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The Rehabilitation Team

What is the Multidisciplinary Rehabilitation Team (MDT)?

A team comprised of a combination of disciplines (job roles) within amputee rehabilitation, with the aim of providing you, the patient, with a seamless and integrated service.

When you, your child or partner are first referred to a Limb Centre you will have an appointment with the Consultant in Rehabilitation Medicine who will asses your needs.

The multidisciplinary team includes:

  • A Consultant in Rehabilitation Medicine (CRM) with a special interest in prosthetics,
  • Prosthetists,
  • Orthotist,
  • Specialist therapists and nurses, including Occupational Therapist (OT) and Physiotherapist (PT)
  • Clinical counsellors
  • Engineering personnel (Prosthetic Technicians and in some cases Gait Lab technicians)
  • Social Worker

THE ROLE OF THE CONSULTANT IN REHABILITATION MEDICINE

The Rehab Consultant has a number of tasks, which can vary depending on their field of work and the functionality of the Limb Centre they work within. Rehab consultants concentrate of five main areas of work:

  • General rehabilitation medicine
  • Amputee rehabilitation
  • Spinal Cord Injury
  • Community rehabilitation
  • Academic rehabilitation medicine

Most consultants will work within one or two areas, but some will work in more. Some limb centres service more than one area of rehab for example Queen Mary’s Hospital in Roehampton run a Prosthetic service, Orthotic service and Wheelchair service. This is invaluable if you have other pre-existing conditions or complications beyond your amputation.

Nearly all will be responsible for both inpatients and outpatients.

They will;

  • Address your medical needs regarding your disability
  • Make recommendations for your ongoing programme of rehabilitation
  • Provide medical expertise in the assessment of your disability
  • Carry out medical rehabilitation interventions and prescribe treatment as appropriate
  • Prevent further complications of your underlying conditions and the treatment of these conditions
  • Provide medical reports on your condition and progress
  • Provide clinical/medical leadership to the multidisciplinary specialist rehabilitation team
  • Work with clinical teams for other disciplines regarding your disability
  • Work with members of the local authority

More information on the work of the Consultant in Rehabilitation medicine can be found through the British Society of Rehabilitation Medicine. www.bsrm.co.uk

THE ROLE OF THE PROSTHETISTS

Prosthetist – A professional person involved in the science and art of prosthetics; specialising in designing, fitting and fabricating artificial limbs. Their job is to provide the best possible artificial replacement for patients who have lost or were born without a limb. A prosthetic limb should, as closely as possible, feel and look like a natural limb. The Prosthetists also provide care for anyone requiring an artificial limb (prosthesis). They will also advise on rehabilitation needs.

Your prosthetist is the member of the multidisciplinary rehabilitation team (MDT ) who you will spend the most time with, so it is important that you build a good working relationship with him or her. The more input you give your prosthetist the more they will be able to help you, which will result in better fitting sockets. Sometimes the results will not be what you want and it is important to remember that a prosthetic leg or arm is not a real arm and will never be the same, but if you work together you can achieve greater functionality and will be able to do more. This can be a frustrating experience and patience really is a virtue if things are not going according to plan.

The first function of fitting prosthesis is to make a model of the area on which the prosthesis is to be fitted. The prosthetists will make a plaster cast or take a digital image using a CADCAM of your residual limb (stump) which would then be modelled on you to produce a safe and comfortable fit. When you are both satisfied with the mould your prosthetist will make a check or test socket.

The prosthetist will use their knowledge to design and select the most suitable prosthesis for your personal needs, from a range of components. It is important that you share information on what activities you like as this will affect the prescription of the prostheses. Your prosthetist will supervise the assembly of the prostheses by a trained prosthetic technician. During the fitting stage the prosthetist is responsible for aligning the componentry to ensures the prosthesis is comfortable; to obtains the optimum performance and to ensure a stable and smooth gait is achievable. During the fitting stage your prosthetist will offer advice on how to use the prosthesis and will make adjustments to maximise its performance. Once you have taken delivery of the prostheses you will attend physiotherapy to learn how to use your prosthesis and for gait re-education. We refer to this as walking school.

THE ROLE OF THE ORTHOTIST

You will come into contact with an orthotists if you have a pre-existing condition or you have a problem which affects your sound limb.

Orthotist – A professional practitioner who evaluates, designs, supplies, and fits orthotic braces, splints, and special footwear to aid movement, correct deformities and deficiencies and relieve discomfort. They also provide care for patients requiring a device to support or control part of the body (orthosis). They will also advise on rehabilitation needs. The orthotists will assess the patient’s needs and then formulate a prescription in conjunction with input from colleagues and yourself.

If a patient has damaged, any part of the human skeleton they may require some form of orthosis. The orthosis may be needed to reposition the body or to provide relief from discomfort.

Your orthotist will be responsible for taking careful and precise measurements and supervise the making, fitting and adjustment of the orthosis, as well as educating you in fitting and using their orthosis.

THE ROLE OF THE NURSE

Nurse: A person trained to care for the sick or infirm.
Oxford English Dictionary.

THE ROLE OF THE OCCUPATIONAL THERAPIST (OT)

Occupational Therapy is the assessment and treatment of physical and psychiatric conditions using specific, purposeful activity to prevent disability and promote independent function in all aspects of daily life.

They work with people of all ages to help them overcome the effects of disability caused by physical or psychological illness, aging or accident. The profession offers enormous opportunities for career development and endless variety.

THE ROLE OF THE PHYSIOTHERAPIST (PT)

Physiotherapists treat people of all ages with physical problems caused by illness, accident or aging.

Physiotherapy is a healthcare profession which sees human movement as central to the health and well-being of individuals. Physiotherapists identify and maximise movement potential through health promotion, preventive healthcare, treatment and rehabilitation.

The core skills used by physiotherapists include manual therapy, therapeutic exercise and the application of electro-physical modalities. Physiotherapists also have an appreciation of psychological, cultural and social factors which influence their clients.

Many physiotherapists work within hospitals. Here they are needed in virtually every department. Hospitals often have physiotherapy gyms, hydrotherapy and high-tech equipment so that specialist therapy can be carried out.

THE ROLE OF THE COUNSELLOR

Some rehabilitation centers will have a counselling psychologist, clinical psychologist or nurse counsellor on their staff. Where the centre does not have a counsellor on their staff they will have access to the counselling service provided by the Primary Care Trust.

This service is available to individuals and their carers who are about to undergo or have undergone amputation surgery. It is also available for parents of children born with congenital limb deficiencies or limb absence.

The counselling service provides you with the opportunity to talk privately and confidentially about your feelings and experiences in a way that might not be possible with friends and family. Counsellors are trained to listen and help you find your own solutions to any difficulties you may be experiencing. The counsellor will not give you the answer, but they will help you make sense of what is happening to you and help you to make positive decisions for yourself.

CONFIDENTIALITY

It can be a great relief to be able to share your fears in the knowledge that what you say will not he repeated without your consent or agreement.

COUNSELLING SESSIONS

Usually tale place on a weekly basis to begin with and last for 40 minutes to an hour. The number of sessions you require will be decided between yourself and the counsellor. Some counsellors only work with referrals from the centre they are based at while others will make hospital visits and home visits. This will depend on the set up and your personal circumstances. Most counselling services will accept self-referrals as well as referrals form members of the multidisciplinary rehabilitation team.

ENGINEERS/TECHNICIANS

The role of the Prosthetic Rehabilitation Engineer/Technicians

The exact role of the technician will vary from centre to centre and it is worth asking your prosthetist what role the technician will play in your rehabilitation.

Below we have outlined the main functions performed by technicians.

  • The Rehabilitation engineer/technician plays an important role in the patient’s rehabilitation.
  • They will assist the prosthetist in the patient’s referral for prostheses, regarding the technical selection /prescription of approved devices.
  • They will assist in the qualitative assessment of the patient through making a biomechanical assessment of the gait, either as part of the multidisciplinary team or independently.
  • They will assist the Prosthetist/Orthotist by supervising technical adjustments or adaptations to prosthetic or orthotic devices as specified by the clinical team, including making repairs.
  • In some cases they will in conjunction with the Prosthetist/Orthotist instruct the patient how to use and care for the prosthetic or orthotic device.
  • Advise on and carry out scientific/clinical measurements on the biomechanical functions.

Technician

The rehab technical department is responsible for the fabrication of the prosthesis to the specification provided by the prosthetist. Each amputee will have different requirements. On a day to day basis the rehab technician is responsible for the many repairs and maintenance required to enable you to live a trouble free life.

Rehabilitation Engineer

The role of the rehabilitation engineer is to ensure the technical quality of the limbs assembled at the centre. This is to ensure that you receive the highest quality limbs available to meet your personal needs. The rehab technician is also available to resolve any queries relating to limb problems. They will liaise with the prosthetist should there be any adverse incidents.

Another role of the rehabilitation engineer is to provide engineering support in the prescription of wheelchairs. This role includes managing the refurbishment programme and designing wheelchairs.

The Gait Lab Technician

Will have an engineering/physical science background. The function of the gait lab is to measure posture, balance and movement and provide gait assesment. Gait Laboratories are used for clinical referrals for gait analysis and electrical stimulation.