Rehabilitation, by its very definition, means a return from difficulty. Few experiences are more difficult than that of limb loss. For these patients, movement is the way back.
It is estimated nearly 2 million Americans are living with limb loss, the majority of which are lower-limb, below knee amputations, which is on the rise. A study published in the Archives of Physical Medicine & Rehabilitation has projected America’s amputee population will nearly double to 3.6 million by 2050.
The most common reasons for amputation are:
- Vascular disease – including diabetes-related and peripheral arterial disease (54%)
- Trauma (45%)
- Cancer (less than 2%)
Taking on Pain from the Start
A person living with the loss of a limb has a long, difficult road ahead, facing physical and emotional challenges along the way. From the start of the journey, pain management has an important role in an individual’s progress.
“Most patients who undergo lower extremity amputation have relatively short term post surgical pain. However, inhibiting phantom pain (a pain sensation in the area of the former limb) is an important component to any amputee’s rehabilitation program,” explains Daniel Rosenberg, MD, board certified in physical medicine and rehabilitation.
Treatment options for phantom pain may include:
- Biofeedback and relaxation techniques to help the patient learn to mentally tolerate their pain
- Heat therapy
- Electrical stimulation (TENS unit)
- Desensitization massage
- Wrapping the amputated
- Medications – the smallest amount necessary to alleviate phantom pain sensation while limiting potential side effects
Beyond the pain factor, re-educating the body about how to move without the limb is a daunting challenge. These early days of movement are crucial to set the pace for how an individual will live with their limb loss in the long term – and the care team is an integral part of that process.
“Commonly after amputation, patients are bed-ridden, use a wheelchair or ambulate with crutches,” explains Dr. Rosenberg. “Their general strength and aerobic exercise fitness levels are diminished. A well-structured PT program will increase strength and aerobic exercise capacity, both essential to ambulate with a prosthesis(es).”
Building Strength to Get Up and Go
Pam* lost both of her legs above the knee after she was struck by a motor vehicle while walking home. Although she has been using prosthetics for years, she continues her rehabilitation journey with help from key members of her care team – her physician, prosthetist and physical therapist.
Together, they help Pam to manage her pain, make adjustments to prosthetics, and perform needed exercises to increase strength and balance—and get her moving.
“These patients need an active physical therapy program to learn how to ambulate again—first without a prosthesis, and later with a prosthesis,” explains Dr. Rosenberg.
“Someone just beginning on prosthetics has much to learn about where their center of gravity is for balance, how to properly control the new limbs and how to adjust their body to be as energy efficient as possible,” explains Maureen Stevens, DPT.
As a physical therapist working with the amputee population, Dr. Stevens is part of a multidisciplinary mix of care providers helping patients reach their goals. She works with the patient’s physicians, including orthopedic surgeons and physical medicine specialists, as well as prosthetists, to ensure the approach to care meets the needs of her patients and their prostheses.
For certified orthotist/prosthetist Wayne Lawall of Harry J. Lawall & Son in Lawrenceville, it’s important to take an active role in the rehabilitation of his clients, even attending their rehab appointments regularly to observe their progress.
“It gives me an opportunity to discuss with PTs what to focus on related to the prosthetic. I also can see what kind of issues the patient might be dealing with, like discomfort. It allows us to help the patient to meet the fullest potential they can reach,” he explains.
It’s about always staying focused on how badly you want to meet your goals. When you hit those hiccups and speed bumps, you work with your doctor, the prosthetist, the PT, and you get on track
Set Goal, Achieve, Repeat
This coordinated approach to care is ideal when it comes to the ever-changing patient needs. Much like someone who has a change in prescription for eyeglasses, a person living with a prosthesis needs to have the equipment checked and updated regularly to keep up with their body.
“Individuals with prosthetics are constantly making adjustments to find what works best for them at a given time. Their bodies, like anyone’s, can change day to day. Every time an adjustment is made to their prosthesis, it’s basically like giving them a whole new limb to work and train with,” says Dr. Stevens.
The individual’s overall condition will influence how frequently an adjustment is made. For example, there is a big difference between the needs of the average elderly amputee who may have the same prosthesis for years, versus those of a teenager.
“Your younger amputees may need new prosthesis every two years. They may have a gain or loss of weight, or their activity level may change,” explains Lawall
Another reason a person may need to make adjustments is advances in prosthetic technology. Lighter, smarter, more comfortable designs are introduced on a regular basis and those living with prostheses are in the know.
“As more advanced technology comes around, the fitting is more intimate, personalized. Patients are up on the technology. Just looking at the prosthetic industry you will see all kinds of great stuff,” Lawall says.
New prosthetics, however, means re-learning how to get around. That is where the care team comes back into the mix throughout a lifetime with prosthetics.
“It’s about always staying focused on how badly you want to meet your goals. When you hit those hiccups and speed bumps, you work with your doctor, the prosthetist, the PT, and you get on track,” Pam says.
“I’m okay with the extra work,” she adds. “I’m not afraid to do the work if it feels better and works better for me.”
*Name has been changed at patient’s request.
