Prosthetic rehabilitation after amputation

An article carried recently in The Times referred to the early stages of rehabilitation for persons with amputation. In this article it was mentioned that the doctor tells the amputee that “he is a good candidate for a prosthesis and that he will be able to walk again”.

Published research and lived experience show that the assessment for suitability that must precede prosthetic rehabilitation is very much an inter professional effort. An effort that involves various members of the multidisciplinary team and centres around the active participation of the person who has sustained the surgery. Each amputee will have his/her unique needs, wants, aspirations, degree of motivation, fears and anxieties. Acknowledging and addressing these emotions and thoughts is crucially important for prosthetic rehabilitation to be successful.

The input of the various health-care professionals is needed to assess how much of what the amputee has expressed can be actually achieved. So, the physical part of the physiotherapist’s assessment might include assessment of range of movement, muscle power, balance and posture, as well as ability to stand and walk with a temporary, early mobility aid. Any past or present medical or surgical conditions which may have an effect on prosthetic rehabilitation are also considered.

The occupational therapist may choose to assess, among other things, the ability of the person to dress and undress the lower body as well as his/her dexterity. This will affect the amputee’s potential to put on and take off his/her prosthesis independently. The amputee’s ability to understand and remember instructions, the degree of independence achieved in transfers as well the presence of adequate eyesight are also noted by the therapists.

The prosthetist gives advice regarding what type of prosthesis and which suspension and componentry will give the best chance of successful restoration of function.

Prosthetic users require a higher energy consumption to walk so their cardiorespiratory fitness needs to be considered and the implications of any limitations in this area also need to be taken into account. The surgeon’s main concern would be the formation of a well-healed, appropriately fashioned residual limb that can take the stress of prosthetic gait and function. The future prosthetic potential of the amputee is also influenced by the level of amputation.

The social aspect of the pre-prosthetic assessment takes into account such circumstances as type of housing, means of transportation, occupation, lifestyle and recreational activities of the amputee. The presence of family members, close friends or any supportive neighbours is also important. Their beliefs, expectations, reactions to the changes going on as well as what they say to the amputee may also impact prosthetic rehabilitation and as such need to be explored. A social worker may need to contribute in this area if there is the need. Once the professionals agree that prosthetic rehabilitation is worth pursuing than the amputee and his/her significant others need to be informed as comprehensively as possible about the actual process of rehabilitation. They need to understand that this process requires a great deal of commitment, patience and perseverance on their part. They will also be assured that the health-care professionals will be supporting and guiding them all the way.

Amputees for Amputees, the local association for amputees, also has a part to play and two of its committee members may be called upon to visit the amputee pre-operatively or early post-operatively to offer support and encouragement.

As can be seen the assessment that needs to be done before prosthetic rehabilitation is not a quick or easy task. However, it is worth noting that if care and commitment to detail are shown in the beginning then the chances of a smoother rehabilitation process and a successful outcome are increased. This way of doing things may result in the surgeon or the rehabilitation consultant actually telling the amputee that he/she is a candidate for prosthetic rehabilitation but they will only do this after all the information has been collected and collated by the inter professional team members.

The supply of the prosthesis takes an average of six weeks because the present prosthetic service is dependent on a foreign company. However, a lot of effort is being made by the authorities concerned to rectify this situation.