Occupational therapy is a vital part of a rehabilitation program whether you’re recovering from a stroke, spinal cord injury or an amputation. And with both Occupational Therapy (OT) Month and Limb Loss Awareness Month in April, it’s a great time to explore how the two are connected—and why therapy post-amputation is critical.
“Occupational therapy is important after a limb amputation because OT is holistic and treats every aspect of the patient—not only the physical, but the psychological and social aspects of limb loss to restore ‘Activities of Daily Living’ function,” says Robert Young OT/L, COMT, CLT, CKTP, Senior Occupational Therapist in the Orthopedic/Amputee Program at Burke.
In Burke’s amputee rehabilitation program, rehab is usually done in two phases: In Phase I, the patient learns to navigate without the limb, while in Phase II, they work with the new prosthesis. While upper limb amputation may require inpatient rehab, it’s more common for patients with a lower limb amputation to be in the inpatient setting, explains Young, who has been at Burke for 17 years. (Upper limb amputee patients are usually ambulatory and can often, depending on their level of function, go straight to outpatient care.)
When you are ready for rehab—specifically after a lower limb amputation—the process may feel daunting, both as a patient or as a family member or caregiver. While every treatment plan is tailored to each person, here’s a general look at what you can expect and a few things to keep in mind as you get started:
You’ll focus on learning to do common tasks. “During Phase I, OT teaches patients to function without a lower limb with everyday tasks such as bed mobility, dressing, grooming, transferring from surface to surface, homemaking, and community re-entry skills,” explains Young. In this phase, the occupational therapist will also teach a patient how to use a wheelchair—from getting around in tight spaces at home to learning how to navigate public spaces, like curbs, ramps and bathrooms. “Some patients may leave at a wheelchair level, while others leave with a walker or crutches, depending on a patient’s physical status prior to surgery.”
Another focus during this phase? Making sure your home is ready for your return: “In Phase I, OT assesses the home environment by interview and sometimes follows up with a home evaluation to determine what durable medical equipment a patient might need or what home modifications are needed for a safe discharge home.”
You can get in some favorite activities. Who says there can’t be some fun involved in rehab? Patients should expect a positive experience filled with activities, where the patient is at the center. This includes choosing activities that are important to you specifically: “Over the years in OT sessions with me, patients have cooked every type of food you can imagine, including hot Italian sausage lasagna with four cheeses, meatballs and pasta, red snapper, and curry chicken,” says Young. “I have been able to work on functional standing balance and endurance, while having fun with patients hitting golf balls, playing bocce ball on the lawn outside, working in the greenhouse, and using the Nintendo Wii for tennis or bowling.”
There will be prosthesis prep. In this initial phase, a patient (and possibly a caregiver, too), will learn how to care for the residual limb—and in particular, how to wrap it with an Ace bandage to help decrease swelling and shape it in preparation for a prosthesis. If a patient is also diabetic, which is common, then the occupational therapist will also be checking to make sure the skin on both limbs is intact. “By the time they are getting discharged from Burke, and the staples or sutures are removed from the residual limb, patients are often measured by the prosthetist for a shrinker,” Young says. “The shrinker replaces the Ace-wrapping and is worn similar to a sock for further compression until the patient obtains a prosthesis.”
Mental health is important as well. “Since limb loss can be a large change in people’s lives, OT evaluates a patient’s coping skills, and if needed, refers the patient for further support from a Burke neuropsychologist,” says Young. And there are other resources as well: From community programs such as Amputee Coalition and Amputee Empowerment Partners to Burke’s own Amputee support group, which Young advises patients get involved with while still in treatment. There are also organizations that can put you in touch with others who’ve had similar experiences. “Hanger Orthotic and Prosthetic Company helps our amputee patients connect with former amputee patients for peer-to-peer visits, which has been extremely helpful for our patients.” Post-discharge, there are lots of other activities to take part in, including many adaptive sports.
You’ll learn to use your prosthesis. Once a prosthesis has been fitted, patients may return to Burke for Phase II of rehab, where they’ll learn how to use their prothesis—including how to trust the new limb. “They repeat most activities from Phase I, but therapy has to ‘retrain’ the brain, for example, with where a patient’s center of gravity is, now that they can bear even weight through both legs,” explains Young.
Caregivers can also get involved. Since caregivers spend the most time with patients post-rehab, they’re an important part of the process as well. “Burke trains caregivers to assist patients with any aspects of care that a patient might not be independent with by the time of discharge from Burke,” Young explains. “The caregiver can observe therapy from the very start and are trained for hands-on assistance toward the last few days of therapy prior to discharge, if appropriate.” At Burke, the Marsal Caregiver Center is also available to provide extra assistance and support for caregivers.
Learn more about Burke’s Amputee Rehabilitation Program.