Challenge for Amputee

The immediate physical effects of an amputation may seem obvious. For example, the loss of a leg will prevent a person from being able to walk without some form of assistance. However, such is the dramatic change to a person’s body, there are several further physical effects that can impact the life of an amputee:

Mobility and dexterity

The main effect of a lower-limb amputation is a reduction of that person’s mobility, meaning that they will not be able to walk as they did pre-injury or surgery. In the majority of cases, after sufficient care and rehabilitation, the injured person will be able to make use of a prosthetic limb.

Meanwhile, the loss of an upper-limb will also affect mobility (most likely affecting a person’s balance). This can make the injured person prone to falls or collisions with objects and people. Whilst they will not usually require a wheelchair, their mobility and agility may be adversely affected, especially in the early stages after the injury.

After someone has undergone an amputation, it is likely that the basic pursuits of daily living will become much more difficult, or perhaps even impossible.

Previously straightforward tasks such as food preparation or housework may become a tremendous challenge, and the amputee may be limited in the activities they can perform unaided. Many of these are tasks that we often take for granted, such as getting dressed, washing, or carrying shopping.

Upper-limb amputees who have lost their dominant hand or arm are very likely to have difficulty completing tasks that require manual dexterity, and to compensate for this will need to learn how to use their previously non-dominant limb. For example, one particularly taxing transfer of skill would be learning how to write with their weaker hand.

Stump and phantom limb pain

An amputee may suffer from either stump pain or phantom limb pain, or perhaps even both. Stump pain is felt in the remaining part of the injured limb, and the source of this pain is found in the damaged groups of nerves at the site of amputation.

Meanwhile, phantom limb pain is a very widespread condition that affects up to 80% of all amputees. It refers to the sensation of pain that an injured person feels in their ‘missing’ limb.

The word ‘phantom’ does not in any way mean that the pain does not exist; it is all too real to the person suffering from it, but the source of the pain is actually within the person’s brain.

The extent of phantom limb pain differs from case to case. Some people may experience temporary and brief shock-like stabs of discomfort or burning sensations, whilst others report more chronic and unbearable levels of excruciating pain.

This phenomenon occurs more commonly in women, and then even more so in those who have lost an upper-limb as opposed to a lower-limb.

Infection

Problems can develop for amputees if the skin on their stump breaks down causing wounds to open. Such occurrences can give rise to infections and may prevent them from being able to make full use of a prosthetic limb.

There may be a problem with blood supply and circulation, culminating in blood clots; or it could be that an excess of moisture has built up at the stump and infected the wounds.

Unfortunately, such infections very often result in further surgical processes to remove more of the extremity, or perhaps even the rest of the remaining limb.

Challenge for Amputee

A person’s life changes the moment they lose their limbs. It can have a direct impact on dexterity and depending on the limb, even mobility. The loss of a leg or arm can impact a person’s ability to walk or balance correctly.

Daily life will be forever changed. The victim may also experience what is referred to as phantom pain. This affects up to 80% of amputees and it comes in the form of a painful sensation in the area of the missing limb.

Many individuals who are amputees suffer from issues regarding body image and how others perceive them.

These feelings often lead to the individual attempting to hide their missing limbs from others or altering their appearance in other ways. An amputation can also be a traumatic experience, causing the victim to relive the memories that caused the accident.

This is especially true because there is a constant reminder that cannot be escaped. Understanding how to deal with trauma is an important factor in the process of healing.

Muscle contractures

A muscle contracture happens when there is an imbalance of the muscles in a limb. Lower-limb amputees are at very high risk of muscle contractures due to the sudden and drastic alteration of their anatomy and central nervous system, as well as the weight-bearing stresses placed on the lower extremities.

Specifically, contractures are shortening and tightening of the various remaining muscle groups in a limb, and are usually the result of the amputee remaining in one fixed position for an extended period of time, such as when they are bed-ridden at home or in the hospital.

It is important that these contractures are addressed through stretching exercises so that potentially devastating complications are prevented from developing in the future. For example, if left untreated an amputee may lose the capability to fit a prosthetic limb, which in turn will mean that their mobility is further diminished.

Deep vein thrombosis

Deep vein thrombosis (also referred to as deep venous thrombosis or DVT) is a deep blood-clotting condition that usually affects the lower limbs of the body.

People who have suffered from an amputation of their lower extremities are at a high risk of experiencing this condition, particularly if they have undergone surgical amputation where their limb has been immobilized and tied.

If untreated, a potentially fatal secondary effect called a pulmonary embolism may develop, which is where part of the blood clot breaks away from the leg and travels to the person’s lungs.

Fatigue

The additional effort required by amputees to perform many of the routine activities of daily life can result in increased levels of tiredness and fatigue.

For example, this might be from the increased exertion required by a lower-limb amputee to walk with a prosthetic limb, or simply from the fact that many ordinary activities can take longer to complete than previously.

In some cases, the side effects of a person’s pain medication might make them feel more tired or cause them to sleep for longer. In addition, the psychological effects of the injury and accident may disturb a person’s sleep and exacerbate their fatigue.

Emotional effects of amputation

The psychological and emotional effects of losing a limb can be extremely significant, not only on the injured person but also on those close to them such as their family, friends, and colleagues.

Traumatic effects

If a person has experienced a traumatic amputation, memories of the incident could cause them to suffer from post-traumatic stress disorder (PTSD) or other similar psychological conditions. Symptoms can include flashbacks; nightmares; depression; insomnia; avoidance; anger outbursts, and various other challenging behaviors.

It is also more likely that a person who has suffered from a traumatic amputation will feel the emotional and psychological impact of their situation more heavily than someone who has undergone a planned surgical amputation because they have not had the time to prepare for the loss of a limb.

Adapting to amputation

Whilst some psychological symptoms are the result of the initial traumatic injury suffered, other symptoms can develop gradually as the amputee lives with their disability.

It can be mentally challenging for a person to adapt to the loss of sensation in their missing limb, or alternatively, it could be just as psychologically demanding for a person to suffer from chronic aches and pains.

As a result, depression is a very common consequence, both in the early stages of the injury and also as time progresses. The injured person may well suffer from a feeling of loss in relation to their removed limb, which some amputees have reported as similar to a feeling of bereavement after the death of a loved one.

It may seem like a downward spiral, but with both professional help and the care of the people that surround them, the hope is that the amputee will be able to navigate successfully through the five-stage cycle of grief; from the initial phase of denial and isolation; past anger, bargaining, and depression; ultimately arriving at the final stage of acceptance.

Body image

After an amputation, people can be prone to suffering from body image issues, and in particular, they can be self-conscious about the appearance of their injured limb.

Such body image issues are the result of an amputee’s internal perception of their own outer appearance and their greater self; and as a person’s body image usually includes four limbs, it can be a very difficult situation to adapt to.

It is not uncommon for an injured person to consciously – or subconsciously – hide their affected limb from sight so as not to draw attention to it, or because of fear about the way other people may react. These body image issues tend not to affect very young children who have undergone amputations, but it becomes more pronounced from adolescence onwards.

Social impact

An amputation can affect a person’s ability to take part in the same social activities, leisure pursuits, or hobbies that they would have otherwise enjoyed. This may be due to practical reasons, such as not being able to participate in physical activities in the same manner as they could prior to their amputation.

In addition, they may be inhibited by the levels of high levels of pain they experience or the side-effects of their medication. Social withdrawal can often result, leaving the injured person feeling isolated.

Their personal relationships can be heavily affected, as some amputees completely avoid contact with their friends and peers, or even exhibit outbursts of anger at those loved ones they are still in contact with; most likely those who are helping them and providing care.

Moving Forward

As devastating and debilitating amputation is, it is also quite possible that somebody who has experienced one – be it traumatic or surgical – could react to their situation somewhat positively.

Some people have been known to adopt an optimistic outlook, which over time develops into a general feeling of acceptance, making it easier for them to adapt to their situation.

Due to the immediately visible physical effects of amputation, it can be all too easy for people to ignore the psychological impact that it can have on an individual.

It is a momentous event in a person’s life, and it is highly important that anybody in such a situation seeks the help and support that they need to rebuild their life.

Hopefully with the right care in place, both professionally and personally, life after an amputation will be happy and fulfilling.

A good way to calm fears is to learn as much as you can about the thing that scares you, Regardless of the reason, losing a limb is never easy. Both mentally and physically, amputation can negatively affect a person and inevitably changes their life as well as the lives of their loved ones. While it may not be a cakewalk, life after amputation is simply a matter of finding a new routine — a new normal.

For new amputees, the whole process can seem intimidating, but it is always important to remember that no one goes through an amputation alone. There are lots of resources and organizations available to help with everything from pre-surgery consultations to programs for life-long peer support.

The healing process: What is the recovery after amputation like? Well, the short answer is that it’s long and can last years. The long answer is that amputation is not just the physical loss of a limb — it is also the readjustment of a person’s very way of living and requires relearning how to do many things that were once second nature.

The healing process begins with three main components:

• Physical therapy and rehabilitation
• Managing the risk of complications
• Gaining mobility and independence

If you plan on getting a prosthesis, it may be months before you are fitted for your artificial limb, which makes physical therapy one of the most important parts of your recovery.

A part of rehabilitation is strengthening the muscles in your remaining limbs, and another part is helping you work towards independence. In the beginning, physical therapy will be difficult and frustrating, but just remember that it is the first step to getting back on your feet — figuratively and maybe even literally.

The stump will be a healing wound and, like any other healing wound, it needs to have adequate care to speed up healing and prevent infections. It is best to avoid submerging the stump in water, such as if you take a bath.

The road to recovery: There are two parts of the recovery process.

1.Physical recovery

2.Emotional recovery

Both physical and emotional recovery is something you will be doing from the time of your surgery on, but while physical recovery likely has an end date, emotional recovery can be ongoing.

Physical recovery includes physiotherapy, which you will likely have to do three to five times a week. Physical therapy may seem like a chore, but it is one of the most critical parts of recovery since it helps the body adapt to its new normal.

Physiotherapy exercises are designed to help you learn how to redistribute your weight and balance with missing lower limbs or exercise your other limbs, which will be used more often, without injuring them.

These exercises are designed to help a person return to their regular routine by relearning how to do everyday activities. The exercises help you strengthen muscles to be able to better control limbs. Similarly, rehabilitation will also help you learn to live without the limb that has been amputated, which will decrease the chances of developing phantom limb syndrome.

Once you are fit for a prosthetic limb, you will learn how to move with an artificial limb and get used to living life with it. You will also learn how to care for your prosthesis.

Emotional Recovery: There are no wrong feelings when it comes to amputation, which is why emotional recovery is as important as physical recovery. The psychological impact of an amputation can run the gamut of emotions, with grief and bereavement being some of the most common emotions. The grief is sometimes strong enough to be likened to the death of a loved one.

Three key reasons an amputation can have such a strong effect on a person’s life are:

1. Getting used to the lack of feeling and sensation in the amputated limb.
2. Getting used to the lack of function of the amputated limb.
3. Adapting to a new sense of body image.

How other people view your body may also have changed, and coping with that is another significant factor. Negative thoughts are extremely common and very much normal during this time, and they can be as mild as temporary frustration or sadness to suicidal ideation.

Your rehabilitation team should be on top of these thoughts and, if required you may be directed to counseling or therapy to help you deal with these feelings constructively.

Sometimes, there is an inability or unwillingness to accept the amputation as reality. Some people may refuse to accept that they will need to alter their lifestyles because of the amputation and may refuse help. Other times, post-traumatic stress disorder is possible, especially when the amputation is the result of severe trauma.

Prosthetics: Approximately six weeks after the surgery, you will be fit for a prosthetic limb. The wound has to have healed well enough to begin the fitting — which involves making a cast of the residual limb.

It can take upwards of a couple of months if the wound is not healed properly or is taking longer to heal.

Choosing your prosthesis will involve multiple considerations, including:

• Activity level
• Health concerns
• Level of amputation
• Cosmetic look versus its functionality
• Need for additional, specialized limbs

A higher amputation may require a prosthesis with more parts, or an athlete may want an extra prosthesis specifically for sports. For example, a bicyclist may need alterations to an arm prosthesis and bike to ride safely.

In most cases, due to exact measurement and fitting, there is no pain but at the same time, it is normal to feel some pain when you first don your new prosthesis since your body will need to get used to the new addition.

Still, it is always a good idea to describe any and all pain or discomfort — like pinching or poking, for example — to the prosthetist, just in case the artificial limb needs to be adjusted in any way.

General tips for new amputees-

• Do not overdo it. It may be tempting to don your prosthesis and return to your life before the amputation, but remember that your entire body is healing from the amputation, so it needs plenty of time to rest and adapt.

The prosthetist will provide you with a wearing schedule, so make sure to follow it to avoid any complications.

• Do use assistive devices. Assistive devices like canes can be an asset in the early weeks of wearing a lower prosthesis. The human body naturally will want to put all pressure on the remaining limbs, but you need to learn how to balance your weight evenly between your prosthesis and your remaining limb.

Using an assistive device will help you to gradually shift weight onto the prosthesis.

• Do not ignore changes in your prosthesis. However well you care for your prosthesis, it could break. If you hear any clicking, creaking, or squeaking coming from your prosthesis when you put it on, point it out to the prosthetist.

Remember, your prosthesis is custom-made for you, so any changes can be detrimental to your progress.

• Do work at being active without prosthesis. You need to build up the stamina for wearing the prosthesis so you can return to a highly independent life.
• Do not ignore the residual limb. Examine your stump every day and report any signs of redness, blisters, or pain to the prosthetist. Make sure to clean your prosthesis using anti-bacterial soap and warm water after every time you remove it. Later, make sure it is completely dry before donning the prosthesis.

The stump size will fluctuate for a while before settling on its final size. The goal is to get it as small as it can be, so wearing shrinker socks is crucial whenever you are not wearing the artificial limb.

As their name suggests, shrinker socks will help mold the stump into a smaller, rounder shape. Of course, as the stump changes sizes and shapes, the socket will need to be adjusted accordingly to ensure the prosthesis is still comfortable.

If you are getting a prosthetic leg, you need to be aware of the heel height. The artificial limb is made for a specific heel height — likely to match your remaining limb’s heel height in your most comfortable pair of shoes.

So adjusting the heel height of your remaining limb can put your body off-kilter, which can then lead to more complications down the road. Always check with your prosthetist before you change your heel height.

Being crammed into a socket all day will inevitably make your residual limb perspire. Cleanliness is particularly crucial. The buildup of sweat and dirt can lead to various skin issues, thanks to the bacteria that will form.

Additionally, your residual limb is likely to develop an odor. Aside from cleaning your stump every day, you can also try sprinkling some baking soda on the stump before wearing your prosthesis to help reduce the amount of sweat.

Similarly, you can also apply some over-the-counter antiperspirant to the stump before donning the prosthesis. And while you are cleaning up, remember to clean up the socket as well.

The good news is the more you wear your prosthesis, the less you will perspire as your body gets used to its new normal. Still, keep checking on your residual limb for any injuries — like blisters or tender areas —as well as your remaining limb, especially if the reason for your amputation was due to health issues, like diabetes.

Retraining your body: Regardless of which limb has been amputated, your body will need retraining to function properly with the prosthesis.

For example, leg or foot amputations will require gait training, which teaches your body how to walk naturally again instead of limping. Gait training also helps take the pressure off the residual limb, which reduces the chances of injury.

The amount of time the training takes varies from person to person and can be further complicated by the type of prosthesis being used. Each prosthesis requires specific training because no two artificial limbs are alike.

You should know exactly how to use your own prosthesis so you can live a highly independent life. Today, technology and our understanding of the human body and mind have come so far that amputees no longer need to be dependent on others to live a fulfilling life.

With training, living aids, and ongoing support, amputees can return to their independent lives. They can participate in sports, cook, drive — whatever they want.

Being independent and returning to the tasks you once did without a second thought can also help you become more comfortable with your new body image and your new reality.

It can boost your self-confidence and help alleviate feelings of grief and anger that often accompany an amputation.