CORONAVIRUS UPDATE: What We Are Doing to Protect Our Clients

Training with a prosthetic arm

When a person loses all or part of an arm, the end result can be very debilitating.  For this reason, it is a good idea to begin the process of rehabilitating the person as soon as is feasibly possible.  The amputated patient can feel very useless and depressed by the lack of ability to do normal activities of daily living that require both arms.

The goal of upper extremity rehabilitation is to restore the person’s function as soon as possible.  The sooner training with a prosthesis happens, the better will the patient be and the greater will their chances be of accepting the prosthesis as a functioning part of their body.

As shown above, amazing advances in technology are being made to facilitate interactions with computer technology after suffering a catastrophic injury such as an amputation.

Prosthetic therapy actually begins as soon as the sutures or staples have been removed from the stump site. In this preprosthetic period, the patient is about 2-3 weeks past their surgery and healing of the stump is well underway.  The goals of this early time period of training include:

  • Shrinking and shaping the stump, which usually is too swollen to accept the final prosthesis
  • Desensitizing the stump so it can receive a prosthesis
  • Increasing muscle strength of the residual upper extremity
  • Keeping the normal range of motion around the arm, including shoulders and elbows, if still present
  • Finding out which muscles can be used in the myoelectric process
  • Learning to do activities of daily living with an amputation
  • Information giving to the patient and family about prostheses
  • Finding out the patient’s future goals

After about 21 days following the amputation of the limb, some type prosthetic should be given to the patient to gauge for for the maximum ability to later accept the prosthesis.  The window of opportunity for trying on a first prosthesis is about 21-30 days after amputation.

The stump needs to be wrapped in a figure of eight wrapping technique in order to lessen swelling.  This kind of wrap should be replaced every 4 hours while awake.  The bandage should remain on the stump both day and night for maximum effect.

The stump should be massaged during this period and the hypersensitive stump should be desensitized using things like vibration therapy, constant touch or by applying different textures to the stump.  As time goes on, more aggressive massage techniques should be performed in order to get rid of scar tissue and adhesions at the end of the stump.  Range of motion should be practiced daily and, using active resistance, the stump should be strengthened during physical therapy.  Occupational therapists can help the client make as much use out of the good arm and the amputated arm as possible during activities of daily living.

What type of Prosthesis is best?

The new amputee doesn’t know what types of prosthetic devices are out there so they need a lot of education as to which prosthetics are out there.  Hook prosthetics should be introduced as they are the lightest weight prosthetic devices and can be powered through body-powered techniques, which are easily learned.  Electric prosthetics that make use of myoelectric techniques are also helpful and more esthetically pleasing; however, they are more difficult to learn how to use. 

The patient should be allowed to start with a simple prosthesis and can work their way up to more sophisticated prosthetic devices that allow for bending at the elbow and finger movement—whatever is needed and can possibly be learned.  Every amputee should have at least two prostheses, one that acts as a back-up if the preferred prosthesis needs repairs.

The finished prosthesis, no matter how good it is, will not replace a lost arm and the patient will face some disappointment.  This is where education and psychological support is necessary so the patient doesn’t give up on using a prosthesis altogether.  Expectations will need to be realistic at all stages of the training for a new prosthesis.  The first few visits to rehabilitative specialists will be long and filled with questions as to what to expect in the future.

The first few Visits to the Physical and Occupational Therapist

During the first few visits, the patient will be taught the difference between a body powered and a myoelectric prosthesis, and will learn how to put the device on by themselves.  This is crucial to the patient’s sense of independence and eventual recovery.

Initially, the prosthesis should be worn for only 15-30 minutes at a time, three times per day, increasing both the time length and frequency of wearing the prosthetic device.  The skin must be continually evaluated so as to adjust the prosthesis if the skin becomes broken.  If there are no skin problems, the amputee can “graduate” up to wearing the prosthesis all the time within a week.

If there are skin problems, both the doctor and the prosthetist should be notified because even minor problems can get out of hand and can prevent the person from wearing the prosthesis.  Skin problems often mean that something about the prosthesis needs to be changed to take the pressure off the irritated area.

The stump and the socket should be washed off every day with soap and water, especially if the patient sweats a lot.  Any stockings worn on the stump should be changed frequently when sweat builds up.  The patient should have more than one stocking so that these changes can happen on a daily basis.  Myoelectric devices need special cleaning techniques because they cannot be immersed in water without damaging the electrodes.

The individual who uses a body-powered prosthesis of their upper extremity needs to be taught the various movements, such as chest expansion, shoulder depression, scapular abduction and humeral flexion techniques that allow for the device to move into the desired positions in order to be functional.  Different movements by the rest of the body allow for things like the locking and unlocking of the elbow prosthetic component and the power over the terminal component (anything that is meant to act as the hand).

With any type of movement or task, the amputee will learn which aspects of a given task is to be done by the prosthetic device and which parts are done by the good arm.  For example, when opening a jar, the amputee learns that the best way to do this is to hold the jar with the prosthetic hand while twisting the jar open using the good hand.  As another example, things like washing and drying dishes are done by having the good hand hold the dish while the prosthetic piece manipulates the sponge or drying cloth as needed.  These things and more are patiently learned by the individual so that a repertoire of movements can be mastered by the patient with the prosthetic limb.
When the individual is training, he or she should stick to the idea that no more than 30 percent of the total functionality of the arms should be performed by the prosthetic hand, with 70 percent of the activity being done by the good arm.

Returning to Work

Depending on the type of work the patient did before the amputation, he or she may be able to learn this type of work with the prosthetic hand and arm.  Alternatively, a different job can be given to them or the patient may realistically not have the ability to do any type of job that fits within the mental and physical skill set of the patient.  These things need to be discussed and worked out as the patient becomes more  used to the prosthesis and can best understand what he or she is now able to do following the amputation.
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