Amputation Rehabilitation is crucial to assist the patient in regaining as much function as possible. Ideally, rehabilitation should begin before amputation surgery. Physiotherapists can show the patient the exercises that will be needed after surgery to begin rehabilitation. Additionally, a prosthetist (someone who makes prosthetics) may see the patient to discuss use of a prosthetic device after surgery (amputation). This may not be possible if the amputation is done on an emergency basis.



Upper Limb Amputation

In upper limb amputation, the hand or one or more of the fingers may be removed. The arm may be removed below the elbow or above it, or at the shoulder.

Most patients with an amputation of an upper limb will be fitted for an artificial arm, which can include fingers, a hook or hand, a wrist unit, and an elbow unit if the patient’s amputation is above the elbow. Movement of the hook or hand is accomplished mainly by movement of the shoulder muscles. Control of above-elbow prosthesis is generally more complicated than below-elbow prosthesis. Newer prosthetic devices can use energy produced by the patient’s own muscles to produce movement (myoelectric prosthetic devices).

Rehabilitation for an upper limb amputation involves:

• General conditioning exercises
• Exercises to strengthen existing arm muscles
• Relearning activities of daily living with and without a prosthesis

Lower Limb Amputation

In lower limb amputation, the leg may be removed above or below the knee, or at the level of the hip. Alternately, a foot or one or several toes may be removed.
Most patients who lose a lower limb are fitted for a prosthetic device, or an artificial leg.

Rehabilitation involves:

• Exercises to stretch the hip and knee (for amputations below the knee)
• General exercises to strengthen existing arm and leg muscles
• Standing and balancing exercises, which are usually done with parallel bars
• Endurance exercises
• Teaching the patient how to avoid contractures, or muscle shortening, which can occur after prolonged bed rest or sitting in a wheelchair.

Rehabilitation involves a lot of patient teaching. Amputation patients must learn how to condition the stump. This is done to prepare the stump for prosthesis, and usually involves the use of stump shrinkers or elastic bandages which are worn day and night. The purpose of this is to provide shape to the stump and to prevent swelling of the stump and fluid retention.

The patient may be provided with a temporary prosthesis so that learning to walk can begin. The patient progresses from using a walker or crutches to using a cane fairly quickly, and may 
be able to walk on their own in a matter of weeks.

When the patient is ready to use their permanent prosthesis, they must be taught how to put it on and take it off, how to care for the device and the stump, and how to walk in it.

Rehabilitation is generally long-term for a lower limb amputation. Patients must not only learn how to walk; they must learn skills such as walking on uneven surfaces and up and down stairs. Walking with a prosthetic device requires much more energy, and how quickly a patient progresses through rehabilitation depends on their age and physical condition before the amputation.