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The importance of psychological counselling when undergoing an amputation – part 1


The loss of a limb is a life-changing situation. However, every individual is unique and how much a person’s life will change largely depends upon the challenges each individual faces. For most people, it can be like moving into another dimension where even the most ordinary daily activities such as walking, may have to be relearnt all over again.

It is not only the amputee who as affected but to a large extent, everyone connected with him or her such as spouse or partner, children, other family members, friends, employers and co-workers.

The psychological impact of an amputation can be as significant as the physical challenges

More often than not, the psychological impact of an amputation can be just as significant as the physical challenges and the perceived loss of ability to engage in leisure activities can play an important role in post-amputation quality of life than the absence of the limb itself. Amputation can negatively influence body image, self-esteem and quality of life. Returning to work can also be difficult. However, the key to successful outcomes lies in making sure that a patient receives appropriate care in terms of their physical and psychosocial needs.

The use of prosthetics is associated with increased quality of life

The use of prosthetics is associated with higher levels of employment, increased quality of life, decreased phantom limb pain and lower levels of psychiatric symptoms. In addition, using prosthetics has been proven to facilitate a reduction in secondary health issues and a greater degree of functional independence and mobility.

Prosthetists and healthcare teams can do a great deal to bring about a successful, fulfilling life for people with amputations while they adjust to the changes in their lives.

Post-traumatic stress disorder (PTSD)

Unlike those who lose limbs due to dysvascular conditions, people with traumatic amputations often suffer post-traumatic stress disorder (PTSD). Fault is often involved with traumatic amputations which causes anger and regret.

The time it takes to heal

One of the main things that people are not prepared for is the reality of the time it takes to heal and what to expect regarding the timeframes for rehabilitation and regaining mobility. Returning to work is influenced by the time it takes to regain mobility.

The number of appointments necessary for medical and prosthetic care, as well as physical or occupational therapy is also dependent on the patient’s own mobility and level of rehabilitation progress. A discussion regarding timeframes is therefore most helpful in reducing anxiety and can help families to plan ahead financially and for periods of absence from work.

An individual with a new amputation often needs to learn new modes of living where it pertains to activities such as cooking, cleaning and bathing. Yet, nothing happens overnight and certain things cannot be planned hence, the key is to recognize that it is all part of the healing process.

Modifications done at home such as the installation of a ramp or the widening of doorways to accommodate a wheelchair may be necessary. For instance, if the bedroom is upstairs, ways need to be found to move around the house easily.


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New video for article 15 May 2019

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Articles/Case Studies

3 important questions you should ask prior to undergoing a lower limb amputation

Statistics show that for every 1000 people in South Africa there are approximately 1.5 amputees.

The main reasons behind why and how amputations occur include:

  • Vascular disease which covers diabetes and peripheral arterial diseases
  • Cancer
  • Trauma

In this article we address three important questions you should consider prior to undergoing a lower limb amputation which can be either below the knee (trans tibial) or above the knee (trans femoral).


  • At one point should I consult with a prosthetist?


To ensure optimal prosthetic outcomes, it is critical that you consult with a prosthetist prior to undergoing surgery.

The process begins with an overall evaluation of your mobility and lifestyle expectations as well as an analysis of the various details involved in your condition as well as the nature of the upcoming surgery.

A number of surgeons see this process as invaluable especially in determining whether certain surgical techniques should be used that could enhance desired outcomes post-surgery.

Detailed knowledge and understanding of the specifics involved in your situation greatly assist the prosthetist to fabricate and fit a prosthetic that will work best for you.


  • How do I prepare for the initial prosthesis fitting


The time it takes before a prosthesis can be worn varies from person to person, and can also depend upon the nature of the surgery as well as your own unique circumstances and can even be influenced by surgical techniques such as Immediate Post-Prosthesis (IPOP).

Your surgeon, your prosthetist and your physical therapist all play very important roles in your rehabilitation. Your residual limb is bandaged and treated immediately post-surgery in order for your surgical wound to effectively heal. It is crucial that you follow the recommendations of all professionals involved in your recovery.

Taking the appropriate time to heal and wear compression stockings to decrease the swelling are both key factors in preparing you for your initial prosthesis fitting.


  • What takes place during physical therapy in the prosthesis fitting process?


Post-operative physical therapy ensures that you retain the function of your residual limb and prepare the area for your temporary and then your definitive prosthesis. Physical therapy is important in maintaining and expanding mobility and activity levels during the prosthesis fitting process.


Maintaining a positive mental attitude is vital to successful recovery

The role of maintaining a positive mental attitude cannot be underestimated in successful recovery and it is not uncommon for a patient to discover that they have greater mobility once accustomed to a new prosthesis as opposed to living with an unhealthy limb prior to surgery.


If you would like to know more about what to do prior to undergoing surgery for an amputation or need to ask Roger a question call us on (011) 640 7198 or drop us an email at





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A day in the life of the child amputee

Malwande Mahlangeni – a brave little boy who is more than determined to get his prosthetic leg up and running every step of the way

Anyone at any age and for many different reasons can lose a limb.  Undoubtedly, the loss of the limb not only results in physical but also emotional and psychological scars.  Adjusting to life without a limb can be influenced by environmental factors yet also depends upon physical strength and inner determination.

However, child amputees have a tendency to adapt extremely well when it comes to living with a prosthesis and in fact, are often more likely to better adapt to using artificial limbs than their adult counterparts.  Childhood development in itself is fraught with many ups and downs and likewise adapting to the loss of a limb poses its own challenges.

For children wearing a prosthesis is not always an easy task every day and every step of the way

Nevertheless, for children, wearing a prosthesis may not always be an easy task every day and every step of the way.  There may even be times when the child simply prefers not to wear a prosthesis, much to a parent’s concern.  Often, healthcare professionals, parents and the children themselves view the experience of wearing a prosthetic from completely different angles.  While such may pose a challenge, it may also help to bear in mind that such behaviours may also be part and parcel of other normal childhood developmental issues.

Under any circumstance, how do parents always know what is best for their children whether it be wearing a prosthetic, managing a residual limb or engaging in sporting or other activities?

How does a parent best guide their children?  During childhood development a child’s self-image changes over the normal course of time, especially with the arrival of puberty and ensuing adolescent or teenage years.  Physical, emotional and social changes mark this time of life as one to be most significant in normal childhood development.

Amputations can happen for different reasons

There are many reasons why amputations occur.  Sometimes, congenital disorders may result in a child having to have an amputation or the amputation may be required due to disease or injury.  It may also be the case that when a child is born with a congenital disorder further surgery may be required post the initial amputation in order to modify the residual limb so that it is more suitable for prosthetic use.

Where there is no sense of loss

According to certain established medical points of view, when a child is born with a congenital disorder and undergoes amputation surgery as a result, they do not feel a sense of loss in the same way as a child who has lost a limb due to injury or progressive disease due to the fact that the way their body is happens to be the only body they have ever known.  Hence, this view maintains that in the early years, the child does not grieve the loss of something it never had in the first place.  Nevertheless, as the child grows and becomes more socially aware, a sense of loss or a sense of being physically different from others may develop.  Such may often lead to a feeling of frustration and symptoms of grieving for fully functional limbs.

When a child has lost a limb through surgical amputation he or she is more likely to feel a sense of personal loss since the child will need to adopt an entirely different mode of living as a result of the body having undergone radical change.  A number of physical adjustments and emotional strain alike are placed upon the child

Attitude and parents

Often, children will readily sense the attitudes and actions of their parents and this invariably means that parents lead the way when it comes to making a difference in helping a child adjust to wearing a prosthetic and how the child copes with accepting his or her status.


Upper limb prosthetic use and childhood development

Children with upper limb prosthetics will require mobility to manipulate objects as part of normal childhood development.

How often will a child’s prosthesis need to be modified or replaced?

As children grow their bodies naturally change and will outgrow a prosthesis in the same way they outgrow clothes and shoes.

Roger and Malwande – partners in walking comfortably

While young children undergo numerous physical growth changes in relatively short periods of time, it is still not a good idea to replace the prosthetic too often, that is, every few months.  This is mainly for the reason that each new prosthetic takes time to get used to.  Under normal circumstances when a child receives a new prosthesis it is usually fashioned larger than required to literally enable the child to grow into it and get used to it at the same time.

Notwithstanding, the fitting, fabrication and satisfactory alignment of any new prosthetic device takes time and it is often several months before walking is optimized.



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