Preparing to Use a Prosthesis
Before surgery, a surgeon, a prosthetist (an expert who designs, fits, builds, and adjusts prostheses), and a physical therapist discuss plans and goals with the person who requires amputation. Also before surgery, everyone who requires an amputation should, if possible, discuss what happens after surgery with a peer counselor who has had an amputation.
Exercises to increase muscle strength and flexibility are taught before and after amputation. The stronger and more flexible people are, the more they can do with or without their prosthesis. Some exercises depend on the type of amputation. All people need to do exercises to help reduce swelling in the residual limb and prevent tissues in the residual limb from shortening. This shortening (called a contracture) stiffens the tissues and thus limits the joint’s range of motion. As a result, using a prosthesis is more difficult.
After surgery, the residual limb must heal before a prosthesis can be worn, and swelling in the limb must be reduced before a prosthesis can be fitted for long-term use. To help reduce swelling, people are taught to apply an elastic sock (called a shrinker) or an elastic bandage over the residual limb. Wearing a shrinker or bandage also helps by shaping the residual limb and preventing irregularities that can make fitting the interface difficult. It increases circulation and makes pain in the amputated limb (phantom pain) less likely. For a while after surgery, a shrinker, bandage, or both are worn whenever the prosthesis is off. The use of a shrinker can help control swelling and reduce phantom pain. How long it is worn varies from person to person.
Until swelling in the residual limb resolves, a temporary (preparatory) prosthesis may be used. Because this prosthesis is lightweight and easy-to-use, some experts think it helps people learn to use a prosthesis more quickly. Later, this prosthesis is replaced with a permanent prosthesis, which has higher-quality components. However, with this approach, people must learn how to use two different prostheses.
An alternative approach is to use a prosthesis with permanent components (such as a knee, foot, or hand) but with a temporary socket and frame. Because some parts remain the same, this approach may enable people to adjust to the new parts more quickly. In either case, the first socket and frame almost always need to be replaced within 4 to 6 months of amputation because the residual limb changes in shape and size.
When the prosthesis is delivered, people are taught the basics of using it:
Training is usually continued, preferably by a team of specialists. A physical therapist provides a program of gait training as well as exercises to improve strength, flexibility, and cardiovascular fitness. An occupational therapist teaches the skills needed to do daily activities. People with lower-limb amputations learn to walk better (for example, to use stairs, walk up and down hills, and walk on uneven surfaces).
Rehabilitation for upper-limb amputations is coordinated by an occupational or physical therapist with the prosthetist. The rehabilitation consists of 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.
Counseling or psychotherapy may help when people have prolonged difficulty adjusting to the loss of their limb and to prosthetic use.