Losing a limb and living with a lost limb are two very different approaches to the concept of disability. While it is true that the loss of a limb (especially lower limbs) poses a very difficult set of challenges to disabled individuals, integrating and settling back into the community is still possible, mainly thanks to the field of prosthetics. A prosthesis allows an individual to ambulate successfully, thereby helping the disabled individual take part in most of the daily life activities. In today’s discussion, we talk about the rehabilitation procedure for the disabled and review its key stages with a special emphasis on prosthetics. Familiarizing masses with the finer points of rehabilitation procedures is crucial since recovery from a disability is considered almost impossible or too expensive in most third world countries. Tag along, read till the end if this is your first time reading about prosthetics! Plenty of insight about the rehabilitation procedure coming your way.
Before we talk about the key steps of the rehab process for the disabled, let us start with the basics and define what rehabilitation means in the current context. According to the WHO, rehabilitation is defined as:
“A set of measures that assist individuals who experience, or are likely to experience, disability to achieve and maintain optimal functioning in interaction with their environments[i]”
Here, it is important to make a distinction between two similar terms i.e. habilitation and rehabilitation. The former refers to a process that helps those individuals who are born with a disability or acquire one in the very early stages while the latter is concerned with helping those who acquire a disability as a result of some unfortunate experience or accident.
What is meant by prosthetics and orthotics?
The rehabilitation procedure for the disabled ones is devised based on key discoveries made in the field of prosthetics and orthotics. It is important to define these terms briefly before we narrate the events of the rehabilitation procedure as well. First, let us talk about prosthetics. Simply speaking, prosthetics are externally applied devices that serve as a replacement to a complete or partially lost portion of a limb. On the other hand, orthotic devices are applied to modify the structural and physiological features of neuro-musco-skeletal systems[ii]. Both of these biomedical technologies fall under the category of assistive health technologies.
The rehabilitation process
We now come to the central point of this discussion i.e. stages involved in amputee rehabilitation. To keep things simple, we have discussed the events of the rehabilitation procedure under separate headings, in the following sections.
Once the pre-operative assessment of the amputee is completed, amputation surgery is performed. It is the responsibility of the surgeon to ensure that the reconstruction phase during an amputation surgery goes as smoothly as initially planned. As for the pre-operative assessment, it involves both objective and subjective assessment. The decision about the extent of amputation is made only after this evaluation of patient history and the current range of movement. Post-operative care involves taking care of the wound, proper dressing with plaster of Paris, and ascertaining that the patient doesn’t displace the dressing for at least a week after amputation[iii].
Pre- prosthetic stage
In this stage of the rehabilitation procedure, a decision is made about the suitability of the prosthetic limb. This decision is made based on information obtained by carefully monitoring a patient’s progress post-amputation. It is important to take the patient’s opinion at this stage as well, only then a clear rehabilitation goal can be set. Another key point to be noted at this stage is how comfortable the amputee is with the use of early walking aids.
If the medical teams monitoring an amputee give a green light about the patient’s condition, then things are fast tracked to the prosthetic prescription stage of the rehabilitation procedure. Two events take place in this stage of the procedure. The first is casting, second is fitting. The former event is concerned with measurements while the latter is concerned with the correct fitting of the assistive intervention. Error-free measurements are essential to the process, it is only precise measurements that allow a patient to stand and walk normally post prosthetic stage.
In this stage of the rehab process, a physiotherapist helps the patient adjust prosthesis and tries to pacify any raging queries that might be building up in the patient’s mind. From here onwards, therapists have a more crucial role to play than the medical team of doctors and nurses. It is essential to educate the patient about the new normal, and implications associated with it. For example, some patients undergoing an amputation might be a little overweight. Hence, the training regimen for them will differ slightly from what a skinny person might have to follow.
Adapting to the new normal
This is where life resumes in a manner almost as natural as it was before a person acquired a disability. Social and personal life resumes, but it does not mean that the role of physiotherapists is over. Instead, regular check-ups are scheduled to ensure that there is no complications post prosthesis implantation. It is important to ascertain that the device has indeed increased a patient’s mobility levels and that the goals that were set at the start of the process are indeed met. In case a patient experiences major discomfort or pain, the amputation surgeon who conducted the surgery and physician are taken on board as well.
A careful estimate suggests that more than 100 million people need prosthetics for the resumption of normal life activities[iv]. But unfortunately, only one in ten get the implant that can help them have another go at life. The challenge is significant in third-world countries, where evils like poverty and poor healthcare systems further lower the probability of a disabled patient getting a prosthetic limb. Hence, there is a need for a serious effort on the part of governments, NGOs, and INGOs to ensure that more and more people can re-enter the normal stream of life with the help of prosthetic and orthotic devices.