Physical therapy is a crucial component of patient rehabilitation following a limb amputation. The goal of physical therapy post-amputation is to improve a patient’s functional abilities, with or without a prosthesis, as to ensure their long-term well-being.
Physical therapy for patients recovering from an amputation may occur at any time throughout the recovery process, such as:
- During the amputation recovery period
- After the amputation and before the prosthesis
- After the prosthesis has been fitted (includes therapy with the prosthesis)
- After the amputation, when a prosthesis will not be used
Physical therapy for patients with amputations is multifaceted, as it includes:
- Monitoring the residual limb and checking the incision for infection, skin breakdown, neuropathy, etc.
- Caring for the residual limb (wound care)
- Preventing or reducing contractures
- Preparing for a prosthesis
- Improving motion and proper functioning once the prosthesis is used
- Providing therapy for a residual limb without a prosthesis
The goal of physical therapy is to help patients recovering from amputations return to their previous level of function, with or without a prosthesis.
The Role of Physical Therapist Assistants in Post-Amputation Care and Therapy
Physical therapist assistants in amputations—under the guidance and supervision of licensed physical therapists—focus on the following areas of recovery and rehabilitation:
- Wound Care and Edema
- Wear and Care of the Prosthesis
- Therapeutic Exercises
- Pain Management
- Prosthetic Training
Wound Care and Edema
Immediately following an amputation, physical therapist assistants:
- Check for signs of infection and skin breakdown
- Manage edema, which includes educating the patient on elevation and positioning and the use of a shrinker or removable dressing
Wear and Care of the Prosthesis
Once a prosthesis is fitted and the patient has begun wearing it, physical therapist assistants educate patients on how to:
- Manage and clean the sock ply and gel liner
- Take the prosthesis on and off
- Care for the prosthesis and amputation sight
They work with the physical therapist and other members of the rehabilitation team (occupational therapists, recreational therapists, psychologists, etc.) to establish a treatment plan.
Based on the patient’s skin integrity, physical therapist assistants encourage patients to wear their prosthesis for a specific amount of time each day, increasing that time as the therapy progresses.
An important part of a physical therapy program for a patient recovering from an amputation is exercise, which strengthens and stretches the muscles surrounding the amputation and strengthens the patient’s core so as to improve balance. Therapeutic exercises also focus on improving range of motion and endurance.
As part of a physical therapy program, therapeutic exercises may include:
- Gait training and neuromuscular re-education
- Balance training
- Assistive device training to learn how to walk with a walker or crutches
Physical therapy begins post-surgery as soon as the patient is stable. During the first few days of treatment, physical therapist assistants may teach the patient:
- Gentle stretching and range-of-motion exercises
- How to position the surgical limb to prevent contractures
- How to get in and out of bed and safely move to a chair
- How to use a wheelchair or other assistive device
Physical therapist assistants can help patients cope with pain following an amputation a number of ways:
- Through the use of electrical stimulation and TENS therapy
- By performing manual therapy, including massage and joint manipulation
- Through desensitization, which involves stroking the skin with different types of touch to help reduce or eliminate sensitivity reaction
Physical therapist assistants work with patients to implement a program that best meets the patient’s life situations and activity goals. Prosthetic training begins upon receiving a temporary prosthesis and may continue for up to a year following the amputation.
The bulk of physical therapy takes place after the patient has moved from an acute care facility to a rehabilitation setting. During this time, physical therapist assistants in amputations teach patients how to function more independently. They help them use assistive devices and teach them skills needed to successfully use the new prosthetic limb.
During this time, physical therapist assistants also continue to check the residual limb through skin checks and hygiene practices and continue contracture prevention with exercise and positioning.
For leg amputations, physical therapist assistants help patients learn how to stand, balance, and walk with the prosthetic limb. This may mean walking with parallel bars, progressing to a walker, a cane, and then finally walking independently without any assistance.
Education and Training Options for PTAs Working with Amputation Patients
Physical therapist assistants with interest in working with amputees often take elective courses focused on amputations and prosthetics within their physical therapist assisting associate’s degree program.
Once individuals have successfully completed an associate degree in physical therapist assisting accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE), passed the PTA National Physical Therapy Examination (NPTE), and have earned state licensure, they can begin gaining valuable experience in prosthetic training and post-amputation therapy by pursuing a physical therapist assisting job where they work alongside licensed physical therapists with expertise in this area.
Just a few of the settings in which physical therapist assistants can work with amputees include:
- Inpatient rehabilitation centers
- Physical therapy practices
- Assisted living facilities/nursing homes
- Military/veterans hospitals
Continuing education is an important component of a physical therapist assistant’s career. The American Physical Therapy Association offers a vast array of courses and seminars related to amputations and prosthetics. For example, the APTA offered the following courses during their 2013 APTA Conference:
- Amputation Management: Introduction to Medicine and Management
- Amputation Management: Limb Loss Prevention
- Amputation Management: Componentry
- Amputation Management: Objective Measurements
Physical therapist assistants can network with others in the industry by becoming a member of the Amputee Coalition, the nation’s leading organization dedicated to enhancing the quality of life for amputees and their families, improving patient care, and preventing limb loss.