Psychological Implications of Traumatic Limb Amputations

A total amputation of a limb is the surgical severing of it from the body or, in some cases, the severing occurs at the time of the accident and it differs greatly, and more physically traumatic, from the surgical removal. A partial amputation of a limb is the surgical severing of a portion of it from that part of the body to which it is normally attached, or as mentioned prior, can occur at the time of the accident. According to recent statistics, there are more than two million people living with limb loss in the United States[1]. Specialized, clinically relevant rehabilitation for those living with limb loss is one of many areas of expertise at NeuLife in Mount Dora, Florida.

Often, amputation is the only alternative for an ongoing disease in the body, the limb(s) or both. In those cases, amputation is a decision made by the individual, his or her family and his or her physician. Although traumatic both in terms of the decision to undergo the surgery and in terms of the surgery, itself, there is time to anticipate the surgery, to begin to acclimate oneself to what lies ahead, and perhaps, to get advanced neurobehavioral, psychological and pre-rehabilitative care to ready oneself for how to handle life and activities of daily living after the surgery.

The analysis is different with respect to a traumatic amputation. By definition, there is no warning of it and no opportunity for forethought about it, the particulars of the acute care, the post-acute rehabilitation or about the ramifications on activities of daily living or one’s independence following the trauma and rehabilitation.

Traumatic amputations can result from a variety of occurrences, including:

• Motor vehicle accidents
• Work-related injuries
• Combat-related injuries

Both the causation of the traumatic amputation and its effect on the individual’s activities of daily living has implications for addressing his or her long-term needs. The goal of post-acute rehabilitation is to achieve a level of function and independence consistent with the client’s physical and psychological abilities. Initially, therefore, when the client who sustained a traumatic amputation has been medically stabilized and becomes a client of NeuLife, he or she undergoes an independent functional evaluation by NeuLife’s multidisciplinary team of professionals to assess all manner of physical and psychological implications. In the case of a client with a traumatic amputation the team often consists of, but is not limited to, the following:

• Board Certified Psychiatrist
• Board Certified Behavior Analyst
• Psychologists
• Board Certified Physiatrist
• Neuropsychologists
• Cognitive Therapist
• Physical Therapists

Because the traumatic injury involves an amputation, it is important that not only the physical aspects be fully evaluated, but the psychological ones, also; an amputation is different from other kinds of traumatic injuries. Due to that, a critical component of the Client Goal Plan that NeuLife develops for the amputation client focuses upon the psychological trauma, as well as other clinically relevant services needed for the his or her rehabilitation.

There are three main areas of psychological significance that differentiate amputation from other types of catastrophic injuries:

• Dealing with the loss of sensation from the amputated limb;
• Dealing with the loss of function from the amputated limb; and or
• Dealing with a change of body image and in the way in which others perceive the client.

In light of these, it is not uncommon to experience negative thoughts and emotions after a traumatic amputation. The emotions can include, but again, are not limited to:

• Depression;
• Anxiety;
• Denial, in the sense of refusing to accept the need to make changes, such as in the ways in which activities of daily living are approached and executed, or the need for specialized post-acute rehabilitation;
• Grief; and/or
• Suicidal ideations[2].

Psychiatrists, who are medical doctors and integral members of NeuLife’s multidisciplinary team, are equipped to address many of the outgrowths of traumatic amputations, including prescribing medication if needed. Psychologists are equally important members of the cadre of professionals at NeuLife and although they cannot prescribe medication, psychologists, including neuropsychologists, participate in the development of the Client Goal Plan and participate in the client’s rehabilitation. The amputation will have implications for the client’s family as well, such as increased care needs of the client; the psychologist is, therefore, an important member of the therapy team for them, too.

Whether a client with a limb amputation has been admitted to NeuLife for rehabilitation, is in supported independent living or lives independently after post-acute rehabilitation, the reality is that he or she has experienced the catastrophic trauma of an amputation and may require ongoing psychological support. It is, therefore, important that the client and his or her family understand some of the terminology used in the psychological milieu. NeuLife’s multidisciplinary team is composed of professionals who may utilize some, or all, of the following types of therapies:

• Psychoanalysis/psychodynamic therapies: Attempts to change problematic behaviors, feelings and thoughts by discovering their unconscious meanings and motivations;
• Behavior therapy: Focuses on learning’s role in the development of both normal and abnormal behavior. “Cognitive-behavioral” therapy is an outgrowth of this theory and addresses both thoughts and behaviors. Since both aspects are involved, a client’s reaction to and consequent behavioral dysfunctions relating to the amputation can be addressed;
• Cognitive therapy: Concentrates on what a client thinks, rather than what he or she does;
• Humanistic therapy: Emphasizes the individual’s ability to make rational choices. A variant of it, Gestalt therapy, emphasizes being aware of the here and now and taking responsibility for it. This may have an especially positive application to a client who has sustained a catastrophic injury like a traumatic amputation alone, with no cognitive deficit[3].

It is apparent numerous individuals suffering trauma from catastrophic injuries or diseases have been excluded from receiving specialized rehabilitation and services in post-acute environments. NeuLife is addressing that need.

Proper and timely post-acute rehabilitation that may determine the difference between disability and independence is what NeuLife refers to as the “platinum post-acute period” — the crucial window following acute care that is needed to nurture the whole person to health with specialized, clinically relevant services.

NeuLife’s philosophy is that healing, wellness and personal fulfillment are best achieved in a positive and uplifting therapeutic environment where caring staff encourages, assists and supports each client so he or she may achieve specific goals. NeuLife believes personal fulfillment is equally as important as goals to achieve function and independence.

NeuLife, in Mount Dora, Florida, is an accessible residential post-acute program providing specialized rehabilitation to individuals diagnosed with traumatic brain injury (TBI), spinal cord injury (SCI), traumatic amputations and other catastrophic injuries.

2725 Robie Avenue

Mount Dora, Florida 32757

[1] Amputee Coalition, http://amputee-coalition.org/limb-loss-resource-center/resources-by-topic-statistics

[2] NHS Choices, Complications of Amputation, http://www.nhs.uk/Conditions/Amputation/Pages/Complications.aspx

[3] Different Approaches to Psychotherapy, American Psychological Association, http://www.apa.org/topics/therapy/psychotherapy-approaches.aspx