Amputee Rehabilitation
- Fysiobasen
- 4 hours ago
- 5 min read
The loss of a lower limb has major consequences for a person’s mobility and their ability to perform everyday activities¹². This can also influence participation in society and the possibility of engaging in different social roles and activities³. A primary goal of rehabilitation after amputation is to enable the individual to walk with a prosthesis and achieve the highest possible level of functional independence in daily life⁴.
Despite this goal, many people who undergo lower limb amputation experience reduced physical function and challenges related to psychosocial factors⁵. Outcomes may become more complicated if expectations regarding the functional possibilities of a prosthesis are unrealistic⁵. Rehabilitation involving a prosthesis is therefore a complex process that ideally involves collaboration between several healthcare disciplines. Although the work is multidisciplinary, physiotherapists often play a central role in the physical rehabilitation process⁶.
The Rehabilitation Process
Rehabilitation following lower limb amputation is typically organised into several stages that reflect the patient’s progression from before surgery through recovery and long-term follow-up⁷⁸.
The main phases include:
• pre-operative phase
• amputation surgery
• acute post-surgical phase
• pre-prosthetic phase
• prosthetic prescription
• prosthetic training
• community integration
• vocational rehabilitation
• follow-up
Throughout the entire rehabilitation pathway, a structured treatment plan is used to guide the management of the individual who has undergone amputation. This plan is developed through assessments carried out by the different professionals involved in the rehabilitation team. It serves as a shared framework that helps the team address goals that are important for both the patient and their family.
Planning for rehabilitation begins at the time of hospital admission. The level and type of intervention are determined after the surgical procedure and before discharge from hospital.
The rehabilitation process generally involves:
• ongoing medical assessment of impairments
• therapeutic interventions aimed at reducing activity limitations
Phase 1: Pre-operative Phase
The initial phase includes a comprehensive assessment of the patient’s overall condition. The subjective evaluation may include the current medical condition, previous illnesses, medication history and social background.
The objective examination may involve:
• assessment of joint range of motion
• evaluation of muscle strength
• examination of the limb that will undergo amputation
• assessment of peripheral pulses
• evaluation of skin condition
Information from these assessments is used to determine the most appropriate level of amputation for the individual. If the patient is expected to become a prosthesis user later, this will also influence the decision regarding the amputation level.
The physiotherapist’s primary focus in this phase is often on evaluating mobility and muscle strength. Based on these findings, as well as knowledge of prosthetic components and gait mechanics, the physiotherapist may contribute recommendations regarding the most functional level of amputation. Patients may also receive exercises before surgery to help prepare for mobility after the procedure.
Phase 2: Amputation Surgery
The surgical procedure and any necessary reconstruction are the responsibility of the surgeon. Decisions regarding the length of the amputation, management of soft tissues and nerves, and closure of the residual limb are made during this stage.
Phase 3: Acute Post-operative Phase
After surgery, the primary focus is on medical care, wound management and planning the next stages of rehabilitation. In some cases, a rigid dressing such as plaster may be applied immediately after surgery and maintained for several days.
Physiotherapy during this phase may include:
• chest physiotherapy
• transfer training
• strengthening exercises
• exercises to improve endurance
• strategies to maintain joint range of motion
Phase 4: Pre-prosthetic Rehabilitation
During this stage, the rehabilitation team monitors the patient’s progress and evaluates the need for further intervention. Counselling may be provided if necessary, and the patient’s personal rehabilitation goals are considered.
The team also discusses the potential prosthetic prescription. This decision may include evaluating how the patient manages with early walking aids and considering the patient’s goals for future mobility.
Early walking aids may help determine whether the patient is suitable for a prosthetic limb.
Physiotherapy in this phase focuses on exercises that prepare the residual limb for prosthetic use and coordination with the rehabilitation team regarding further management.
Phase 5: Prosthetic Prescription
When the prosthesis is being prepared, the prosthetist performs casting and measurements of the residual limb. A primary prosthesis is then fitted, ensuring correct alignment and appropriate length during standing and walking.
The physiotherapist may assist during the casting appointment to help maintain neutral pelvic alignment.
Further physiotherapy may include:
• guidance on mobility
• training in static balance
• gradual weight-bearing through the prosthesis
Phase 6: Prosthetic Training
During this phase, the prosthetist and physiotherapist work closely together. The prosthetist may adjust the prosthesis if any problems arise.
The physiotherapist usually takes a leading role in patient education. This may include instruction on:
• how to put on and remove the prosthesis
• monitoring the condition of the skin on the residual limb
• identifying appropriate weight-bearing areas
Once the patient becomes familiar with the prosthesis, a structured gait rehabilitation programme can begin.
Phase 7: Discharge and Return to Daily Life
As discharge approaches, occupational therapists often take an important role in facilitating the patient’s return to everyday activities. This may include participation in family life, recreational activities and community involvement.
Occupational therapists may also assist with planning future vocational activities. This may involve assessing the need for additional education, workplace modifications or retraining.
Counsellors may also be involved to support emotional adjustment and the development of healthy coping strategies.
During this stage, physiotherapists ensure that the patient receives education about long-term self-management, coping strategies and the resumption of functional activities.
Phase 8: Follow-up
After discharge, the patient is typically reviewed regularly by the physician, physiotherapist and prosthetic team. The purpose is to assess whether the prosthesis remains appropriate, whether functional abilities have changed and whether any modifications are required.
As the patient’s condition evolves, adjustments to the prosthesis or changes in rehabilitation goals may become necessary.
In some situations, physiotherapy may be required again. For example, if mobility changes or if modifications are made to the prosthesis, gait rehabilitation may need to be restarted or the patient may require further advice regarding activity.
References
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