Losing a limb is an extremely traumatic event. No one plans for it. You live your life only for it to change in a blink of an eye. When the unthinkable happens, you must learn to live as best as you can. You must seek rehabilitation.
Amputee rehabilitation methods come in three forms: prosthetics, physical therapy, and counseling. Depending on your situation, you may only need one form or all three. Either way, none of these methods will restore your life, but they can help you move forward.
Regardless of how your rehab plays out, it will mostly revolve around the use and care of your prosthetic limb. As a unique creation, your prosthesis comes with special needs which must be met for you to stay healthy long after your recovery.
Rehabilitation Procedures for Amputees
An amputee is anyone who lost a body part. Amputee rehabilitation attempts to restore the amputee’s mobility, or their ability to perform activities, by providing a means for him or her to overcome the disability.
The Rehabilitation Process
While the plan is to allow the amputee to become independent once again, a single rehabilitation plan will not work. Each amputee is different. Some lost a leg. Others are missing an arm or anything in between. You need a plan tailored to the situation.
However, having a solid and standardized rehabilitation process is a good place to start. Physicians and therapists can modify the plan to suit the needs of their patients. However, they usually plan around these 9 steps.
- Pre-surgical assessment
- Amputation surgery and reconstruction
- Acute post-surgical examination
- Pre-orthotic evaluation
- Orthosis prescription
- Orthosis training
- Discharge and physiotherapy
- Occupational therapy rehabilitation
- Follow up assessments
Benefits of Amputee Rehabilitation
Regardless of your rehabilitation structure, the plan is to help you achieve the best possible quality of life. While your life will never go back to the way it was before you lost your limb, you can learn how to deal with your situation with the right rehab.
As you go through the process, your rehabilitation team will help you
- Alleviate pain through effective pain management techniques such as medication and reducing the pressure on your stump
- Lower your risk for depression through extensive training, emotional support, and counseling that cover such issues as body image, grief, phantom limb pain, and post-traumatic stress disorder
- Learn how to use your prosthesis and mobility devices without injury by understanding their proper operation and care
- Improve your mobility and strength through progressive muscle growth, tone, and flexibility so you can have your life back
- Achieve greater independence by showing you how to care for yourself and manage your day-to-day activities
- Improved confidence in your understanding of your situation and how you must adjust your home life and workplace to accommodate your amputation
The 9 Amputee Rehabilitation Steps
These 9 steps of rehabilitation asses the amputee’s needs to devise the right treatment for them. The process also identifies which experts can provide the best and appropriate care for patients and their families.
Pre-Surgical assessment
The amputee rehabilitation process begins well before the surgery. Right after your physician determines that you need an amputation, he or she will examine your medical and social histories. You will also get a complete and comprehensive physical examination to assess your skin health, pulse rate, and unaided range of motion, among other vital statistics.
Your physician will use this information about your health and musical strength to decide which orthosis devices you need. He or she will also gather your rehabilitation team who will see you through your amputation and recovery.
During this examination period, you are likely to meet your entire rehabilitation team and go through the entire process with them. This team will consist of your physician, surgeon, therapists, therapy assistants, orthotist, and anyone else who will help you through the process. You may even get a visit from another amputee who went through rehabilitation before you.
The Amputation and Reconstruction
While you may not believe it, amputation is a part of your rehabilitation. The surgery is a complex operation. It is not just for cutting off your limbs. During the operation, your surgeon will prepare your wounded stump to receive orthotic care.
Acute Post-Surgical Examination
The main recovery phase begins as soon as you leave the operating room. During the week following the surgery, you will meet with your physician, surgeon, and therapist. Your rehabilitation team uses this time to check for any complications that may develop from the surgery.
You may need more surgery if there are complications, but most of this step involves quality-of-life care and discharge planning. This care begins with another comprehensive physical assessment to ensure your overall health and strength still falls within certain thresholds.
You may also complete other exams to assess your:
- Mental health
- Pain management needs
- Wound healing and health
- Muscle Strength
- Past Medical History
- Sensation to pain, temperature, and light
- Range of Motion
- Balance and Coordination – including how well you can sit and stand
- Bed Mobility – or how well you can get in and out of bed and how well you sleep
- Wheelchair Propulsion – or how well you can use a wheelchair
- Functional transfer mobility to and from toilets, showers, and your car
Your rehabilitation team will use the exam results to determine and coordinate your treatment plan going forward.
Pre-Orthotic Evaluation
Orthotic devices come in two variations.
- Socket-based: You slip this traditional form the same way you wear clothing. You can take them on and off as much as you want.
- Osseointegration: These orthotic devices attach directly to the bone in your residual limb. These devices act and feel like natural extensions of your body.
To determine the right form for you, your physician will assess your muscle and bone health, and give you his or her recommendation about 5 to 7 days after your surgery. After which, your orthotist will begin measuring your stump to create a cast for your orthotic devices.
This step may also include therapy assistants, physiotherapy, and counselling to improve your strength and to determine if your orthotic device requires special features such as running pads.
Prosthetic Prescription
After taking your measurements, your physician will issue a prescription. He or she will base the prescription around the information already collected throughout the process to ensure that you get the mobility device you need and can use.
Most amputees will get a customized prosthesis unless they cannot use one. If you cannot use a prosthesis for any reason, you will get a general orthotic device. Either way, you may get additional mobility devices such as a wheelchair, or walker to help you stand and walk as well.
Prosthetic Training
During the sixth step of rehabilitation, you start doing physiotherapy with the prosthesis. This is where you truly learn how to use and live with the device. Throughout the step, you may have the device readjusted as needed.
Discharge, Therapy, and Training
The seventh and eighth steps are often completed together. These steps revolve around your discharge from rehabilitation care and your reentry back into society and work.
You will meet with your therapists, counsellor, and occupational therapist for several sessions until you are deemed ready to go on your own. Each session will help you find answers to your questions about your orthosis and the logistics of how to live with it.
Physiotherapy Sessions
Your physiotherapy sessions teach you how to move and use your orthosis. They also serve to improve and maintain your flexibility, endurance, coordination, and strength. Your goal for these sessions is to grow your confidence and comfort so you can live your life independently.
During therapy, you will:
- Prepare for orthotic or prosthetic training and the proper care for your residual limb
- Learn how to use and care for your prosthesis or orthotics device
- Increase your level of recreational activity starting with walking. The duration of this training depends on how you learn each activity
- Learn about support groups and recreational organisations available in your local area
Occupational Therapy Sessions
While you go through physiotherapy, you may also have an occupational therapist. These sessions help you relearn how to perform your daily activities such as cooking, self-care, and work. You will also learn about which jobs you can comfortably and confidently perform. These skills include activities you can do with and without your orthotic device.
Discharge Counseling
Between therapy sessions, your rehabilitation counsellor or psychologist will help you mentally and emotionally prepare for any changes to your lifestyle you might face. Your counselor, along with your physician, will discuss any future recovery treatments you may need to address any pain you may have.
Follow-Up Examinations
In the final rehabilitation step, your physician will consult your therapists and other experts to see if your orthosis device still works as intended. If you need adjustments, you will get them as needed to ensure you have the best possible care and mobility. This final step can last for the rest of your life or until you no longer need assistance.
The Amputee Rehabilitation Process for Specific Situations
Every amputee goes through the rehabilitation process, but everyone goes through it differently. Some people can breeze right through it. Others require extended physiotherapy. A few may require several orthotic adjustments to get it right.
Then, there are differences between orthotic devices. A prosthetic arm works differently than a prosthetic leg, and these differences can affect how well an amputee adjusts to their new life. For instance, you can still walk if you lost an arm, but you are completely dependent on your orthotic device if you lost one or both of your legs.
While we cannot walk you through every scenario imaginable, we can show you the most common situations. If none of these scenarios fit your situation, you should consult your physician to develop the right rehabilitation process for you.
Arm (Upper Limb) Amputation
Most amputations are arm injuries. Despite how common they are, people rarely lose their entire arm. Usually, it is just a part of the arm or the hand.
Regardless, you get the same rehab for upper-limb amputation if you lost:
- Fingers
- A hand
- Your lower arm below the elbow
- Your lower arm above the elbow
- The entire arm at the shoulder
In either scenario, you get fitted for your prosthetic as soon as your wound heals. The prostheis can be either a replica of the lost body parts or a custom replacement such as a hook for a hand. Hooks are more functional, but the final piece is up to you.
Regardless, you will control the movement of the prosthesis through muscles in your stub. Newer models even give you full control over through a computer and sensors embedded into the prosthesis and your stub.
Upper Limb amputee therapy typically revolves around general conditioning exercises to help you strengthen your shoulder and elbow. If necessary, you may also receive endurance exercises to improve your skills for using your prosthetic and any adaptive devices you may have.
Leg (Lower-Limb) Amputation
Leg amputations are usually the last resort. You were either severely injured such as in a car crash, or you developed life-threatening complications from a disorder such as diabetes. Either way, your leg was cut off somewhere below the hip. Most leg amputees will receive a prosthetic leg, foot, or toe to replace the parts they lost with newer models featuring built-in computers that provide full control over the limb.
Lower limb rehabilitation includes general conditioning and endurance component to strengthen your arm and leg muscles, but it also attempts to teach you how to walk again. To that end, your early exercises involve learning how to stand as well as how to maintain your balance. In either case, your activities will depend on whether you lost only one or both your legs.
Lower Limb Therapy Attempts to Limit Contractures
Therapy sessions also try to control the effect of joint shrinkage. Amputated joints tend to shorten or contract from everyday sitting and wheelchair use. These contractures can also form if you lie in bed improperly.
The shrinkage limits your range of motion, but it can prevent your prosthesis from fitting if you do not account for it as well. Some amputees cannot even wear an artificial leg because of how much their joints contract.
However, your stump must shrink until it falls under a threshold to even qualify for a prosthesis. Therefore, your nurses and therapists will show you how you can adjust your contractures to get them in shape without going too far. The process also prevents fluid buildup and other adverse health effects.
Temporary Lower Limb Prosthesis
Until you get your contractures under control, you may get a temporary prosthetic device so you can begin your walking lessons as soon as possible.
Depending on your situation, your temp prosthesis may consist of:
- Permanent leg but a temporary socket
- Permanent socket but a temporary leg
- A fully temporary structure
You may need crutches or a cane while you are on the temporary leg, but accelerating your therapy comes with many benefits. For one, the extra exercise helps your stump shrink, reducing your wait for your permanent leg.
Permanent Lower Limb Prosthesis
Once your stump reaches the right size, you are fitted for a permanent prosthesis. The process starts several weeks after your amputation, but the prosthesis normally lasts for decades with proper care. Though, you may need it readjusted if your height and stump change.
With your prosthesis in your position, your rehab turns to how to use it. Therapy sessions go over:
- How to wear and remove the prosthesis
- How to walk with the prosthesis
- Proper care for your prosthesis and stump
The exercises also continue to promote flexibility, balance and coordination, strength, and cardiovascular health. The walking sessions may begin with the assistance of a walker or cane, continuing for a few weeks until you can do it without assistance.
Other sessions focus on athletic activities such as walking up and down hills, using stairs, and how to move across uneven surfaces. Young amputees may even learn how to run and play sports. You may even learn how to bend the artificial knee if you have one.
Lower Limb Stump Care
Along with your prosthesis lessons, your lower limb rehabilitation will also include training sessions on how to properly care for your stump. This is because leg prostheses are only for walking. You are not meant to keep them on all the time. This is because dirt and dust can collect inside the socket, which can lead to other health problems if left alone.
Stump care includes:
- Removing the prosthesis during long periods of non-use such as sleeping
- Thoroughly inspecting the stump for discolourations and other issues
- Cleaning the stump with warm water and mild soap
- Completely drying the stump after each cleaning
- Treating the stump with talcum powder
- Applying moisturiser if the skin is dry
- Using antiperspirant if excessively sweating
- Clearing and treating any inflamed skin as soon as possible
- Avoiding the prosthesis if you have unhealed wounds
- Wearing a clean prosthetic sock or liner between your stump and the prosthesis
Through it all, you must avoid getting your artificial limb wet as it usually not waterproof. If it gets wet, you must completely dry it before using it. Just note that you can get a specialized waterproof leg if you need to use yours to shower or to swim.
Pain Management
While not universal, some amputees report feeling pain after their amputation. This pain congregates in either the amputated limb (called phantom pain) or in the stump. A part of your rehab therapy is learning how to relieve and deal with this pain.
Phantom pain is a misnomer. It is real pain, but you feel it in the wrong place. Fortunately, only a few amputees experience it and usually just suffer from phantom sensations. Both conditions are byproducts of any severe pre-amputation pain. Luckily, both phenomena diminish over time, and your surgeon can reduce them by using a spinal anesthetic during your surgery.
Normally, the pain comes from your spine and nerves, but occasionally it can come from your stump. You can massage the pain away, but you can reduce your risks by keeping the stump clean. The pain may also come from an infection or the breakdown of your skin. So, you may want to notify your doctor immediately just in case.
Prosthetic Fitting and Proper Care
Your prosthesis is the key component of your rehab. This marvel of modern medical technology has come a long way from its humble beginnings.
Shaped as the parts you lost; your new limb comes with:
- A suspension system that holds the limb to your body
- Cushioning gel that protects your stump by adjusting the pressure
- Joints and appendages
- A socket for attaching the limb to your body
- Synthetic skin and muscles made from a foamy material
- An adjustable internal skeleton that gives the limb its structure
However, your prosthesis is no good if it does not fit your body, as the wrong fit can lead to disasters later down the line. The wrong prosthesis will also impede your recovery. Therefore, you will not begin the process until your doctor deems you ready for it.
The Prosthetic Fitting Process
Once you are healthy enough, your prosthetist, or prosthesis expert, will begin the long process of measuring you for your artificial limb. The process normally takes about 6 months but will last as long as needed.
In the first step, the prosthetist will create a mold of your stump as either a plaster cast or a 3-D computer-generated image. From this mold, your rehab team will generate a socket that comfortably fits your stump. As the construction process can take months, you will get a temporary limb until your permanent one is ready.
The temp limb has a dual purpose. It gives you some mobility while it allows the prosthetist a means to adjust the process to your needs. This is because it serves as a testbed for the various components that will end up in your permanent limb.
You might have to face several temporary variations until everything gets iron out. The average amputee goes through about 16 sample limbs before getting the final product. There is no one-size-fits-all solution. Therefore, your doctor must ensure everything goes smoothly the first time.
How to Properly Care for Your Prosthesis
Once you receive your prosthesis, your rehab shifts to how to care and use it. Your physical trainer usually gives you the usage training with your prosthetist giving you the care instructions. You should listen to them carefully. A damaged prosthesis does you no good, and your prosthetist is there for you. Feel free to ask for clarification on things you do not understand as you go along.
Your prosthetist will go over the specifics of your prosthesis with you, but here is some commonly given advice.
Take Things Slowly:
You might feel pressured to put on your new limb right away and go out into the world, but that may not be a wise choice. Amputation affects your whole body, meaning you need enough time to rest, heal, and adapt to the new you. You should follow your given wearing schedule to avoid complications.
Use Assistive Devices as Needed
As a part of your rehab, you will learn to use orthotic devices such as canes, crutches, and walkers. You should never forget about them, especially in the early weeks of your rehab. They can remove some of the pressure your body will place on your remaining limbs while helping you keep your balance.
Beware of Changes in your Prothesis
Prosthetic devices can take a lot of strain, but they can and will break under the right conditions. Report anything out of the ordinary such as creaks, clicks, or squeaks coming from your prosthesis to your prosthetist.
Learn to Live Without Your Prosthesis
Your prosthesis exists to assist you in your daily life, but it can never replace the limb you lost. If you can do somethings without your artificial limb, you can make it last longer. You will also increase your stamina for when you do need to wear it.
Do Not Forget Your Stump
The health of your stump is vital to your recovery and rehab. Therefore, you want to inform your doctor and prosthetist of any irritation, redness, or pain. You also want to keep the stump and your prosthesis’ socket clean as possible.
Because stump size can fluctuate, you should wear a shrinker sock whenever you take your prosthesis off to help mold your stump into its final form. You may also want to adjust your prosthesis socket to maintain a comfortable fit.
While you must regularly check your stump for blisters, irritation, and injuries for the rest of your life, things will get more manageable as you progress through rehabilitation.
Conclusions
While losing a limb is a traumatic experience, it is not the end of the world. You can learn to live on after your amputation with the right rehabilitation plan. Such a plan would find the right prosthesis for you as well as the tools and understanding to use it. You also get access to many qualified therapists who can help you restore your independence.
Content Disclaimer
The information contained above is provided for information purposes only. The contents of this Blog article are not intended to amount to advice, and you should not rely on any of the contents of this Blog article. Professional advice should be obtained before taking or refraining from taking any action as a result of the contents of this Blog article. OccupationaltherapyBlog disclaims all liability and responsibility arising from any reliance placed on any of the contents of this Blog article.
