Casting a vision for amputation rehabilitation.

Kathleen E. Yancosek, MS, OTR/L, CHT In my 4 years of clinical work as U.S. Army occupational therapist (OT) working with hundreds of amputee patients, I gained enthusiasm and hope for a brighter future for amputee rehabilitation. I believe that now is the time to leverage knowledge, creativity, and interest in prosthetic development and rehabilitation. I propose that a need exists to certify OTs and physical therapists (PTs) wishing to specialize in rehabilitative management of amputee patients; here I examine a future research agenda related to amputee rehabilitation. First, let us consider the idea of a specialty certification available through professional OT and PT organizations. I believe that a specialty certification related to rehabilitative management of amputee patients would benefit therapists, prosthetists and, most importantly, patients. Rehabilitation of an amputee patient is a complex process that demands a knowledge base and skill level above that of an entry-level licensed OT or PT. Recent acceleration in prosthetic development contributes to the complexities of managing the amputee patient. During my time working solely with amputee patients, I came to understand and appreciate the value of clinical experience. I know firsthand how steep the learning curve is for a therapist trying to navigate the maze of complexities related to amputee patient care. Many issues contribute to this learning curve, such as residual limb care; knowledge of mechanical operations of prosthetic equipment; the many choices of terminal devices; the psychological, social, and emotional repercussions of limb loss; phantom pain and sensations; adaptive equipment options; muscle retraining; and integration of a prosthesis into everyday movement patterns. The desired outcome for each patient is application, training, and integration of a prosthesis; however, quality rehabilitation goes beyond that outcome and accounts for individual variables that ultimately impact the entire calculus of successful rehabilitation. Interventions must be orchestrated in such a way that the timing facilitates the patient’s acceptance of limb loss and ignites a desire to participate in the rehabilitation process. This rehabilitation process is one of overcoming a change in both form and function. I worked in a treatment section with three other therapists who also provided rehabilitative services solely to amputee patients. Every new patient contributed to our knowledge, deepened our understanding, and refined our clinical skills. We consequently improved rehabilitation methods, established best-practice guidelines, and improved efficiency in delivery of services. This organization of specialized staff within the occupational therapy clinic led to information sharing among practitioners exclusively related to the holistic needs of amputee patients. Establishment of a certification specialty program would facilitate a national standard of care, requiring therapists to demonstrate the knowledge and skills necessary to prove clinical competence. With this professional certification, therapists could define themselves as practitioners able and eager to provide rehabilitation services to amputee patients and physicians and prosthetists could