Rehabilitation of the lower extremities after amputation

Doctors and a nurse will take care of the stitches after surgery. You need to follow their instructions. This is especially true for patients with diabetes mellitus and vascular disease, as they are at increased risk of infection.
After amputation, the skin of the stump is very sensitive. Using a soft brush or massage ball, you can lightly massage the stump. It is also effective to rub the stump with a stiff towel or a terry cloth washcloth. Always massage from the end of the stump to its base.
For daily care of the skin of the stump, it is necessary to observe hygiene - a contrast shower of the stump, washing it with baby soap is recommended. Inspect the skin of the stump daily for any changes in the skin condition and, if they occur, immediately inform your doctor or prosthetic technician. It is convenient to use a small hand mirror to examine the stump.
In most cases, it takes three to four weeks for the wound to heal after amputation, and then a postoperative scar is formed, which must be moisturized regularly. Lubricate the scar daily with an odorless cream.

An important problem that needs to be addressed is swelling after surgery as a natural reaction of the body to surgery. Under normal conditions, the swelling subsides in one to two weeks.

Until the stitches are removed, the wound should not be bandaged tightly. Initially, no pressure should be applied to the stump. In order to reduce swelling in the first few days after amputation, it is important to place the stump above the level of the heart. Then comes the stage of compression therapy to reduce swelling and prepare the stump for prosthetics. This therapy helps to improve blood circulation in the stump, reduces pain and accelerates scar healing.

To eliminate swelling, it is recommended to use an elastic bandage, compression knitwear, and a silicone cover. A lymphatic drainage massage performed by a specialist will also be helpful. Initially, all of the above actions are performed by medical staff, teaching relatives and the patient himself. Then the patient performs these procedures independently.

The bandage should not be loose or tight. The stump is bandaged in the morning after sleep, and the bandage is removed before going to bed: the pressure in the distal (lower) part of the stump should be maximal, but not painful. The higher the bandage, the lower the pressure. This helps to avoid limiting blood circulation in the stump.

Patients after amputation above the knee level are recommended to lie on their stomach for 30 minutes twice a day. The head should be turned to the healthy side. This ensures easy stretching of the muscles on the stump.

To determine the effectiveness of decongestant therapy, the circumference of the stump is measured in the morning and evening at the same measurement points.

Joint contracture is a limitation of passive movements in a joint caused by scarring deformation of the skin, muscles, tendons, and joint. Most often, flexion contractures (i.e., limb conditions when it cannot be bent) occur in the hip, knee, and elbow joints, which impede prosthetics and prolong rehabilitation.

Prevention methods:

1. Ensuring the correct position of the limb during its immobilization. The stump should be in a straightened position as much as possible. Do not keep the stump in a bent position for a long time, as the muscles will shorten and the mobility of the stump will decrease.

2. Timely elimination of pain and swelling. After the amputation, it is recommended to use a wheelchair with a special footrest for the stump, which prevents deformation of the spine. Sometimes it is necessary to change the position of the stump so that the joints do not lose mobility. The combination of proper body position and movement is an important condition for the treatment of swelling and pain.

3. Active and passive therapeutic exercises. When performing exercises, avoid movements that cause pain. At the first stage, gymnastics is performed under the supervision of a physiotherapist, starting with breathing exercises, stretching exercises, strengthening the muscles of the spine, arms, healthy legs, balance and coordination.

Phantom pain is a feeling of pain that occurs in the lost limb. For example, a feeling of tissue damage that occurred at the time of injury or itching, a feeling of numbness in the missing limb. Early patient activation (sitting and upright position), massage and lymphatic drainage of the stump, uniform pressure in the stump created by bandaging and compression knitwear, physiotherapy, early start of physical exercises, and early prosthetics help to reduce phantom pain.

In rare and complex cases, nerve block and surgery are required. In addition to the participation and support of family and relatives, the help of professional psychologists should not be neglected. In the first months after surgery, pain can be exacerbated by poor blood circulation in the amputated limb, prolonged immobility, infections, and sleep disturbances.

The cause of pain in the later period is mainly negligence in the care of the stumps and improper wearing of prostheses. To check the correctness of the prosthesis, you need to put on the prosthesis and take a few steps. If, despite observing all the rules for its use, severe pain occurs in the stump, you should consult a doctor.

Mirror therapy is very effective. The brain integrates signals as coming from the amputated limb (contraindications - double amputation). The help of a psychotherapist is possible. In some cases, the use of medications is recommended with the consent of the doctor.

Here are some tips that will help during the rehabilitation period:

Try to dress and undress yourself
Replace buttons with Velcro. Today's range of clothing and footwear allows you to choose options that greatly simplify the process of use. As for shoes, in addition to Velcro, there are now models with special laces that are easy to tie with one hand.
You can cook on your own
Use special devices to open cans and preserves. Also pay attention to special boards for cutting and chopping food. In addition, there are many devices that are designed to be used with one hand. A fork-knife, for example, simplifies the process of eating and makes it more comfortable.
Get back to your favorite work
If you're used to working at a computer, take a look at the lists of gadgets that make this process easier. There are, for example, computer keyboards designed specifically for people with one hand.

Living with a prosthetic leg means, first of all, acquiring new walking skills and the difficulties associated with this process. Walking with a prosthesis is much more difficult than without it. Many patients, especially at the first stages of rehabilitation, say that using crutches is a better option than using a prosthesis. But over time, persistence in learning and training shows, and the prosthesis allows these people to cover significant distances and return to a full life.

The rehabilitation process can be very different and depends on the patient's psychological state, willingness to make efforts, as well as the nature of the injury and the type of prosthesis.

A below-the-knee prosthesis provides greater stability and the ability to maintain balance, as the amputation did not affect the knee joint. The brain adapts better to such movement, and the body can more easily bear weight and get used to new movements.

Rehabilitation after an above-the-knee prosthesis is always a more difficult process. Your prosthesis will have an artificial knee joint. This is necessary so that you feel more stable and can better distribute the load. However, learning to walk on such a prosthesis is more difficult and often leads to falls in the early stages of training. Patients with this type of prosthesis need to use walkers and crutches more to regain their confidence and mobility.
What should I do to learn to walk with a prosthesis?
The process of adjusting to the prosthesis and learning to use it is different for everyone. The average training period is about five months.
Use the following tips to help you learn to use your prosthesis:
Actively participate in the fitting process
Fitting the prosthesis is one of the most important processes in the first stages of rehabilitation after prosthetics. The more comfortable and secure the fit is, the more effectively you will be able to control your movements and the easier the learning process will be.
Always share information with your prosthetist about changes in your sensations, inform them of any discomfort or other problems. The task of the specialists is to respond to your feelings and thus help you get used to wearing the prosthesis.
Learn to distribute weight
An obligatory stage of training is the use of parallel bars. The support is necessary because we are afraid to load the prosthesis, to transfer the weight of our body to it. Do not worry if you use the bars for what seems like a very long time. This is the most important stage - learning to distribute your body weight while walking. Once your brain gets used to the new environment and your muscles start to get stronger, you will automatically start to rely less on the bars.
Start by supporting yourself on both hands, and over time you will notice that you rely less and less until you can move with minimal upper body support.
It is clear that this stage is likely to be longer for patients who have undergone a knee amputation. And, as a rule, it is even longer for those undergoing rehabilitation after bilateral amputation.
Balance
The ability to keep your balance will also take time. Your brain will record the absence of the usual mechanisms that used to be responsible for body balance. Dozens and dozens of muscles and joints in the toes, feet and ankles used to help with balance. Now, new roles will be created, and muscles will be further developed that will now take on the function of balance. At first, you will need to make a conscious effort to train these muscles. Then everything will be done automatically.
Take your time
As soon as you are ready, you will feel it. Patients talk about the surge of strength and internal excitement that precedes walking on their own.
Then do everything slowly. Take time to learn how to stand. Your body needs to find a new center of balance. This is important for future success.
Repeat the standing exercises over and over again. Your goal is not to make a conscious effort. The key to success is unconscious stability, without which further progress is impossible.
Once stability is achieved, take one step at a time. Focus on this process. Monitor your muscles and your comfort level. Your comfort level will increase all the time until you start covering long distances.

Exercises should be started after the postoperative wound has healed and with the permission of the operating doctor.

The pace of the exercises should be slow, starting with a small number of repetitions, 2-3 times a day. Over time, after the sutures have been removed, each exercise should be performed about 10 repetitions 2 times a day, provided that you feel well and there are no contraindications.