Stage 2: Visiting the Limb Centre
OVERVIEW
A prosthetist is the professional who makes the artificial limb (prosthesis). Once the rehab team is satisfied that the residual limb has healed well enough, a prosthesis can be fitted. A temporary prosthesis (more common for leg amputees) provides early mobility while allowing the residual limb to continue to shrink and change shape (which is normal following any amputation). Once the residual limb has settled into its final shape and the incision has healed, a “definitive” prosthesis (for permanent use) will be made. Arm amputees, unlike leg amputees who need a limb for mobility, are usually fitted once their limb has finished shrinking and changing shape. Many amputees are fitted with a simple prosthesis at first (for example a passive arm that has no grip function), which allows them to get used to wearing a limb and to help early on with balance. Later on, the amputee and prosthetist often decide together on a more complex and functional limb.
Working Closely With Your Prosthetist
The prosthetist (often with the help of the prosthetic technicians) is the professional who will fabricate your prosthesis. The rehabilitation consultant , working with you, recommends the type of fitting appropriate for you and a prescription will be provided to your prosthetist. The prosthetist attends a clinic at the rehabilitation centre (limb centre) at which the other rehabilitation professionals are present.
It is important to remember that you have the choice of which rehabilitation centre you will attend. As the person who makes, adjusts and repairs your artificial limb, visits to the prosthetist will be part of your life from this point on. Having an open relationship with your prosthetist and feeling comfortable discussing your needs is critical.
The Process of Being fitted
Once your residual limb is healed and the swelling is reduced, you are ready for your first fitting for an artificial limb. This is usually about one to two months following surgery, but underlying medical conditions such as vascular disease or an infection might extend this time period.
During a fitting, your prosthetist will examine your residual limb closely. It is a very personal experience and it can take some time to feel at ease with the process. When going for your first fitting, wearing a t-shirt will make fitting easier if you are an arm amputee. If you are a leg amputee, it is a good idea to wear shorts as well as a comfortable shoe and bring its mate for the foot of your artificial limb. Do not forget to bring your prescription or any other relevant documents that you may have been given.
The first step in making your prosthesis is to create a mould; this usually starts with a plaster cast being taken of your residual limb. Generally, the prosthetist uses a “hands-on” method, as he/she manually checks the residual limb for cysts or similar conditions which may need special consideration during the fitting process. However, some prosthetists use “CAD-CAM,” a computer-aided design method, instead – after entering your measurements into a computer, a milling machine carves out a reproduction of your residual limb. The finished product in both cases is the mold, which is used to fashion a socket to custom fit your residual limb. Prosthetists use a “check socket,” a test socket often made of clear material, to visually inspect the fit. Stump socks and liners can help provide proper padding and comfort within the socket.
The most important considerations during a fitting are that the socket fits properly and that the artificial limb is aligned well with the rest of the body. Your feedback to the prosthetist is needed to help him/her provide the best fitting for you. For example, be sure to tell the prosthetist if your residual limb is slipping up and down (called pistoning) inside the socket, or if your artificial limb “feels” too long or too short if you are a leg amputee.
Your First Limb
Depending on your situation, you may be fitted with a temporary limb early on. Before a fitting is considered your reahb team will want to ensure your residual limb has completely healed.
As the name suggests, the temporary limb is worn temporarily as the residual limb continues gradually to change shape. The temporary limb allows you to improve your balance and, if you are a leg amputee, learn how to walk. The prosthetist will make adjustments to the temporary prosthesis if necessary. A leg amputee may often have a metal pylon (a rigid central shaft) attached to a basic prosthetic foot as a temporary limb. An arm amputee may be fitted with a passive prosthesis as a first limb – one that has no grip function but which helps with balance and gets you used to the weight of wearing an artificial arm – you may be fitted later with a more functional prosthesis or may decide to stay with the passive prosthesis.
Wearing the temporary limb for short periods everyday will allow your body to adjust; you can then gradually increase the time until you are able to wear it comfortably all day. Physiotherapy exercises will help strengthen your residual limb and allow you to wear the artificial limb for longer periods.
A definitive or permanent limb can be fitted once the residual limb has stabilised and you are comfortable wearing the temporary prosthesis. Your definitive prosthesis is customized to your body and is made for long-term use. Usually, it will last about three years or more for an adult amputee. A child amputee may need a new limb once a year or even more often because of growth spurts. Some amputees have a spare limb to use when their definitive limb is being repaired or a new limb is being made.
This section has been created using information provided by War Amps, minor amendments have been made, which reflect more accurately the UK rehabilitation process.
