Amputation surgery can be life-changing for both patients and their families. To help you understand what can happen in the first six months following an amputation, including how your day-to-day life might change, we spoke to occupational therapist Emma Benfield.

Emma is a qualified occupational therapist and associate case manager working alongside Bush & Co. Since 2008, Emma has worked with adults in both statutory and private sectors; with specialist experience in the management of upper and lower limb amputations, complex orthopaedic injuries as well as subsequent mental health conditions, including depression and post-traumatic stress disorder (PTSD).

She has worked with patients who have undergone lower limb amputations in the context of poly-trauma following catastrophic incidents, which is when a person is subjected to multiple serious injuries. Find out more about Emma here.

What challenges will an amputee experience following surgery?

Having an amputation is a life-changing experience that, as one client commented, ‘is difficult to put into words’. The loss of a limb can be terrifying and devastating to come to terms with, particularly if it was an unexpected outcome of a sudden injury. The challenges are, for many, overwhelming - changes in pain and sensation, changes in body image and self-identity, and grieving the loss of the limb will all be aspects to try and come to terms with.  

One aspect that many clients have found surprising is just how much harder doing basic, day-to-day activities can be following an amputation. Many will need to relearn and rethink how to do the most basic activities, which they didn’t ever have to even think about before their injury.

John, a 29-year-old client who underwent an above-the-knee amputation in a workplace accident six years ago, commented:

With the right support and advice, life will become manageable again. The best approach is to break all the challenges and changes down into small milestones and goals - focusing on everyday transfers are a good place to start, for example, getting in and out of bed, on and off the toilet, in and out of the car, off the sofa, and focusing on dressing and grooming activities. These are all tasks that the physiotherapist and occupational therapist would have started in hospital following the procedure, and that community and inpatient rehabilitation input can continue with.

What Support is There for an Amputee in the First Six Months?

There is a clear clinical pathway for NHS services, providing both inpatient and community rehabilitation and, generally, statutory provision can be very good. Expect to have a lot of involvement from several different professionals, for instance, physiotherapists, occupational therapists, district nurses, psychological support and, sometimes, orthotists and prosthetists for the fitting of a pneumatic post-amputation mobility aid (PPAM), who can assess your ability to use an artificial limb.

The condition of the skin at the site of the amputation is particularly important during this time; expect to be asked about any changes, no matter how small, and expect to be monitored for infection or skin breakdown on a regular basis. 

Generally, rehabilitation options can vary from NHS trust to trust; however, most inpatient units will have a therapy kitchen and bathroom, where you can practice life skills such as washing, dressing, and preparing basic meals. There is also likely to be an outdoor mobility area, and a physiotherapy gym. 

Additionally, there is a strong emphasis on psychological support; up to 30% of people who have an amputation experience depression, particularly when the amputation was unexpected, and up to 60% can experience PTSD following the loss of a limb. 

Early rehabilitation in the first six months will focus on building up strength in the muscles around the amputation site, gait re-education, exercises to improve balance and prevent falls, and educating the client on caring for their stump. Falling is a particular risk factor for people who have had a limb, upper or lower, amputated, and it is very common to automatically assume that your amputated limb is still there and, for example, automatically try and take a step. 

Phantom limb pain is experienced frequently; up to 80% of clients report this, particularly within the first six months. Several interventions have been shown to reduce phantom limb pain, including mirror therapy, pain medication, hypnotherapy and, more recently, phantom motor execution therapy which activates the motor area of the brain, reducing pain. It is a lot to take in, and many clients say the first two years following amputation are, by far, the most challenging.

The recovery process following amputation can be long. Generally, a wound can take up to 18 months before it can be considered for a prosthetic limb. Not all people will have a prosthesis, but if you are to have one, the wound needs to have healed first. The fitting of a prosthesis and getting used to life with a prosthetic limb is a further journey in itself, taking up to eight months for most people who are able to engage well in rehab. 

A previous client, Edward aged 41 underwent a below-knee amputation following a road traffic incident, commented: “The process takes all this time and energy…I didn’t realise. But it is very worth it, now, everything seems much easier now than it was”.

What Kind of Changes to the Home Will Need to be Made Following an Amputation?

The discharge home from hospital or an inpatient therapy unit often requires planning and thinking both practically and creatively. John, who returned home following an above-knee amputation, needed to make some changes to accommodate his new level of function following his amputation. 

“Initially I could not climb the stairs, so I needed to be set up with a bed downstairs for a while. Standing to prepare meals was very difficult, so I relied on a stool to perch on whilst preparing meals. I needed a bed rail to help me get on and off the bed. I also realised how tired I would get, and put a few extra chairs around the house, for example in the hallway, so that I could stop and rest when I needed. Later on down the line, the occupational therapist organised a level access shower, with grab rails inside, so that I could take a shower on my own.” 

Changing and making adaptations to the home environment can enable you to live more independently after an amputation, and your occupational therapist can help facilitate these changes for you. Some of the most common changes are based around reducing the risk of falls, increasing bathroom access or making space for a wheelchair if required, for example, the installation of a wetroom, a level access shower, additional grab rails, additional stair rails and levelling entry and exit points can be common adaptations to a home following amputation.  

A Disabled Facilities Grant can be available for many people living with a long-term disability, and up to £30,000 can be granted to adapt your property if needed - again, your occupational therapist will be able to start the application process if more major adaptations are needed to your property.

Knowing and understanding how to do things differently will also help in regaining independence. For clients who have undergone an upper limb amputation, particularly with their dominant hand, everyday tasks such as getting dressed, eating, typing, opening and closing doors, and grooming can all seem impossible. There are, however, lots of strategies and ideas of how to overcome functional challenges. For example: 

• Putting a ring on a zip makes it much easier to do up
• Using an elastic band that slides onto the arm with an amputation to hold a toothbrush or spoon can help with grooming and feeding 
• Using one-handed chopping boards to prepare ingredients that have a spike to hold food can help with meal preparation 

Many mainstream commercial companies, such as Amazon and the Complete Care Shop, stock a wide supply of everyday items that are adapted for use of one limb. 

It takes time, support and practice, but many clients learn to live, and to live a happy, fulfilled and independent life following their amputation, doing the things they used to, even if in a slightly different way.