Improve balance and transfers
The patient is allowed to sit in a wheelchair from the first day provided that he is alert and cooperative. Transfer to the wheelchair from the bed may be achieved by a backward or a sideways transfer with the help of a sliding board. A sideways transfer is easier to the side of the remaining leg. Double amputees transfer forwards to the bed or toilet because a sideways transfer requires much more strength. Once the method of transfer has been determined, all team members must use the same method to reinforce it. Following transfers the patient is taught how to maneuver the wheelchair. This will enable him to move around the ward and give the patient a sense of freedom. Balance in sitting can be improved by encouraging balance reactions by tapping the patient in all directions, or by trunk stabilizations if the patient is unsteady. Later use can be made of a balance (wobble) board for advanced balance work.

Walking without a prosthesis
When the wound is healed the patient has the stump firmly supported with compression socks or a bandage and gait training can be done in the parallel bars. The patient can progress to a frame or crutches depending on stability. This form of mobility may be useful for the patient to move around the home because it may be easier and faster than using a prosthesis and all rooms may not be accessible to a wheelchair.

Restore functional independence
As soon as the patient is able, functional training should be carried out in the physiotherapy department approximately 4–6 days post–operatively. The patient is encouraged to dress each day and propel himself in a wheelchair to the department. The exercise program should now consist of resisted pulley work, mat exercise, slow reversal and repeated contractions to the trunk and limbs, spring resistance. During this time the occupational therapist will help the patient with any dressing difficulties, teach bath transfers and provide cooking practice. The patient must be encouraged to be as independent as possible.

Phantom pain
There is pain or sensation in the stump or ‘Phantom limb’ and its incidence is higher in patients with a severely painful limb preoperatively. It should be explained to the patient that it is due to memory of the amputated part in the cortex and nerve impulses still traveling through nerve fibers in the part, but the pain is only temporary and will gradually fade within a year. Persistent severe phantom pain may be helped by non–invasive treatment. The patient should be give adequate analgesic preoperatively and be encouraged to handle the stump postoperatively to reduce its sensitivity. A number of modalities can be tried such as transcutaneous nerve stimulation (TENS), interferential, acupuncture, ultrasound and percussion manually or electrically.