Prosthetic Prescription
Some provision is made for the rehabilitation of all amputees, including those who will not benefit from prosthesis. Each year there are around 5,300 new referrals to artificial limb (rehabilitation) centres for the provision of prostheses. Of these the larges proportion are below knee amputees at around 35%.
It is generally the responsibility of the Consultant Surgeon to refer amputees to the Disablement Service Centre (Limb Centre). This decision is made with input from the hospital rehabilitation team, the patient (you) and your family.
If it is decided that you will benefit from wearing a prosthesis you will generally be referred for an assessment. This can take place at the DSC or the hospital. The hospital will have referral forms for the appropriate DSC. Although you will attend the limb centre (DSC) for an assessment, the prosthetic fitting may be delayed for four to six weeks after the amputation.
At the DSC you will be assessed by a rehabilitation consultant (doctor) trained in prosthetics and rehabilitation techniques. The assessment will be with input from the Multidisciplinary Rehabilitation Team (MDT). Click here to view the Rehabilitation Team.
The decision to prescribe a prosthetic limb is the responsibility of the Consultant in Rehab Medicine and is made in consultation with the MDT. The choice of limb which is most appropriate to you will be decided in consultation with the Prosthetist and other team members, including the Physiotherapist and Occupational Therapist.
The team aim to provide you with the completed prosthesis as soon as possible. The emPOWER Prosthesis & Orthoses User’s Charter advocates the provision of a new prosthesis within 21 working days of the initial assessment. It is worth noting that the delivery time of the prosthesis may be affected by the residual limb (stump) healing process and the need to make adjustments to ensure a comfortable fit.
The MDT are also responsible for the prescription of a second or duplicate limb and for the provision of new components, socks and liners. It is worth noting that not all users will be given a duplicate limb. Your prosthetic prescription must be appropriate to your needs. (See the section on needs for more information).
Factors which affect this prescription include:
• Your age
• Your health
• Associated medical conditions
• Type and level of amputation
• Condition of your other limb
• Personal circumstances
• Your own motivation and acceptance
• The environment
• NHS Budget
Generally a prescription in not required for a new socket or utility items such as a suspension belt and stump socks. This prescription procedure does apply for the prescription of liners (sleeves). Most services operate a baseline prescription protocol.
Each patient’s prescription is discussed as an individual case. It is important for you, the patient to articulate what you want and need from your artificial leg to ensure the prosthetist can give you the best prescription.
N.B. If it is decided that you will not benefit from wearing an artificial limb you may still attend the limb centre for therapy or be referred to other services.
New products and components
Manufacturers frequently bring out new products and run clinical trials. These take place at different centres across the country. It is worth asking if you can trial a product as some centres and manufacturers offer products on a trial basis. It is worth noting that Prosthetists may approach a change of prescription with caution, because prescribing a wrong product to a patient can be a costly error.
Sources
Amputee and Prosthetic Rehabilitation – Standards and Guidelines (2nd Edition)
Talk by John Sullivan to the Roehampton User Group.
The emPOWER Prostheses & Orthoses User’s Charter
