Physiotherapy - Post–prosthetic advice after having an Amputation

What is a Prothesis?

A prosthesis is a formal name for an artificial limb. Many factors need to be considered for a prosthetic limb:

1. Your state of health
2. Your aims
3. Your rehabilitation progress
4. The benefits verses the difficulties of using an artificial limb

Not everyone who has an amputation goes on to use an artificial limb. Some people may find that walking with an artificial limb is very tiring, and they choose to get about using their wheelchair instead. You should never compare yourself to anyone else; everyone is an individual and gets treated as such.

The prosthesis only fits the person it is made for. There are various types of prosthesis available. The type of prosthesis you have is dependent on:

1. Your health and fitness
2. Body weight
3. Shape of amputated limb
4. Amputation level
5. Lifestyle

Wearing your Prosthesis

If you are eligible and receive your prosthesis at the Specialised Ability Centre Manchester (SACM), the physiotherapists will discuss, practice, and advise you how and where to don (put on) and doff (remove) your prosthesis at home. If you are also having input from any community teams, the physiotherapists may also speak to them regarding your home environment to determine where you are best to don/doff your prosthesis at home. The physiotherapists at the SACM will also advise you on how long to wear your prosthesis for initially and will progress to building up your tolerance gradually. The physiotherapy team at Oldham will then advise you on progressing with your prosthetic limb use.

You should always check your skin of your residuum before and after wearing your prosthesis. If you are a below knee amputee and have a patella-tendon weight bearing trans-tibial (below knee) prosthesis, some redness will be expected over the quadriceps tendon and soft tissues around this area.

If you are an above knee amputee, some redness will be expected over the ischial tuberosity (seat bone) for a trans-femoral (above knee) prosthesis due to the socket. Your physiotherapist will discuss this further with you. It is important that you monitor your skin for blistering, rashes, and redness in all areas and especially over bony prominences.

Caring for your prosthesis

• In warmer months and with increased weather temperatures, you are likely to sweat more at rest and on exertion. It is therefore important that you are washing your residuum, prosthesis, and socks regularly with soap and water to maintain good hygiene. It is important to follow the advice given by your prosthetist and to contact your GP/SACM if any skin rashes develop for advice and treatment
• If you have been provided with a Juzo sock, please follow the manufacture’s guidelines for washing and drying
• Store your prosthesis in a clean, dry place, when you are not using it
• Do not change the heel height of your shoes without consulting your prosthetist as this may change the way the prosthesis feels when you walk and can make you feel unbalanced
• Your prosthesis is a mechanical device and will require maintenance at the SACM. If you are a very active person, the prosthesis may need more regular maintenance to avoid wear and tear problems. Ensure you regularly check your prosthesis to ensure that it remains in a good and safe condition. It is important to be aware of the functions and limitations of your prosthetic limb as this can vary for activity level. Contact the SACM for further advice if you have any concerns.

Caring for your residual limb

Your residuum will often change in size due to many factors. It is important to ensure you adapt the number of socks provided by the SACM and monitor the size of your residuum regularly so that your prosthesis fits correctly, when wearing. It is important that you wash your socks regularly to maintain good hygiene.

Lower Back Pain

As you will adapt your walking pattern so that you can safely use your prosthesis, you may put strain on some muscles that have been weak. Because of this, you can develop lower back pain, when using your prosthetic limb. Please inform your physiotherapist if you have any concerns.

Falls

As a new amputee you are at an increased risk of falling. At night-time you may wake up to go to the toilet, forget about your amputation, and try to stand up as you previously would.

To reduce the risks of falls

Avoid

• Bad footwear e.g., old slippers, worn down shoes
• Long trailing nightdresses and dressing gowns
• Trailing telephone cables and electrical cords
• Poor lighting
• Floor obstacles, including rugs
• Wet slippery surfaces
• Bending down to pick things off the floor

If you are using your wheelchair

• Always wear your seatbelt so that if you go to get up in a rush this will stop you and remind you to think about the transfer
• Don’t over-reach to pick things up off the floor as you may tip the wheelchair
• Don’t transfer without putting the brakes of the wheelchair on
• Always move footplates out of the way when transferring
• When waking up from being asleep take 5 minutes to come round. Don’t try and get up straight away. You may wish to leave your wheelchair next to your bed at night as a visual and physical prompt to remind you about your amputation and transfer method
• Always use the wheelchair parts and functions correctly as taught during your in-patient stay

If you are a prosthetic user

• Always follow your physiotherapists advice on your prosthetic limb use
• Ensure you always wear the same footwear as this may affect the alignment of your prosthetic limb
• Always check your prothesis is fitting correctly and in a good state of repair. If you wear your prosthesis with a locked knee, ensure this is working properly
• Are your walking aids in a good state of repair? If not please contact the team, who provided you the walking aids for advice

What to do if you have a fall

1. Always keeps your mobile phone or careline bracelet/device with you.
2. Check yourself from head to toe for any pain or injuries.
3. If you have not injured yourself and feel you can get up off the floor, attempt to get up from the floor using the techniques you have been shown by your physiotherapist on the vascular inpatient ward, outpatient amputee class, or community physiotherapy team.
4. If you are unable to get up off the floor, shout for help, press your pendant alarm if you have one for help, or call 999.
5. If you are waiting for help to arrive, try to make yourself comfortable by getting a cushion and a blanket to keep yourself warm and to protect your head from the floor.

If you need to urinate in an emergency, it is advised to urinate into a cushion/towel so that the urine doesn’t burn your skin.

If you feel that you have injured yourself during the fall, it is important to either attend A&E, contact your GP, or contact the district nursing team if you are known to this service.

Useful Contact Numbers

SACM Reception - 0161 611 3700

Oldham Amputee Therapy Number - 0161 627 8017

Amputation Foundation - 01744 808 850

Limb power
General Enquiries - 07502 276858
Sport Enquiries - 07503030702

Oldham
Crisis Enablement Team - 0161 770 6771
If you are struggling at home this integrated team and visit you at home to assess you needs for up to 5 days.

Home First Support Service - 0161 622 928 or 0161 633 0213
•    Practical support
•    Provision of grab rails, emergency small aid and key safes
•    Supply of emergency heating, clothing, bedding and household goods
•    Access to longer term support services
 
Wheelchair Repair Contact Number - 0161 344 0482

Rochdale
STARS - 0300 300 8886
If you are struggling at home this integrated team and visit you at home to assess you needs.

Rochdale Adult Social Care - 0300 3038886
HMR Single Point of Access (SPOA) - 0161 763 8525
This service is to contact multi-disciplinary teams such as District Nurses and Physiotherapy.
 

Rosscare Wheelchair Repair Contact Number - 0345 120 4992

Bury
Rapid Response - 0161 253 5153
If you are struggling at home this integrated team and visit you at home to assess you needs.

Wheelchair Repair Contact Number - 0345 120 4992