Preparing to Use a Limb Prosthesis
When amputation is elective, certain preoperative measures can help optimize recovery. After surgery, other steps to prepare for use of a limb prosthesis are helpful for all patients.
Before surgery, the surgeon, prosthetist, and physical therapist should discuss plans and goals with the patient. Also before surgery, patients 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 by a physical therapist before and after amputation. The stronger and more flexible patients are, the more they can do with or without their prosthesis. Some exercises depend on the type of amputation. All patients need to do exercises to help reduce edema in the residual limb and prevent contracture of tissues in the residual limb, which stiffens tissues, limits the joint’s range of motion, and thus makes using a prosthesis more difficult.
After surgery, the residual limb must heal before a prosthesis can be worn, and edema in the limb must be reduced before a prosthesis can be fitted for long-term use. To help reduce edema, patients 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 shape the residual limb and prevent irregularities that can make fitting the interface difficult. It increases circulation and makes phantom pain (pain seeming to come from the amputated limb) less likely. For a while after surgery, a shrinker, bandage, or both are worn whenever the prosthesis is off. The use of shrinkers can help control postsurgical edema and reduce phantom sensation (a feeling that the amputated limb is still there). How long it is worn varies from patient to patient.
Until edema resolves, a temporary (preparatory) prosthesis may be used. Because this prosthesis is lightweight and easy-to-use, some experts think it helps patients 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, patients must learn how to use 2 different prostheses. An alternative approach is to use a prosthesis with permanent components (eg, knee, foot, hand) but with a temporary socket and frame. Because some parts remain the same, this approach may enable patients 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 mo of amputation because the residual limb changes in shape and size.
When the prosthesis is delivered, patients 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. Patients with lower-limb amputations also learn advanced gait training skills (eg, using stairs, walking up and down hills, walking on uneven surfaces). Rehabilitation for upper-limb amputations is coordinated by an occupational or physical therapist with the prosthetist. Rehabilitation consists of specific exercises designed to strengthen muscles and maintain flexibility in the residual limb, as well as teaching patients how to use the prosthesis for daily activities.
Counseling or psychotherapy may help when patients have prolonged difficulty adjusting to the loss of their limb and to prosthetic use.