Written By:
April Meyer, MOTR/L, CHT
VHSF Faculty & Former Fellow
Did you know there are approximately 2 million amputees living in the US today with just 3% of that number classified as an upper extremity? And only a fraction of that 3% is greater than a partial hand amputation. So it will come as no surprise that there are few therapists (including CHTs) that know how to properly treat and educate patients that experience partial, total or bilateral limb loss of the upper extremity.
After limb loss amputees are faced with a new way to live life. Simple tasks that you and I take for granted such as eating and dressing can become cumbersome or even impossible without the proper tools. That's where we as therapists can make a difference with the knowledge and skills we've acquired to help these individuals navigate their new challenges. After amputation, the patient must first go through post surgical rehab for wound care, pain/edema management, desensitization, ROM of the unaffected joints and residual limb reshaping. All of this is part of the perioperative phase transitioning into the pre prosthetic process. After the initial fit collaborative efforts with the prosthetist is tantamount for the proper fit as the limb changes-- this will yield the best outcome for the prosthetic patient. Research shows that prosthetics have a higher rejection rate if the user is not properly trained in its use. Below are a few tips in helping the
therapist in this phase.
Tips: 1. Never turn away an upper extremity amputee especially as a CHT even if it’s outside of your comfort zone. Remember, you are the specialist and many of these patients have no one else to turn to. 2. Focus on the patient as a whole and ways to modify ADL’s and later IADL’s to suit their individual needs with AND without the use of their prosthetic(s). Amputees report preferring to perform some tasks without the use of prosthetics if possible and don them as needed. 3. When teaching the use of prosthetics think orthopedically. Strengthen the surrounding muscles that have become the primary movers of the residual limb. Then start with moving or manipulating larger objects with mastery before slowly grading-up the tasks to improve fine motor skills. 4. Repetition, repetition, repetition! If frustration sets in, remind your patient with anything sometimes it just takes a lot of practice! 5. Don’t be afraid to research AE yourself for recommendations—there are constantly new and innovative tools available. 6. Don’t get frustrated with your patient if your suggestions aren’t working for them. Remember not everything works for everyone and no two amputees are the same. Try another way. 7. Most importantly, be patient and kind. These are individuals with families and lives just like you that have suffered devastating injury and disability—most often times in a traumatic way. Loss of limb is similar to grieving the death of a loved one and not everyone has a good support system. Approach with reassurance, sympathy and genuine care. Don’t get discouraged. There are resources available to educate you as a therapist to help this special patient population. Reach out and get to know to your local prosthetists and build relationships to help you with this challenging rehab.
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