By Ken Mosier

For Health Care Today

News coverage is replete with stories of soldiers and Marines losing extremities because of improvised explosive devices in current combat zones. Military hospitals take care of the majority of those injuries although one occasionally appears on local physical therapy programs.

But working with amputees is not an uncommon occurrence in hospitals throughout the Miami Valley. The majority of amputations locally are due to medical reasons or a severe trrauma.

“There are times when we will have half a dozen and then go three or four months and never see one,” said Physical Therapist Katie Jenkins, who works at Miami Valley Hospital. “What I do is teach them how to function without having that leg.

“The biggest thing is teaching them to function on one limb — teaching them to balance on one leg and trying to take some steps or, in some cases, to function using a wheelchair to get around until they get the new leg.”

Attitude sometimes comes into play when a person has just lost a limb.

“You get everything from ‘Oh, this isn’t any different from when I had both legs’ to ‘My life is over, why am I even bothering to try?’” Jenkins said.

Across town at Kettering Medical Center’s Rehabilitation Services, PT Chris Mancuso sees a different attitude — or lack thereof.

“They tend to be more highly motivated individuals and they want to get better and kind of regain that control of their life again and be able to walk,” he said.

Mancuso normally sees patients after they have been fitted with a prosthesis.

“When you look at an amputee, it’s kind of looking at the whole individual, just as you would with a stroke or neurological problem,” he said. “(You have to make) sure the non-amputated side is good and strong as well as their upper body. You work on core strengthening so, if there are any balance issues because their center of gravity is going to be shifted after an amputation. We need to make sure that they are stable that way as well.

“They have a tendency to use that non-amputated leg more so you have to make sure there is good strength there so they are not causing damage to that leg as well,” he added.

Luci Busch, a certified and license prosthetist for Dayton Artificial Limb — one of several prosthetic companies in the Dayton area — described the process for an amputee.

“The surgeon does the amputation and refers them to an inpatient rehab facility, or they may go to a nursing home and have in-home rehab in their own home. I think they have to do three hours a day of physical therapy based on state requirements.

“Once they are healed — they have to be healed to be fitted with a prosthesis — then we get involved. We can start shaping the limb to get it into a conical shape so it will fit inside the socket of the prosthesis. That usually involves taking an impression of their residual limb so that we can get an exact mold to duplicate that,” she continued.

“They don’t get the prosthesis right away (after fitting). They have to get physical therapy in order to learn to use the prosthesis and they have to build their endurance up and learn to balance on the prosthesis.”

Adjustments can be made as the amputee’s body changes with weight gain or loss or improvement in their gaits.

Busch added that modern prostheses are much better than in recent decades. Older artificial limbs could not be washed, whereas the silicon sockets in newer ones are washable and more user-friendly. She said the current movement is toward a vacuum-controlled socket system.

“The vacuum doesn’t hold the leg on but creates an environment for the residual limb where it is under hydrostatic pressure and increases the blood flow to aid in healing,” she explained.

Some patients have one leg amputated and then, later, must have the other leg removed.

“With one leg, it’s not that hard. You can still walk with the walker and you can get around pretty easily,” Jenkins said. “It gets a lot harder when you are missing both.”

“It is rare that you come across a bilateral above-the knee amputation in this (civilian) setting,” Mancuso said.

“You are seeing that a lot more with younger soldiers in a VA medical center.”