Around the country, experts have been searching for alternative ways to keep patients with limb loss engaged and excited about their recovery. From walking in swimming pools to virtual reality environments, patients have been working toward recovery in ways that take them outside therapists’ clinics.
The premise for using alternative types of therapy in conjunction with traditional, proven therapeutic methods is simple: Even if an individual has access to the best therapies in the world, they will not be effective unless the patient has the motivation to improve and succeed.
Alternative therapies might motivate patients in ways that traditional therapies can’t. For instance, patients may be able to gain confidence by walking in a pool after struggling to do so on land or may get more practice using their myoelectric arms if they are training to use them via a video game.
If a patient takes an interest in the therapy—whatever form of therapy it may be—that interest can help keep him or her motivated during recovery and provide an outlet beyond traditional post-amputation therapy, experts say.
“If patients are engaged in it, you see a change in their mood and attitude versus patients who don’t engage…with their traditional recovery,” says Alex Hetherington, CP, CFo, program director for the Amputee Comprehensive Training (ACT) Program within the Department of Orthopaedic Surgery at the University of California, San Francisco (UCSF).
That motivation can make all the difference in keeping patients working toward improvement.
“I think with therapy, a big component of it is motivation and patient compliance,” says Susan D’Andrea, PhD, director of the Virtual Reality and Motion Analysis Rehabilitation Laboratory at the Providence VA Medical Center (PVMC). “If you are enjoying something, you are more motivated to do it.”
One way to reduce the pressure of learning to walk with a new device is to literally take the pressure off through aquatic therapy.
Kelly Sacky, PTA, aquatic therapist at the Texas Orthopedic Hospital in Houston, helps her patients learn to live with their devices on land by conducting exercise training for prosthesis use in the water.
“If a patient is having a hard time due to contractures or if pain or overall weakness is an issue, and they are not tolerating land therapy really well, aquatic therapy can really help,” she says. “It allows them to be successful in the pool and gain their confidence, so they can then increase their participation with land-based interventions,” Sacky says.
“Maybe they don’t have much endurance—get them started in the pool where it is not as difficult, and you can do 45 minutes of therapy where you can only do 20 minutes on land.”
Along with helping build confidence and endurance, Sacky says aquatic therapy is a great way to help patients build the muscle strength they need. “I’m able to work with them in the water using buoyancy to force them to use the muscles they need to be successful in a prosthesis,” she says. “It really increases their awareness of what muscles they need to engage. In the pool environment, even though their weight is unloaded, their body is constantly working to keep vertical.”
That effort can help strengthen the body and core and give patients a greater range of motion of their residual limb, Sacky adds. While some therapeutic rehabilitation facilities or hospitals have pools, not all have therapists who are trained to work in the aquatic setting, which can make a difference. Her patients offer their own clarification; she says they tell her, “It’s more than just little old ladies doing exercises in the pool.”
There is one caveat to this kind of therapy, however. The patient must wait until his or her residual limb has fully healed, with no open areas or signs of infection before beginning aquatic therapy. Besides that, it’s great exercise and a great confidence builder for patients with limb loss, Sacky says.
“It increases their awareness of what muscles they now have to use,” she says. “So many of them still feel like they have a foot at the end of their limb down there. This helps them realize that this is the new normal and they figure out how to make it work.”