Pre–operative Period of Amputation
Management
These patients are most successfully managed in specialized units using a team approach. A typical team will consist of the surgeon, physiotherapist, prosthetist, occupational therapist, social worker, nurse and the GP on discharge.

After an amputation the patient must have the rehabilitation program and what can be achieved with cooperation explained. For the elderly the main aim is to achieve independence but for the young adult a high level of physical activity can be attained.
Rehabilitation of lower limb amputations
The rehabilitation program can be divided into:

Pre operative exercise
• The preoperative period.
• The post–operative period:
  (a) Pre–prosthetic stage.
  (b) Prosthetic stage.

Preoperative period
If possible the patient should be assessed and treated by the physiotherapist before surgery. The longer the preoperative treatment the greater its value. An assessment of the physical, social and psychological states of the patient should be made.

Physical assessment
Assess the:

• Muscle strength of the upper limbs, trunk and lower limb apart from affected limb below the level of amputation.
• Joint mobility, particularly the joint proximal to the amputation level.
• Respiratory function.
• Balance reactions in sitting and standing.
• Functional abilities.

The examination findings should be recorded for comparison at a later date.

Social assessment
The patient’s social circumstances should be noted: family and friend’s support, living accommodation, (stairs, ramps, rails, width of door, wheelchair accessibility) proximity of shops.

Psychological assessment
Note the patient’s psychological approach to amputation and the motivation to walk.
Following assessment
A treatment program should include:

• Breathing exercises to clear secretions in the lungs because many vascular patients are smokers.
• Strengthening exercises for the shoulder extensors and adductors, elbow extensors, hand grip, abdominal and trunk extensors, hip extensors, adductors and abductors (and quadriceps for below–knee level).
• Mobilizing exercises for hip extension (and knee flexion and extension for BK level).
• Bed mobility–bridging, moving up and down the bed, rolling to prone and back to supine.
• Transfers from bed to chair and back.
• Wheelchair mobility–the ability to stop, start, turn and control the wheelchair. The patient should have a wheelchair supplied preoperatively because it will be necessary for at least a few weeks post–operatively.
• Stabilizations for the trunk in sitting and standing.