28 Aug Life After Limb Loss – The First Year of Rehabilitation
THE JOURNEY THROUGH REHABILITATION
Grant Monaghan & Associates GUIDES You through YOUR FIRST YEAR POST-AMPUTATION: Challenges, AND A GENERAL TIMELINE FOR CONQUERING THEM
No matter the reason behind an amputation, losing a limb is challenging both physically and emotionally. The first year can be particularly difficult as the amputee adjusts to drastically new circumstances, all while facing the challenges of physiotherapy and other forms of rehabilitation.
REHABILITATION: WHAT TO EXPECT
The meaning of “rehabilitation” itself refers to the ‘restoration’ of the body, mind and spirit. While fitting an artificial limb is an important milestone, is only a small part in the bigger picture of rehabilitation. A holistic approach to healing is taken with a team members including the Surgeon, Prosthetist, Physiotherapist, Occupational therapist, Psychologist and Dietitian.
Rehabilitation may include any of the following:
- Treatments to help improve wound healing and stump care
- Activities to improve motor skills and help the patient reach maximum independence in their daily activities
- Exercises which help the patient in building muscle strength, endurance, and control
- Measuring and fitting of the artificial limb, and assistance with the use of the prostheses
- Pain management for both post-operative and phantom pain
- Support and coping strategies to assist with the grieving process and with readjustment to a new body image
- The use of assistive devices to restore function and independence in daily life
- Vocational counseling to help the amputee to re-integrate into the workplace
- Educating the patient and their family, as well as adapting their home environment for safety and accessibility.
THE FIRST YEAR AFTER LOSING A LIMB: A GENERAL TIMELINE
Every amputee’s situation is unique. While there is no set timeline to rehabilitation, the following guidelines may be helpful in understanding the first year of rehabilitation following the loss of a limb.
The prosthetist is involved in the following phases, along with other therapists:
1. Three to four weeks post-surgery:
The prosthetist will meet with patient to start with compression therapy and thorough evaluation of the patient’s circumstances.
2. Month 1 – 3 – The first prosthesis:
Once the wound has healed enough, a diagnostic “test socket” will be created for the patient. It is a complete prosthesis that the amputee can mobilize on initially with walking aids. At this point, the physiotherapist can begin assisting the patient with mobilization, gait training and strengthening.
Many adjustments are done during this period to the test if the prosthesis fits comfortably and functions as intended. The time needed to create the prosthesis depends on how complicated the shape of the residual limb is, as well as health complications the amputee has such as scar tissue. The final prosthesis is normally fitted 2-3 weeks after the test fitting.
3. Month 3-6 – Adapting and adjusting to the prosthesis:
The patient’s stump will continue to go through physical changes as the patient uses their prosthesis more and more – usually resulting in volume loss or atrophy of the stump. Because the prosthesis does not shrink with the stump, it may become too large and cause painful pressure ulcers and instability in the patient. This is the time a new, downsized prosthesis socket is made, and same process is followed as with the first prosthesis fitting: 1-3 weeks on a test socket, followed by a final socket.
4. Month 6-9: Reintegration:
By now, the patient’s stump may have stopped shrinking, and is ready to be fitted with a long-term prosthesis. Once again, this process starts with a test prosthesis. The prosthetist will re-assess the design of the of the prosthesis and match it with the patient’s current or potential level of activity. At this point, the patient will likely be able to move around without the help of assistive devices.
5. Month 9-12 – Living with limb loss:
By the 9th to 12th month, the patient will have mastered how to use their prosthesis – This includes putting on and taking off the device and managing small daily volume changes and skin irritations. The patient will likely be able to do many of their daily life activities and will have established a good relationship with the prosthetist who has accompanied them through the rehabilitation journey.
6. After year 1: Maintenance –
It is vital for the patient and their prosthetist to establish an annual maintenance schedule for the patient’s prosthetic limb. This ensures that the prosthesis remains comfortable and reliable on a daily basis, and that the patient can enjoy better mobility, a better quality of life and financial savings in the long run.