IDS ::: Prosthetics ::: Procedures -
Rehabilitation

Prosthetic Rehabilitation

Prosthetic rehabilitation can begin even before amputation has been performed. Depending upon the circumstances, a patient may need to give consent for amputation. This should be informed consent which by definition depends upon the patient being in possession of relevant information.

It may therefore be appropriate for the potential amputee to discuss the topic with a person or persons who is qualified to advise on this. IDS clinical staff frequently fulfil this role – they can give sensible advice about the likely situation post amputation, especially with regard to time scales, rehabilitation procedures and activities of daily living. The role may also be fulfilled by specialist nurses, physiotherapists or occupational therapists. It is important that such advice is given by such appropriate persons as other well meaning but inappropriate persons may give advice which is inaccurate, rendering the informed consent process meaningless.

In the absence of pre amputation discussions, similar information and advice can still be made available to a primary (new) amputee by appropriate persons. It is particularly useful if the person is the prosthetist who will be attending to the amputee. Amputation can obviously have a severe emotional effect and it is important that as many fears and concerns can be laid to rest as possible.

Post amputation rehabilitation normally involves physiotherapy and/or occupational therapy. Physiotherapy includes such elements as maintaining/improving joint ROM and muscle power. Physiotherapists normally will also carry out walking training for lower limb amputees while occupational therapists are generally focused more on activity of daily living and training of upper limb amputees in the use of their prostheses.

In the past residual limbs (stumps) were routinely bandaged to prevent or reduce oedema. Very often specially designed elasticised devices known as stump shrinkers are used instead.

Initial walking training often begins, not with a definitive prosthesis but with a Pneumatic Post Amputation Mobility Aid (PPAM Aid). This may start even before the sutures are removed, depending on other factors. The input of the physiotherapists and occupational therapists is absolutely crucial to successful amputee rehabilitation.

Approximate prosthetic rehabilitation time scales, please note this is only one model and may be inappropriate in some situations.

Amputation until drains removed – 5 to 10 days.
When drains removed apply stump shrinker.
After 2 to 7 days, cast for the prosthesis.
Once the drains have been removed a PPAM aid may be used while waiting for the prosthesis.
First prosthetic fitting at around 5 to 14 working days from casting.
Final fitting and discharge may be within a 14 days but can be much longer!