Written by Whitney Brandon
Amputation can be a scary concept and post-amputation can be even scarier. There are a lot of unknowns that lead to questions and concerns such as: What’s next? Will things go back to how they were before? When can I walk again? Timeline and goals may differ from patient to patient, so while there are no set guidelines that will fit each amputee’s situation, there are some generalities that may apply.
Soon after the amputation takes place, the physician will send a referral to the prosthetist and from there an appointment for an initial evaluation is scheduled. During the initial evaluation a lot of information is exchanged. The initial evaluation is a comprehensive, individual assessment that includes, but is not limited to, medical history, working and living conditions, evaluation of residual limb and contralateral limb, and assessment of patient goals. This information will help the prosthetist formulate a patient specific plan. During this appointment, the patient may be introduced to prosthetic componentry to become familiar with pieces they may see or use and to understand how they work. Component selections are based upon individual needs. This is a good time to ask any questions regarding the treatment plan. Patients are often referred to begin prosthetic care while their limbs are still swollen and sore. At the end of the initial evaluation, a patient will receive a shrinker, an elastic stocking that provides tolerable compression to reduce edema, that they will wear for a couple of weeks. They will also be given exercises to begin desensitizing their residual limb to make weight-bearing more tolerable.
After the shrinker has been worn for a couple of weeks, the edema will have decreased enough to take an impression of the residual limb. From the impression, a socket, which is a structure of the prosthesis that fits over the residual limb, will be made. The socket will be custom fit as it was made directly from the impression of the patient’s limb. From there, a series of diagnostic fittings will occur. A diagnostic fit is when a check socket is applied to the patient. Typically, a check socket is made from a transparent plastic that allows the prosthetist to see any points of pressure that may lead to redness or pain. A check socket can be easily modified to relieve any points of pressure and increase comfort. If the socket is too large or too small, or if several modifications are needed, then another check socket may be indicated. The more time spent modifying a check socket, the better the final socket will fit.
Once we have completed the check socket phase, we are ready for delivery. Every patient is encouraged to bring a walker and/or cane, and a good pair of shoes to the delivery appointment. These items will be used to ambulate out of the facility on their new prosthesis. It is not uncommon to need an assistive device, such as a walker or cane, especially in the beginning. The delivery appointment will be a lengthy appointment as we ensure fit of socket, height of overall prosthesis, and alignment are all correct. Prosthetic supplies, education, and wear and care instructions will all be given at this time.
Expect periodic and routine follow-up visits with a prosthetist. As a patient begins their prosthetic journey and attends physical therapy (highly recommended) the prosthesis will need to be adjusted to accommodate for any gait, volume, or limb shape changes. After a patient has been ambulatory with their prosthesis for some time, it is not uncommon for the residual limb to change in size or shape, causing the current socket to become ill-fitting. An ill-fitting socket that can no longer be adjusted to accommodate for such changes, will need to be replaced to achieve an optimal fit. Without an optimal fit, a patient may experience pressure areas that lead to skin breakdown, which can lead to bigger problems. The same concept applies to those who may experience weight gain or loss. Regular maintenance and periodic componentry replacement is needed to ensure optimal function and to prolong life of the prosthesis.
The relationship between patient and prosthetist is crucial, as they will be working together over a long period of time and the patient will often need their prosthetist for adjustments and supplies. Here at WTRC, we can ensure you will receive the best care.
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