The earliest and most crucial tasks during rehabilitation are to ensure that the prosthesis fits properly and the skin gradually develops a tolerance to the socket.
Your rehabilitation team at the UPMC Rehabilitation Institute will play an important role in this process and in your entire rehab journey.
The Role of Physical Therapy
Your physical therapists will become a vital part of your recovery.
Some of the areas that physical therapists focus on include:
- Skin care and edema (swelling)
- Your prosthesis
- Exercise
Skin care and edema management
- Inspection of the skin includes looking for red spots or blisters, especially over bony areas. Skin can be very delicate and painful after first wearing your prosthesis.
- Desensitization of the skin will reduce irritation of your prosthesis. Phantom pain or sensation is normal and should gradually disappear.
- Scar mobilization can keep the skin flexible and pliable, and make your prosthesis easier to wear.
- Edema management includes elevation, positioning, and wearing your shrinker or removable dressing (RRD). Swelling may be caused by keeping your stump unwrapped when not wearing the prosthesis, so continue to wear your stump shrinker or RRD at night and report any unusual or persistent swelling to your doctor. Also, avoid sitting with your knees crossed, this may compress an artery and cut off blood supply.
The wear and care of your prosthesis
A physical therapist will teach you how to:
- Manage and clean your sock ply and gel liner (if worn).
- Put your prosthesis on and take it off.
- Care for both prosthesis and stump.
He or she will also manage prosthetic wear time progression during your rehabilitation stay.
Your wear time of the prosthesis will gradually increase based on your treatment plan established by the rehabilitation team. You’ll often start with a wear time of 15 to 30 minutes twice a day, increasing by 15 to 30 minutes based on your skin integrity.
Therapeutic exercises
A physical therapist will instruct you on a therapeutic exercise program to stretch and strengthen the muscles around your hip, knee, back, and trunk.
- Gait training and neuromuscular re-education will help you focus on standing evenly on both limbs (weight bearing).
- Balance training will help you enhance your balance during standing and walking.
The physical therapist will gradually progress your exercises in order to strengthen your stump and remaining leg and arms, and improve your balance.
During these exercises, it is best to dress in comfortable, unrestrictive clothing.
The Role of Occupational Therapy
An occupational therapist will assist you in addressing your self-care needs and activities of daily living, including:
- Household chores
- Bathing
- Dressing
- Toilet and tub transfers
- Donning/doffing your prosthesis
An occupational therapist may recommend and train you to use a variety of specialty equipment — such as a raised toilet seat and inspection mirror — to:
- Increase your independence
- Improve your safety
- Help you become more efficient in daily activities
Mobility Training and Environmental Modifications
Your rehabilitation team will assist you in adapting to community re-entry through mobility training in a variety of settings, such as:
- Curbs
- Ramps
- Stairs
- Uneven terrain
They’ll also help you make arrangements for environmental modifications if needed, including:
- Home or workplace modifications
- Bathrooms
- Ramps
- Appliances
- Clothing
- Automobile adaptations necessary for driving
Before you leave, we'll also provide you with information on resources to help you manage and cope with the transition to everyday life challenges, such as:
Outpatient Care
Our experts are with you at each phase of recovery after an amputation.
We integrate outpatient follow-up with local and national prosthetic companies who make prostheses.
Additionally, through the Department of Physical Medicine and Rehabilitation our doctors can:
- Help manage post amputation pain and
- Perform gait evaluations
- Develop protocols to correct abnormal walking patterns with the prosthesis
Also, our research on complications after amputation have helped us to improve protocols for evaluating abnormal bone formation in the residual limb.
