What are limb loss and limb differences?

The term limb loss generally refers to the absence of a limb (arm or leg) due to surgical or traumatic amputation, whilst limb difference is used when referring to the congenital absence or malformation of a limb.

What causes limb loss and limb difference?

Limb loss can occur due to trauma, infection, diabetes, vascular disease, cancer and many other diseases. The causes of congenital limb deficiency are frequently unknown. In the past many causes of limb deficiency were attributed to the use of medications (such as thalidomide) by the mother during pregnancy.

How can I reduce the risk of amputation?
• Practice good hygiene and foot care particularly if you are diabetic
• Don’t smoke
• Ensure that safe work practices are in place and adhered to when operating machinery in the workplace
• Ensure that you use machinery such as lawnmowers and power tools safely in and around the home
• Reduce the risk of limb deficiencies in unborn children by only using medications under your doctors’ strict supervision.

Are there increased risks for other health problems?
Limb loss is more often the result of rather than the cause of other health problems. Since the loss of a limb can cause a decrease in activity health problems related to a sedentary lifestyle may be of concern. Residual limb and phantom pain, as well as skin problems associated with prosthetics can be common.

What is involved in caring for people with limb loss and limb difference?
The care required for a person who has undergone amputation will depend greatly on their overall health and ability. Physical therapy, occupational therapy and gait training will be required to assist the person with the use of prosthetics and other assistive devices to help them regain independence. Some amputees may also require professional help to overcome the emotional issues related to the amputation. Amputees who are not suited to using prosthesis will require more care and assistance with mobility.

Can I speak to someone else who has had the same type of amputation?
Yes. The Amputee Association Peer Support Program can arrange for you to be visited or called by an amputee who is the same gender, age group and a similar amputation and/or activity level.

How can I help myself to learn about adapting to limb loss?
No-one should have to suffer through limb loss alone or uninformed. There is information available to you and your caregivers at the Amputee Association of NSW that may assist you in your journey. You will find information on disability services available, prosthetists in your area, and peer support available. There is information available on sports activities, phantom limb pain, as well as books available for amputees.

What happens after the amputation?
Generally you will be assessed as to your suitability for a prosthesis (the artificial replacement for the missing limb or part of the limb). Although a prosthesis is never as natural as your own limb it can help you do many things quite effectively if you are willing to combine your energy and willpower into learning how to use it. It is important for you to work with your doctor, prosthetist and therapists; these people can address all of your concerns. They will work with you on the design and function of your prosthesis and training on how to use it.

What does a prosthesis look like and how does it stay on?
Depending on the type and level of amputation, physical ability and functional needs of each person, every prosthesis will differ. Prosthetic components are available if you desire a “cosmetic look” however, most standard prosthetics provided are comprised of conventional component parts attached to a socket that fits over your residual limb. There are a number of ways that the prosthesis is held on, some use strapping, some suction; your prosthetist will advise you of what will be suitable for you.

Will I be able to do all the things I did before I lost my limb?
The majority of people who lose a limb are able to return to their former lifestyle and functioning within several months. Returning to work, driving a car and social activities are all still possible depending on the location of the amputation and your physical ability. Having a positive “can do” attitude and setting achievable goals will assist you in getting on with your life. A timely and well fitting comfortable prosthesis and good follow up care are all contributing factors to how quickly you can get back to “normal”.

When will I get a prosthesis?
Generally you should be ready for a prosthetic measuring and fitting within a few weeks after surgery, when the wound is healed and tissue swelling has decreased. During this stage of rehabilitation your medical team will be concerned with maintaining proper shape of the residual limb as well as increasing your overall strength and function. Fitting will usually involve several steps to create a prosthesis that is unique for you.

What if the prosthesis doesn’t fit correctly?
Follow up is as important as the initial fitting. You will need to make several visits for adjustments with the prosthetist as well as training with a therapist. They can help you ease pressure areas, gait issues, adjust alignment, work out many other problems and regain the skills you need to adapt to life after limb loss. Tell your prosthetist if the manufactured limb is uncomfortable, too loose or too tight. Ask questions about things that you need or want to do. Communicate honestly about your needs. The more you communicate with your prosthetist and therapist the better you will be able to succeed with your prosthesis.

How long will my prosthesis last?
Depending on your age, acitivity level and growth, the prosthesis can last anywhere from several months to several years. In the early stages after limb loss, many changes occur in the residual limb that can lead to shrinking of the limb. This may require socket changes, the addition of liners and socks, or even a different device. Later on, increased activity level and desire for additional function can necessitate a change in the prosthesis or its parts. Once you are comfortably adjusted and functioning at the desired level of activity, the prosthesis needs only minor repairs or maintenance and can last for an average of three years.

Is it difficult to learn how to use a prosthesis?
Learning to use a prosthesis is a tough job. It takes time, effort strength, patience and perseverance. You will do best to work with a therapist while learning how to handle the new device. Much like learning to drive a car, you need guidance on how to:

  • take care of the prosthesis
  • put on and take off the prosthesis
  • walk on different types of surfaces, including stairs and uneven terrain
  • handle emergencies safely, including falling over and getting up again
  • perform daily activities at home, at work and even in a car
  • investigate new things you may be uncertain of, including sport and recreation activities.

What can I do to prepare myself for a prosthesis?
There is a lot that you can and must do to be able to use a prosthesis well. Some of these are:

  • working through the feelings about losing a limb and deciding how to rebuild your life after amputation
  • exercising to build the muscles needed for balance and ambulation
  • preparing and taking care of the residual limb to maintain a proper, sound shape for the prosthesis
  • learning proper body positioning and strengthening, to maintain tone and prevent muscle loss.

Will I need to use a wheelchair or crutches?
Some people choose not to use a prosthesis, relying only on mobility devices such as crutches or wheelchairs. However with a prosthesis the use of mobility devices depends on several factors including the level of amputation, whether you have a single or bilateral amputation, and your level of balance and strength. Most amputees have a pair of crutches for times when the limb is off, including night-time trips to the bathroom, showering, participating in certain sports, and to help if problems arise that may require leaving the prosthesis off for any length of time.
If you are a person that has lost both legs you will probably use a wheelchair at least some of the time. Unilateral amputees may find it helpful to use a cane or crutches for balance and support in the early stages of walking or just to have a break from the prosthesis; this is an individual decision based on factors such as age, balance, strength and security.

Once I have been fitted and feel comfortable in its function, what will happen next?
Plan on making follow up visits to your prosthetist a normal part of your life. Proper fit of the socket and good alignment will ensure that the prosthesis is useful to you. Prostheses, like cars, need regular maintenance and repair to continue efficient functioning. Small adjustments can make a big difference.

Can the limb breakdown?
Yes, things can happen that will require repair or replacement, so it’s a good idea to know about warranties and what to expect from your prosthetist. Get small problems with your prosthesis taken care of promptly. There is no benefit to waiting until your prosthesis falls apart or causes serious skin breakdown. If you wear a prosthesis too long when it needs repair or replacement, you can do harm, not only to your residual limb, but also to other parts of your body. Strain on other muscles, especially in your back, shoulders and hips will affect posture in addition to performance of the device and the energy needed to use it. Early prevention is much better than long term treatment.

Who can I contact for more information?
The Amputee Association of NSW – 1800 810 969

Your nearest branch of the Amputee Association (go to Support then Amputee Associations and Support Groups NSW)
Enable NSW (New South Wales Artificial Limb Service (NSW-ALS) – 1800 362 253

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