One of the best ways to maintain overall fitness of the heart and lungs is
to walk. Immediately following an amputation you are unable to do this and
you must use different ways of getting around. You may be supplied with a
wheelchair or you may be taught to hop with a frame or crutches. Hopping will
involve much greater effort than walking and you may tire quickly and find
yourself out of breath.
Using a wheelchair
requires much less effort than walking, although you are using your arms to
push and they may tire quite quickly at first. Early on when you are not walking,
pushing the wheelchair yourself or hopping are activities that will aid in
maintaining your general fitness. For example, you may be encouraged to propel
yourself to and from therapy each day to aid your general fitness. These activities
are also using the muscles of the arms and legs, helping to strengthen them.
When your activity
levels change you may find that you also gain weight. Excessive weight gain
can contribute to long term ill health and problems with maintaining a good
fit of your prosthesis therefore it is important to try and keep at a stable
weight. Maintaining some level of aerobic activity is helpful in preventing
excessive weight gain. Swimming has been identified as a good aerobic activity
and is worth discussing with your physiotherapist.
and flexibility of limbs
Following an amputation it is important to maintain the movement and strength
of all your joints and muscles. The physiotherapist will assess the range
of movement of your joints and the strength of your muscles. Many people are
tight or weak in particular muscles or stiff in particular joints. Your physiotherapist
will teach you specific exercises for these areas of concern. You will also
need to regularly exercise to maintain the muscles in the legs and to help
prevent the development of a joint contracture. It is likely you will be asked
to attend therapy once or twice daily to participate in an exercise program.
If you have had an above-knee amputation, or even higher such as a hip disarticulation
or hemipelvectomy, your sitting balance will be affected.
The higher the amputation, the less area you have to sit on and distribute
your weight through, you may hear this referred to as having a 'smaller base
of support'. You may find that sitting for prolonged periods becomes uncomfortable.
Some people require specialised cushions or seating to ensure they are comfortable
and have good posture when sitting in a wheelchair or chair.
Your physiotherapist may instigate activities in sitting to help improve your
sitting balance, if appropriate.
After the amputation your balance will be significantly affected. The shape
of your body has now altered and you have a much narrower base of support.
It is important that you re-adjust your balance and that you are able to stand
on the remaining leg if possible. Your physiotherapist will assess your balance
and ability to stand on one leg. They may instigate activities or exercises
in standing to help improve your ability to stand without holding on, or to
improve the time you are able to remain standing.
of your other leg
The remaining limb needs to be carefully looked after, for example, by using
appropriate footwear particularly if it has also been affected by the disease
process which caused the amputation, such as vascular disease or diabetes.
With good care of the remaining limb, particularly the foot, the risk of further
amputation can be minimized. You should check the skin on your remaining leg
regularly. If you notice any sores or areas of broken skin you should consult
your doctor to ensure you receive appropriate attention.
Regular Podiatry appointments are also recommended for cutting toe nails and
to help maintain a healthy foot.
around: Moving around in bed and getting out of bed
When you first meet the rehabilitation staff they will want to assess how
much you can move by yourself. They may start by assessing how you move around
in bed. For example, they may ask you to roll from side to side and move up
and down the bed to see if you are able to do these activities independently.
Next they will need to see whether you can independently sit up over the edge
of a bed from a lying position. If you are unable to do these tasks you may
need some practice and these tasks will be incorporated into your daily physiotherapy
program of exercise. Some special equipment may also help you.
Moving from one place to another is often referred to as "transferring".
Transferring out of the bed into a wheelchair or regular chair and back again
is very important. If you have one leg amputated you may be taught how to
do a low standing pivot transfer. You should always wear a slipper or a shoe
when transferring, this will help protect your other foot. If you have both
legs amputated you will need to use a forwards/backwards bottom shuffle or
a sideways transfer. Sometimes with the sideways transfer, a slideboard is
also helpful. Usually the physiotherapist will decide which is the most appropriate
transfer and what equipment you need and they will teach you. Other staff
members such as the nurses and the occupational therapist will also be assisting
you with transfers and ensuring you are safe.
around: Using a wheelchair
If you are provided with a wheelchair for your non-prosthetic mobility you
will be taught the safety features first. You must know how to put the brakes
on and off and move footplates and stump boards, if applicable. It is very
important that you learn the features of your wheelchair well. You will also
be taught how to propel the wheelchair with your arms and how to turn corners
and manoeuvre in tight spaces.
around: In the toilet and bathroom
Getting on and off the toilet is another activity that the therapy staff will
assess. Staff are aware that being able to get to the toilet independently
is very important to most people. In most hospital situations rails are located
beside toilets and these can be used to assist you in moving from your wheelchair
to the toilet safely. To begin with it is helpful to be able to position your
wheelchair at a 900 angle to the toilet and do a low pivot transfer if you
have one leg amputated. This way there is a minimum amount of distance to
If you have both
legs amputated then to begin with you may continue to use the frontward/backward
transfer method and sit on the toilet facing the cistern. Alternatively you
may position your wheelchair so that you can transfer sideways on to the toilet.
Shower transfers are another task that will be assessed and you may be given
some assistance with. Safety is of paramount importance when transferring
in the shower as this area is often wet and slippery. Ideally the shower base
should be level with the floor to allow ease of transfers. You may use a shower
chair or stool, and if there are grab rails in the shower, you can use these
to assist with a low pivot transfer. Alternatively you may use a wheeled shower
commode initially to get to the shower.
If you don't have a shower recess at home, only a bath, then there is equipment
available to assist you to sit over the bath and have your shower. Some people
who have had both legs amputated find this the safest and easiest method long-term.
You will need to practice these transfers with a variety of staff members
while you are in hospital and they can advise you about the equipment you
might need, and the methods you might use once you return to your home.
around: In and out of the car
Getting in and out of the car is much the same as getting from your bed onto
your wheelchair. When you begin you may find it easier to practice in the
front passenger seat as this allows you the maximum room.
You should position your wheelchair as close as possible to the side of the
car after you have taken off the footplates.
If you have one leg amputated then you should line up the front of your wheelchair
with the back of the car seat. Then you can do a low pivot transfer with one
hand on the arm of your wheelchair and one hand on the car seat.
If you have had both legs amputated then you should line up your wheelchair
with the car seat and use a slideboard to move sideways in and out of the
car. Always put your hand on the slideboard so it doesn't slip out of place.
your daily activities
One of the key goals of rehabilitation is to assist you to carry out the activities
that you want or need to be able to do to the best of your ability. Activities
will include tasks that you may need to do at home, at work at school or university,
or in other community settings. It is important that you can return to being
as independent as possible at home but also within the community, e.g. shopping,
visiting friends, attending church, playing bowls. Initially this may involve
learning to carry out these activities from a wheelchair and later on may
involve a trial of these and other activities using your prosthesis.
Following your amputation you will be encouraged to return to daily living
activities as you are able. This may begin quite soon after the amputation
in the acute hospital setting when you begin to complete some of your self-care
activities (e.g. showering and dressing) with some help from the nursing staff.
It will then continue as you begin to try some of the activities that you
used to do before you had your amputation. This may include such things as
cooking meals, completing housework, driving, gardening and returning to leisure
activities-all the things that contribute to having a full and meaningful
therapist will know of many different techniques and pieces of equipment that
will help you to maximise your independence. Some equipment may be useful
in the early stages while you are still getting stronger but you may not need
it longer term. Sometimes when you leave hospital and you can find that you
would benefit from a certain piece of equipment. You are advised to discuss
these issues with your occupational therapist and to talk to them about what
you hope to be able to do in the house.
I need to alter my house? Will I need to move house?
As one of the primary goals of the people looking after you is to help you
to return home to a safe and independent lifestyle it is important that you
discuss where your daily activities take place. While you are in hospital
you may be asked questions about your home. The sorts of things you may be
Which entrance do you go in and out of?
How many steps do you have?
Is everything inside on the same level?
Do you have a shower or a bath?
Have you already got any equipment at home?
It is common for a member of your treating team (usually an occupational therapist)
to arrange to visit your home soon after your admission to rehabilitation.
They may take you with them if practical, but on some occasions they may not
be able to e.g. if there are many stairs to your door. If you are unable to
attend, then it is useful to have a family member or close friend there to
help show the occupational therapist your home and help to give you information
about the visit.
Following the visit,
the occupational therapist will discuss their recommendations with you, and
together you will make a plan for any equipment or changes which may be needed
at home. The occupational therapist will make recommendations based on helping
you to maximise your independence, ensuring you are safe at home, considering
how you will manage activities independently as you get older, and financial
issues. There may be some financial assistance available and you are encouraged
to ask your occupational therapist or social worker about information regarding
this if you are unsure.
may include such things as:
Having a chair in the shower, or seat over the bath to assist you to shower
Having a ramp built to enable you to get in/out of your home in the times
when you need to use a wheelchair.
Putting rails beside the toilet to assist you to get up/down from the toilet.
Moving frequently used crockery to cupboards where you can reach it easily.
Having an extra phone point installed by the bed.
It is not only your home environment which needs to be considered but the
other places you spend time should also be brought to the attention of your
occupational therapist, e.g. homes of family or friends, the local shopping
centre, the library or bowling club, church or school.
Some of these places may already be accessible for individuals who have had
changes to their mobility. Some may present difficulties. Your occupational
therapist may be able to recommend some strategies to assist in accessing
I be able to continue driving?
Driving is a significant activity allowing independence and freedom. For some
people it is an activity that does not appear to require much skill and can
almost be done automatically. It is actually highly skilled and demanding-both
physically and mentally.
Many people with an amputation continue to drive following their operation.
In some cases individuals are advised not to drive due to age-related changes,
problems with vision associated with diabetes or pain that may affect concentration.
Some of these factors may improve following medical intervention and you may
be able to resume driving at a later stage.
The doctor looking after you will be able to advise you when it is safe for
you to return to driving. Following your amputation the licensing authority
for your state, and your car insurance company, should be notified. In some
Australian States a driving assessment is required. This assessment is conducted
by an occupational therapist with specific training and skills in assessing
the many and varied demands of driving. The assessment may include checking
your reaction time, an eye test; an assessment of road knowledge, and a driving
In some circumstances
there may be certain recommendations made (following your amputation) for
You may need to have modifications to your vehicle
You may be licensed to drive an automatic vehicle only
You may be limited in the times of day that you drive or within a certain
distance of your home.
You are encouraged to talk to your occupational therapist about issues associated
with driving and they will advise you about the process and timing relevant
for you to return to driving. You may also wish to talk to your occupational
therapist about strategies to assist with transferring in and out of the car,
loading and unloading the wheelchair from your car, parking permits, and public
I be able to return to my work and leisure activities?
Often individuals find that their health condition or the amputation has forced
them to have a break from their work or leisure pursuits or, perhaps they
have stopped them all together. If you have had an active life prior to your
amputation then you may find this frustrating. After your amputation you may
need a period of time to recover physically, but part of your return to 'normal
life' is also to return to your work or leisure activities. The therapy staff
taking care of you may ask you questions about your work activities (whether
paid or unpaid; inside or outside the home) and about the activities you do
to relax or enjoy yourself. This will help the therapists to work with you
in constructing a plan for your rehabilitation that will be relevant to your
When it is appropriate for you to return to work, therapy staff might arrange
to have a meeting with you and your employer, and they might arrange to do
a work assessment with you. Sometimes they may refer you to another agency
whose job it is to specifically help you with work issues. They will need
to consider with you:
The demands of
the job-both physically (e.g. balance; energy requirements, etc.) and mentally
(e.g. concentration, planning, etc.).
Whether some aspects of your work or the work environment can or need to be
Travel to and from work.
Whether you can build up your work hours over a period of time if you need
to begin in a part-time capacity.
You may not work in paid employment. It may be that you are involved in volunteer
work; working with your family; or doing the household work in your own home.
Some of these activities may also require some modifying following rehabilitation
or it may be helpful to talk to the occupational therapy staff or other staff
about how you might return to these activities independently and effectively
during your rehabilitation.
It is important to have a balance in your life between the things you have
to do and the things you want to be able to do. Returning to your leisure
activities and hobbies are important parts in your rehabilitation as well
as being able to look after yourself or return to work
Some of your leisure
activities may be active and require physical skill, some may be more passive
activities. Sometimes talking to the therapy staff about the hobbies that
you enjoy, and the places that you carry out various activities will enable
them to assist you to return to these activities or to pursue new hobbies
Many public facilities
will be accessible for people with reduced mobility or specific mobility requirements.
Some venues, e.g. theatres, cinemas, sporting facilities, etc. may assist
with special seating requirements. Some venues may have a hire or loan system
for wheelchairs or provide specially located disabled parking facilities.
If you are attending a venue for the first time it is worthwhile ringing in
advance to ensure that they can meet your individual needs.
be given to holidays as there are specific issues when planning to travel
away from home. You may need to think about issues such as arranging accommodation
that is wheelchair accessible or has appropriate equipment; considering the
sort of transport you might use during your holiday; or the location of a
local prosthetic facility near your holiday destination. These things should
not stop you going on holidays but some pre-planning will ensure that you
enjoy your break with a minimum amount of fuss.
there be other issues as I get older?
An amputee goes through phases of life and it is important that there be regular
specialised clinic reviews, not just focussing on your amputation but your
whole body and other relevant issues. Needs change over time and other issues
may become important, for example, managing with arthritis, increase in body
weight or loss of general fitness, all of which may be associated with aging,
but not necessarily.
In reality it becomes
more difficult to compensate for amputation as one gets older. The aim is
to keep walking. By paying attention to good health management and dealing
with some of the issues mentioned mobility can often be maintained. At times,
it may be necessary to fall back to wheelchair use, for example, over longer
Sometimes people make a pragmatic decision that it is easier to use the prosthesis
over shorter distances. At higher levels of amputation and with other medical
problems a decision not to wear prosthesis at all, and use a wheelchair as
the main form of mobility is reasonable.
However, it is
still necessary for an amputee be reviewed by a specialised clinic team, not
just in relation to the prosthesis, but for all other aspects of being an