Amputation
The following
diagrams illustrate the common levels of limb amputation on the human
body.
(click
on the part names for more info.)
Who Has
a Need For a Prosthesis
In the majority
of cases a prosthetic device is fit to an individual to replace a missing
limb lost to amputation. Individuals who were born with congenital absence
of or malformation of a limb or limb segment may also require a prosthesis
to return function to that limb.
The vast majority of amputations result from complications which arise
from peripheral vascular disease and diabetes. Circulatory diseases resulting
in amputation primarily affect persons 50 years of age and older. Traumatic
injury resulting in limb amputation most often occurs in persons aged
50 years and younger.
Regardless of the situation, the process of amputation itself causes a
degree of trauma to the limb. Swelling, inflammation and pain usually
occur in the remaining limb segment ( residuum ), and will subside over
the next few weeks that follow.
The Rehabilitation
Team
Most major cities
in Canada and the US have a method to treat groups of patients with similar
problems, usually by way of a treatment team. This team is comprised of
medical professionals who regularly deal with the specific issues of a
particular patient group. By contributing their combined expertise the
team is able to provide their patients with solutions to their problems.
An amputee rehabilitation team is usually comprised of the following professionals:
Physician - Doctors are considered to be the lead team members. Typically
the physician representative is an Orthopaedic Surgeon or a Physiatrist
( doctor of physical medicine and rehabilitation ). The doctor acts as
coordinator for the team and facilitates the referral of the patient to
other doctors and specialists as needed.
Prosthetist - Prosthetists contributes their expertise to the clinic by
providing any and all information required in regard to prosthesis design,
fit and function. The prosthetist is also available to recommend changes
or fixes in alignment or fit that may improve the function of the patients
existing prosthesis.
Physiotherapist - The physiotherapist is responsible in part for the management
of the patients recovery while in hospital as well as the patients physical
reconditioning following surgery. A physiotherapist also takes part in
training new amputees how to put on and use their prosthesis. The most
crucial role of the physiotherapist in amputee rehabilitation is to provide
the patient with gait training. Gait training is essential in order for
the amputee to learn how to walk with their prosthesis effectively.
Occupational Therapist - Occupational Therapists assess and provide new
amputees with a variety of walking aids and home aids to make their your
new life more functional. Occupational therapists also work with amputees
to prepare them for performing specific tasks they wish to resume once
in hospital rehabilitation has ceased.
Social Worker/Psychologist - There are a number of issues which arise
following an amputation that must be overcome to successfully rehabilitate
with a prosthesis. The mental and emotional rigors that accompany an invasive
procedure such as amputation surgery are many. Social workers and psychologists
are trained to help individuals deal with the pain and anxiety which are
associated with limb amputation.
The final member of the rehabilitation team is the amputee. Amputees must
be made aware of and take part in the decisions that are being made regarding
their care. The rehabilitation team is performing its function if patients
are informed, educated and motivated with respect to rehabilitating with
their prosthesis.
Pre and
Post Operative Care
Preoperative care
is beneficial for individuals undergoing elective amputation surgery.
It gives the individual a chance to direct questions to medical professionals
regarding the surgery and rehabilitation. By gaining some knowledge about
the process ahead of time, some of the mystery is removed and a comfort
level is established which may make portions of the upcoming rehabilitation
easier.
The purpose of postoperative care is to allow the residuum to heal properly
and prepare it for the acceptance of a prosthetic socket. Postoperative
care varies from center to center but the end result is the same. After
the staples or sutures are removed from the incision ( usually 4 to 6
weeks post op ), the residuum is wrapped in a tensor bandage or elastic
shrinker which compresses the tissues and causes the swelling in the residuum
to be reduced to a point where prosthetic fitting is possible. The shrinking
process usually takes place after suture removal and continues for up
to four weeks. The residuum is not only being shrunk but is also being
forced to assume a desirable shape for weight bearing in a prosthetic
socket.
Financial
Matters
The average cost
of a below knee prosthesis and the supplies necessary to use it averages
around $ 8000.00 in Alberta. The average cost of an above knee prosthesis
in Alberta is around $ 15,000.00. So how does all this get paid for in
Alberta.
Alberta Aids to Daily Living - All residents of Alberta with a valid Alberta
Health Care number who have undergone an amputation are entitled to prosthetic
benefits under the Alberta Aids to Daily Living Program. The coverage
for prosthetic devices ranges from 75 % to 100 % of the total cost depending
on the individuals financial status.
Alberta residents over the age of 65 years are entitled to prosthetic
benefits from Alberta Blue Cross under their Group 66 plan. This plan
pays 100 % of the cost of prosthetic limbs and supplies.
Prosthetic Benefit assistance is usually available to individuals who
have established private health insurance coverage through their place
of employment. Benefits of plans such as these typically cover a primary
party as well as the spouse and children.
The War Amps of Canada has an established Adult Amputee Program as well
as the Champs Program for persons 18 years of age or younger. The Adult
Amputee Program was established to help adult Canadians with the cost
of prosthetic upgrades. The Adult Program will accept any new amputee
who applies and will only provide financial assistance toward the cost
of a new prosthetic device. The War Amps will contribute 20 % of the cost
of the new device every three years. The Champs Program usually provides
partial supplementary coverage for common prosthetic devices. Recreational
and Myoelectric prostheses are of special interest to the War Amps and
they take great pains to make sure that child amputees have what they
require to persue their daily activities.
The Workers Compensation Board of Alberta provides 100 % prosthetic benefit
coverage to individuals who suffered an amputation in a work related event.
Veterans Affairs Canada supplies persons with prostheses who have lost
their limb during wartime or peace keeping missions.
Health Canada supplies all Registered Indians, Eligible Inuit and Innu
with prosthetic benefits. The prosthetic benefit coverage is 100 % for
all devices and supplies.
In Calgary
Hospitals
Amputations are
performed at one of the following centers:
- The Foothills Hospital
- The Peter Lougheed Hospital
- The Rockyview Hospital
- The Alberta Childrens Hospital
After the amputation, one of
the hospitals physiotherapists will initiate the rehabilitation by getting
the patient out of bed and down to the therapy department to begin the
reconditioning and exercises. Any postoperative care will be completed
in the weeks that follow. The patient may be sent home to recover within
a week following the surgery. In this case amputees would attend therapy
as outpatients two to three times a week until they are ready for prosthetic
fitting.
Transportation
Transportation during the rehabilitation
period is available through The Calgary Handi-Bus Association. Contact
Handibus directly for details (403) 276-8028.
Prosthetists
In Calgary Prosthetic services
are available from the following five companies:
- Alberta Artificial Limb
- Jon Allen C.P.(c) and Kerry Calder C.P.(c)
- Calgary Prosthetics/Orthotics
- Paul Osborne C.P.(c)
- Cascade Prosthetics - Noel
Birkett C.P. (c) and Steve Scott C.P. (c)
- Clynch Prosthetic Laboratories
- George Clynch C.P.(c) and Milan Zadravec C.P.(c)
- Colman Prosthetics/Orthotics
- Ron Handkamer C.P.(c) and John Sowerbutts C.P.(c)
We encourage every new amputee
to try and speak to all the prosthetists prior to choosing where to receive
services. Wearing a prosthesis requires many hours be spent at a prosthetic
facility fitting and adjusting the limb. Patients should feel comfortable
in the facility where they are being treated and with the prosthetist
they are dealing with.
The Canadian Board for Certification
of Prosthetists and Orthotists
is an incorporated body which governs and regulates the prosthetic and
orthotic industry in Canada. The CBCPO is responsible for dealing with
issues such as:
- standards for training and continuing education for members of the P
& O industry
- enforcing the Canons of Ethical Conduct in the P & O industry
- defining the ongoing responsibilities of individual practitioners with
regard to the public
Lifestyle
After spending time using a
prosthesis, many amputees want to persue sporting activities or participate
in special group activities involving amputees. The Alberta Amputee Sports
and Recreation Association operates from Calgary but provides services
for all amputees in the province of Alberta. The annual Pro Am golf tournament
is a lot of fun and is one of many activities organized each year for
amputee members. AASRA also provides in hospital peer visitation for new
amputees and their families if needed.
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