International Prosthetics Day: the key role of the rehabilitation doctor

In 2021, Fraternidad-Muprespa took a decisive step in the comprehensive care of its amputee work patients with the creation of the Orthopedics and Prosthetics Unit, a service designed to offer more complete and coordinated clinical and personal care.

Since its launch, the unit has developed a specific action protocol for amputee patients, in collaboration with the different Mutual care centers. The goal: ensure that each person receives individualized and continuous care.

This joint work involves a multidisciplinary team made up of a rehabilitation doctor, social workers, physiotherapists and orthopedic technicians, who coordinate their interventions to adequately respond to the needs of each patient at each stage of their recovery. 

On the occasion of International Prosthetics and Orthotics Day, which is celebrated every November 5, we spoke with doctor Maria Eugenia Delpon, rehabilitation doctordoctor at the Hospital Fraternidad-Muprespa Havana. Graduated in Medicine in 1999 from the U.University of the Basque Country he trained in his specialty at the Jimenez Diaz Foundation between 2001 and 2005, the year he started working at the Mutua. 

What is the role of the rehabilitation doctor in the adaptation and monitoring of a patient with a prosthesis?

Patients who undergo an amputation in the hospital begin immediate physical therapy after the intervention. This treatment, aimed at remodeling the stump and postural correction, prepares the body for future prosthetics. 

The rehabilitation doctor is responsible for supervising that this prosthesis is correct and whether or not the type of prosthesis recommended by the orthopedic technician is indicated. The treatment is multidisciplinary and the rehabilitation doctor tries to coordinate this process between the amputee patient and the rest of the professionals: physiotherapy or occupational therapy, surgeons, social workers, psychological support, pain unit, etc.

The rehabilitation doctor supervises the correct prosthesis, indicates the type of prosthesis recommended by the orthopedic technician and coordinates the process with the professionals involved, physiotherapy, occupational therapy, surgery, social work, psychological support and pain unit

The approach is not limited to the clinical treatment of the stump, often of traumatic origin and complex management, but also includes the functional and social assessment of the patient, addressing their daily living activities and their adaptation process.

At Fraternidad-Muprespa we have very direct contact with the social workers, who are the first that the patient contacts to convey their needs, and they inform me to try to provide a quick solution to the extent possible. Subsequently, medical and functional monitoring is carried out until stabilization and correct adaptation to the prosthesis are achieved.

How do you work from rehabilitation so that the patient regains his autonomy and confidence when a prosthesis is implanted after a work accident or due to an occupational disease? 

Usually the patient follows rehabilitation treatment in the lower limb for gait re-education. This treatment takes place in any of the Fraternidad-Muprespa healthcare centers throughout Spain, always with the support of orthopedic technicians for proper handling of the prostheses. In addition, at the Fraternidad-Muprespa Habana Hospital we have a physiotherapist who has been trained to treat amputee patients. If requested by the patient or by the network's healthcare center itself, we can facilitate this treatment. In upper limb amputations they usually continue treatment with occupational therapists from the orthopedics themselves. 

What factors do you consider key for a prosthesis to improve the patient's quality of life?

That it is appropriate to the activity and expectations of the patient. There are patients who request a type of prosthesis because they have seen it on the Internet, for example, and you know that the patient will be unable to handle it. If you approve this prosthesis, the only thing that is achieved is the abandonment of use of the prosthesis and frustration for the patient. 

Does early rehabilitation influence the success of prosthetic integration?

It is essential. It has been seen that the beginning of immediate postoperative rehabilitation influences adaptation and the reduction of phantom limb syndrome. If we can, it begins in the immediate postoperative period, with care of the stump, posture and reduction of edema with compressive bandages or liner shaper to remodel and improve the shape of the stump and exercises to maintain body image and work healthy limb muscles.

What recent advances have transformed the use of prostheses in trauma patients?

Currently there is a very important advance, especially at the level of prosthetic technology that is based on electronic joint control. There are even works that aim to reproduce the sensitivity of the prosthesis and advances in the quality and comfort of socket materials. 

At the level of the upper limb it is more spectacular because it is more visual, like articulated hands where each joint moves with the muscular contraction of the stump, capable of picking up a coin with the first and second fingers of the prosthetic hand, or picking up a plastic cup without it being deformed. Or a patient disarticulated from the shoulder capable, through pectoral and periscapular contraction, of performing movements in a prosthetic elbow. 

What message would you give to patients who are beginning their rehabilitation process with prostheses?

The most important message is to be patient because it is a long process, and I am not talking about a few months until the stump is stabilized, the pain is controlled, the prosthesis is controlled, etc... 

And when has this adaptation process already taken place?

Once the patient has incorporated the prosthesis and demonstrates adequate handling, periodic reviews are established according to their needs. 

The evolution of the amputee patient with a prosthesis is dynamic and can vary over time, so the Mutua's commitment is to continue offering solutions and support at each stage of this vital process.

Can you share with us a story about a prosthetic patient that you particularly remember? 

The truth is that it is a field that offers a lot of gratification to the doctor when a patient with a process as traumatic as a limb amputation can improve their quality of life, especially in independence.  Luckily amputation is not so frequent but I still remember many, with their good and bad stories, with their complications and their needs.

One of the first evaluated at the beginning of the unit comes to mind, with special affection. It was a patient who suffered a double amputation due to a very traumatic work accident that ended with bilateral amputation at the tibial level. The stumps were very well shaped and seemed like they would facilitate prostheticization, but since the amputation was double, it was very difficult to adapt to the sockets due to the reduction in the volume of the stumps, the pain during weight bearing, and so on. Furthermore, the patient lived in a rocky town with many hills, which did not facilitate the patient's daily retraining. To this day he occasionally comes for evaluation by the unit, due to phantom limb pain, and he comes walking with two canes for better support, but always thanking us and with a smile when he sees us.