Rehabilitation after amputation varies greatly, depending on which body part is amputated and what amputation level is involved. In the early stages of rehabilitation following amputation, the most important considerations are to control pain and swelling and to avoid infection. Cold treatments, such as cold packs with or without compression, cause blood vessels to become smaller, helping to control excess bleeding and swelling of soft tissues. Physical therapists often combine various cold treatments with electrical stimulation. If extremity pain is severe and persists for extended periods of time, transcutaneous electrical nerve stimulation (TENS) may be helpful. Electrical stimulation methods used in physical therapy decrease pain by producing an electrical response in the muscles around the region that was traumatized.
Once pain and swelling have subsided, rehabilitation then focuses on returning range of motion and strength to the remaining joints of the extremity (or residual limb) following amputation. Maintaining the flexibility of specific muscles will help the individual function as normally as possible. For example, if the amputation is below the knee, keeping the hamstrings flexible is critical. If the amputation is above the knee, therapy focuses on the hip muscles, both in front and in back of the thigh.
Strengthening the residual upper or lower limb begins early in rehabilitation. Regarding lower extremity amputations, walking exercises (gait training) with the use of a temporary prosthesis are often indicated and started when appropriate. A temporary prosthesis allows a predetermined amount of weight to be placed on the involved limb and enables the individual to progress with exercises while the size of the residual limb stabilizes, allowing a permanent prosthesis to be fitted.
The upper or lower extremity amputee depends heavily upon muscles to control the prosthesis. The therapist will instruct the amputee in muscle strengthening exercises. Similarly, exercises related to functional training are important in preparing the individual for physical demands at home and for the return to work. These activities include ascending and descending stairs or repeatedly practicing going from sitting to standing. Upper extremity activities include dressing and other self-care requiring reaching, pulling, and grasping. Such activities more closely match normal requirements of activities of daily living (ADL).
The therapist will instruct the individual in a home exercise program that gradually progresses in difficulty up to the date of discharge. The final step is to incorporate activities that resemble work requirements with patient education regarding placement and removal of the prosthesis, so that the individual may successfully return to home and work.