Coping With Amputation

September 21, 2021 Jessica Kluetz

How to cope with a lower extremity amputation.

Amputation of a lower extremity, be it above the knee, at the knee, below the knee, a single leg, or both legs, is a life changing event. I want to talk about what to expect in the initial weeks after a lower extremity amputation. There are so many different reasons for amputations, with some being planned and some being sudden, unexpected. No matter what leads to the amputation, more often than not, people going into the amputation have very little knowledge of what will take place afterwards.

The first thing I want to stress is the importance of requesting a physical therapy and occupational therapy evaluation for your loved one after the amputation occurs. I would also request the consultation of a physical medicine and rehabilitation (PM&R) physician while your loved one is in the hospital. The PM&R doctor will be able to assess your loved one, discuss therapy needs and recommend the appropriate level of rehabilitation once he is ready to discharge from the hospital.

If your loved one was able to at least transfer himself and do basic activities of daily living with minimal assistance, then he will most likely be a candidate for acute inpatient rehabilitation. In addition to helping to recommend and coordinate the appropriate level of rehabilitation, the PM&R doctor can also assist with management of pain in the residual limb that is unique to amputations. Getting control of the pain early on with the appropriate medications for this type of pain can make for better outcomes long term.

Pain after the amputation.

On the topic of pain, it is imperative to know that pain is likely to occur after an amputation. There will be pain at the surgical site, which is to be expected given the procedure that just took place. In addition, there is another type of pain that is very likely to occur, and this pain is known as phantom limb pain. Phantom limb pain occurs in up to 80% of the amputee population within the first week of amputation (1). There are multiple options for treatment of phantom pain, including non-medication treatments. If the PM&R doctor along with the therapists can help to get these other methods going earlier in the process, there is a better chance that fewer medications at lower doses will be required for pain management.

(Related blog post: Phantom Limb Pain)

Rehabilitation after the amputation.

Unless there are other medical issues being managed in the hospital, it is likely your loved one will be ready to transition to a rehabilitation facility within a few days post-operation. I want to reiterate the fact that if your loved one was fairly independent prior to the amputation, then acute rehabilitation is likely going to be the best option for your loved one for the first stage of rehabilitation.

The therapies will be more intense (3 hours/day, 5 days/week), and your loved one will be seen by a rehabilitation physician on a near daily basis. This is so important for many reasons. The surgical wound will likely be more closely monitored, and more frequent adjustments to the pain care regimen will be able to occur as well. The therapist, along with the physician, will begin to train your loved one and any accompanying family members on the importance of positioning the residual limb, which is critical to avoiding contractures in the joints of that limb.

For example, for someone who has a below knee amputation, the knee needs to remain in the extended position when at rest so that the knee does not get stuck in a bent/flexed position. If the knee gets stuck in a flexed position, it makes it very difficult, and sometimes even impossible, for a prosthetic to be properly used for ambulation.

The therapists will work with your loved one on learning to transfer from different surfaces using the appropriate assistive devices. If your loved one still has one lower limb, he or she will also eventually begin to learn to use a walker to hop from one location to the next. This can be very difficult because it requires a significant amount of endurance and strength. With many of my patients who have undergone amputations, they already had severely impaired endurance and strength due to other comorbid issues, thus it can take a long time to be able to get to the point in which she or he can single-leg hop even very short distances.

After amputation it takes time and work before getting a prosthetic.

One misconception many of my patients have had is that they will walk out of rehabilitation with their new prosthetic. This is definitely not the case. The fitting of a prosthesis is a long process, usually lasting several months. The first prosthetic cannot be made until the surgical wound is fully healed (clearance for this is given by the surgeon) and the limb needs to be properly “shaped.” The shaping of the residual limb is a process that starts early in the rehab process. Oftentimes, it starts with the use of an ACE wrap. The therapist and/or the rehab physician will do these wraps with the goal to train the patient or family member on performing the wrapping of the limb appropriately. The ACE wrap, or other compression methods, provides light compression to the residual limb to allow for the swelling that is present to gradually improve. It also helps the limb to be appropriately shaped to be able to fit into the socket of the prosthetic. Eventually, your loved one will be given a shrinker, which provides a bit more compression to the residual limb.

If your loved one is in an acute rehabilitation hospital, he or she will likely be introduced to a prosthetist during the stay. The prosthetist is the one who makes the prosthetic. As I said earlier, the prosthetic is not made during the acute rehabilitation stay, but it is so nice for the patients to be able to meet the prosthetist early on in the rehabilitation process so that the patient and family members can get their questions answered on the process of fabricating the prosthetic.

I will touch more on this in a future blog post, but I do want to say that if your loved one is put in contact with a prosthetist early on in the rehab stay, your loved one does not necessarily have to use that person for their prosthetic. Your loved one will be having multiple appointments with the prosthetist for many years to come, so in the same way you want to have a good rapport with your primary care physician, you want your loved one to feel he or she can have a good rapport with their prosthetist as well.

Losing a limb is difficult both physically and emotionally.

Going through an amputation is not an easy process in both the physical and emotional sense. Many people will go through the stages of grief following the loss of a limb. That is to be expected. The best thing you can do for your loved one is to be there for them. Listen to them and root them on as they move through the rehabilitation process.

(Related blog posts: Being Present For Your Aging Parent During Rehab)

Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367:1618-1625.

Feeling overwhelmed with the process?

Afraid you may not make the right decision at the right time? This stage of life for you and your aging parent often brings more questions than answers. Reading information from a trusted source like me can help guide you in the process. However, if you still feel overwhelmed, don’t hesitate to reach out to me. I am happy to help with a personalized plan for your unique situation.