Clinically Speaking

Life After Amputation

In the U.S., an estimated 1.6 million people are living with an amputation, with about 113,000 lower-limb amputations performed each year, according to the Agency for Healthcare Research and Quality (AHRQ). Approximately 82 percent of amputations are due to vascular disease, 22 percent to trauma, 4 percent to tumors and 4 percent are congenital.

Because of the tremendous effect an amputation can have, it is important to consider several clinical tactics that will help the wound heal properly and efficiently, and ultimately allow you to readjust to daily life seamlessly.

Adjusting to a New Body

An amputation can severely aff ect a patient’s balance because their center of gravity will shift towards the remaining leg. Th is experience is brand new not only to your body, but to your mind as well.

The mind will actually need to re-educate itself in order to adjust to a new center of gravity. Th is functional mobility transition will require you to strengthen and re-educate your upper extremities, core muscles and remaining leg to ultimately rebalance your body, which is why physical therapy is imperative. Your physical and occupational therapists will work with you closely to increase core and leg strength to off set the limb loss.

Range of motion may also be significantly affected by amputation. Following an amputation, the immediate reaction is to keep the remaining limb in a position of comfort. Unfortunately, what’s comfortable isn’t always the best option to help your body heal.

In order to maintain range of motion in the leg, for example, it is important to straighten the knee out and stretch it, even if it is painful. Doing so will maximize the capability of your remaining limb and will ultimately allow a more “normal” movement pattern when attempting gait training and prosthetic fittings.

Supporting Wound Healing

The rehabilitation team will provide specific exercises and guidelines for properly positioning your limb for optimal wound healing. Failure to straighten your limb (knee, hip, elbow, etc.) can result in a contracture, which is the shortening of muscular or connective tissue. You want to preserve as much range of motion as possible in the remaining limb.

To ensure proper wound and bone healing, it is extremely important to refrain from smoking. One of the worst things you can do before and after an amputation is to continue to smoke cigarettes. Those who smoke drastically delay proper wound and bone healing. As a result, the wound and the remaining bone do not receive enough oxygen to adequately heal. There are several resources to help you quit smoking, including the American Lung Association. Your healthcare team can also provide additional information regarding smoking cessation.

Wound protection is central to adjustment following an amputation. It is very easy to hit your recovering limb on an object such as a wheelchair or a commode. Protect your recovering limb and wound by paying close attention to your surroundings. A misstep may mean prolonged recovery or worse, another surgery.

Easing Back into Your Daily Life

Amputations have an acute impact on activities of daily living and mobility. Your occupational and physical therapists can teach you safe mobility techniques to help you complete your activities of daily living (gait training, transfers to/from shower or commode, in/out of bed, wheelchair management). They can also teach you exercises that strengthen the muscles needed to potentially return to your previous level of function. You may also learn how to use a walker or how to properly prepare for using a prosthetic limb. Educate yourself about what to do to help your healing.

Recovering from an amputation may be a long and frustrating process, so surround yourself with friends and family to keep your spirits up. Your healthcare team and family/friends support system are two-in-one in the fight for independence and mobility. It is OK to lean on them. Eventually, you will feel more confident in your ability to maintain balance, range of motion and strength. This will allow you to move about safely and confidently.

Although your daily activities have changed a bit, set goals for yourself. It is important to set these goals because they can act as a driving force to getting you back into your old lifestyle. For some, walking may be a primary goal aft er surgery, while for others it may be getting into the shower without any help. Set a goal of attending a special event or rejoining your book club. Doing so will put you on the path to mobility in no time.

Most importantly, believe in yourself. Confidence and motivation are just as important as exercising and strengthening.

Editor’s Note: For a related story called “Getting Back Into the Driver’s Seat After an Amputation” — as well as other resources on our newly created Consumers & Caregivers homepage.

This article originally appeared in the Consumer Edition April 2011 issue of Mobility Management.

About the Author

Amber Fitzsimmons, MSPT, has been a practicing physical therapist for 12 years in diverse healthcare settings. Her current focus is advocating for appropriate automotive mobility solutions for consumers.

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