Amputee patients

So we spent the last few days learning about the amputee population and the rehab involved and also got to talk to a few amputees and how they are doing. It really surprised me how well many people adjust to not having part of their body. Prosthetics have become really amazing devices and the technology is evolving every day. Now there are artificial knees that sense how the body is moving and know when to bend and when to lock, people can even walk up stairs with no hams/glutes and the artificial knee doing all the work!

Although I realized today, that recovery really depends on whether the pt is otherwise healthy and how much insurance the person has. The government does not fund anything but the most basic prosthesis, and unless the pt has insurance from MVA, work-comp, or work insurance, they have to pay out of pocket. Let me mention the amazing C-leg or micropressor computer knee is 50K, the price of a car.

Another disparity is the amount of rehab pt receive and this depends on where they acquired their injury. MVA + work= more rehab, since the insurance companies pay the rehab centre extra money. Injured at home, or diabetes= goverment= only a few months of rehab and then you're on your own...This was especially frustrating to see, since the more rehab pt receive at the beginning, the better they do, and even though they are 'functional' at home (can walk, transfer, cook), that doesn't mean that they are able to return to their normal life, and ultimately that should the goal of rehab and not just to be functional.

On the other hand, I was really inspired how people overcome very very hard injuries, and many are very resilient, positive and every day give it their all in therapy, complaining very little and given what a lot of them have been through, they definitely have the right to complain. For many pt even after an above knee amp, they are able to walk, do stairs and even playing modified sports which is fairly remarkable. Imagine, snowboarding and playing competitive volleyball with an above knee amputation? Really inspiring.

Although after this week, I realized this population is not really for me (sigh, I keep crossing things job environments off my list instead of adding them). The main issue for me is that I'm so far still fairly bad at analyzing normal gait, let alone amputee gait, and trying to correct amputee gait is very difficult since you have to think, what muscles are there, which ones are missing? What can you compensate with? Is it the muscle weakness/imbalance, the other leg or the prosthesis that is causing the gait deviation? Definitely a lot harder than it seems, and the therapists are definitely experts and can spot even the slightest limp and can fairly quickly identify the cause. I usually can spot there is a problem, but my guess work at what is causing it is usually wrong...sigh.

Being back working with patients for even 1 day was definitely challenging after being in class for so long. It is definitely a challenge to suddenly become the professional that has to take think about what to say, how to be appropriate, and how to even motivate again. The other problem is that everyone views you as a person with knowledge, and it is not really an option to say 'I don't know', so in those cases, my brain quickly tries to put together the enourmous amount of info we have learned so far to come up with a semi-right answer and hopefully attempt to answer their questions, although it was definitely a challenge. In most instances, the type of exercises and treatment techniques we learn should be adaptable to many patients, but for me, the adaptation of these exercises is definitely a challenge since I constantly wonder will I cause more harm? Can this exercise break their prosthesis? Will the manual mobs for a pt with a disc herniation cause more pressure on the spinal cord? It doesn't make it easier when without any preparation, (I end up being on my own since everyone got other partners) do a subjective+ obj Ax + suggest a Rx plan in an hour. I mean I should start getting prepared for this, since this is what awaits me in 2 months (internship), but it is really really challenging for my brain...

Another thing that frustrated me, is that we don't see everything. What therapists and doctors consider a good success story where the pt is able to walk without aids and live in the community, may not be good enough for the pt. They may still be in pain, have to deal with other medical problems from their disease (diabetes), and depending on the type of job they did, they may not be able to return to their previous job, and may also have a lot of changes in their interpersonal relationships such as with friends and family, and we don't see a lot of that. So for them, success is not just being able to walk without a gait aid, for them success is being able to go back to their jobs, play sports, be able to play with their kids, have good relationships with their family, and live in a their own home without having to modifying it. What I've learned is that many do suffer from depression, and many may start medicating with alcohol, and for me the most frustrating thing is I don't know how to help them....ROM, strength, gait, balance are often a lot easier to fix then their relationships, employment and mood. Struggling with depression myself has actually made it harder to help others, since I know how hard it is to come out of and that their are no easier answers, and even though I could just say like everyone else, 'push through it, it will get better', 'life is what you make it', 'there are always things to live for'. I know that they can be empty promises for a person that has diabetes, possible kidney failure, pain, and little prospect of going back to what their life was like before...

So I quess to summarize, even though a lot of people struggle and continue to struggle with a prosthesis, a lot of people are able to get back to their life and for many, it is almost impossible to tell from their walking or activities that they had a amputation, and that is truly inspiring because it takes a lot of work.