REHABILITATION FOLLOWING A LOWER LIMB AMPUTATION

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1 REHABILITATION FOLLOWING A LOWER LIMB AMPUTATION This booklet gives you information about the rehabilitation process following your amputation. The information is a guide as everyone will progress differently following surgery. We hope it will answer any questions you may have. However, if you need any more information please ask a member of the rehab team. Why do I need / why have I had an amputation? You may need / have had an amputation following an accident, injury, or disease. This may have cause severe pain, discolouration of the leg, ulceration and/or gangrene. If left untreated you would have become dangerously unwell, which could have been life threatening. From the investigations that you have had, it has been found that it is NOT possible to improve the blood supply to your leg and so an amputation is / was required. How long will I be in hospital? This will depend on your recovery, but after the operation you will be working with members of the rehab team so that you can either return home or to a place which is more suited to your needs. Sometimes you may need a little longer to rehabilitate and the rehab team may make a recommendation that you go to a rehabilitation hospital for extra rehab. If you are discharged home, this is usually days following your operation. When you are discharged from hospital you will be using a wheelchair to get around. Who will I be seen by? Following surgery you will be seen by members of the rehabilitation team (rehab team) who will work with you to maximise your independence. This will include: An Occupational Therapist (OT) The occupational therapist s job is to ensure that you are as independent as possible with daily activities such as toileting, getting washed and dressed, and making your own meals. This may be achieved through practice and/or issuing of adaptive equipment. On discharge, if you are not independent, the OT will make recommendations to ensure you have the support you require and arrange for any equipment that is essential. It is likely that the OT will visit your home prior to discharge in order to make these recommendations. The community OT will assess for, and arrange, any adaptations needed to your property once you are at home. These may include ramps and stair lifts. A Physiotherapist (Physio) The physio s job is to help you to move about again after your amputation. You will be given an exercise programme for muscle strengthening and general fitness. If appropriate, you may progress to walking with an early walking aid in the rehab gym. 1

2 What happens after the operation? The information below is intended as a guide, if you have been transferred to Wexham Park Hospital from another hospital, the days the activities are completed will be different. Day 1-3 post amputation a member of the rehab team will visit you after your operation and loan you a wheelchair to enable you to move around. This wheelchair will be on loan to you until you get your own supplied by your local mobility centre. If you have had a below knee amputation you will be provided with a stump board. It is important that your stump (amputated limb), is always supported to reduce swelling and to aid wound healing. You should never place anything under the stump, unless a member of the rehab team tells you to, as this can encourage the knee or hip to contract and cause problems later with your rehab. Details of your wheelchair repairer can be found at the back of this booklet. Between days 1-3 The rehab team will give you a series of simple bed exercises to complete daily to help with preventing contracture of the hip or knee and maintain strength and movement in the affected limb. You will be advised if you are suitable to begin gym sessions held in the rehabilitation department (you can use the lines below to note the gym dates and times) Where possible you should make your own way down to the gym, but please let the ward staff know when you are leaving the ward to attend these sessions. Please note these sessions are mixed (men and women), attended by both in patients and out patients. We advise you to wear appropriate clothing (tracksuit or shorts and ideally a trainer/shoe). It is essential for your rehab that you attend these gym sessions. Your consultant will be informed if you do not attend. Day 3-11 This is the period in which the rehab team will assess your capabilities. They will discuss with you returning home and your long-term aspirations. The rehab team will make assessments of your independence with the following: Using your wheelchair and getting on/off your wheelchair, bed and toilet. Doing your exercises and attending amputee gym sessions on a regular basis. Washing and dressing, and basic kitchen skills, if required. If appropriate, your ability to use an early walking aid in the gym 2

3 Prosthesis (Artificial Leg/ Limb) Not all patients decide to use or are appropriate for a prosthesis (artificial limb/leg). You may feel that you find everyday activities easier and safer in the wheelchair, especially if you have had an amputation above the knee. The team is there to discuss all the options with you and your family. If you are appropriate for a prosthesis you will be measured for a stump shrinker sock to reduce the stump swelling and you will be referred to the Oxford Centre for Enablement for a prosthesis. Day This is the period where the team will prepare you for discharge from hospital. The team will discuss the following with you: Falls management. If appropriate, the team will check your ability to be able to get up from a low surface or the floor. Your ability to get around your home. If required, a home visit may be arranged with the OT. Your independence with daily tasks and any services required to support you on discharge from hospital. Your potential to use a prosthesis and outpatient follow up may be arranged. How much pain can I expect? You will initially get pain around the incision site. This can be controlled with pain killers, so please ask a nurse for pain tablets. If these are not working please inform your doctor. Most patients having an amputation feel that the limb is still there. You may experience a burning, tingling, itching, or cramping sensation. This is normal and is known as phantom limb pain. These phantom feelings in your leg will feel real and, as a result, it is very easy to think your leg is still there. It is therefore important that you focus when standing and transferring to prevent you from falling. You may find that by actually handling your stump and looking at it, it helps you psychologically to come to terms with your loss and helps reduce your phantom pain. Medication can also be given to reduce phantom limb pain. Please talk to a member of the rehab team if you experience this type of pain. What care should I give to my stump? You may be provided with a stocking called a stump shrinker. This stocking helps reduce the swelling to the stump in preparation for prosthesis and can help reduce phantom limb pain. The stocking should be put on first thing in the morning and removed last thing at night. It is extremely important to look after your stump. You should look at and handle it at least once a day, as you need to be aware of any ulcerations or blisters that may develop. If you have any concerns relating to your stump, please inform a member of the rehab team (or your GP if you are at home). I am worried about my remaining leg? It is important you care for your remaining leg as this leg will have all your body weight going through it when you transfer and move around. You should wash the leg daily, ensuring you dry between the toes. If you have dry and/or cracking 3

4 skin, apply a non perfumed moisturising cream. If you develop ulceration to the foot or leg after you are discharged, you should consult your GP for advice. Should I give up smoking? It is important you try to stop smoking completely, as smoking is known to delay wound healing and block the arteries, reducing the blood flow to your lower limbs. If you continue to smoke it will take longer for your stump wound to heal, and you are more likely to develop problems with your other leg. If you would like to stop smoking the vascular nurse is able to help you while you are in hospital so please discuss this with her. The NHS smoking help line, your GP or local pharmacist will also be able to help you when you are discharged. Please see page 5 for contact details for smoking cessation services. Why am I getting a sore/numb bottom? As you have limited mobility there is pressure constantly on your bottom (sacrum). This can cause a lack of blood supply to your sacral skin and the skin may break down forming, an ulcer. This can be very painful and take a long time to heal. It is therefore recommended that you change your position frequently, e.g., when you are in bed move from side to side. If you are in the wheelchair and able to, stand up for a few minutes or alter your position from side to side. If you find yourself getting a sore bottom please inform the ward nurse and they can assess the problem and take the appropriate action. If you have a sore on your bottom when you are discharged you need to contact your GP. Can I have a shower? Please check with a nurse, but providing your wound is dry and covered with a waterproof dressing you can have a shower. It is important, however, to use the shower chair provided by the ward. Initially it may be wise for someone to assist you as you may feel faint. Am I able to resume a sexual relationship? There is no reason why you cannot resume your normal sexual activity once you are discharged from hospital. Please be aware, however, that you may have problems with balance and may need to adapt accordingly. Will I be able to drive? If you wish to return/ learn to drive you must inform the DVLA of your amputation. You will probably be asked to complete a questionnaire. They may also contact your GP and you may be requested to have a driving assessment by a mobility centre. If you are entitled to the higher rate mobility component of the personal independence payment, you may be able to get a vehicle through the Motability Scheme. When can I return to work? This depends on the type of job you have. Please talk to a member of the rehab team for further advice. Prior to discharge you can obtain a sick certificate from the ward. Sick certificates can also be obtained from your GP. 4

5 When should I seek help? Please see your GP if the wound looks very red and starts weeping. If you notice your other leg becoming very cold, pale and painful or ulcerated, speak to your GP. Am I entitled to any benefits? For more information of what benefits you may be entitled to please contact the following: Benefit Enquiry line Your local Citizen Advice Bureau Age UK Contacts Services at Wexham Park Hospital Occupational Therapy Physiotherapy Hospital Transport Wheelchairs Mobility centre (East Berkshire-St Marks): NRS (for repairs to Berkshire NRS wheelchairs): Mobility centre (South Bucks & Aylesbury): Hewerdines (for repairs to Buckinghamshire NHS wheelchairs): Community OTs Slough Windsor and Maidenhead Bracknell South Bucks Driving DVLA medical enquiries Motability advice about driving following amputation, general advice about choosing cars, adaptations and getting you or a wheelchair in/out of a car Limbless Association Oxford Limb User Group- Gail Wellings, NHS Smoking Helpline Mon - Fri 9am- 8pm, Sat + Sun 11am 4pm for free advice, help and support, phone

6 If you would like a copy of this leaflet on audiotape, in large print or translated, please telephone Title of leaflet: Rehabilitation following a lower limb amputation Reference No: BB/017/2 Issue Date: October 2013 Review date: October 2015 Compiled by: Nicola Bobyk (Occupational Therapist), Danielle Wright (Physiotherapy Technician), Emma West (Occupational Therapist) Legal Notice Please remember that this leaflet is intended as general information only. We aim to make the information as up to date and accurate as possible, but please be warned that it is always subject to change. Please therefore always check specific advice on any concerns you may have with your doctor. Heatherwood Hospital London Road Ascot Berkshire SL5 8AA Tel Wexham Park Hospital Wexham Street Slough Berkshire SL2 4HL Tel Web: 6

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