Life after amputation
An amputation is a life-changing experience.
No two cases of amputation are exactly the same. A number of factors must be taken into account:
- The type of amputation (eg. below the knee or above the knee)
- The condition of the remaining limb
- Whether a prosthetic limb can be used
- The person’s age
- Their pre-injury health
- Other injuries sustained at the same time as the amputation
- Their domestic situation
- The emotional and psychological effect on the person
- The support and care the amputee will need.
To get a better idea of what a new amputee has to tackle, we review some of the physical and emotional effects below.
Physical effects of amputation
Mobility and dexterity - A lower-limb or leg amputation is inevitably going to affect mobility. In the majority of cases, after sufficient support care and rehabilitation, the injured person will be able to make use of a artificial limb called a prosthetic. The loss of an upper-limb can also impact on mobility, affecting a person’s balance, making the injured person prone to falls.
Previously straightforward tasks such as food preparation or housework may become a tremendous challenge, and the amputee may need specialist equipment, adapted rooms and furniture. Click here to read information on innovation in aids and equipment. Upper-limb amputees who have lost their dominant hand or arm are very likely to have difficulty completing tasks that require manual dexterity, and will need to learn how to use their previously non-dominant limb, for example, learning how to write with their weaker hand.
Stump and phantom limb pain - An amputee may suffer from either stump pain or phantom limb pain, often both. Stump pain is felt in the remaining part of the injured limb, and the source of this pain is found in the damaged groups of nerves at the site of amputation.
Phantom limb pain is a very widespread condition that affects up to 80% of all amputees. It refers to the sensation of pain that an injured person feels in their ‘missing’ limb. Some people may experience temporary and brief shock-like stabs of discomfort or burning sensations, whilst others report more chronic and unbearable levels of excruciating pain. This phenomenon occurs more commonly in women, and even more so in those who have lost an upper-limb as opposed to a lower-limb.
Infection - Problems can develop if the skin on the stump breaks down, causing infection of the hair follicles or wounds to open. Such occurrences can give rise to infections, and may prevent them from being able to make full use of a prosthetic limb. There may be a problem with blood supply and circulation, culminating in blood clots, or it could be that an excess of moisture has built up at the stump and infected the wounds.
Muscle contractures - A muscle contracture happens when there is an imbalance of the muscles in a limb. Lower-limb amputees are at very high risk of muscle contractures due to the sudden and drastic alteration of their anatomy and central nervous system, as well as the weight-bearing stresses placed on the lower extremities. These can be addressed through stretching exercises. If left untreated an amputee may lose the capability to fit a prosthetic limb, which in turn will mean that their mobility is further diminished.
Deep vein thrombosis - Deep vein thrombosis ("DVT") is a deep blood-clotting condition that usually affects the lower-limbs of the body and amputees are at a high risk of experiencing this condition, particularly if they have undergone surgical amputation where their limb has been immobilised and tied. If untreated, a potentially fatal secondary effect called a pulmonary embolism may develop, where part of the blood clot breaks away from the leg and travels to the person’s lungs.
Fatigue - The additional effort required by amputees to perform many of the routine activities of daily life can result in increased levels of tiredness and fatigue. In some cases the side-effects of a person’s pain medication might make them feel more tired or cause them to sleep for longer. In addition, the psychological effects of the injury and accident may disturb a person’s sleep and exacerbate their fatigue.
Emotional effects of amputation
The psychological and emotional effects of losing a limb can be extremely significant, not only on the injured person but also on those close to them such as their family, friends and colleagues.
Traumatic effects - If a person has experienced a traumatic amputation, memories of the incident could cause them to suffer from post-traumatic stress disorder ("PTSD") or other similar psychological conditions. Symptoms can include flashbacks, nightmares, depression, insomnia, avoidance, anger outbursts, and various other challenging behaviour.
It is also more likely that a person who has suffered from a traumatic amputation will feel the emotional and psychological impact of their situation more heavily than someone who has undergone a planned surgical amputation, simply because they have not had the time to mentally prepare for the loss of a limb.
Adapting to amputation - Some psychological symptoms can develop gradually as the amputee adapts and lives with their disability. The mental challenge of living with the loss of sensation in their missing limb, or living with chronic aches and pains can take its toll.
As a result, depression is a very common consequence, both in the early stages of the injury and also as time progresses. The injured person may well suffer from a feeling of loss in relation to their removed limb, which some amputees have reported as similar to a feeling of bereavement after the death of a loved one.
Body image - After an amputation people can be prone to suffering from body image issues, and in particular they can be self-conscious about the appearance of their injured limb. It can be a very difficult situation to adapt to.
Social impact - An amputation can affect a person’s ability to work, which bring financial concerns. They also struggle to enjoy the same social activities, leisure pursuits or hobbies that they enjoyed before the amputation. In addition to the obvious mobility issues, they may be deterred by the levels of high levels of pain they experience, or the side-effects of their medication.
Social withdrawal and isolation can often be the result. Personal relationships can be heavily affected, because some amputees completely avoid contact with their friends and peers. Some exhibit outbursts of anger at their loved ones; most likely those who are helping them and providing care.
Support can be obtained from counselling, CBT and other treatment options (click here to read our article on rehabilitation) and if you have a compensation claim the cost can be recovered from the compensator.
Social Media and support groups can help with both the physical and emotional challenges of amputation, such as the Douglas Bader charity - www.douglasbaderfoundation.com, and Limbcare - www.limbcare.org.