The Quality of Hope for the Amputee Maintenance well-being
of
hope
ture is vital to the
for the fu-
psychologi-
cal of an amputee. It enlists his cooperation and that of his family in therapeutic efforts on his behalf. But if the surgeon ebulliently instills in the amputee an unrealistic concept of potential for future function, he creates a basis for later disillusion that is sure to lead to depres-
sion, resentment, and, sometimes,
efforts at legal redress. We must require honest appraisal at all stages of the amputee's treatment if we expect to retain his respect and obtain his
cooperation.
We recommend the following items for discussion with the patient and his family prior to operation (where feasible) and repeatedly afterward. The traumatic amputee should be told. 1. You will feel the sensation of a "phantom limb." This is normal in all amputees and is not evidence of psychiatric disturbance. 2. You will be able to lead a functioning and happy life, whether or not it is advisable to provide you with a
prosthesis. 3. You
will, however, have
to make
adjustments in lifestyle so as to cope with various problems engendered by amputation. These problems are psy¬ chological, physical, social, vocational,
and recreational. 4. If a prosthesis is to be advised, a rough description of its gross charac¬ teristics is given to the patient. Show¬ ing him another patient of similar age, level of amputation, and medical condition is advisable if possible. 5. Becoming accustomed to the wear of the prosthesis will take some weeks since it does not feel like a nor-
mal limb. It lacks sensation and, at the beginning, seems heavy. 6. There will be a training period in the use of a prosthesis, without which you will be unable to use it ade¬
quately.
7. Your stump will shrink as a re¬ sult of disuse of muscles, bandaging, stump shrinkers, and pressure from the prosthesis. This will require pros¬ thetic adjustments over an indefinite future period. In patients whose amputations are done for malignant neoplasms, the following additional points are impor¬ tant: 1. You must realize that the level
of your amputation is dictated by medical knowledge that tells us how far cancer cells can extend. 2. The prosthesis you will receive (are receiving) is basically cosmetic, but partially functional. If you are an upper-limb amputee, it has almost no practical function. A one-handed per¬ son can become independent in most functions in a few weeks. The person with an amputation above the midthigh level can and does use the arti¬ ficial leg, but in many instances the hip disarticulation prosthesis has a value that is more for cosmetic ap¬ pearance than for walking. 3. No cosmetic prosthesis is ever entirely natural looking, especially at close range. Your gait will not be completely normal. 4. Externally powered artificial arms are rarely advisable because in their present state of development their function is inadequate, their cost, both for purchase and main¬ tenance, is high, and the time neces¬ sary for fitting and training is long. Patients with amputation for vas-
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cular disease should receive the fol¬ lowing additional information: 1. The physicians and surgeons did their best to save your leg. Every ef¬ fort will be (has been) made to ampu¬ tate below the knee to improve func¬ tion. 2. The care of your other leg is vi¬ tal, especially if your amputation is above the knee. Bilateral above-knee amputation eliminates functional ambulation in most patients, except for the very young. 3. Prolonged medical supervision will be required, not only for care of the stump but for treatment of the arterial disease that necessitated the
amputation.
The above information cannot and should not be presented in brief form nor all at once. Patients cannot as¬ similate more than a few of the items at one time. The information must, therefore, be repeated often after
amputation. The prosthesis
must be viewed by the medical team and by the patient as a tool to perform certain tasks and not as a replacement for the human limb. We should encourage patients to have hope, but it must be tem¬ pered with realism, so as not to con¬ vert a useful force into disappointed, resentful hopelessness. LAWRENCE W. FRIEDMANN, MD KIM Institute of Rehabilitative Medicine 240 Central Ave East Orange, NJ 07018 LIESL FRIEDMANN, OTR Institute of Rehabilitation Medicine 400 E 34th St New York, NY 10016
of
hope
ture is vital to the
for the fu-
psychologi-
cal of an amputee. It enlists his cooperation and that of his family in therapeutic efforts on his behalf. But if the surgeon ebulliently instills in the amputee an unrealistic concept of potential for future function, he creates a basis for later disillusion that is sure to lead to depres-
sion, resentment, and, sometimes,
efforts at legal redress. We must require honest appraisal at all stages of the amputee's treatment if we expect to retain his respect and obtain his
cooperation.
We recommend the following items for discussion with the patient and his family prior to operation (where feasible) and repeatedly afterward. The traumatic amputee should be told. 1. You will feel the sensation of a "phantom limb." This is normal in all amputees and is not evidence of psychiatric disturbance. 2. You will be able to lead a functioning and happy life, whether or not it is advisable to provide you with a
prosthesis. 3. You
will, however, have
to make
adjustments in lifestyle so as to cope with various problems engendered by amputation. These problems are psy¬ chological, physical, social, vocational,
and recreational. 4. If a prosthesis is to be advised, a rough description of its gross charac¬ teristics is given to the patient. Show¬ ing him another patient of similar age, level of amputation, and medical condition is advisable if possible. 5. Becoming accustomed to the wear of the prosthesis will take some weeks since it does not feel like a nor-
mal limb. It lacks sensation and, at the beginning, seems heavy. 6. There will be a training period in the use of a prosthesis, without which you will be unable to use it ade¬
quately.
7. Your stump will shrink as a re¬ sult of disuse of muscles, bandaging, stump shrinkers, and pressure from the prosthesis. This will require pros¬ thetic adjustments over an indefinite future period. In patients whose amputations are done for malignant neoplasms, the following additional points are impor¬ tant: 1. You must realize that the level
of your amputation is dictated by medical knowledge that tells us how far cancer cells can extend. 2. The prosthesis you will receive (are receiving) is basically cosmetic, but partially functional. If you are an upper-limb amputee, it has almost no practical function. A one-handed per¬ son can become independent in most functions in a few weeks. The person with an amputation above the midthigh level can and does use the arti¬ ficial leg, but in many instances the hip disarticulation prosthesis has a value that is more for cosmetic ap¬ pearance than for walking. 3. No cosmetic prosthesis is ever entirely natural looking, especially at close range. Your gait will not be completely normal. 4. Externally powered artificial arms are rarely advisable because in their present state of development their function is inadequate, their cost, both for purchase and main¬ tenance, is high, and the time neces¬ sary for fitting and training is long. Patients with amputation for vas-
Downloaded From: http://archsurg.jamanetwork.com/ by a Oakland University User on 06/08/2015
cular disease should receive the fol¬ lowing additional information: 1. The physicians and surgeons did their best to save your leg. Every ef¬ fort will be (has been) made to ampu¬ tate below the knee to improve func¬ tion. 2. The care of your other leg is vi¬ tal, especially if your amputation is above the knee. Bilateral above-knee amputation eliminates functional ambulation in most patients, except for the very young. 3. Prolonged medical supervision will be required, not only for care of the stump but for treatment of the arterial disease that necessitated the
amputation.
The above information cannot and should not be presented in brief form nor all at once. Patients cannot as¬ similate more than a few of the items at one time. The information must, therefore, be repeated often after
amputation. The prosthesis
must be viewed by the medical team and by the patient as a tool to perform certain tasks and not as a replacement for the human limb. We should encourage patients to have hope, but it must be tem¬ pered with realism, so as not to con¬ vert a useful force into disappointed, resentful hopelessness. LAWRENCE W. FRIEDMANN, MD KIM Institute of Rehabilitative Medicine 240 Central Ave East Orange, NJ 07018 LIESL FRIEDMANN, OTR Institute of Rehabilitation Medicine 400 E 34th St New York, NY 10016
