Having an amputation is difficult for people. Losing a limb is not only physically challenging, but people's self-image often changes after they lose a part of "themselves." Doctors try to prepare people and their family by explaining why an amputation is necessary and what will happen before and after the amputation and during the prosthesis fitting process. People who understand the process and have realistic expectations of the difficulties they may face and the most likely outcomes are more likely to persevere and have a better result. Doctors and prosthetists often arrange for the person to talk with someone who already has an amputation and has adjusted well to it.
Before Surgery
Prior to surgery, the surgeon, prosthetist (an expert who designs, fits, builds, and adjusts prostheses), and a physical therapist discuss plans, goals, and realistic outcomes with the person who requires amputation. They work together to complete a
Functional assessment to determine the person's current capabilities and goals
Presurgery plan, including an exercise program to start before surgery
Postsurgery plan
Healing and rehabilitation after an amputation are more successful in people who are as healthy as possible prior to surgery. Prior to the amputation, people should, for example, follow a healthy diet, control their medical conditions (such as diabetes and heart or lung disease) as much as possible, and stop smoking.
Regardless of age and current physical status, people having an amputation should begin a general and specific exercise program before surgery and continue exercising after surgery. Exercises to maintain or increase muscle strength, flexibility, and range of motion are taught by a physical therapist. The stronger and more flexible people are, the more they can do with or without their prosthesis. An occupational therapy program can also be useful when difficulties doing daily activities are anticipated.
After Surgery
After surgery, the clinical team and the person who had the amputation work together to develop goals to
Protect the residual limb from accidental trauma (for example, from bumps and falls)
Control swelling
Promote healing
Maintain strength, cardiovascular endurance, and joint range of motion
After surgery, the residual limb needs to heal. Massage, tapping, vibration, and progressive load-bearing can help the residual limb be less sensitive. There are many dressing options to protect the residual limb and control swelling. Swelling that is effectively controlled helps to increase blood circulation, promotes healing, and reduces severity of postoperative pain and phantom limb pain. Eating a healthy diet also remains important after surgery.
A physical therapist will work with the person before and after hospital discharge. Training may include standing balance, walking in parallel bars, use of a walker, crutches, and/or wheelchair, and self-care skills including transfers and personal hygiene.
The prosthetist will monitor healing progress every week and evaluate the person's readiness for a preparatory (temporary) prosthesis.
Preparatory prosthesis
When the residual limb has healed and fluid volume is fairly stable—usually 6 to 10 weeks after surgery, but longer if there are complications—the person is fitted with a preparatory prosthesis. A preparatory prosthesis is a temporary prosthesis that allows progressive weight-bearing and switching of components, which is necessary as the person becomes accustomed to walking and doing other activities. The socket of the preparatory prosthesis may need to be refit several times during this period.
In addition to improving mobility and independence, advantages of early prosthesis fitting include achieving better acceptance of the amputation, restoring body image, reducing phantom limb pain, and improving overall health.
The residual limb of adults continues to undergo considerable volume and shape change for 12 to 18 months after amputation. At this time, when volume and shape have stabilized to a reasonable degree, a definitive prosthesis is fitted, while the person continues to use the preparatory prosthesis. A definitive prosthesis has higher-quality components and often uses the same joint and appendage components that were considered to be the best during the preparatory phase. However, residual-limb fluid volume will continue to fluctuate daily and long-term. How much the fluid volume changes varies among individuals and can sometimes be problematic.
Learning to use a limb prosthesis
During the fitting process, the person learns how to function with a prosthesis. The process involves several appointments to achieve acceptable levels of comfort and stability.
For people with an upper limb prosthesis, once comfort and stability are achieved, the prosthetist adjusts the joints and appendages to maximize function. Rehabilitation with an occupational or physical therapist includes specific exercises designed to strengthen muscles and maintain their flexibility in the residual limb, as well as teaching the person how to use the prosthesis for daily activities.
For people with a lower limb prosthesis, once residual-limb comfort and stability are achieved, a prosthetic hip, knee, ankle, and/or foot is introduced to achieve balance and posture. The person initially begins walking within parallel bars. As the person learns to walk with a prosthesis, the prosthetist adjusts or changes the joints and appendages to maximize function.
Counseling or psychotherapy may help people who have are having difficulty adjusting to the loss of their limb and to prosthetic use.
(See also Overview of Limb Prosthetics.)
