Occupational Therapy

Perioperative care is the initial phase of occupational therapy and begins soon after injury or surgery. This phase involves assisting the patient with wound care, sterile whirlpool, ultrasound, debridement and edema control. The therapist recommends adaptive equipment to help the patient achieve more independence prior to receiving a prosthesis. The perioperative phase also includes scar management, range of motion, soft tissue mobilization and desensitization of the residual limb. The early involvement of a therapist helps ensure that the patient moves through the rehabilitation process without lapses in care.

Prosthetic training is where therapists guide patients in the functional use of their prostheses and offer a range of essential information that includes:

• Putting on (donning) and taking off (doffing) the prosthesis
• The wear schedule, which outlines a gradual progression of how many hours a day the patient wears the prosthesis so their residual limb is not injured
• Skin hygiene for the residual limb, and basic care and maintenance of prosthetic components and accessories
• Controls training that focuses on teaching the patient how to use the prosthesis, including opening and closing the terminal device at various speeds, operating the wrist, flexing and extending the elbow, and operating the shoulder
• Repetitive drills training where the patient uses the prosthesis to manipulate objects of various sizes, shapes, weights and densities while sitting, standing and walking
• Pre-positioning the terminal device to facilitate grasp and to decrease awkward body movements
• Engaging in basic activities of daily living (ADLs) like eating, dressing, toileting, bathing, grooming and writing

This phase also includes adjustments to the alignment and controls of the prosthesis, and modifications to the shape of the interface or socket. The patient, prosthetist and therapist work together to resolve any prosthetic and therapeutic issues, maintaining steady progress toward the patient's functional goals.

Lifelong care focuses on the patient's long-term prosthetic use and begins after they complete training and return home with their definitive prosthesis. As they increase their independence and use their prosthesis for more complex tasks, therapists may visit patients in their home to help with minor modifications and recommend adaptive equipment and other outside resources. This can include information on driver training and vehicle modification services.

Prosthetic success rates improve dramatically when therapists focus on activities that relate to the patient's specific vocational and recreational interests. Therapists may go to a person’s workplace to guide them on how to efficiently use their prosthesis on the job. Therapists may also accompany patients on initial visits to the grocery store, gym, restaurants and other locations.

An annual appointment with the upper limb prosthetic team addresses prosthesis maintenance, ongoing therapy needs and emerging prosthetic technologies.