This month we are spotlighting Michelle Jamin, PT, DPT as she shares her journey and how she is inspiring others interested in limb loss care. She has also outlined information for clinicians and clients below.
How did you get into this specialty?
I have known since around the 4th grade, right after September 11, 2001, that I wanted to work with individuals with limb loss. I was fascinated by the prosthetic rehabilitation performed at Walter Reed and knew that was what I wanted to do when I grew up. I worked hard in undergraduate and graduate school to gain exposure to prosthetics through shadowing, volunteering with adaptive sports, and taking continuing education courses. I had a fantastic O&P course in PT school, instructed by Dr. Robin Waldron (Elon University), and a wonderful mentor, Cosi Belloso who helped guide me to this point.
How do you recommend a clinician, who is interested in pursuing this field, get started? Get involved with adaptive sports! It’s a totally different experience than a clinical setting and you learn real world skills that do not necessarily come up during didactic work. I would also find a local prosthetist and ask to show them to start learning about different prosthetic technology. Next, call me! One reason I opened Align Rehabilitation was to serve as a resource for providers interested in limb loss care.
What do you add to your treatment plan for patients with phantom limb sensations and mental health disorders stemming from the limb loss? ** I would not word this as mental health disorders. I would word it as “What are some phantom limb pain interventions and how do you support the emotional recovery after someone has lost a limb”
Where can they find PTs that specialize in limb loss? There are far and few of us out there, but more are popping up! I suggest starting with “Find a PT” offered by the APTA https://aptaapps.apta.org//APTAPTDirectory/FindAPTDirectory.aspx and search under ‘Practice Focus’ for Amputation Care. Next, I would call some local prosthetists and ask who they refer their patients to. Finally, find a PT willing to take time to learn more about amputee rehab and invite them to your prosthetic office visits.
Where can they look for resources or services other than PT? The Amputee Coalition is the nation’s leading organization on limb loss offering essential resources for the limb loss and limb difference community. There are also numerous support groups on social media – my favorite one is Cosi Talks. Check with your local hospital or prosthetist for any amputee support groups they may have in person.
What are some of the complications to watch out for after limb loss? Pain is one complication. It is important to differentiate between phantom limb pain (pain in the portion of the limb that has been amputation), phantom limb sensation (sensing movement in the portion of the limb that has been removed), and residual limb pain (pain in the portion of the limb remaining) as each one can have a different pain management approach. Skin breakdown can occur due to pressure, friction, or heat inside a socket and this can prevent the use of a prosthesis until the wounds heal. Slow healing wounds are another complication and common in those who had amputations due to vascular issues. Delayed wound healing can delay prosthetic fitting which is very frustrating for patients. Contractures of the hip and knee can decrease joint range of motion and can make it difficult to use a prosthesis. These are largely preventable through positioning and stretching. Infection is a risk after any surgery, including amputation. It is important to monitor the incision site for signs of infection, such as redness, swelling, or drainage.
What are the chances of requiring higher level amputation after the first surgery? One study found that 55% of individuals with diabetes who have a lower extremity will require amputation of the second leg within 2‐3 years. Many factors contribute to the need for a second amputation such as vascularization of the limb, presence of an infection, and scar tissue formation or a bone spur requiring a revision. It is important to remember that for those whose amputation was vascular in nature, that the underlying disease (e.g. diabetes) is still present in the body. Healthy lifestyle changes must be made in order to reduce the likelihood of a second amputation.
Source for stat: Pandian G, Hamid F, Hammond M. Rehabilitation of the Patient with Peripheral Vascular Disease and Diabetic Foot Problems. In: DeLisa JA, Gans BM, editors. Philadelphia: Lippincott‐Raven; 1998.
Why won’t they prescribe pain meds for limb loss related pain? This is not true, I have never heard of this before. I wish not to answer this question.
How should one take care of a prosthesis? How often does it need to be done?
The prosthesis should be wiped down 1-2x a week – since it does not come in direct contact with the body, alcohol wipes can be used or use gentle hand soap and a towel to wipe it down. Liners need to be cleaned daily to prevent the buildup of sweat, dirt, and bacteria since these come in direct contact with your skin. The liner should be turned inside out and scrubbed with (unscented) soap and water. Be sure to rinse it off completely as soap residue can irritate the skin. Turn the liner right side out and allow it to dry completely.
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