Pre-Prosthetic Rehabilitation is important immediately after amputation surgery. the earlier the onset of rehabilitation, the greater the potential for success will be. The patient needs to receive physiotherapy treatment early to avoid complications such as joint contractures, pathological scars and depressed psychological state. The main post-surgical complications are cardio-vascular, residual limb pain and phantom sensation, oedema, contracture and wound dehiscence. Rehabilitation begins soon after surgery. The amputee will work with physical therapy in the hospital and will most likely continue after being discharged. Typically, most people are fit with a prosthesis 6-8 weeks after surgery but it may take longer depending on personal circumstances. Once you have been fit with your first prosthesis your physician will order out-patient therapy (at a rehab facility) or therapy at home.
The ideal stump is one that is well-healed, has good vascular supply, soft and mobile scars, minimal pain, minimal oedema, a length sufficient for biomechanical leverage but not too long to restrict choices for prosthetic components, and large surface areas for distribution of pressure. Oedema in the residual limb is a common complication after surgery. Controlling the amount of oedema post-surgically is vital for promoting wound-healing, pain control, protecting the incision during rehabilitation and assisting in shaping the stump for prosthetic fitting. These are achieved by Compression therapy with silicon liner or bandaging which not only shape the stump but also promotes increase blood circulation and wound healing.
When your physician has given clearance to begin the prosthetic fitting, your prosthetist will take a cast or a 3D scan of the limb; this will provide him/her with a model to make the prosthesis. Prior to this appointment he/she will have assessed your individual needs and goals for life as an amputee. This includes but is not limited to determining how active you are or would like to be, your current weight, occupation or leisure activities, current health status and the condition of the residual limb. This information is extremely important when determining the components and which type of prosthetic device is most suitable for the individual amputee.
Check Socket and Component Selection – A clear plastic check socket (diagnostic socket) is made from the model for the initial fitting. This allows the prosthetist to make changes to the fit of the socket or to change the alignment as you begin to walk. The check socket is typically utilized for one or two weeks while beginning therapy. Your prosthetist will follow-up with you as well as your therapist to ensure the fit and the function of your prosthesis is optimal and to address any issues immediately. As you become stronger, more flexible and confident on the prosthesis, your gait (the way you walk) will change and therefore your prosthetist will need to make changes to your alignment. Your check socket will consist of a clear socket, means of suspension, knee (for above knee amputees), pylon and a foot. The components that are used in your prosthesis are determined by your prosthetist.
Permanent Prosthesis – Once the fit of the prothesis has been determined and no immediate changes are needed, the permanent prosthesis will be made; typically, this is after you have completed physical therapy. A permanent prosthesis is a much stronger and more durable version of the check socket used in the fitting process. This socket is constructed of carbon fiber, nylon, resin, and other materials that give it its strength. Typically, the limb will continue to change as you begin to wear the prosthesis more consistently. You will need to follow-up with your prosthetist regularly so that he/she can accommodate those changes. To become a successful wearer of a prosthesis it is best to follow the recommendations of your physician, prosthetist and physical therapist and it is imperative to follow through with all appointments and call when you are having issues.