Casualties of the war in Iraq have created a growing number of young amputees who face the need to learn new ways to function in their daily lives.
Many prosthetists and physicians are learning to depend on the holistic perspective of OT practitioners to tend to functional retraining while appreciating the psychosocial needs of the new amputee. Several prosthetics companies such as Otto Bock Health Care and Advanced Arm Dynamics now hire OTs for this express purpose.
According to Shawn Swanson, a prosthetics OT employed with Otto Bock, the role of the prosthetics-trained OT is multifaceted and occurs in stages as the client's status evolves. The first stage is the period of time immediately following the trauma of the amputation, when the OT is working with wound care, debridement, edema control, scar management and desensitization. The therapist also opens dialogue to create rapport with the client and her family and begins to explore her future plans and current abilities with ADL, vocational and leisure pursuits, so that they can determine what she will need to be able to do with the prosthesis. An OT who works closely with a prosthetist and has expertise in this area can actually help select the type of device to be issued.
The second stage, pre-prosthetics training, includes interventions that prepare the residual limb for the use of the device. Interventions include shaping the stump, increasing strength and endurance of remaining muscles, working to enhance muscle control and differentiation, EMG signal training (for myoelectric prosthetics) and education for use of the device.
The third phase occurs when the client receives the initial device. The OT helps the client to develop skills in donning and doffing it, operating it (doing the proper sequence of movements to grasp and manipulate ADL objects such as eating and writing utensils, and use the prosthesis during functional mobility and movement transitions). The OT's work, in collaboration with the prosthetist and the client, is paramount at this phase. Problems with fit or use can be quickly remedied to expedite the client's return to function and minimize the time and cost of rehabilitation.
In the fourth phase, clients continue to build their basic prosthetic skills into the ability to complete more complex tasks. OTs assist in helping these people develop greater independence and mastery of their new devices. Training in self-care; ADLs such as eating and cutting food, grooming, dressing and toileting; and instrumental ADLs such as child care, driving, house care and cooking are the focus of this stage. This is when work, school and leisure activity independence is achieved.
Throughout this process it is paramount that the OT become well aware of the specific issues and unique concerns of each client; empathy and psychosocial support augment formal counseling sessions in which many post-trauma clients participate.
The reward of being a member of a profession that is holistic in its approach to client assessment is to have input into the choices that will affect the future life of the amputee.
This is an emerging area of OT practice that should be embraced and nurtured. OTs who specialize in upper-extremity prosthetics practice must have a strong background in kinesiology and muscle training, as well as knowledge of wound healing and modalities/methods such as edema management and hydrotherapy. AOTA and individual therapists are encouraging efforts to enhance prosthetics practice through the networking/education of practitioners new and experienced within this field. For more information, visit Otto Bock at www.ottobockus.com or Advanced Arm Dynamics at www.armdynamics.com.
Deborah Amini, MEd, OTR/L, CHT, is director of the occupational therapy assistant program at Cape Fear Community College in Wilmington, NC. A 1983 graduate of Quinnipiac University, Hamden, CT, she has been a clinical hand therapist for 17 years. Readers may reach her at 910-362-7096 or by e-mail at firstname.lastname@example.org. or through ADVANCE at email@example.com.