Clinical Specialties in Orthotics and Prosthetics Prosthetic rehabilitation after amputation – promoting function and mobility

Amputation in Australia Pre-surgical The leading cause of amputation in Australia is diabetes-related education foot disease. One Australian loses a lower limb every 3 hours as Prosthetists often a result of compromised circulation, sensation or infection. Other have the opportunity less common causes of amputation include trauma, malignant to meet with a client tumours and congenital limb loss. prior to amputation The role of the prosthetist surgery. This can occur within the acute Prosthetists (pron. pros-the-tists) are tertiary qualified allied health hospital setting or practitioners who specialise in the clinical assessment, provision through an outpatient and ongoing review of prostheses (artificial limbs). This includes clinic. This allows education, therapy and rehabilitation and ongoing prosthesis time to discuss the repair and maintenance. In Australia, prosthetists are trained in rehabilitation process both disciplines of orthotics and prosthetics at either a Bachelor and answer questions. or Masters level. Prosthetists work autonomously and within Not every person who multidisciplinary teams. has an amputation Prosthetists are involved in the entire post-amputation will require or want a rehabilitation pathway, from: prosthesis and these • Pre-surgical education options should also be Image Courtesy of Limbs4Life • Post-surgical care, including the application of Removal Rigid discussed. In Australia, peer support - meeting someone who has Dressings (or RRDs) also had an amputation - is available through Limbs4Life, a not- for-profit amputee peer support organisation. • Prescribing, designing and fitting a person’s first interim or ‘rehab’ prosthesis Removable Rigid Dressing (RRD) • Prescribing, designing and fitting the longer term or ‘definitive’ Ideally, prosthetists will apply an RRD to the residual limb prosthesis, including managing repairs and changes to the immediately post-surgery. The RRD is a custom-made protective prosthesis as required over time. dressing made from plaster or fiberglass bandages. The RRD Prosthetists still care for amputees even when they are not able is used to protect the limb against bumps and falls, minimize to use a prosthesis. They will often provide assessment about a swelling and help shape the limb in preparation for a prosthesis. person’s suitability to manage a prosthesis and advice regarding The early application of RRDs after amputation surgery has long term care of the residual limb such as management of other benefits including reducing the length of hospital stay and swelling. reducing the time between amputation and prosthetic fitting. www.aopa.org.au 1 of 2 Orthotist/Prosthetists – Supporting the Australian community

During this time a team The definitive prosthesis of professionals, which will be regularly reviewed may include a prosthetist, as limb shape continues physiotherapist, occupational to change - which requires therapist, nursing staff and adjustments to the socket doctors, assist with retaining and/or use of stump stocks good range of motion and - and as other parts of the strength, promoting wound prosthesis require ongoing healing, teaching functional maintenance. The type of mobility exercises and parts within a prosthesis may providing ongoing education change over time, depending and support. on client requirements. Some clients have more The interim or than one prosthesis, one for rehab prosthesis everyday use and one for a specific activity, such as a The prosthetist will usually water prosthesis or sports provide the first prosthesis prosthesis. once the wound is seen to be healing well and swelling has started to be controlled. How do I access more information? Typically, this is between 3 and 6 weeks after amputation surgery. To learn more about amputation rehabilitation please speak with The purpose of the first prosthesis is to allow gait re-training to your prosthetist. Certified Orthotist/Prosthetists (c-OP AOPA) begin. A prosthetist and physiotherapist will work with the client can be located using the ‘Find a practitioner’ search function on to teach standing and transferring (for example, moving between the AOPA website (www.aopa.org.au). To find out more about a bed and a chair) and then potentially walking with the new Limbs4Life please visit www.limbs4life.org.au. prosthesis. During this time, the prosthesis socket may be replaced multiple times as the shape of the residual limb changes. The prosthetist will also spend time adjusting the alignment of the prosthesis, by altering the angle and position of the socket relative to the other parts of the prosthesis. The definitive prosthesis A definitive prosthesis is a more permanent, or long-term prosthesis. A definitive prosthesis is provided after initial Disclaimer – This fact sheet does not replace clinical advice. If you require orthotic services AOPA reccomends rehabilitation is completed and when limb volume has stabilised, speaking to your practitioner. This fact sheet was developed based on interpretation of current evidence as of indicated by consistent prosthetic fit over a period of time. May 2018. References available on request. www.aopa.org.au 2 of 2