Preparing for Your Prosthesis
A prosthesis, or an artificial limb, is a fabricated substitute for a missing body part that helps with function and appearance.
Most amputees are ready for a prosthesis prescription 4-8 weeks after amputation, but it may be longer depending on your medical condition.
If you aren’t at risk for healing difficulties, you can try walking on a post-operation prosthesis very soon after your surgery. Carefully analyze with your doctor, the benefits and risks of using these devices before trying them.
It’s important to follow your rehab team’s recommendations to preparing your limb for prosthetic use. You need to manage swelling, maintain proper positioning, improve flexibility and strength with prescribed exercises, and prepare your limb for pressure tolerance. You’ll receive instructions from your physical or occupational therapist soon after your surgery.
Fitting Your Prosthesis
A typical prosthetics fitting at Mary Free Bed involves creating a plaster or computer impression of your residual limb, followed by check-up fittings with test sockets, and final fittings with the prosthesis you'll take home.
A check socket, or test socket, is a temporary socket, often a transparent material, made over a plaster model to ensure your socket fits you properly. A successful test socket is re-made into your lighter weight socket.
The fitting process averages 2-6 weeks, depending on your fitting needs. It frequently takes more than one attempt before you achieve the proper fit, especially if the limb shape changes significantly as post-surgical swelling reduces.
In lower-limb amputations, your prosthetist adjusts the alignment position of your prosthetic socket in relation to your hip, foot, and knee to give the greatest balance and comfort.
Upper-limb prosthetics are adjusted for ideal function, such as degree and force of opening or closing the terminal device. The terminal device is the piece on the end of the limb that has the functional motion for manipulating objects. It can have opening and closing ability, and can have the appearance of a hand or a hook. Terminal devices are available for specific activities such as operating tools or catching a ball.
Your terminal device may be externally powered or body powered. Externally powered means the power to control your terminal device comes from a battery built into the prosthesis. Movement in your externally-powered prosthesis is initiated from sensors that sense muscles contracting. A body-powered prosthesis is an upper-limb prosthesis that uses shoulder movements to produce motion in your terminal device.
Every prosthesis and its components are selected specifically for you. There are hundreds of foot, knee, arm, and hand socket designs and suspension systems available. Advancements in improving the energy, safety, comfort, and ease of using a prosthesis are happening all the time. Mary Free Bed prosthetists are trained on the newest technologies, and are able to provide them to you, based on a physician’s prescription.
Dr. Bruinsma and the team at the Mary Free Bed Amputee Clinic are educated on the newest prosthetic devices. Your Mary Free Bed rehab experts will develop a prosthetic prescription for you, provide you with your prosthetic device, train you to use your prosthesis, and create a cosmetic appearance for your prosthesis.
A cosmetic cover is the outer covering of a prosthesis, usually made of foam covered with nylon or rubber-like material. This makes your prosthetic limb appear similar to your original limb.
Learning to Use Your Prosthesis
Initially, therapy focuses on preparing you for prosthetic use, which includes gaining strength and range of motion, desensitizing the limb, and developing good soft tissue mobility.
After the prosthesis is received, you may need therapy 2-3 times a week. The average number of weeks in therapy for a below-knee amputation or upper-limb amputation is 6 weeks. Therapy duration for an above-knee amputation is generally 12 weeks.
Your therapy includes practicing daily home exercises and safe practice of skills in a therapy setting and in home-like settings. Your first home program may only involve practice putting the prosthesis on and taking it off.
Therapy progresses to daily living and mobility activities, and includes getting up and down from chairs, the toilet, a car, and the floor. Walking training involves learning to walk on level surfaces as well as ramps, curbs, and steps. Other mobility activities include managing heavy doors, carrying objects, and stepping over objects. You may also receive training for specific needs such as returning to work, sports, and leisure activities.
Upper-limb amputees become independent with activities of daily living using a combination of prosthetic and adaptive equipment. Adaptive equipment are devices designed to assist you in your daily life. Examples of devices are steering knobs for driving or a reacher to grab things in low or high places.
By the end of therapy, most amputees with lower-limb amputation are discharged with independence in basic household and community ambulatory skills using an assistive device, such as a cane or walker. Some are able to develop the ability to walk without a cane or walker. After 6-12 months of practicing, you can return for therapy for higher-level skills training, such as walking without an assistive device or running.
Mary Free Bed’s Drivers Rehabilitation Program has specialized therapists who are experts in the adaptive technology and training needed to help you return to safe and independent driving.
Using Your Prosthesis At Home
After you’re cleared to wear your prosthesis outside of your prothetist’s office, you’ll receive a specific prosthesis wearing schedule. Your schedule encourages an increase in wearing time over a 4-6 week period until everyday use is achieved.
As the swelling in the limb reduces, and you develop an ability to perform more demanding activities with the prosthesis, your prosthesis will need to be modified. You may need frequent adjustments for up to a year after the initial fitting to achieve the proper final fit.
Learning to Walk
The ability to walk well on a prosthesis depends on many factors, the level of amputation being one of the most important. In general, the longer your residual limb, the better chance your gait or walking pattern will be restored to near normal.
Most people who have an amputation of just a toe or forefoot walk virtually normal and have no need for a prosthesis.
A below-knee amputation gives you the best chance of remaining mobile and walking well post-surgery.
If you’re an above-knee amputee, proficiency in walking is more challenging. New microprocessor-controlled knees and better socket design, available from Mary Free Bed Prosthetics, have made this goal far more achievable than it was in the past.
How easy it is for you to walk depends on a number of other factors. If you were able to walk normally before your amputation and don’t have other illnesses such as heart disease, breathing difficulties, major diabetic problems, or obesity, it’s more likely that you’ll walk after your amputation. It usually takes 6-12 months for full rehabilitation potential to be reached.
With the treatment and therapy provided through Mary Free Bed’s Amputee Clinic, even those with multiple medical conditions can achieve functional ambulation.
Deciding to Use a Prosthesis
If you’re wondering whether or not you can wait for awhile after surgery to decide if you want to use a prosthesis, the use-it-or-lose-it phenomenon tends to apply. Osteoporosis, weakness, and loss of range of motion can occur in a limb that isn't being used regularly. Many people learn to manage their lives without the limb, and become quite proficient.
Deciding later to trial a prosthesis can be frustrating, as it requires you to slow down and concentrate on developing proficiency with a prosthesis. You need to be committed to working toward proficiency, whether it’s walking with a prosthesis or skilled use of an upper limb prosthesis.