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Below Knee Amputee Advice and Exercises Booklet
Above Knee Amputee Advice and Exercises Booklet
Patient Information Fact Sheets
Northern Regional Alliance - Amputee Rehabilitation Pathway
Click here to view the Northern Regional Alliance's Regional Amputee Rehabilitation Pathway across DHBs, Auckland Artificial Limb Centre and the Community. This resource is designed to ensure that all people with amputations have access to Interdisciplinary Team rehabilitation services across the Northern Region.
Little Jelly Bean
A shared story from a great family and a brave girl who had an amputation. Read more
There are many questions to ask around the time of amputation and during rehabilitation. We have divided these questions and answers into three sections to help you find an answer to your question. Answers may also be found by exploring the rest of the website.
Answering some questions about the amputation itself – who you can talk to, what happens after the surgery and how long it might be before you can walk again, and all about bionic limbs.
I Have Been Told I Need An Amputation - Who Can I Talk To?
We can arrange for you to come to an Artificial Limb Centre to talk to our prosthetists (who will make and fit your artificial limb) and physiotherapists. We can also arrange for you to meet with another amputee of similar circumstances if you want to talk to someone who has been through it before.
What Happens After The Amputation? When Will I Walk Again?
After the amputation there will be a time of recovery, adjustment and rehabilitation.
Everyone is different so there's no set time span for recovery and walking again. Recovery time is often determined by amputation level, your health and fitness and also the desire to get back to normal life again.
Are Bionic Limbs Available That Can Make Me Just Like I Was Before?
A prosthesis or artificial limb is an artificial replacement for a missing limb or part of a limb.
Although an artificial limb will not be as natural as your own limb, it can help you to do many things successfully if you put your energy and willpower into learning how to use it.
It's important to work with your doctor, prosthetist and therapist. Keeping up with your team so they can design and fit your limb correctly and then train you how to use it is the key to being a successful artificial limb user.
Questions about your artificial limb are answered here including how it stays on, how it works, how to prepare yourself for your new limb and how you learn how to use it, what happens if it breaks down and whether you can swim or shower wearing it.
What Does An Artificial Limb Look Like? How Will It Stay On?
Each artificial limb is tailor-made for you, depending on the level of your amputation, your physical ability and your needs. Most standard artificial limbs are made of component parts attached to a socket that fits over your residual limb.
The artificial limb is generally held on by the socket and also a strap, but there are other ways too. Your prosthetist will decide which method suits you best based on both the type of amputation and the type of artificial limb you have.
How Does An Artificial Limb Work? Will I Be Able To Do All The Things I Did Before I Lost My Limb?
Most people who lose a limb can get back to normal daily activities within a few months.
How well you function depends mainly on your goals, along with a comfortable artificial limb, good follow-up care, and a can-do attitude from you as well as your team at the Artificial Limb Centre.
What If My Artificial Limb Doesn't Fit Right?
Follow-up is as important as the initial fitting. You will need to make several visits to the prosthetist for adjustments, as well as training with a therapist. Between them, they can help ease pressure areas, work out any problems, and enable you to regain the skills you need to adapt to life after limb loss.
Tell your prosthetist if your new limb is uncomfortable, too loose or too tight. Ask questions about things you need or want to do. Communicate honestly about your needs. The more you tell your prosthetist and therapist, the better you will be able to succeed with your artificial limb.
How Long Will My Artificial Limb Last?
Depending on your age, activity level and growth, your artificial limb can last anywhere from several months to several years.
In the early stages after limb loss, changes in the residual limb can lead to shrinking. This may lead to a need for socket changes, the addition of liners, or even a different device.
Later on, increased activity levels and the desire for additional function can mean a change in the artificial limb or some of its component parts. Once you are comfortably set-up and the limb is working as you want it, it will only need minor repairs or maintenance and can last for an average of three years.
Is It Difficult Learning To Use An Artificial Limb?
Learning to use an artificial limb is a tough job. It takes time, great effort, strength, patience and perseverance. You will work with a therapist while learning how to handle your new artificial limb. You will need guidance on how to:
- take care of your artificial limb
- put on (don) and take off (doff) your artificial limb
- walk on different surfaces, including stairs and uneven terrain
- handle emergencies safely, including falling down and getting up again
- perform daily activities at home, at work and driving a car
- investigate new things you may like to try, like sports and recreational activities
What Can I Do To Prepare Myself For An Artificial Limb?
There's a lot you can and must do to be able to use an artificial limb and use it well. Top priorities are:
- working through your feelings about losing a limb and deciding how to rebuild your life after amputation
- exercising to build up the muscles needed for balance and walking
- preparing and taking care of your residual limb to attain a proper, sound shape for the artificial limb
- learning proper body positioning and strengthening, to maintain tone and prevent contractures.
You will be advised by the therapy staff in the hospital on all of the above before you go home
Will I Need To Use A Wheelchair Or Crutches?
Some people choose not to use an artificial limb, relying on mobility devices.
However, even when you have an artificial limb, whether you also use crutches or a wheelchair depends on several factors including level of amputation, whether you have a single or bilateral amputation, and your level of balance and strength.
Most amputees have a pair of crutches for times when their limb is off, including night time trips to the bathroom, showering, participating in certain sports, and to help if the artificial limb needs to be left off for any length of time.
If you have lost both legs, you will use a wheelchair at least some of the time. Unilateral amputees may find it helpful to use a walking stick, walking frame or crutches for balance and support in the early stages of walking or just to have a break from the artificial limbs. The best advice will come from your therapist and is based on factors such as age, balance, strength and sense of security.
Once I Have Been Fitted And Feel Comfortable With My Artificial Limb, What Will Happen Next?
It's best to plan on making follow-up visits to your prosthetist as a normal part of your life. Proper fit of the socket and good alignment are the keys to making sure that your artificial limb is meeting your needs. Artificial limbs, like cars, need regular maintenance and repair to keep working well. Even small adjustments can make a big difference.
Can The Limb Break Down?
Yes, things can happen to your limb that will require repair or replacement, so it's a good idea to contact your prosthetist if you think something's not right and let him/her have a look at your artificial limb.
Get small problems with your artificial limb taken care of straight away. There's no benefit to waiting until something falls apart or causes you serious skin breakdown. If you wear an artificial limb too long when it needs repairs or replacement you can do harm, not only to your residual limb, but also to other parts of your body. Strain on other muscles, especially in your back and shoulders, will affect both your posture and also the performance of the artificial limb and the energy needed to use it. Early prevention is more valuable than long-term treatment.
Can I Choose What Kind Of Artificial Limb I Want?
We will discuss your prosthetic prescription with you, and then make the decision on your artificial limb in consultation with you. This is based on your lifestyle, activity level and general health.
Can I Swim Or Shower With My Artificial Limb On?
No, because the parts inside the limb will corrode. It is better to swim without wearing your artificial limb.
Why Is The Leg Heavy?
Your artificial limb needs to be strong enough to support your weight, so it's as light as we can make it. It is actually much lighter than the leg that has been amputated. However, it feels heavy because it is not part of the body and is being moved by a shorter section of your remaining leg or arm.
How Long Can I Wear The Leg For?
Everyone is different and has different levels of tolerance. Initially you will have a structured programme designed to increase your tolerance to wearing the artificial limb. You will become more familiar with your own limits with practice.
My Skin Goes Red When I Wear The Limb. Is This OK?
Certain areas of your socket will produce more pressure than other areas and your skin will tend to redden with this pressure. The redness should go away within around 20 minutes of removal of the limb. If the redness persists or is also itchy, contact your prosthetist for advice, he/she may suggest you see your GP.
Why Are The Bones In My Stump Becoming More Prominent?
At first your limb will be swollen. As the swelling goes down, your bones will start to show more. Also the muscles that used to move your limb will begin to reduce in size through lack of use which makes the bones seem more prominent. This is very normal and isn't usually a problem.
Will The Arm Look Natural?
Unfortunately most artificial arms do not look completely natural and can have a mechanical look about them. Your arm will not hang completely straight due to the suspension required. There are various movements you can make for the arm to rest in a natural position when, for example, you sit down. Basically, the more you wear the arm, the more natural your movements will become. You can also use jewellery or a watch to give a good effect.
What Will I Be Able To Do With My Artificial Arm?
Your arm will either be purely cosmetic or have a detachable hand which can be exchanged for a hook. The method of opening and closing a hand or hook will vary. You'll need to dicuss your needs with your prosthetist.
Will The Bone At The Bottom Of My Stump Take The Weight
The level of your amputation will determine where the pressure is taken. Any cut bones will not directly support your weight although there may be contact. Every effort is made to ensure comfort and protection of your stump.
Can I Change The Shoes I Wear?
Yes you can, but the height of the heel and sole need to be similar unless you have a foot which is able to be adjusted at home - check with your prosthetist first.
Answers to all the general and practical questions like how you get an appointment at a Limb Centre, what happens when you get there, how to get your house assessed by an Occupational Therapist, whether you can drive your car and what’s involved if you’re a carer.
How Much Does The Artificial Limb Cost?
In general, artificial limbs are free to New Zealand citizens and permanent residents. Special artificial limbs that may be needed for vocational and recreation purposes may be available under certain circumstances and can be supplied at the amputee's own expense.
Non-residents will need to pay before receiving our services - the price varies depending on the artificial limb required - please call us for further information.
How Do I Get An Appointment?
In most circumstances the hospital that did your amputation will send a referral for you to the Limb Centre. The Limb Centre will then make an appointment for you. Sometimes (rarely) a referral is not done and no contact is made - in this instance we accept referrals from a GP, health provider or from the amputee. Once you have made your initial appointment, further appointments can be made directly with the Artificial Limb Centre and you do not need to go through your GP.
How Will I Get There?
If you are still an inpatient, the hospital will arrange transport for you either by ambulance or taxi. Once you are discharged you will need to arrange your own transport. You can apply for travel assistance through ACC (if your amputation was the result of an accident) – ACC - What help can I get?, or through WINZ – Civilian Amputee Assistance. You can also apply for a Total Mobility Card (TM Card) that gives a discount on taxi fares. You can also try the Ministry of Health – Who's eligible for travel assistance. The Artificial Limb Centre has all the forms for you to claim back travel costs.
What Happens When I Get To The Artificial Limb Centre?
You will be assessed by the clinical team who are: surgeon, physiotherapist & prosthetist. They will discuss your rehabilitation plan with you and assess your healing, strength, ability and importantly what goals you have. We take a plaster cast or measurements of your stump so we can begin to make your artificial limb. All artificial limbs are custom-made for each individual.
There will be several appointments for fitting before you receive your finished limb.
What Do I Need To Bring To My Appointments?
If you have a discharge report from hospital please bring it with you so we can put a copy with your records.
Please make sure you are wearing comfortable clothing, if you are an above knee amputee you may like to wear shorts (we appreciate you wearing underwear with substantial cover) as we will need to work intimately.
Please bring a pair of shoes to your fitting appointments.
Can I Drive My Car?
Depending on the site of amputation you might need an adaptive device to get driving. You will need to advise your insurance company that you are now an amputee. You might be required to undergo a driving assessment to ensure you are able to continue to drive safely. If you are concerned please consult your GP.
I Can't Get Into My House Or Into The Toilet/Bathroom Because Of Steps.
Are There Increased Risks For Other Health Problems?
Limb loss is usually the result of, rather than the cause of other health problems. However, since the loss of a limb can result in decreased activity, the risk of health problems associated with a sedentary lifestyle may be increased.
Residual limb and phantom pain, as well as skin problems associated with artificial limb use are also common.
Maintaining a stable weight is extremely important so you can keep fitting into the socket of your artificial limb. Regular exercise also helps decrease the risks of other health problems.
My Baby Was Born With A Limb Difference But Is Not Strictly An Amputee - Can You Help?
Yes, we can usually assist with a prosthetic device from an early age, which will be determined by the clinical team at the Artificial Limb Centre.
What Are Limb Loss And Limb Deficiencies?
Limb loss generally refers to the absence of any part of an extremity (arm or leg) due to surgical or traumatic amputation. The term limb deficiencies means the congenital absence or malformation of limbs.
What Causes Limb Loss And Limb Deficiencies?
Limb loss can occur due to trauma, infection, diabetes, vascular disease, cancer and other diseases. The causes of congenital limb deficiencies are frequently unknown.
What Is Involved In Caring For People With Limb Loss And Limb Deficiencies?
Caring for a person who has undergone an amputation will depend greatly upon his or her overall health and strength. People who are candidates for artificial limb use will make several visits to their prosthetic facility to obtain a correctly fitting limb. Physical/occupational therapy or gait training may be needed to facilitate successful use of their artificial limb and other assistive devices to regain independence. Some new amputees may also need professional assistance with emotional adjustment to limb loss. Amputees whose health does not permit artificial limb use may require more assistance with mobility and transfers.
How Do I Cope? I Don't Want To Be Seen Out In Public.
As a new amputee you have a lot to deal with. The trauma of the amputation and the impact it has on your career, relationships, finances, sexuality, and self-esteem can be difficult to handle. Getting to grips with the emotional side of things can also help you to deal with the physical barriers. Getting out of the house and participating in life is essential to your long-term health and well-being.
Design and Implementation of Interdisciplinary Care Guidelines for Hospital Management of Amputees in Christchurch
Amputee Mobility Predictor
Confused by some of the terms we use? Jargon Buster is here to break down those word barriers and help you understand what we mean when we say things like ankle disarticulation, contracture, dorsiflexion or supercondylar. Once you've looked it up here, you'll know exactly what we mean, and you'll always be able to tell your transfemoral from your transtibial.
Abduction - where part of the body or prosthesis is angled away from the midline of the body.
Adduction - where part of the body or prosthesis is angled towards the midline of the body.
Alignment - the adjustment of the relationship of the socket to the foot to provide optimum comfort and the best possible function.
Amputation site - the actual site or level where the amputation has or will be performed.
Above elbow (AE) or transhumeral amputation.
Above knee (AK) or transfemoral amputation.
Ankle disarticulation - usually called a Symes amputation, through the ankle joint.
Artificial Limb Centre - a clinic for treating amputees and where prostheses are prescribed and manufactured.
Atrophy - the reduction in the size of a muscle, often from disuse.
Below elbow (BE) or transradial amputation.
Below knee (BK) or transtibial amputation.
Bilateral - affecting both sides. For amputees this often means a double amputee.
Check fit socket - a clear plastic socket from which the prosthetist will be able to determine the accuracy of the socket fit.
Clinical prosthetist - a professional specialising in the fitting, fabrication, aligning and repair of artificial limbs.
Congenital limb deficiency - the absence of a limb or part of a limb at the time of birth.
Contracture - a contracture of tissue, usually muscle, tendon or joint capsule, which limits the range of movement of a joint. The joint cannot be straightened.
Cosmetic cover or cosmesis - shaped foam which covers the internal structure of the prosthesis.
Cosmetic hand - a terminal device that provides a cosmetic replacement. They are usually non-functional or passive.
Cuff – a strap used to suspend a below knee prosthesis.
Digital amputation - amputation of a toe or finger.
Disarticulation - amputation through a joint.
Doffing - the act of taking the prosthesis off.
Dorsiflexion - the position of the foot when the toes are pulling up.
Donning - the act of putting the prosthesis on.
Dynamic foot - a type of prosthetic foot which stores and releases walking energy, hopefully making walking more efficient.
Edema or oedema - swelling of the limb, usually due to excessive accumulation of fluid.
Elbow disarticulation - amputation through the elbow joint.
Extension - the straightening of a joint.
Femur - the thighbone.
Fibula - the thinner bone that runs down the outside of the shinbone.
Flexion - the bending of a joint.
Forequarter amputation - amputation that removes part of the shoulder with the arm. More correctly know as an interscapular thoracic amputation.
Gait - the process of walking.
Gait analysis - the study of how a person walks.
Hemipelvectomy - amputation that removes part of the pelvis with the limb. Historically referred to as a "hindquarter" amputation.
Hip disarticulation - amputation through the hip joint.
Interscapular thoracic amputation - amputation that removes part of the shoulder with the arm. This used to be known as a "forequarter" amputation.
Ischial tuberosity - a thick part of the pelvis in the buttocks, used to take the weight in an above knee prosthesis. Sometimes called the ischium or sitting bone.
Jig - a device used by a clinical prosthetist to assist in the process of alignment of a prosthesis during manufacture.
Jig (walking) - an adjustable jig that allows the clinical prosthetist to try variations of alignment during prosthetic fitting, used at the stage when walking alignment is being built into the prosthesis.
Knee disarticulation - through the knee joint.
Limb Centre (Artificial Limb Centre) - a clinic for treating amputees and where prostheses are prescribed and manufactured.
Liner - a soft flexible lining insert worn between the stump and the socket.
Multi-disciplinary team or clinical team - team members include clinical prosthetist, orthopaedic surgeon/rehabilitation specialist and a physiotherapist.
Modular (endoskeletal) prosthesis - a prosthesis with an internal rigid structure and (optionally) a cosmetic foam cover.
Oedema or edema - swelling of the limb, usually due to excessive accumulation of fluid.
Orthopaedic surgeon - a surgeon trained in disorders of the bone and joint, muscle and nerve, with a particular interest in correcting gait.
Osseointegration - a revolutionary procedure for amputees that utilises a titanium rod implanted in the bone of the residual limb to attach the prosthetic appliance instead of a traditional socket. Over time, the existing bone grows into the the titanium, creating a single structure that offers a number of advantages over a prosthetic socket.
Parallel bars - two parallel bars at palm height between which an amputee can walk during gait training.
Patella - kneecap.
Patella tendon - a thick tendon that can be felt between the kneecap and the top of the shinbone. It takes weight well so is often used for support in below knee prostheses.
Phantom limb - awareness of the part of the limb that is missing.
Phantom pain - the feeling of pain in an absent limb or a portion of a limb.
Phantom sensation - sensory awareness of the part of an amputated limb that is no longer present - a normal and non-painful condition.
Pistoning - when the residual limb moves slightly into and out of the socket.
Plantarflexion - position of the foot where the toes are pointing down.
Plaster cast - the application of a plaster bandage to produce a cast or replica of the stump.
Pressure area - an area of tender or broken skin caused by pressure.
Pylon - the pole of the prosthesis that gives it height.
Prosthesis - a device which replaces a missing body part; an artificial limb. Some common types are:
- PTB - Patella Tendon Bearing prosthesis - attached by a cuff
- KBM - Modified Supra-condylar prosthesis – self-suspending
- PTS - Patella Tendon Supra-condylar prosthesis – self-suspending.
Prosthetist - a professional specialising in designing, fitting and making of artificial limbs.
Range of movement - the distance a joint can be moved in its various directions.
Rehabilitation specialist - a medical specialist trained in all forms of rehabilitation.
Rigid removable dressing - a removable cast applied to the below knee stump to protect and shape the stump.
SACH foot - Solid Ankle Cushion Heel prosthetic foot.
Shoulder disarticulation - amputation at the shoulder joint.
Shrinker - a compression sock specifically for stumps, used to control swelling.
Silicon or gel liner - a type of liner made of a rubbery synthetic material that rolls onto the stump.
Sleeve suspension - for below knee amputees a sleeve rolls over the prosthesis and onto the thigh for suspension.
Socket - a hollow replica of the stump that provides an interface between the body and the prosthesis.
Split hook - a functional steel or aluminium terminal device for the upper extremity prosthesis.
Stump/residual limb - the remaining part of arm or leg following amputation.
Stump sock - a protective sock to be used when wearing a prosthesis. They are made of various materials, the commonest being wool.
Stump pain - pain felt in the stump (residual limb).
Stump volume - size of the stump
Suction socket - a socket that requires no external suspension as it is held in place by total contact adhesion.
Surgeon - a doctor who specialises in operative treatment.
Suspension - a harness or device that holds a prosthesis on.
Supercondylar - above the condyle (which is the widest part of the knee joint).
Symes amputation - amputation through the ankle joint.
Tracer CAD - digital image of the residual limb (stump). The image is modified electronically to create the shape by the clinical prosthetist from measurements taken. It is then sent to the carver to produce the socket design out of lightweight foam.
Transfemoral - above knee (AK).
Transhumeral - above elbow.
Transtibial - below knee (BK).
Transradial - below elbow.
Tibia - shinbone.
Ulcer - lesion or opening of the skin.
Unilateral - affecting only one side.
Vascular surgeon - a surgeon specialising in operative treatment of blood vessel disease.
Volume loss - when the stump shrinks, making the prosthesis not fit as well.
Volume changes - when the stump goes up and down in size, often related to body fluid levels. Makes a consistent fit of the prosthesis difficult.
Wrist disarticulation - through the wrist joint.