Amputee patients achieve comfort with new limbs

Program helps enhance patients’ quality of life

Patients who have had amputations generally have suffered a number of traumas in their lives, leading up to the moment when they are fitted for prostheses. A rehab facility can help reduce patients’ pain, discomfort, and trauma by helping them prepare for and use a new limb.

HealthSouth Rehabilitation Center in Concord, NH, has a prosthetic clinic that provides that type of service, with the goal of helping a patient find the best fit for a new limb.

"We are an inpatient rehab hospital, and we do see a fair amount of amputee patients during the course of the year, coming from different parts of New England," says Stuart J. Glassman, MD, medical director of the facility.

The hospital’s amputee program includes Glassman, a physical therapist who serves as coordinator, and the outpatient prosthetic clinic. The rehab provider works with prosthetists, who make the artificial limbs. "We assess overall any issues the patient has," he says. "For pain we use anti-seizure medication."

The program’s initial goal in working with amputee patients is to get their limbs shaped properly for an artificial limb. "We also focus on cardiac endurance for amputee patients, because it takes a lot more effort to walk with an artificial limb, and if they have diabetes, it will be much tougher."

Building a prosthesis typically works this way: A cast impression is made of the person’s remaining limb. From the cast, a temporary socket is made that can be easily adjusted to fit the person’s residual limb. It consists of a single type of plastic molding. The person may have a change in the circumference of the residual limb over time, so a new socket may have to be made.

Problems arise usually when a patient is using a bad prosthesis, one that has too much space between the real and artificial limbs. And a rehab facility that works with such patients can make a huge difference in their quality of life by helping them find and use a proper fit, Glassman says.

He provides this case study, as an example:

A 17-year-old boy was in a car accident that caused him to lose his left leg above the knee. He returned to his boarding school about six months after the accident. The school’s health clinic called HealthSouth because the boy’s artificial leg was causing him considerable pain. "He came into the clinic, and we could see a lot of skin breakdown on his residual leg, and there was a lot of redness and pain around it," says Glassman.

The problem appeared to be that the socket fitting around his residual leg was much too large. "He was getting some skin irritation from it, which is why he was in pain," Glassman recalls.

The prosthetic rehab staff advised the boy to stop using the artificial limb for two weeks, and they gave him treatment for the skin problems. When he returned to the rehab facility, his leg was beginning to heal, but the prosthesis still was too large. Glassman discussed the problem with the boy’s family and suggested he have a new socket and new leg made. "Within a day of putting on his new artificial leg, he was able to walk around the hospital. He was on the treadmill for 20 minutes the next day."

That same year, the teen-ager participated in a national junior amputee soccer tournament, golfing, and bicycling. "His school life now is such that some people can’t tell he has an artificial leg," Glassman adds.

The boy’s mental outlook has also improved. Before the rehab facility helped him fix the problem, he suffered from a lack of confidence and a poor self-image. "Now he feels like his whole life has turned around, and he has a tremendous amount of confidence, plus no pain," Glassman says.

Need More Information?

Stuart J. Glassman, MD, Medical Director, HealthSouth Rehabilitation Center, 254 Pleasant St., Concord, NH 03301. Phone: (603) 226-9800.