Helping Hands – The Journey of Rehabilitation for amputees
By Anagha Kerur
An amputation is a traumatic experience and requires proper healthcare to help the person overcome physical and psychological barriers, in addition to their pain post-surgery. Amputation is an irreversible surgical option which may result in the patient becoming physically challenged and can cause bodily disfigurement. Most amputations in developed countries are due to atherosclerosis and peripheral vascular disease but in developing countries, including India, the main cause is seen to be motor accidents or untreated diabetes.
Therapy plays a major role in the healing process and physical therapy is a mandated procedure post-amputation. Unfortunately, an aspect which is not yet fully recognised, especially in developing countries, is the need for psychological therapy as well as physical therapy to help patients fully recover from their trauma.
The physiotherapist plays a major role in the patients’ recovery process when recovering from an amputation. They observe the patients’ range of motion of the residual limb, prescribe exercises to strengthen the major muscle groups of all the limbs including the residual limb, track their balance and coordination, and even teach correct bed mobility to avoid sutures on the frail skin. They may also teach the patient how to transfer themselves safely and independently from one place to another, or from their bed to the wheelchair, especially for lower limb amputees.
They play a big part of the rehabilitation process and will also help with the fitting of the prosthesis, putting it on and taking it off, and building strength in the amputated limb for the amputee to be able to properly use the prosthesis.
This type of therapy is not well known in the developing world but is quite prevalent in the developed world. An occupational therapist works closely with the physiotherapist and helps the patient practice everyday activities so that they are better equipped to handle any barriers they may come across. Barriers are any factors that hamper the patient including cultural, economic, political, social, or even structural factors, among others.
The occupational therapist will help the patient with the social aspects of their rehabilitation process. For example, getting dressed by themselves. A patient may be recommended ways to dress or a type of clothing which would make it easier for them to do so by themselves, such as substituting buttons and laces with Velcro’s. For lower limb amputees, guidance may be given on how to maintain balance, or work their way around their house using aids other than their prosthesis. An occupational therapist will also instruct the patient with proper personal care procedures, including how to care for the residual limb and give general rehabilitation guidance in terms of the use and maintenance of their prosthetic. In short, they help the amputee regain their independence.
Only a few places provide occupational therapy alongside physiotherapy even though it was introduced in India in 1950. Despite it being established for over 65 years, there is sadly a lack of such institutes in India; only in the last 30 years has there been a notable growth in this sector. Despite this, the importance of occupational therapy has not yet reached the mainstream therapeutic industry for amputee after-care.
This sort of traumatic experience is sudden and has a great impact on the amputee’s life. It not only creates a lifelong disability but also drastically changes their world view; their perception of what was “normal” must now change to accommodate the lack of a limb. Even small daily activities such as opening a bottle cap is a big challenge to upper limb amputees. Further, social media promotes certain body types as ‘attractive’ over others and this will negatively impact patients’ body image. It can cause a lot of mental illnesses, primarily anxiety and depression, which is why it is very important to provide psychological therapy alongside physiotherapy when treating post-surgery amputees. A study found that when provided with emotional as well as physical therapy, the patients were able to rehabilitate much more effectively. Their levels of anxiety and depression, as well as their body image disturbances, were lower than those undergoing only physiotherapy.
This kind of rehabilitation needs a multidisciplinary approach, one that combines counselling, physical therapy and occupational therapy. Ideally, there should be an amputation team which consists of the surgeon and nurse, the physical therapist, occupational therapist and psychologist at the very least. Unfortunately, no such focused “amputee clinics” are available in India, or for that matter in the underdeveloped world. It is clear that solely relying on physical therapy does not help. It is essential that initiatives to provide occupational and emotional support are allowed to grow and benefit the health of the population, allowing amputees to better overcome their barriers.