Limb Loss/ Amputee Rehabilitation

Rehabilitation means the restoration to the maximum degree possible of a person suffering from disease or injury.

Older couple enjoying a walk during a brisk fall afternoon.Rehabilitation Depends on Many Factors           

For those who have lost a limb, rehabilitation depends on the combined efforts of many people.  Ideally, you will be part of a team that includes your key family members and/or friends, a physician, a prosthetist and their support staff, a physical therapist, an occupational therapist, and a psychologist.  While it is true that most of the effort is up to you, the expertise and guidance of each person on your support team is critical. It is likely that your payer will have limitations on the number of physical/occupational therapy sessions allowed.  When you know this in advance, you can consult with your therapist about the most efficient sequence of scheduling. Paying out-of-pocket for extended therapy is also an option worth considering.

Early Stage of Recovery       

We believe that new amputees should be seen by a physical therapist in the first 24 hours following surgery. During this early stage of recovery, the physical therapist will help you with basic but important needs like getting positioned in the bed; transferring from bed to chair and back; balancing when standing; and using crutches, a wheelchair, or an upper extremity assistive device.  Pain control is another important area the physical therapist can help with. The physical therapist and the prosthetist will work together to teach you how to care for the residual limb to promote healing, and how to wrap it to reduce swelling. Swelling is less of a problem for upper extremity patients, although it still must be managed. While you are in the hospital and after your release, physical therapy will consist of dynamic exercises that condition and strengthen the residual limb. Your physical therapist will teach you specific exercises that flex and tone the muscles in the hip, back, abdomen and knee, or the upper back, shoulder, upper arm and elbow.

Heath Calhoun walks with his son on his shoulders. In addition to this practical guidance, working with a physical/occupational therapist immediately after amputation gives you a tremendous psychological advantage. It can be very empowering to immediately begin focusing on what you can do and setting goals rather than spending days or weeks being immobilized and focusing on your loss. Unfortunately, people are often so overwhelmed that they don’t understand the importance of immediate therapy, and the opportunity slips by them.        

If you’re an experienced prosthetic user, you can still benefit from physical and/or occupational therapy.  It’s easy to think you’re walking or using your arm as well as possible when in fact a therapist could give you valuable guidance. Remember that each time you go to get a new prosthesis you should be entitled to receive some physical/occupational therapy to help you make the most of new technology and componentry. Retraining definitely takes effort but most people find it’s worth it.

It’s very important to care for and monitor your residual limb throughout the rehabilitation process. Ignoring even minor scratches or abrasions can lead to pain, infection and serious delays.  Your therapist and prosthetist will help you learn the rules of hygiene as they apply to your prosthesis and residual limb. This includes daily cleaning of the socket, assistance with determining the best ply of prosthetic sock, and managing perspiration in the residual area.   

New Lower Extremity Users   

When lower extremity users begin to wear a temporary or preparatory prosthesis, the focus shifts from mostly sitting or lying exercises to standing exercises that are aimed at re-orienting the center of gravity. Weight shifting exercises between parallel bars help you learn to displace your center of gravity forward, backward and sideways. These exercises carefully move you towards bearing weight on the prosthesis and will prepare you for the weight shifting that accompanies walking. Instruction in putting on and taking off your prosthesis will also be part of physical/occupational therapy.

Actual gait training consists of many specific exercises and careful analysis by the physical therapist and prosthetist.  Your physical therapist will do a lot of hands-on positioning and resistive techniques as you begin walking. For the best results, we recommend that the therapist and prosthetist continue to work together throughout gait training. Minor adjustments in the prosthesis can sometimes enable you to make real improvements in your gait. The physical or occupational therapist will also work with you on strengthening exercises and on specific daily living activities like dressing, using the bathroom, standing up and sitting down, carrying objects, getting in and out of a car, driving, and ambulating in the community.

New Upper Extremity Users

Early physical/occupational therapy for the upper extremity focuses on maintaining or increasing the mobility of the joints.  In some cases, strengthening exercises will also be important. Pain control is a major issue in many upper extremity cases and the physical therapist has various methods of assisting with this including ultrasound, massage, electrical neural stimulation, acupressure, acupuncture, and resistive exercise.  

Another focus of early upper extremity therapy is learning to use the sound hand for daily activities like eating, grooming, using the bathroom, picking up objects, and writing.  The therapist can also offer guidance in using the teeth to help with some tasks.  

When upper extremity users begin to wear a temporary prosthesis, the therapists and the prosthetist are involved in the training process.  The first goal is to help you learn how to put on and take off the prosthesis. It is key to your success as an upper extremity user to be able to don and doff the prosthesis independently, accurately and quickly. From here, therapy will focus on learning to control the terminal device, wrist unit or elbow unit. How training proceeds depends largely on whether the prosthesis is body-powered or externally powered.

It’s very important to care for and monitor your residual limb throughout the rehabilitation process. Ignoring even minor scratches or abrasions can lead to pain, infection and serious delays.  Your therapist and prosthetist will help you learn the rules of hygiene as they apply to your prosthesis and residual limb. This includes daily cleaning of the socket, assistance with determining the best ply of prosthetic sock, and managing perspiration in the residual area.

Physical Therapy for the Long Run

 As stated earlier, physical therapy is not just for new amputees and new prosthetic users. For optimum mobility, you need to be evaluated by a physical therapist every year or two throughout your life.  They can pinpoint problems that if left untreated, will result in back problems or pain in other areas of the body.  Many people have a little bit of therapy and then decide they could do fine on their own.  A typical situation would be a lower extremity user going to physical therapy with the strong desire of learning to walk.  When the therapist works on their upper body and other muscles, the person feels like there’s not enough emphasis on walking.  They stop going to therapy because it doesn’t seem helpful to them.  

Kevin Carroll, CP, Hanger Clinic’s Vice President of Prosthetics puts it this way: “People who continue to go back for therapy do a lot better with their prosthesis and are the best walkers.  Those who don’t follow through tend to lose out over the years and start declining.”


Interested in learning more? Call 1-877-4HANGER or visit this page to request more information.

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