Principles of contemporary amputation rehabilitation in the United States, 2013.

Providing rehabilitation services for the person with an amputation has become more difficult in today's health care environment. Amputation rehabilitation calls for specialized, multidisciplinary rehabilitation training. In examining the principles of amputation rehabilitation, one must understand the lessons learned from the Veterans Affairs Amputation System of Care and return to the founding principles of rehabilitation medicine. Persons with amputations must be reevaluated in a tight program of follow-up care.

Amputation surgery.

The best level of amputation must take into consideration the newest socket designs, methods of prosthetic suspension, and technologically advanced components. In some instances stump revision should be considered, to provide a better prosthetic fitting and function. Targeted reinnervation is a new neural-machine interface that has been developed to help improve the function of electrically powered upper prosthetic limbs. Osseointegrated implants for prosthetic suspension offer amputees an alternative to the traditional socket suspension, and are especially useful for transfemoral and transhumeral levels of amputation. Cadaver bone can be used to lengthen an extremely short residual bony lever arm.

Pain issues and treatment of the person with an amputation.

Most people with amputations should not experience pain that interferes with their quality of life or requires regular medication more than 6 months following the amputation surgery. In fact, most people with amputations do not experience significant pain more than 3 months following the amputation. However, the clinician must specifically define what these patients mean when they relate that they have pain. The pain must be carefully differentiated to treat it properly. Most problematic pain that is present more than 6 months after amputation is related to a poorly fitting prosthesis and should be labeled as residual limb pain.

Ideal functional outcomes for amputation levels.

This article provides a generalized overview of amputation classifications and the idealized outcomes for upper and lower amputations at their respective levels. The following levels are discussed: above knee/transfemoral, below knee/transtibial, above elbow/transhumeral, below elbow/transradial, and bilateral for upper and lower extremities. This classification defines a framework for clinicians to share with patients so that they understand the potential for their expected functional outcomes regarding mobility and activities of daily living, both with and without a prosthesis. Moreover, it addresses some of the vocational and avocational needs of the individual regarding amputation.

The person with amputation and their life care plan.

This article describes the collaborative relationship between the physiatrist and life care planner/case manager when preparing a life care plan for a person with an amputation. The complexities and interrelationship of physical, emotional, and pain issues require medical expertise and knowledge for the development of prognosis and relevant recommendations. The life care plan requires coordination between medical and rehabilitation professionals to address the impact of amputation and its associated impairment on all life roles.

Landmine injuries and rehabilitation for landmine survivors.

There is a tremendous international need for the development of rehabilitation educational programs, especially in low-income countries. These programs are most urgently needed in those countries where there is active conflict, where there has been recent civil war, and where significant casualties have been created because of landmines and weapons-fire. Most of these countries are developing nations where rehabilitation is a lower priority than the provision of basic health needs. These countries generally have few financial, personnel, and system resources to provide much rehabilitation for their disabled citizens. Also, they generally have few, if any, physicians trained in the principles and practice of rehabilitation medicine. These countries can benefit from the use of psychiatric consultants to help assess their rehabilitation needs in designing relevant educational curricula for health professionals and in developing rehabilitation teams. These teams can then develop systems of care for the most common disabling conditions in that area of the world. Western technology, however, cannot be imposed on these countries. Any rehabilitation systems of care must be established within the context of the particular culture and governmental health system organization, if it is to be useful and succeed in a particular nation.