Rehabilitation at the Artificial Limb and Appliance Centre

The following will provide you with information on what rehabilitation at the Artificial Limb and Appliance Centre (ALAC) will involve. It is not an exhaustive list. If you have any concerns regarding the content then please feel free to discuss it with us.

Assessment

Learning to use a prosthesis (an artificial limb) involves physical assessment, review and treatment. Your rehabilitation will mainly take place in the Physiotherapy Gym. The team may ask you to partially undress (for example when completing assessment or checking the fit of your prosthesis) therefore please dress appropriately (shorts or trousers with wide legs).

As with most forms of rehabilitation, the response to individual treatment varies and cannot always be predicted as each person’s condition is unique to him or her. Please be aware that other health problems, previous ability to walk and your level of amputation will affect the final outcome of your rehabilitation. Let the team know if your health changes during your rehabilitation.

Communication

A translator can be provided if needed, to help the team communicate with you. Please ask the team to book an appropriate translator for you. This information and other information provided by the Physiotherapy Team can be provided in Welsh if preferred.

The Rehabilitation Journey

Rehabilitation after an amputation is sometimes not an easy journey and there may be complications or problems that we could not foresee. The ALAC team will do their best to help you overcome any unforeseen problems but sometimes this is not possible and you may be unable to continue with your rehabilitation. It is important to consider other options for mobility such as using a wheelchair. If you are unable to complete rehabilitation we will offer to help you adjust to this.

Commitment to the rehabilitation journey with us is important. If for any reason you are finding it difficult to commit to rehabilitation please let us know. We will do our best to help understand why this is and offer help.

Rehabilitation will involve attending the centre for about 1 hour, twice a week. If you are unable to attend your appointments for any reason, please contact the centre so that your appointment can be offered to another patient.

Ambulance transport can be arranged to bring you to your appointments if you are unable to attend using your own transport.

The length of your rehabilitation will vary depending on your needs and the team will regularly review and discuss this with you.

You will be expected to complete exercises at home. This is an important part of your rehabilitation and needs to be completed as instructed.

Where rehabilitation will take place

Rehabilitation will mainly take place in the Physiotherapy Gym where there will be other people also completing their treatment (both male/female and of different ages). If you are not happy to be treated in a mixed sex environment then please alert your Physiotherapy team who will try to accommodate your wishes. Screens will be used to maintain your privacy where needed.

Treatment may be completed by a male or female member of the Physiotherapy team. Please highlight if you would rather be assessed and treated by a male or female member of the team. A chaperone can/may also be provided if requested/indicated.

If appropriate you may progress to completing rehabilitation outside the Physiotherapy Gym for example in the ALAC corridors, courtyard, wider Rookwood site and local community. ALAC/Rookwood provides numerous other services therefore there will be other people accessing the site/sat in waiting rooms/receiving treatment. We will always ask your permission to go outside the gym. If you do not wish to be treated in other environments then please inform the Physiotherapy Team.

Early walking aids may be used as part of your rehabilitation.

PPAM (Pneumatic Post-Amputation Mobility) Aid

For amputations below the knee we use the PPAM equipment.

The Femurett

For amputations above the knee we use the Femurett.

Early Walking Aids / Check Socket

The PPAM Aid and the Femurett will only be used as part of your rehabilitation at the Artificial Limb and Appliance Centre and cannot be taken home.

A check socket may also be used during early rehabilitation. This is a prosthesis which allows the ALAC team to establish the best fit and prosthetic components for you. When using a check socket there may be activities which you cannot complete such as stairs/outdoor mobility. This is due to the material that the socket is made from. The check socket cannot be taken home.

A definitive socket will be made when appropriate. This is the prosthesis that you can take home. The time taken to progress from a check socket to a definitive socket varies and will depend on your progress.

Learning to use your prosthesis

You will be expected to learn how to put on/take off your prosthesis either independently or with support from your family/carers.

If the plan is for you to walk with your prosthesis, you will learn to walk within the parallel bars initially before progressing onto walking aids such as a frame, elbow crutches or walking sticks. Which walking aids you use will depend on your progress and previous level of mobility. The team will discuss and agree this with you.

You will be able to take your prosthesis home when you and the Physiotherapy Team feel that you are ready.

Sometimes a Home Visit with an Occupational Therapist may be helpful. This will be discussed and agreed with you.

We will discuss and agree individual goals with you at the beginning of your rehabilitation and these will be reviewed throughout your time with us

Pain

Rehabilitation can cause an increase in pain, for example pain in the remaining limb, change in phantom pain/sensations, increased risk of low back pain and aching muscles from using muscles which you may not have used for some time.

Please tell the Physiotherapy Team if you experience any increased pain during your rehabilitation. We will do our best to understand the reason for the pain and provide appropriate support. Occasionally we are unable to continue with rehabilitation due to pain.

Diabetes

If you have diabetes you will need to monitor your blood glucose levels carefully throughout your rehabilitation. This may involve monitoring your blood glucose levels before/during and after rehabilitation as exercise can affect these levels. Please bring your blood glucose monitoring machine with you to each session.

If your blood glucose levels are too high or too low you may be unable to continue with treatment on that day.

Risk of falling during rehabilitation

Rehabilitation has risks. Artificial limb users are at an increased risk of falling. “Studies found 20 – 53% of amputees experienced at least one fall a year” (BACPAR – Guidelines for the Prevention of Falls in Lower Limb Amputees).

You will be encouraged to try all sorts of different activities as part of your rehabilitation. This is to prepare you for using your prosthesis at home and in the local community.

Your rehabilitation may involve walking outdoors. Unlike the Physiotherapy Gym the external environment cannot be controlled therefore outdoor mobility must be completed with caution. The risk of injury through falling can be higher when completing rehabilitation outdoors.

The risk of falling can also be higher when using certain types of artificial limbs such as a prosthesis with a free knee. The ALAC Team will highlight this to you.

You will be provided with information on falls during your rehabilitation. The Physiotherapy team may ask you to practice getting up from the floor as part of your rehabilitation. If there are any activities such as outdoor mobility/falls practice which you do not feel comfortable completing then please inform the Physiotherapy team.

Energy needed to walk

Rehabilitation using an artificial limb requires a significant increase in energy. This increases with a higher level of amputation (Barsby P [1995]: Amputee Management).

This can put strain on your heart/lungs such as increased shortness of breath and increased heart rate. Please tell the Physiotherapy team if you feel uncomfortably short of breath, get chest pain or any other symptoms during or after your treatment.

Occasionally we are unable to continue rehabilitation due to the strain on the body.

Residual (amputated) Limb

Rehabilitation can cause deterioration in the skin of your amputated limb, causing the skin to break down. We will monitor your skin closely during rehabilitation. You will also need to monitor your amputated limb carefully between rehabilitation sessions. Please tell the ALAC team if you experience any problems during or after your rehabilitation.

Occasionally we are unable to continue rehabilitation due to skin problems.

Contralateral (Remaining) Limb

You may experience problems with your remaining limb during rehabilitation and rehabilitation could cause the skin to break down. If the skin fails to heal this could lead to a further amputation. We will monitor your skin closely during your rehabilitation. You will also need to monitor your remaining limb carefully between rehabilitation sessions. Please tell the team if you notice any problems or changes in your remaining limb.

Rehabilitation may also cause an increased strain on the remaining limb with regards to any pre-existing problems such as arthritis. Please tell the team if you experience any problems during or after your rehabilitation.

Occasionally we are unable to continue rehabilitation due to the problems highlighted above.

Also in this section

Useful Links

If you have any questions or concerns regarding the information above then please get in touch with the team at the Artificial Limb and Appliance Centre.

Artificial Limb and Appliance Centre (ALAC)
Rookwood Hospital
Fairwater Road
Llandaff
Cardiff
CF5 2YN

Reception: 029 2184 8100

Find out more on the Cardiff and Vale University Health Board website.