Amputation is an acquired condition that results in the loss of a limb, usually from injury, disease, or surgery. Congenital (present at birth) limb deficiency occurs when an infant is born without part or all of a limb. In the US, 90 percent of amputations are due to vascular disease. Nearly 70 percent of amputations due to trauma involve the upper limbs. About 1.7 million individuals in the US are living with an amputation, with approximately 110,000 lower limb amputations performed each year according to the National Limb Loss Information Center (NLLIC).
The causes for amputation may include any of the following:
- diseases - such as blood vessel disease (called peripheral vascular disease or PVD), diabetes, blood clots, or osteomyelitis (an infection in the bones).
- injuries - especially of the arms. Seventy-five percent of upper extremity amputations are related to trauma.
- surgery - to remove tumors from bones and muscles.
Loss of a limb produces a permanent disability that can impact a patient's self-image, self-care, and mobility (movement). Rehabilitation of the patient with an amputation begins after surgery during the acute treatment phase. As the patient's condition improves, a more extensive rehabilitation program is often begun.
The success of rehabilitation depends on many variables, including the following:
- level and type of amputation
- type and degree of any resulting impairments and disabilities
- overall health of the patient
- family support
It is important to focus on maximizing the patient's capabilities at home and in the community. Positive reinforcement helps recovery by improving self-esteem and promoting independence. The rehabilitation program is designed to meet the needs of the individual patient. Active involvement of the patient and family is vital to the success of the program.
The goal of rehabilitation after an amputation is to help the patient return to the highest level of function and independence possible, while improving the overall quality of life - physically, emotionally, and socially.
In order to help reach these goals, amputation rehabilitation programs may include the following:
- treatments to help improve wound healing and stump care
- activities to help improve motor skills, restore activities of daily living (ADLs), and help the patient reach maximum independence
- exercises that promote muscle strength, endurance, and control
- fitting and use of artificial limbs (prostheses)
- pain management for both post-operative and phantom pain (a sensation of pain that occurs below the level of the amputation)
- emotional support to help during the grieving period and with readjustment to a new body image
- use of assistive devices
- nutritional counseling to promote healing and health
- vocational counseling
- adapting the home environment for ease of function, safety, accessibility, and mobility
- patient and family education
Rehabilitation programs for patients with amputations can be conducted on an inpatient or outpatient basis. Many skilled professionals are part of the amputation rehabilitation team, including any/all of the following:
- orthopaedists/orthopaedic surgeons
- rehabilitation nurse
- physical therapist
- occupational therapist
- social worker
- recreational therapist
- case manager
- vocational counselor
There are a variety of treatment programs, including the following:
- acute rehabilitation programs
- outpatient rehabilitation programs
- day-treatment programs
- vocational rehabilitation programs
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