What to Expect Following an Amputation
A lower or upper extremity amputation can challenge an individual’s lifestyle, but a strong amputation rehabilitation program will provide the education and skills needed to regain independence.
Each individual’s experience is unique but generally amputation rehabilitation can be seen in four phases: pre-operative, post-operative, pre-prosthetic and post-prosthetic. Rehabilitation can include multiple levels of care: long-term acute care, inpatient rehabilitation, outpatient rehabilitation, in-home therapy and ongoing wellness programs.
If amputation does not occur due to a trauma, you may begin therapy before amputation to prepare your body and mind for the challenges ahead. Pre-operative therapy may include:
- Aerobic/endurance conditioning
- Strengthening the sound limb
- Stretching the muscles closest to the amputation site
- Preparing for mobility and activities of daily living for the time between surgery and prosthesis
Immediately following amputation, patient care includes the surgical team and a variety of therapists including physical, occupational and recreational therapists. The post-operative emphasis is balance recovery and beginning to shape the residual limb, encouraging mobility and activities of daily living as soon as possible. You can expect your inpatient rehabilitation care team to:
- Closely monitor the newly amputated limb for signs of infection and other complications
- Work with you to prevent painful and deforming swelling, contractures and manage any pain including phantom limb pain
- Provide education on observation for complications, residual limb hygiene and care
- Begin early assisted mobility therapy for standing, sitting, lying, turning in bed, walking, transfers and fall prevention
- Continue aerobic/endurance conditioning
- Encourage stretching and strengthening
- Prepare the patient for eventual use of a prosthetic
While the patient, physiatrist and rehabilitation team work closely together to select and fit the patient’s prosthesis, therapy progresses in complexity and intensity as individually tolerated. The pre-prosthetic phase focuses on strengthening, flexibility and shaping of the residual limb for prosthesis fitting.
This phase, and the following one, can occur in sub-acute facilities, skilled-nursing, home health or outpatient rehabilitation programs.
Post-prosthetic therapy becomes more individualized, and emphasis is placed on patient goals. Work hardening and occupational therapy could become more important during this time as you seek to return to activities you enjoy or return to work. Three areas of focus can be seen during this time:
- Patient education including instruction in the wear and care of the prosthesis and assessment of proper fit.
- Intensive rehabilitation to learn how to use the prosthetic for transfers, walking and other daily activities.
- Self-care, such as standing tolerance and balance, home management, work and leisure activities, energy conservation and activity adaptations.
- Many basic prosthetic skills must be learned including donning/doffing the device, volume management techniques, getting dressed, maintaining the prosthesis and residual limb hygiene.
Choosing the right care team to guide you through the phases of inpatient and outpatient rehabilitation will help you maximize your functional independence and regain a productive, rewarding lifestyle.