avid McGill, vice president, legal and reimbursement, for Össur Americas, has both a professional and a personal interest in seeing patients get the physical and emotional care they need to deal with limb loss. “Seventeen years ago when I lost my leg, the only mechanism for emotional support was support groups—but I’m not a support group kind of guy,” recalls McGill, who survived a near-fatal car crash in 1996. The types of questions he had as a new amputee “were outside the scope of my prosthetist.” While he was able to get through the recovery and rehabilitation stages without outside support, he doesn’t describe it as an optimal experience. “When you’re struggling with the changes that limb loss brings you, having the ability to locate appropriate mental support that can provide feedback and education you can use” can be a game-changer in terms of adapting to life as an amputee, says McGill. By offering a diverse array of resources to assist both introverted and extroverted patients, practitioners can better serve the physical and emotional needs of every patient.
The Physical-Emotional Connection Just as devices have evolved over the years, so too has the recognition that patient care goes well beyond providing an artificial limb. “We think our job as prosthetists is to make patients a prosthesis—but, really, our job is to solve their problem,” says Paul Armstrong, MS, CP, area clinic manager for Hanger Clinic in Vernon, Connecticut. “We help them gain control of their life back, which goes beyond prosthetics.” Learning to properly and professionally communicate with patients who are having trouble coping is a challenging but important aspect of the profession.
Many practitioners agree that emotional well-being and prosthesis acceptance and use are interconnected: “They’re closely linked,” says Scott Cummings, PT, CPO, FAAOP, of Next Step Bionics and Prosthetics in Manchester, New Hampshire. “We see people who are terrific candidates [for prostheses]—who are physically capable—but if they don’t have their head in the game, they won’t maximize their potential.” Part of the prosthetist’s job today is involvement not only in the clinical aspect of providing a device, but also the “emotional and psychological health of the patient to the best of a clinician’s abilities based on training and available resources,” says Jay Tew, CP, area clinic manager for Hanger Clinic. All of the engineering and computer enhancements in prosthetic limbs over the past 20 years “can’t address how people with limb loss feel about their body, self-image, and well-being,” says Tew. “If a person cannot accept what has happened to them and understand what a prosthetic device can and cannot do for them, the prosthetist and the patient can never really launch from that first step to maximum functionality.” Tew believes an amputation to be as much a psychological event as a physical one, and working through grief is a part of the process. “Limb loss invokes the same grieving process as losing a child, spouse, or someone very close to you. Amputees who get through the stages of acceptance, and even learn to have fun with their prosthesis, seem to do better physically as well as psychologically in their new life with limb loss.”
Lending an Ear For the most part, prosthetists remain on the sidelines as patients work through the grieving process and embrace using prostheses to regain control of their lives. But as practitioners assist with a patient’s physical recovery, they may also contribute to that individual’s emotional recovery by listening when that patient wants to talk, and by sharing helpful information with individuals who may be struggling. For example, Armstrong suggests engaging in “active listening.” Because prosthetists rarely know their patients before they lose their limbs, he recommends asking questions to learn about their abilities and activities in addition to fitting their prosthesis. “I ask them, ‘Are you working?’ ‘Are you dating?’ ‘What activities are you doing?’” he explains. “It’s important to engage them to find out how things are really going.” And if a practitioner identifies a patient who may be in need of additional emotional support, providing a list of peer support groups or professionally trained resources is a logical next step. “It’s not our job to be a counselor, but it is our job to recognize whether our patients are on the right track,” says Armstrong.
OCTOBER 2013 O&P Almanac