In order for you to get back to your usual daily routine after the amputation, it is important that treatment measures and the stump care are well matched.
This applies both to the time of the hospital stay after the amputation, as well as to the subsequent stationary rehabilitation in a special clinic. Even the first weeks and months that you will spend at home are a part of this important recovery phase.
The World Health Organization (WHO) has a following definition of the term rehabilitation: "Rehabilitation is a set of medical, educational/pedagogical, professional and social measures that assist individuals with a disability to create the best possible physical, mental and social environment for them. These are intended to allow them to retain or maintain a place in the society on their own."
The rehabilitation of an amputee begins before the operation with the choice of the correct amputation level. It is also the doctor's job to carefully educate the patients about the operation process and the next steps.
After the operation, the further rehabilitation course will be determined as well as how quickly the patient can return to the familiar environment.
The most important goal is stabilization of the main disease and proper wound healing, because it is pointless to transfer the patient to a rehabilitation clinic until the wound is mostly healed.
The stump treatment is adapted to the amputation cause and the characteristics of the residual limb. Attention is paid to the careful wound care and stump forming. Since the accumulation of tissue fluid (edema) after the operation is very pronounced, compression bandages must be applied at first. After the wound drainages have been removed, special silicone covers, called post-op-liner, can be used.
First physiotherapy exercises mobilize and strengthen the body and the healthy side.
In addition, the patient is trained by a specialist on how to move from bed to wheelchair and backwards. If possible, the first standing and moving exercises are carried out on the parallel bars without a prosthesis.
If the disease progresses normally, the patient is transferred to a rehabilitation clinic that specializes in the mobilization of amputees two to three weeks after the operation.
In consultation with the orthopedic technician, the doctor usually determines the optimal time of the first prosthesis supply, this is why the first contact between the patient and the orthopedic technician should take place as early as possible.
The key function of an orthopedic technician is to accompany the patient in the future – both during and after rehabilitation. Since he takes care of all aspects of the prosthesis supply, it is important that a relationship of trust arises between him and the patient.
At first, the orthopedic technician will examine the stump conditions and select the right stump stockings and silicone liner. Based on the patient's individual requirements, the orthopedic technician makes suggestions for the further prosthesis supply. He provides a link between the doctor, health insurance and patient.
Rehabilitation in a specialized clinic usually lasts for three weeks, but can also be extended in some medically justified cases.
The ultimate goal of any rehabilitation is to achieve the best possible medical, professional, family and social reintegration of the patient.
This depends essentially on the physical and mental condition of each amputee. The specific rehabilitation goals can therefore vary from patient to patient.
Many factors play an important role in the reintegration into everyday life, e.g.:
- Amputation level
- Cause of amputation (e.g. trauma, cancer),
- Bilateral amputation,
- Physical general condition (e.g. need for nursing care, neurological diseases, restricted
- functioning of the sensory organs),
- Accompanying diseases (e.g. heart failure, arterial occlusion, asthma),
- Patient's motivation,
- Mental illnesses (e.g. depression, anxiety) as well as
- Social factors (e.g. family environment, living environment).
The first task of the rehabilitation team is to determine the rehabilitation potential of the patient based on these factors and to move to the rehabilitation goals together with the patient, taking into account his wishes and life circumstances.
Rehabilitation in a specialized clinic is usually based on the concept described here. The step by step transition is seamless.
- Creating stable physical conditions
- Residual limb treatment: Hardening, bandaging, stump forming and lymphatic drainage
- Prosthesis fitting (temporary or interim prosthesis)
- Intensive walking training with the prosthesis
- Extension of autonomous walking range
- Extension of the daily wear time
- Optimization of prosthetic supply
- Individual and group discussions
- Gait analysis
- Exercising everyday movements (climbing stairs, falling and standing up, overcoming obstacles, putting the prosthesis on and off)
- Creating as much autonomy as possible
- Creating the handicapped accessible living and working environment
The duration of each phase as well as the of the stationary rehabilitation as a whole, the exact procedures, the intensity of the individual training sessions and the focal points correspond to the individual requirements of the respective patient.
Not only the physical conditions, but above all the motivation to master the everyday life even with a prosthesis, contributes to a successful completion of the rehabilitation program and ensures that the amputee will soon retain independence.
A doctor, usually a specialist in physical medicine and rehabilitation or an orthopedist is responsible for the rehabilitation process including the treatment of wound healing disorders and pain therapy.
The stationary nursing service takes care of the wound and the stump. They reduce the wound oedema using compression stockings, silicone liner or simply by wrapping the stump and, often in cooperation with the ergotherapy specialists, are responsible for training the patient on how to put on and off the prosthesis and correctly apply the liner.
The physiotherapist is involved in all phases of the rehabilitation process. Whereas in the beginning it is mainly a matter of reducing the stump edema, to promote blood circulation, to maintain joint mobility, to prepare the stump, to harden and to form it, and to perform first standing and walking training, the rehabilitation is actually mainly dedicated to the prosthetic training. One of the main foci is the Amputee walking school.
The task of the orthopedic technician is to create and adapt the prosthesis together with the other members of the rehabilitation team, to train the patient how to use it, to make adjustments and to maintain the prosthesis and its components two times a year.
Occupational therapists support the patient in improving their daily life activities. They advise on the prescription and application of the nursing aids. They also provide assistance to relatives and prepare the patient to return home.
Since an amputation is often associated with huge psychological stress for the patient, a psychologist should also be a part of the rehabilitation team. He assists the amputee in learning how to deal with the new situation.
In addition, it has proved useful to widen rehabilitation with offers from sports and physical therapy. In physical therapy, the most important matter is to harden the stump, to improve the blood flow in the residual limb and as an accompanying therapy to relieve phantom pain. The sports therapist, on the other hand, assists the patient in power and circulatory training and introduces him to suitable sports.
In addition to these, further specialist disciplines are included in the rehabilitation process if necessary. This includes, above all, referring family physician, social services and professional advisors, who organize professional reintegration.
When the stay in a rehabilitation clinic is over, the stationary rehabilitation is finished, but the amputee is not left without support. Physiotherapy is still important in order to maintain the mobility and to train the use of the prosthesis even more. In addition, it is mainly a question of professional reintegration for patients who have nothing hindering their further professional activity.
The domestic environment should also be adjusted to make the patient's everyday life as easy as possible.