Recovering from an amputation and adjusting to life after limb loss isn’t something anyone should face alone. Behind every successful journey is a team of dedicated health professionals who play vital roles in an amputee’s recovery, rehabilitation, and long-term wellbeing. From surgeons and physiotherapists to prosthetists and mental health specialists, each expert brings unique skills and support at different stages of the journey. In this article, we’ll explore the key professionals who work alongside amputees — and how they make a lasting difference, every step of the way.
This is a general overview and not a complete list of everyone who could be of assistance, so please ask at the Limb Centre to find out who is available to help.
The Specialist Nurse
The specialist nurse works closely with consultant surgeons, the ward staff and the
multi-disciplinary healthcare team involved in the care of amputees. They also liaise with the limb fitting clinic, GPs and the community teams. This central role allows them to provide information and support for amputees and their families throughout their treatment and rehabilitation, to help to coordinate and streamline the amputee’s care.
This is also a time of confusion and concern for families. The nurse is available to offer support and provide information to them as well. Patients are usually confronted with a bewildering array of Consultants, nurses and other medical staff. It isn’t always obvious who does what. The specialist nurse can explain which professionals will be present and what each of their roles is. Every healthcare professional, while being an expert in their own field, is also genuinely interested in the patient as a person, as well as in their welfare and progress. Hospital staff do not mind patients asking questions – in fact, they should encourage this to ensure Patients feel confident in the way forward and have the opportunity to ask any questions or express concerns or ideas.
The Consultant
The rehabilitation service is free to all NHS patients. The Consultant in clinical charge will be a consultant in rehabilitation medicine and a specialist in upper and lower limb prosthetics. A multi-disciplinary team, led by the consultant, provides a coordinated rehabilitation programme to meet the needs of the limbless person, and people with severe permanent mobility problems.
The patient, and his/her family and carers, are considered members of the team, and their views are taken into consideration. They are encouraged to participate in the treatment programme within the Centre and at home.
The Consultant may have visited the patient on the ward prior to the amputation.
Upon arrival at the Centre, the Consultant will carry out a full physical examination, payingparticular attention to the residual limb, or stump. They will discuss the various factors on which successful rehabilitation depends on the patient and members of their family. These will include, for example, the patient’s general condition, motivation, eyesight, amputation level, and the condition of the residual limb.
Some amputees are not able to use prostheses, but most are, and the patient will be advised of the choices available and procedures involved in the supply and after care of the prosthesis.
The type of prosthesis provided, and its various components, will depend on the patient’s needs, and are unique to each individual. The multi-disciplinary team will work with the patient to provide the most appropriate prosthesis in terms of function and aesthetics, and the patient will be given details of the full programme of rehabilitation that must be undertaken to achieve self-sufficiency and a good gait.
The Physiotherapist
The role of the physiotherapist in the rehabilitation of a patient following amputation is to help enable the individual to achieve their maximum independence and functional ability. This depends on several factors, including the patient’s pre-amputation lifestyle, expectations and medical limitations. The physiotherapist works closely with other members of the rehabilitation team to achieve the individual goals of the amputee.
If the patient’s condition allows, the physiotherapist will see the patient before the amputation to explain their role and the proposed rehabilitation programme, and to answer any questions and queries the patient or his/her family may have. Often, it is not possible to see the patient before the operation, but physiotherapy begins very soon afterwards.
Treatment consists of advice and a carefully graded exercise programme to improve the patient’s strength and general fitness. The patient will also be assessed for their potential to use a prosthesis and will be given specific exercises to prepare for prosthetic use.
In physiotherapy (as an in-patient or an out-patient) using an Early Walking Aid (e.g. a PAM aid) to retrain walking until the individual is ready to use a prosthesis. This is when the post-operative swelling has reduced, the wound has healed and the patient has shown they will benefit from, and are able to manage, a prosthesis.
By this time, the physiotherapist will know the patient well and so will be able to advise the rehabilitation team and the patient, thereby contributing to the decision about prosthetic use and what type would suit the individual best.
Rehabilitation then continues with the physiotherapist teaching the amputee how to walk with the prosthesis and how to get the most out of it. Many Limb Centres offer a maintenance programme to make sure the user remains fit and able to use the prosthesis effectively. It is important to remember that an amputee’s rate of progress, and their final functional outcome, will be determined by The Occupation Therapist (OT).
Occupational therapists (OTs) work closely with physiotherapists and specialise in helping patients tackle many aspects of independent living, some of which might initially be difficult or embarrassing, and which they may want to do on their own in the future.
The OT will initially work with a patient on the ward (they usually wear dark green trousers and a white tunic) and then in the Occupational Therapy Department within the hospital or Limb Centre, where patients can practice everyday activities with a view to being discharged. The aim is to encourage personal independence, with and without prosthetics, and activities might include:
– Dressing practice: If a patient has trouble balancing, it might be difficult for them to get dressed. The OT will show them how to get dressed safely and advise on suitable clothing
– Personal care: This includes regaining independence when washing, getting in and out of the bath, and on and off the toilet
– Kitchen practice: If necessary, the OT will help to develop or regain independence,
and make sure a patient can cope in the kitchen, starting with making a hot drink and progressing to preparing a meal
– Upper limb strength: The OT may carry out specific activities to strengthen the arms/upper limbs, to make manoeuvring a wheelchair and wheelchair transfers easier
– Wheelchair use (lower limb amputees):If appropriate, the OT will order a suitable wheelchair and cushion. This is normally ordered as early as possible to allow a degree of personal independence in mobility soon after the operation
– Home visit assessment: To help with any practical problems a patient may have
when returning home, a home visit may be arranged in advance of discharge. The OT will note logistical and structural issues, and will work out practical solutions with the patient such as installing ramps and rails, or widening doors for wheelchair access.
An assessment will be made for the provision of equipment (e.g. for bathroom or kitchen use) which could be introduced into the home to make life easier
– Upper limb use: Occupational therapists also work with arm amputees. In hospital, they help patients regain their independence and solve practical problems, and provide them with exercises to increase the dexterity of the remaining hand, especially if the dominant hand has been lost. The patient may be advised on aids to help them. Before discharge, a home visit may be carried out to ensure the patient will be able to manage safely and independently
– General rehabilitation: The OT from the hospital, Limb Centre or community may continue the patient’s rehab as an out-patient after their discharge from hospital to help them plan for the future. This could take the form of further help to develop independence, giving advice on driving, resuming and developing hobbies/interests, and helping to ‘live with’ (increasing tolerance to and use of) the prosthesis. At the Limb Centre, it is usually the OT who will teach the patient how to use the prosthesis. Occupational therapists also work in Social Services and specialise in the home environment. They will oversee any required housing adaptations. If circumstances change at home it may be these OTs who help to find solutions
The Prosthetist
A vital member of the rehabilitation team whose views and expectations are very important. They will discuss (along with other members of the rehabilitation team) a patient’s past activities and future goals to give a realistic expectation of what the patient will be able to achieve with a prosthesis. In the case of young children, the parent/s or carer/s are active members of the rehabilitation team.
Following initial examination of the residual limb (or stump) and discussions with members of the rehabilitation team, the prosthetist will formulate a prescription for the fabrication of a prosthesis. They will then take relevant measurements and a plaster cast of the residual limb so the ‘socket’ can be fabricated.
The socket is the part of the prosthesis that fits onto the residual limb and, as such, needs to be an accurate fit. It is prudent to note that no matter how good a socket fits, it can in no way be called comfortable. The prosthetist will endeavour to make it tolerable. (Think of a bicycle saddle which, when used for the first few times, can be challenging to use for anything other than a short period but, with increased use, can become bearable).
After a patient has been cast and measured for a prosthesis, they will be given an appointment for a fitting approximately one week later. At the fitting stage, the prosthesis is constructed without a cosmetic covering. This enables the prosthetist to adjust the settings of the prosthesis to suit individual needs. It is at this stage that the patient will take their first steps. During this time, the prosthesis will need to be dynamically aligned and adjusted to the correct height, while the socket will be assessed for accuracy of fit.
Once the prosthetist is satisfied with all these parameters, the prosthesis may be finished there and then with soft foam or a temporary cosmesis (an aesthetic covering that makes the prosthesis look more natural), or the patient may be given a delivery appointment for approximately one week later. Once the prosthesis has been ‘delivered’, physiotherapy will be arranged for gait (walking) training. During the first few weeks and months, the residual limb will be swollen. This will reduce over time, causing the socket to loosen, requiring adjustment. The patient may be taught how to make up for volume loss by adding additional stump socks. During the first 12 to 18 months, the residual limb will change in shape and volume, which will require regular adjustments by the prosthetist. If the change in volume/size is too great for adjustment, the patient may need to be recast for another prosthetic socket.
Recent Comments