Occupational therapists have distinct roles in each of the therapeutic phases of recovery for individuals with limb loss and prosthetic devices. Throughout the process, the ultimate goal is to increase the individual's occupational participation and overall quality of life.
Acute Phase
*Pre-Operative (when possible)
& Post-Operative Follow-Up
This stage includes...
*Evaluation (When possible, the occupational therapist should perform an evaluation preoperative, but this is not always possible (Hermansson & Turner, 2017).)
*Identification of client-centered short- and long-term goals
*Development of client-centered intervention plan
*Beginning stage interventions should be focused on the following:
- Wound Care
- Range of Motion
- Desensitization
- Pain Control
- Psychosocial Support
Pre-Prosthetic
Training
Focused more on the
skills needed to complete
meaningful activities
This stage includes...
*Preparation for fitting and optimal use of prosthetic
*Interventions should be focused on the following:
- General Conditioning Exercises
- Posture (changes due to limb loss or weight of prosthesis)
- Basic ADLs without Prosthesis (feeding, dressing, bathing, toileting, etc.)
- Edema Control
- Desensitization
- Scar Management
- Noninvasive Feedback for Muscle Control
- Instruction of Body Motions Needed to Operate Prosthesis
- Introduction of Adaptive Equipment
- Change of Hand Dominance (if applicable)
Basic Prosthetic Training
Focused on monitoring the ability to perform desired, basic activities with a prosthesis
This stage includes...
*Providing training, education, modifications, and psychosocial support
*Interventions should be focused on the following:
- Donning/Doffing the Prosthesis
- Creating a Wear Schedule
- Learning Basic Controls of Prosthesis
- Completing Basic ADLs with (and without) Prosthesis
- Integrating Coping Strategies as Appropriate
- Facilitating Interaction with Others Who Have Similar Experiences
Advanced Prosthetic Training
Focused on integrating the prosthesis into desired, more advanced activities
This stage includes...
*Identifying and integrating prosthesis into advanced activities desired by the individual
*Interventions could be focused on the following:
- Child Care
- Home Management
- Work Tasks
- Driving
- Sports
- Hobbies
Discharge Planning
Occurs throughout the entire process!
This stage includes...
*Identifying appropriate discharge locations (in-patient rehabilitation, outpatient rehabilitation, home health, etc.) - varies for each individual
*Conversations could include the following:
- Progressive Community Reintegration Plans
- Consultations with Vocational Rehabilitation Staff
- Resources for the Client and Family
- Education and Training for Continued Engagement in Self-Care, Vocational, and Leisure Activities
(Gulick, 2016; Latour, 2015)
REFERENCES
Gulick, K. L. (2016). Fact sheet: The occupational therapy role in rehabilitation for the person with an upper-limb amputation. American Occupational Therapy Association. https://www.aota.org/About-Occupational-Therapy/Professionals/RDP/upper-limb-amputation.aspx
Hermansson, L. N., & Turner, K. (2017). Occupational therapy for prosthetic rehabilitation in adults with acquired upper-limb loss: Body-powered and myoelectric control systems. Journal of Prosthetics & Orthotics (JPO), 29, P45–P50.
Latour, D. (2015, May 4). Series: Upper Limb Prosthetics. [On-Demand Webinar]. OccupationalTherapy.com https://www.occupationaltherapy.com/ot-ceus/course/upper-limb-prosthetic-series-2441