Life with an arm amputation

Amputation rehab: What to expect

The rehabilitation process is critical for anyone who has recently lost a hand or arm. Find out how it can help heal your residual limb, restore your mobility, and prepare you for a prosthetic arm.

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Healing, training, and preparing for a prosthetic

After your amputation surgery, recovery and healing are your top priorities. The rehabilitation process is an essential part of this time. Together with your care team, you’ll focus on rebuilding your strength, carefully caring for your residual limb, and taking the first steps toward using a prosthetic arm. 

Amputation rehab begins as soon as possible after your operation, and typically lasts about six month. During that time, your care team will create a detailed plan to heal your residual limb and get you ready for prosthetic. You’ll also need to start preparing yourself for everyday life with your new upper limb difference. 

This article will guide you through some of the key steps in that process. Just remeber: everyone’s experience will be different. Your care team will help you understand which activities like these are most important for you. 

Keep reading to learn more about how amputation rehab helps:

  • Heal your residual limb as quickly and successfully as possible

  • Strengthen parts of your body affected by your amputation

  • Prepare you to use a prosthetic device*

*This article focuses on devices for users who’ve had a transhumeral amputation. If you’ve had a different procedure, your prosthetist can provide you with more information on higher amputation levels.

Managing swelling

Reducing edema in your residual limb

The first steps in amputation rehab begin immediately after your operation. In the days after amputation surgery, your hospital care team will closely monitor your wound, carefully watch for any sign of infection, and ensure that your residual limb begins to heal properly.

One of the most important changes your care team will focus on is swelling, or “edema.” Edema is a normal reaction to an amputation operation, and will typically go down over time. But if it lasts too long, it can slow down your healing and make it harder to fit a prosthesis. Right after surgery, you and your care team will start working together to make sure any swelling goes down over time.

Oedema therapy

After the operation, the tissue around the residual limb will usually swell up at first. This swelling (oedema) is a normal reaction to the operation. It usually subsides after about one week. Only a loose wound dressing is applied until the sutures are removed. No pressure can be applied to the residual limb at first.

The circumference of the residual limb should be measured regularly to evaluate how the swelling is going down. The same measuring points always have to be used for this, and the results must be documented on measurement forms. If this isn’t done, the results are not comparable with each other and there is no way to tell whether the swelling is decreasing.

Correct positioning

Pronounced swelling of the residual limb for an extended period of time interferes with wound healing, and the time when a prosthesis can be fitted is delayed. You should assume a proper posture, even in the hospital bed, to prevent shortening and stiffening of the muscles and joints. Patients usually assume a comfortable and pain-free position at first, but experience has shown that this is not always optimal. As time progresses, the residual limb should lie in an extended position as far as possible. Permanently elevating it – for example, on a pillow – always has to be avoided, otherwise the muscles will shorten and the subsequent mobility of the residual limb is reduced.

Mobilisation

Move your residual limb several times a day. Doing this can prevent a loss of mobility in your joints. Early mobilisation is important because it activates the circulation and promotes balance. Get your therapist to show you movement exercises that are right for you at the respective time. The shoulder joint in particular has to be mobilised as early as possible; otherwise, it can become stiff. With a combination of correct positioning and movement, you can properly prepare your arm for wearing the prosthesis.

Early compression therapy

After the operation, a wound dressing is applied and changed at regular intervals. Compression therapy begins after that, for example, with a compression bandage. Your doctor will determine the exact timing. The purpose of compression therapy is to reduce the residual limb oedema and prepare your residual limb for your subsequent prosthesis. Residual limb compression helps optimise the fitting of your prosthesis. Compression also promotes blood circulation in the residual limb. This reduces pain and promotes scar healing.

Vendaje de compresión

El vendaje de compresión permite regular la presión según el día o el momento del día. La presión debería ser la máxima en el extremo del muñón e ir reduciéndose hacia el cuerpo. Para colocar este vendaje se utilizan vendas elásticas que se fijan con un apósito. Puesto que este método exige algo de práctica y experiencia, el vendaje debe colocarlo personal técnico especializado (fig. 3). También puede dejar que el personal de enfermería le muestre la técnica de vendaje correcta. Lo importante es que el vendaje no "estrangule" el muñón; no debe producirse dolor.

Liner de silicona

Por el contrario, los liner de silicona son rápidos y fáciles de manejar. Están disponibles en diferentes tamaños prefabricados. Para generar una presión lo más amplia y homogénea posible en la zona de la amputación, al colocarse el liner es imprescindible prestar atención a que no entre aire en el extremo del muñón. Al principio puede ocurrir que sude más con el liner. Esto se regulará tras un tiempo de uso. A fin de evitar posibles irritaciones en la piel, puede aplicar un poco de Ottobock Derma Prevent en la piel en contacto con el borde del liner. Además, la limpieza del liner de silicona al final de cada día es muy importante. Consulte más indicaciones al respecto en las instrucciones de uso del liner.

Terapia de compresión posterior

En cuanto el volumen del muñón lleve estable un tiempo, es decir, cuando los contornos medidos del muñón ya no se reduzcan, puede dar comienzo el tratamiento protésico. Hasta ese momento debería mantenerse la compresión. Su equipo de tratamiento le mostrará a usted o a sus allegados cómo puede hacerlo solo.

Training exercises

Preparing to use a prosthetic arm

While you and your care team are working to manage any post-surgical swelling in your residual limb, you’ll also start taking the first steps toward using a prosthesis

These steps typically include:

  • Strengthening and stretching muscles in your residual limb, shoulder, back, and torso

  • Any training you may need to use your remaining hand and arm (your “sound side”) in new ways

Here are a few key areas you and your care team will probably focus on.

Estiramiento de la musculatura del muñón

Pronto se empezarán a estirar también los músculos y las articulaciones en torno al muñón. Si le resulta difícil mover las articulaciones de forma activa, también puede hacerlo de forma pasiva sirviéndose de una toalla. Es importante que sus articulaciones conserven o recuperen la máxima movilidad en todas las direcciones.

Mejorar la destreza del lado sano

En función de si su mano afectada es la dominante o la no dominante, el entrenamiento del lado sano será más o menos intenso. Se entrena la motricidad fina, la destreza y la fuerza. Debería practicar sobre todo actividades complicadas, como escribir o cepillarse los dientes.

Entrenamiento de desarrollo muscular del muñón

Antes del tratamiento con una prótesis es importante reforzar la musculatura del muñón, el brazo sano, la musculatura del tronco y las piernas por medio de un entrenamiento preparatorio. De este modo no solo mejorará la movilidad máxima de sus articulaciones, sino también la destreza del lado sano. Así también gozará de una mayor autonomía al realizar las actividades de la vida diaria.

Entrenamiento de desarrollo muscular del tronco

Tras la amputación es muy importante que mueva lo máximo posible el tronco. Evite torcer en exceso la columna vertebral. Debido a la falta de contrapeso en un lado, la verticalidad y, con ello, a menudo también el equilibrio estático de la columna vertebral pueden cambiar. Por ello, para evitar posturas incorrectas y dolores debe practicar movimientos que refuercen la espalda.

Skin & scar care

Supporting your healing wound

In most cases, amputation wounds close in three to four weeks and then start forming a scar. But while your scar may look like it has healed after a few weeks, the full healing process takes much longer – typically about eighteen months.

During that time, caring for your skin and scar is a top priority. A few key steps can help you ensure your residual limb heals successfully, and that it’s ready for a prosthetic when you’re ready to start using one.

Desensitizing your skin

Tome, p. ej., un cepillo suave o una pelota de masaje con pinchos y páselos por encima de la piel sensible o golpee la zona suavemente. Esto aumenta la resistencia. También puede frotar el muñón con una toalla gruesa o con una manopla.

Cleaning your skin

Las medidas higiénicas para el muñón, como el lavado diario con agua templada y jabón suave sin perfume, son muy importantes. Los productos de cuidado de Ottobock pueden facilitar la limpieza.

Caring for your scar

Regularly moisturize your scar and the skin around it. Scars can’t produce the moisture that typically keeps your skin soft and flexible, which it will need to be when you start wearing a prosthetic. Prosthetics and rough, dry skin can be a painful combination, one that makes it much harder for you to consistently wear your device.

Unscented moisturizing creams are often a good choice. Ask your prosthetist for their recommendation. They’re always the best place to start when you need advice on how to get the most out of your prosthetic!