02 July 2013
Iona Meeres-Young on the effects of traumatic amputations
As a Medical Researcher at Slater and Gordon I have been involved with many cases in which clients have suffered severe trauma resulting in the loss of a limb. These cases really emphasise the different needs both physical and psychological of the client and how these affect the overall outcome.
If we consider the general case for amputations, the NHS performs around five to six thousand amputations a year, more than half of these are on patients over 70 years of age. 70% of lower limb amputations are performed due to problems with blood supply to the limb, commonly a result of diabetes.
Subsequently not all of these patients are suitable candidates for prosthetic limbs. Frail patients and those with other significant medical conditions, such as heart disease would not be considered due to the extra energy required to use a prosthesis. It is estimated that walking with an above the knee prosthesis requires 80% more energy than walking with two legs.
Organisations such as the Douglas Bader Foundation give an idea of the care pathway for amputees - this involves extensive physiotherapy and counselling both pre and post surgery. Meeting other amputees who have had an amputation to the same level is also recommended prior to surgery.
However the situation for our clients is often very different from the average NHS amputee. In many cases the limb is removed soon after injury, without the opportunity for any counselling. This is understandable due to their life threatening injuries, however it should also be understood that they will need greater support psychologically during their recovery.
Our clients are usually much younger and fitter than the average NHS amputation patient. They require more from their prosthesis to achieve somewhere near their pre-injury ability. Whilst the NHS can supply a wide range of prosthesis, some of our clients have wanted the more advanced models that can only be sourced privately. Within the NHS there is extra funding available to provide such prosthesis for war veterans however provision for civilian trauma victims can be limited.
As our clients are often younger the long term effect of using a prosthetic limb should be considered. Quite often the use of a prosthetic limb results in an increase in long term joint problems in the remaining healthy limb. Advanced prosthetics that allow a more natural gait minimise this problem.
Clients who have suffered severe trauma without the loss of a limb can later go on to have amputations. Failure to heal, chronic pain, tissue viability and lack of function can all result in having to make such a decision. Again the needs of the individual client are paramount, some wish to try anything to save a limb irrespective of function whilst others feel they will benefit more from a working prosthesis.
Listening to the needs of our clients we aim to provide the best possible outcome for them and their family. Understanding the limitations of the NHS we can ensure their rehabilitation is not delayed. Rehabilitation from such a traumatic event needs to start as soon as possible with specialist counselling and physiotherapy and the provision of suitable prosthesis.
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