Rehab after your amputation: What to expect
Rehabilitation after the leg amputation
After your amputation, an interdisciplinary team will prepare you for everyday life with a prosthesis – including residual limb care, handling, and gait training with a leg prosthesis. Once your residual limb wound has healed, your rehabilitation will begin a few weeks after the operation. In most cases, initial rehabilitation will take up to six months.
During your rehabilitation, you will be cared for by a team of doctors, nurses, physiotherapists, and occupational therapists, and your therapy programme will be adapted to your current health and functional needs. Initially, you will usually have a daily physiotherapy session with gait training, and treatment sessions for occupational therapy. These will be spread throughout the day with regular breaks The goal is for you to get back to your usual everyday life as quickly as possible, it’s important to understand that your active participation is crucial to the rehabilitation results. Part of your rehabilitation may also involve questioning and modifying your previous lifestyle, your doctor, psychologist or counsellor will be able to support you with this.
Gait training with a leg prosthesis
The goal of rehabilitation is to prepare you for life with your prosthesis. First, this includes regaining your strength, endurance, and coordination through targeted physiotherapy. In addition, gait training will teach you how to use your prosthesis.
The basic functioning of the knee joint you're pescribed will play a major role in gait training for transfemoral (above knee) amputees. For this reason, your training programme will be tailored to the prosthetic components you are using. The programme should be aimed at relearning everyday movements and explaining the functionality of your prosthesis to you.
Learn more about what gait training for leg amputees entails here.
Putting on and taking off your prosthesis correctly
Putting on and taking off your prosthesis correctly by yourself will form the basis for walking with a prosthesis, which you will practice first. Your family may have to help you at first, so it’s important to also include them in rehabilitation, however, the goal is for you to learn how to do this independently. There are various ways to put on a prosthesis, depending on the type of prosthesis you have been prescribed and the condition of your residual limb. Your therapist or prosthetist will show you the best method for you.
Sitting down and standing up with a prosthetic leg
Once you know how to correctly put on your prosthesis and take it off, sitting down and standing up will be the next everyday actions to learn. Users with a transfemoral (above knee) amputation who have a knee joint that supports sitting down can put weight on both legs while sitting down. The Prosedo, Kenevo, C-Leg® 4, Genium and Genium X3 from Ottobock offer this function. This results in significant relief for your sound side, which helps prevent problems from excessive strain. Users with a transtibial (below knee) amputation should also put the same amount of weight on both legs when sitting down and standing up for the same reason.
Walking on level surfaces
Once you are confident in using your prosthesis in general, actual gait training can begin. The focus now moves on improving balance and coordination, sufficient weight bearing on the prosthetic side, and straightening the pelvis and upper body. Your physiotherapist will also continue to work on strengthening your muscles because strong muscles are essential for a stable body posture while walking.
First, you will learn how to shift your body weight and stand on one leg between parallel bars. Don’t support all your weight with your arms and sound leg; use your prosthesis too. As soon as you can walk between parallel bars, you start the first exercises without support. The first objective is to gradually reduce the use of any walking aids you may require initially. This is achieved through a combination of a proper walking technique and strengthening your torso muscles. All gait exercises are monitored by your physiotherapist to ensure that no gait deviations creep in. At first, your physiotherapist will always be by your side, offering help. However, you will gradually learn to do this unaided over time.
Once you have mastered walking on level ground, you will start to practice walking on various other surfaces.
Walking safely on stairs and ramps
Encountering obstacles is part of daily life, these include curbs, stairs in your home, or a ramp leading up to the garage. Walking safely on stairs and ramps is a constant part of your daily life and will be practiced with your physiotherapist during gait training. The individual components of your prosthesis determine which walking technique is right for you.
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Residual limb care
In hospital, the nursing staff and doctors will take care of your residual limb by cleaning your wound and changing the bandages or dressings. As you begin your rehabilitation, you will be shown how to care for your residual limb, the scar, and also your sound leg yourself. Regular and intensive care is essential so you can wear your prosthesis without problems, and there are special care products for your residual limb that you can use. Over time, you will develop a daily care routine that will become a natural part of your everyday life.
Daily care of the residual limb and prosthesis
During your rehabilitation, you will be shown how to properly care for your residual limb. To prevent the skin from becoming rough, you should wash your residual limb with water and mild soap (e.g. Derma Clean) in the morning and evening. Then dry the skin thoroughly or carefully dab it dry and apply a cream. Derma Repair and Derma Prevent are two products from Ottobock developed especially to care for residual limbs and highly stressed skin. Derma Prevent, helps prevent chafing by covering the skin in a protective film, keeping it soft and supple. Derma Prevent is usually used in combination with the liner and is therefore applied directly before putting on the prosthesis. Derma Repair alleviates the consequences of heavily stressed skin and protects it against damaging external influences. Derma Repair is generally applied in the evening after taking off the prosthesis. Putting on your prosthesis in the morning – immediately after washing – can often more difficult than usual, since warm water causes the skin on the residual limb to swell slightly.
In addition to caring for your residual limb, your prosthesis should also be cleaned daily. Your prosthetist will be happy to advise you. Wipe the inner socket of the prosthesis with a damp cloth to remove perspiration and skin particles. A clean contact surface to the skin helps prevent skin irritation. If you wear a liner, care for it daily according to the instructions for use.
Help for residual limb problems
If wrinkles or drawn-in scars have formed on your residual limb, special care is required to prevent infections, your rehabilitation team can provide you with specific advice. While caring for your residual limb, also look for skin injuries, pressure points, and blisters, as these may require medical treatment. A mirror can help you examine the back of your residual limb. Regularly massaging and gently stretching the scar is another important element of residual limb care and desensitising the sensitive skin on the residual limb.
Caring for the sound leg
After your amputation, your residual limb won’t be able to support a lot of weight. This automatically puts greater strain on your sound leg. However, it’s very important that your sound leg remains healthy so you can regain your mobility.
If you have a circulatory disorder, regularly examine your sound leg for minor injuries, as they could become dangerous in the event of infection and should therefore be treated immediately by a doctor. Comfortable shoes with a good fit reduce the strain on your sound leg, and insoles may also be recommended. In addition to footwear, your choice of socks is important: socks should be made of wool or cotton so they absorb perspiration well, if the cuff is too tight, it can disrupt blood circulation. Socks should fit without wrinkles and should be worn only for one day, otherwise, perspiration can cause salt deposits to form and chafe the skin leading to infections. If you have circulatory disorders, it’s also important not to transfer to a wheelchair while barefoot, you shouldn’t stand or walk barefoot either – the risk of injury is too high, and when you are in bed, you can put a padded support under the heel and ankle of your sound leg in order to prevent pressure points.
Frequently asked questions
The loss of one or more limbs will pose numerous questions not only to you but also to your loved ones. You’ll find answers to some of the most frequently asked questions here. If you can’t find the answer to one of your questions here, contact your prosthetist, physiotherapist, or doctor. Your rehabilitation team is in the best position to assess your individual situation and provide you with professional advice on this basis.