have seen people who couldn´t walk, because they thought that leg was unsecure.......

@susan.....try to find somebody who is in the skills of the c-leg to train you. some of the walking techniques are very different to other knees. try the yielding of that knee....feels at first a little unsecure, but when you get used to it, you will love it. but always remember, that you are a beginner.....you are doing fine, but when you want to make two steps at one time, you will fall on your nose ;)

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@ ally and oneblueleg

walking with the c-leg, and i thing with the rheo is the same, is when going slopes down totally different. i know this from my time with the total knee. with the c-leg you don´t need to go sideways.....and you won´t start running the slopes down.

thats the advantage of such a "fancy knee". its not a good idea learning all other techniques which don´t use the skills of the c-leg, then you won´t need it.

This is also true for the ENDOLITE Adaptive and other Hydraulic knees. My knee is a stabilizing knee, so is not designed for the knee to yield through stance like these other knees. What a stabilizing knee does is causes me to 'vault' (the leg stays straight through stance) making slightly sideways the prefered option.

I thing I do hate with a passion is going up a slope diagonally where it rises to my right (I'm a RAK)... that's a real pain.

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i forgot some knees, which can yield? sorry, but i know most about the knees which could fit me.

susan asked for the c-leg, so should we discuss the skills of all other kness in this thread?

i learned with the total knee and use now the c-leg for more than 3 years. walking techniques are regarding slopes totallly different. the c-leg makes it for me look more natural ;)

....but the total knee walking looks much better on even ground.

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If the ramp is really steep, I just plant my AK foot a bit sideways, or zig zag down the ramp.

The advantage of the C-leg is that you can customize its behavior to help you out. You should really get your prosthetist out with his laptop and go up and down ramps with him changing the settings in order to see what works best for you. Don't accept a "generic" setting and, if he is unwilling to spend that time with you, find someone else. My prosthetist actually loaned me the cable and a laptop I played with changing the settings on my own until I felt comfortable.

Also, as you gain confidence in walking with the C-leg, you will be able increase the toe load required to unlock the leg. With a higher toe load, you will lose some of the feel of having the leg "unlock" too early going down ramps (when your "foot" is angled down you will naturally have more load on the toe than if you are on level ground, so the leg will "unlock" more easily on a ramp than on a level surface. Being able to use a higher toe load in normal walking will give you more of a safety factor on ramps).

Will

RAKA - C-leg

LBKA - Harmony

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Hi Susan,

thohom stated walking down slops can be different using the c leg as you “ride the hydraulics” which I fully agree with. However my knee unit is the adaptive which is very similar to the c leg (microprocessor) (oneblueleg feel free to step in and explain the differences) and lets you ride the hydraulics going down. However I found that when I started to use this method I found that I was constantly fighting with the leg, I wanted to do one thing and the leg wanted to do something completely different, so despite many “reprogramming” sessions I decided to have the ramp assistance taken off and now use the knee as a” free knee” when im going downhill.

I have found it allows me to go a lot faster l and it’s more flexible to my needs & it encourages me to use my limb muscles to control everything, (which I prefer)

It certainly isn’t as safe as having it on but as you will find out every thing is a trade off to a certain degree.

I guess what im trying to say is get the leg set up for what’s best for you, not what the people at the limb centre think!

I know that they have years of experience with setting it up but its you who has to wear it and live with it……………….take care ………..Mick

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Hi Everyone,

Thanks for all your responses. I've printed them off, and am slowly getting the concept of "riding" this knee. Will, I am not ready to "find a new" prosthetist yet, however, despite the fact that he hasn't taken me out with the computer on ramps. :blink: I think I need to try the current setting to see if it works before I go back and complain.

I have been on the lookout for ramps with handrails though, found one today in fact, and want to play with that. up and down, up and down, etc. Slowly, it's making sense and working, though I'm still holding on. It's still a bit cold to go out on a picnic at the park, Mick, plus, where I am it's pretty flat.

I've also been playing with going down stairs foot over foot, which seems like the same concept with the leg. My therapist has been helping with that as they do have a set of stairs inside. She will also help with the ramp once it's above freezing!

Thanks again.....you guys are the best!!! :)

Susan

PS it's interesting, Ally, these "many evil slopes"....never thought of them before as evil!!!! Now if they had handrails, they'd be OK!! :lol: :lol: :lol:

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