Taking the
next step in discovering life after limb loss or difference can be both
exhilarating and intimidating. The process of getting a prosthesis, whether
it’s your first time or you’re replacing an existing device, deserves careful
consideration for achieving the best outcome possible. We understand just how
daunting this journey may seem so we’ve put together some helpful answers to
get you started!
Why would I use a prosthesis?
A prosthesis is
simply a tool. It is an artificial replacement for a missing limb or part of a
limb that can help you regain independence after your amputation or if you are
living with limb loss. Choosing to use (or not use) a prosthesis depends on
your personal goals. The best prosthesis is one that will help you reach your
goals and live the life you’d like to live. Some important things to ask
yourself are:
·
What do you want to be able to do with a prosthesis?
·
What activities do you plan to do?
·
Do you want to walk or run?
·
Do you care about the way it looks?
There is no one
device that is best for everyone. The key to success is working with your
doctor, prosthetist, and rehabilitation team to address your needs and
concerns. Your prosthetist will work with you on design and fit. Your physical
and occupational therapists will work with you to teach you how to use your new
prosthesis to the fullest and to help you achieve your goals.
In general, how does a prosthesis work? What does a prosthesis look
like?
A prosthesis is
basically an extension of your body. Individual prostheses will differ
depending on the level of amputation, a person’s physical abilities, and their
personal goals and needs. Your prosthetist is responsible for making design
recommendations and creating a device that is custom-made to fit your limb and
suit your lifestyle.
The basic
components of a standard upper-limb prosthesis are similar to those of a
lower-limb prosthesis (sockets, pylons, etc.). While a lower-limb prosthesis
incorporates a foot with a focus on ambulation (walking), an upper-limb
prosthesis will have a “terminal device” such as a hook, hand, or a specialized
tool, with a focus on functional enhancement.
The socket is
the receptacle into which your residual limb will fit. Usually a liner or
socks—or a combination of both—are applied first over the residual limb,
followed by the socket. Liners fit over your residual limb and provide a
barrier between your skin and the socket. Socks of various thicknesses, or
“plies” may be worn over the liner to keep the socket fitting intimately as the
volume of your limb may change during the day or over time. The liner
provides cushioning and comfort while providing a better fit for the socket. It
is essential that the socket fits correctly. A poorly fitted socket can lead to
pain, sores, or blisters on your residual limb. The prosthesis must also be
suspended or held onto the limb by some means, such as a suspension sleeve, or
a locking pin that is attached to the liner and fits into a locking
mechanism. Other suspension options include suction or vacuum, and cuffs
or harnesses. Some sockets are held on by gripping over the anatomy, such
as the widening of the femoral bone above the knee. Your prosthetist will
be able to discuss the many socket and suspension options with you and can help
you understand the pros and cons of each.
A prosthesis can
look pretty much however you want it to. Be sure to discuss what you have in
mind with your prosthetist because each option has pros and cons that can
affect the weight, ease of cleaning and maintenance and durability of the
finished prosthesis. From the ‘uncovered’ look of the mechanical
parts to a cosmetic cover that looks like a natural limb, you have many
options. If you want to make a fashion statement, you can have your socket
covered in your favorite team’s logo or accessorize it with your favorite color
or pattern. The prosthesis is an extension of you and your style – wear it
proudly!
Technology and
innovative prosthetic device approaches continue to provide more and better
care options. The provision of a prosthesis represents the culmination of
assessment, evaluation, design, fabrication, fitting, training and follow-up,
ultimately resulting in a custom device. The profession is clinically-based and
service-oriented, so it is important that you work with a prosthetist who
listens to your needs and goals, and to whom you will have relatively easy
access for adjustments and maintenance over time. With advances in
techniques, materials and components such as microprocessor knees and advanced
feet, hands with multiple grasp patterns, and osseointegration, new
opportunities continue to be developed to help people with limb loss and limb
difference live the lives they most want to live.
Will I need to use a wheelchair or crutches?
Some individuals
find that a wheelchair or crutches are helpful in reaching their goals. The
type of assistive device you use is your choice. Many individuals with limb
loss and limb difference have a wheelchair or pair of crutches that they use at
least part of the time. They may use them for nighttime trips to the bathroom,
showering, traveling long distances, or if problems arise that require leaving
the prosthesis off for a period of time. A wheelchair may continue to be used
for exercise and sports. Crutches may help save wear and tear on your
residual limb for activities like longer walks or hiking, and can help you get
around if you occasionally have times you can’t or don’t want to use your
prosthesis. Using an assistive device is an individual decision that is
based on your needs and comfort level. Find your state’s Department of
Assistive Technology in Community
Connections.
How much will a prosthesis cost, and how can I pay for it?
A prosthesis can
range widely in price and will depend on your amputation level and the type of
device that is best suited to you and your individual needs. Typically, your
prosthetic device will be partially covered by your insurance plan. Some
insurance plans may even cover the entire cost of the device. You will need to
work closely with your insurance company to understand the types of devices and
services that will be covered under your policy. Be prepared to make several
phone calls, provide documentation, and be your own advocate with your
insurance company. You should check to see if your policy includes coverage for
a prosthesis and know the limitations and exclusions in your policy. It is
important to know that working with your prosthetist on fit and alignment of
your prosthesis should be bundled with the total cost of your device. Your
prosthetist should continue to work with you until you reach a comfortable fit
and alignment.
The Amputee
Coalition has created an Insurance Coverage and Reimbursement Guide to
help you navigate common insurance questions. Contact the Amputee Coalition’s
National Limb Loss Resource Center at 888-267-5669, option 1 to request your
free copy. If you find yourself in need of help to pay for a prosthesis, you
can find different funding opportunities by reading the Financial
Assistance for Prosthetic Services, Durable Medical Equipment, and Other
Assistive Devices fact sheet.
What is a K Level?
A K level is a
scale used by Medicare to rate your rehabilitation potential. Many private
insurance companies follow Medicare’s example to establish coverage guidelines.
The K level is a rating from 0 to 4 that is used to predict your potential
success with your prosthesis. It may change over time as you improve in your
ability to wear and use the prosthesis. The K level is important because it is
used by your insurance company to figure out what type of prosthetic device and
specific components like the knee and foot, they will cover for you. Insurance
companies want to know that the prosthesis you receive will be appropriate and
functional. The potential function of your prosthetic device is determined by
your pre- and post-amputation capabilities and goals in order to create a full
picture of your functional abilities and any limitations you may face on a
typical day. Your doctor will complete an assessment of your physical and
cognitive abilities to determine your K level. The different K Levels are:
·
K0 Level: Does not have the ability or
potential to ambulate or transfer safely with or without assistance. A
prosthesis does not enhance quality of life or mobility.
·
K1 Level: Has the ability or potential to
use a prosthesis for transfers or ambulation on level surfaces at fixed walking
speeds. Typical of the limited and unlimited household ambulator.
·
K2 Level: Has the ability or potential
for ambulation with the ability to traverse low-level environmental barriers
such as curbs, stairs, or uneven surfaces. Typical of the limited community
ambulator.
·
K3 Level: Has the ability or potential
for ambulation with variable cadence. Typical of the community ambulator who
has the ability to traverse most environmental barriers and may have
vocational, therapeutic, or exercise activity that demands prosthesis use
beyond simple locomotion.
·
K4 Level: Has the ability or potential
for prosthesis ambulation that exceeds basic ambulation skills, exhibiting high
impact, stress, or energy levels. Typical of the prosthetic device demands of
the child, active adult, or athlete.
How do I choose a prosthetist?
The relationship
between a person with limb loss or limb difference and their prosthetist is
unique and critically important. Many individuals with limb loss have a
lifelong relationship with their prosthetist. This makes choosing a prosthetist
a very important decision. A prosthetist may be recommended to you, but the
decision is ultimately yours to make. Be sure your prosthetist is professional,
knowledgeable, reliable, licensed (if your state has licensure), nationally
certified, and is recognized as a provider by your specific insurance company.
You can find more information about choosing a prosthetist by reviewing the
brochure produced by the Amputee Coalition and American Academy of Orthotists
and Prosthetists: Patient and
Prosthetist: Working Together for a Successful Outcome or our Locating a
Certified Prosthetist fact sheet.
For help in finding
a prosthetist near you, visit the Prosthetist Finder.
When will I get a prosthesis?
The timing depends
on how quickly your residual limb fully heals from the surgery. Some
individuals receive a temporary prosthesis immediately following amputation or
within two to three weeks after surgery. Usually, a prosthetic device fitting
begins two to six months after surgery once the surgical incision has healed
completely, the swelling has gone down, and your physical condition
improves. The rehabilitation process, however, should begin soon after
your surgery with physical and/or occupational therapy, learning mobility with
a wheelchair, walker, or crutches, and exercising and stretching to avoid
contractures to keep you as mobile as possible and prepare you for
wearing and using your prosthesis.
Once I get my prosthesis, how soon can I get back to what I used to do
before my amputation?
Your new normal
will depend on the type of amputation(s) you have, your rehabilitation process,
and your overall health and well-being. Your prosthesis will be a tool to help
you do the things you used to do as well as the activities you want to do now.
How well you do will depend on your goals, a correct and comfortable prosthesis
fitting, follow-up care, and determination. The first year following an
amputation can be a difficult adjustment. There will be changes in the shape
and size of your residual limb. You and your team will put in a lot of work to
recondition muscles. Your body will need to relearn activities, gait, balance,
and coordination. You will also need to learn to trust your prosthesis.
You will continue
to improve with time and effort. It is important to have a strong support
network around you for this journey. The Amputee Coalition’s Peer Support
programs are an excellent resource to help you build support with others who
have experienced limb loss or limb difference. Our Peer Support team can
connect you with a support group online or in your area, as well as connect you
with a Certified Peer Visitor who can offer you encouragement and information
from their perspective. For more information on how to connect with others in
the limb loss community, visit the How to Find Support page.
What if the prosthesis does not fit correctly?
The process of
being fit for your prosthesis will involve several visits to create a device
that fits you and your needs. Some amputations can be more challenging to fit
correctly and may require multiple fittings. Remember, your prosthetist
doesn’t restore your limb, but rather replaces it
with a prosthesis. Even when fitted properly, it takes some time to get used to
the sensation of taking weight through your residual limb. While some initial
discomfort can be anticipated as you get used to a prosthesis, pain is not an
anticipated part of the process. If you should experience pain, try to be as
specific as possible in describing what you are feeling and where you are
feeling it to your prosthetist so that it can be addressed. Follow-up visits
with your prosthetist can be as important as the initial fitting. As your
residual limb changes and continues to heal, you will need to make follow-up
visits for continuing evaluation of your progress and potential adjustments.
Tell your prosthetist if the prosthesis is uncomfortable in any way, so your
prosthetic team can relieve pressure areas, adjust alignment, or resolve
problems you are experiencing. The more comfortable the fit, the more likely
you are to use your prosthesis. Talk honestly with your prosthetist about your
needs and goals. Discuss the things you want and need to do in your life after
surgery.
How long will my prosthesis last?
Depending on your
age, activity 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 the shrinking of the limb. This may
require socket changes, new liners, or even a different device. Increased
activity level and a desire to do more activities can create a need for a
change in the prosthesis or its parts. Once you are comfortable with the fit of
your device, the prosthesis should only need minor repairs or maintenance.
However, your prosthesis should be regularly checked by your prosthetist to
avoid any major problems.
Is it difficult to learn to use a prosthesis?
Learning to use a
prosthesis can be a challenge. It takes time, effort, strength, patience, and
determination. Your prosthetist should give you some training on using your new
prosthesis. Many people also find it helpful to work with a physical therapist
or occupational therapist who is familiar with working with individuals with
limb loss and limb difference. This is especially true for your first
prosthesis or after a major change in the components. Much like learning
how to operate a car, there is a lot to learn at the beginning. It should become
second nature with practice.
Your prosthetist
should teach you how to:
·
Take care of the prosthesis;
·
Put on (don) and take off (doff) the prosthesis; and
·
Walk on different types of surfaces, including stairs and uneven
surfaces.
A physical or occupational
therapist can teach you how to:
·
Handle emergencies safely, including falling down and getting up again;
·
Perform daily activities at home, work, and in a car;
·
Improve your gait to help you walk better; and
·
Try out new things you may be unsure about including sports and other
recreational activities.
What can I do to prepare myself for a prosthesis?
There is a lot you
can and must do to be able to use a prosthesis, beginning with these top
priorities:
·
Work through the feelings and emotions you are experiencing and decide
how to approach your life after an amputation. Remember that everyone responds
differently to the loss of a limb or being born with a limb difference. Don’t
be afraid to look into visiting with an amputee peer, attending an Amputee
Support Group, or working with a counselor or Psychologist, as these are all
normal ways of coping with such a major life change.
·
Exercise to build the muscles needed for balance and moving around.
·
Prepare and take care of your residual limb to attain a proper, sound
shape.
·
Learn body positioning, stretching and strengthening to maintain muscle
tone and prevent contractures.
Once I have been fitted for a prosthesis and it feels comfortable, what
happens next?
You should plan to
make follow-up visits to your prosthetist a normal part of your life. Any
changes in your residual limb, such as swelling or shrinkage, or a significant
change in your body weight, may require a follow-up with your prosthetist to
adjust the fit of your socket. Prostheses, just like cars, need regular
maintenance and repair to keep working. Small adjustments can make a big
difference. Proper fit of the socket and good alignment will make sure that the
prosthesis works for you. It can also help prevent some secondary conditions
individuals may experience such as skin breakdown or a misaligned gait.
Can the prosthesis break down?
Yes, things can
happen that will require repair or replacement. It is a good idea to know about
warranties and what to expect from your prosthetist. Get small problems taken
care of right away — there is no benefit to waiting! Waiting may cause a more
difficult repair or even serious skin breakdown. You can do harm not only to
your residual limb, but also to other parts of your body. Strain on other
muscles, like your back and shoulders, will affect your posture and the
performance of the device and will increase the amount of energy needed to use
your device.
Would it be helpful to speak with others who use a prosthetic device?
There is great
value in talking and meeting with others in the limb loss and limb difference
community. The Amputee Coalition can connect you in a variety of ways with
others who have experienced limb loss or limb difference and have chosen to
use, or not to use, a prosthesis. Visit the How to Find Support page to
explore the many different ways you can connect with other individuals with
limb loss and limb difference both locally and across the country.
For additional
information, helpful tools, and resources, please contact the National Limb
Loss Resource Center at 888-267-5669, option 1 or via our Ask an Information
and Referral Specialist form.
Additional Resources
·
Amputee
Rehabilitation Video Series