An amputation is the loss or removal of a part of your body, such as an arm or leg. The loss of a limb can be a life-changing experience, but there is help and support available.

There are several reasons why someone might need to have an amputation. These can include:

• diabetes complications
• peripheral vascular disease (narrowing of the arteries leading to your legs and feet)
• other causes of severely reduced blood supply to the limb
• severe infection
• cancer
• serious injury

Many people can use a prosthesis (artificial limb) or mobility device to regain function after an amputation.

Amputations can be done as emergency or elective (planned) surgery. Finding out that you are facing an amputation can be difficult and scary.

Before planned amputations, you will meet with your surgeon. They will discuss the operation with you and any preparation needed. It can help to take a relative or friend with you to these appointments.

It can also help to make a list of questions before your appointment. This is so that you can discuss these with your doctor or other healthcare providers.

Preparation for an amputation may include:

• a thorough medical examination
• a psychological assessment
• making adaptations to your home or work environment

Your surgeon will remove your limb, or part of the limb under anaesthetic. An anaesthetist (specialist doctor) will discuss with you beforehand what type of anaesthetic will be best for you.

The wound will be closed with stitches or staples. A drain may be inserted under your skin to drain away excess fluid. Your wound will be covered with a wound dressing and bandage.

Pain control

Your wound will be sore after surgery, but this should start to ease in 2 to 5 days. Pain relievers can be used to keep you comfortable after your surgery.

You may feel what is known as 'phantom limb' pain. This means you feel pain in the amputated limb, even though it is no longer there.

Some people also have ‘phantom sensations’, meaning they can still feel the limb that has been removed. You may have sensations such as:

• pins and needles
• itching
• tingling sensations

Phantom limb pain and sensations are common and may last for a few weeks after your amputation. If phantom limb pain persists or is very uncomfortable, speak with your doctor.

Rehabilitation will help you recover and regain your independence.

Usually, several healthcare members will be involved in your care, including a:

• rehabilitation doctor
• nursing team
• occupational therapist
• physiotherapist
• prosthetist (healthcare worker who looks after the design and fit of a prosthesis)
• social worker

Your physiotherapist and occupational therapist will work out a rehabilitation program to help you return to work and other activities.

The program will start a few days after surgery. It will help you manage independently, for example by teaching you how to get in and out of a wheelchair.

You may then progress to an exercise program and learn how to use your prosthetic limb if you have one.

Your physiotherapist will also work with you to keep your joints as mobile as possible. This is to help prevent contractures, where your muscles, skin, tendons or ligaments become shortened and stiff. Contractures can limit how you move. The more you move and exercise, the less likely you will be to develop a contracture.

Prosthesis

You may be able to have a prosthetic (false) limb fitted after your surgery. Your prosthetist and healthcare team will help you prepare for this.

Psychological support

For some people, losing a limb is like losing a loved one and they will need to grieve. Coming to terms with the psychological impact of an amputation is just as important as coping with the physical changes.

Peer support can be helpful — peer support volunteers are people who have experienced and lived with limb loss.

It can also help to join a support group, either in-person or online. Try talking to friends and family about how you are feeling and stay connected.

You may also benefit from professional support, such as seeing a psychologist or counsellor. Talk to you doctor if you have ongoing feelings of:

• anger
• irritability
• denial or grief
• anxiety or depression

Amputation can affect every area of your life, including your home and work. It’s a lot to adapt to, and you will need support.

You may need modifications to your home, or equipment such as:

• a stair-ramp
• handrails
• a wheelchair lift
• a modified car

You may need to change your routines and find new ways to do the things you are used to doing. The right help, training and equipment will make it easier for you to adapt.

Mobility Research

Disturbance Response in Amputee Gait

Eversion and inversion movement model.

Errors in foot placement while avoiding obstacles and maneuvering in the household and community environments may lead to falls and injuries. This research aims to develop an ankle that can invert and evert and thereby control the center of pressure under the prosthetic foot; enhancing balance and stability of lower limb amputees.

Foot-Ankle Stiffness

Models of foot stiffness

Many ambulatory lower limb amputees exhibit fatigue, asymmetrical gait, and the inability to walk at varying speeds. We are using a rapid prototyping approach to fabricate feet of varying stiffness for exploring the effects of foot stiffness on amputee gait.

Turning Gait

Maneuvering required in a typical house.

Turning corners and maneuvering around obstacles are essential abilities for successful community and household ambulation. The aim of this research is to test the efficacy of a compliant torque adapter in the pylons of transtibial amputees.

Energy Storage & Release

Many ambulatory lower limb amputees exhibit fatigue, asymmetrical gait, and the inability to walk at varying speeds. We are developing and testing several approaches aimed at providing the propulsive forces necessary to alleviate these problems.

Three different propulsion test devices.

Stochastic Resonance

Transtibial amputee wearing a stochastic resonance capable socket.

Stochastic resonance (sub-threshold vibration) may enhance peripheral sensation sufficiently to result in improved postural stability and locomotor function. This research explores application of this phenomenon to the residual limb and intact plantar surface of diabetic lower limb amputees.

Research in Robotics and Biomechanics

Biologically Informed Robotics

Dr. Aubin’s research spans robotics and biomechanics with applications in health and mobility. He motivates his research by engaging with patients and stakeholders to understand shortcomings in the areas of rehabilitation, prosthetics, orthotics, and physical therapy. Dr. Aubin strives to address these unmet patient and caregiver needs by establishing multidisciplinary research teams that leverage state of the art technologies in robotics, neuroscience, and computational intelligence. Dr. Aubin’s research goal is to develop and utilizes novel sensors, algorithms, assistive powered devices, and robotic tools that can augment human performance and/or improve mobility and function for those affected by disease, age or trauma.

Smart Cane System

Smart Cane System

People with pain or arthritis in their knee often walk with a cane to reduce knee pain and to improve or maintain their mobility. Increased pressure on the knee joint likely causes knee arthritis and reducing the pressure on the knee joint may slow the progression of arthritis. Walking with a cane reduces the pressure inside the knee joint, but only if the cane supports 10% to 20% of a person’s weight. Many people may not be using their cane in the best way they can because they don’t know how much force (percent of their body weight) they are putting on the cane when they walk. In this study we are looking at how using a computerized cane that beeps or vibrates (like a cell phone) when a certain amount of force is applied to it might help people learn to more effectively use a cane. We are also examining how walking with a cane changes the pressure in the knee joint. We hypothesize that giving the user biofeedback, a sound or vibration signal from the cane, will help them apply the optimal amount of force on the cane. Our secondary hypothesis is that increased cane loading will result in a decrease in knee joint pressure.

Sensory Feedback For Prosthetic Limbs

It has long been recognized that restoring movement function after amputation is a priority. We are now entering an era in which restoration of sensation may be possible as well through the use of smart sensorized prosthetic devices and haptic feedback. We are working on understanding how feedback of forces and events on the foot - for example the placement of the prosthetic foot as the user is walking down stairs - can lead to improved function.

Injury Prevention Research

Vacuum Suspension Systems

Many amputees live with an ill-fitting socket and can experience limb pistoning within the socket, which in turn may result in skin irritation, tissue breakdown, discomfort, and a reduction in activity. The aims of this research are to characterize the response of the lower residual limb to a vacuum suspension system and to measure changes in limb volume with a structured light scanning system.

Vacuum suspension system modelling

Socket Systems & Tissue O₂

Fiber-optic video-oximetry imaging system

Limb health and wound healing capacity is closely related to the amount of oxygen present in limb tissues. Using our fiber-optic video-oximetry imaging system, we aim to discover if prosthetic prescription can influence residual limb tissue oxygenation during both rest and gait.

Distributed Sensing

The goal of the proposed project is to develop enabling sensing technology based on a flexible array and to build a prototype of a prosthetic liner with distributed, unimodal field sensing capability. The specific aims include: (1) the design of the flexible sensing array for measurement of moisture, temperature, pressure, and shear stress; (2) integration of this array into a prosthetic liner/socket; and (3) testing of device performance.

Distributed sensing images

Torsional Prosthesis

This research seeks to develop a prosthetic limb whose torsional characteristics can adapted depending activity. Our goal is to reduce torsional stresses and the incidence of residual limb injuries.

This research seeks to develop a prosthetic limb whose torsional characteristics can adapted depending activity. Our goal is to reduce torsional stresses and the incidence of residual limb injuries.

Patient Comfort Research

Thermal Comfort

Lower limb amputations often experience discomfort related in part to higher skin temperatures within their prosthetic socket. Our research has found prosthetic liners and sockets are excellent insulators that can retain heat. Activity can cause a dramatic increase in skin temperature within the prosthesis requiring substantially long periods of inactivity to restore resting state temperatures. Our current work involves developing active cooling systems and embedded sensor networks to monitor skin temperature.

Lower limb amputations often experience discomfort related in part to higher skin temperatures within their prosthetic socket. Our research has found prosthetic liners and sockets are excellent insulators that can retain heat. Activity can cause a dramatic increase in skin temperature within the prosthesis requiring substantially long periods of inactivity to restore resting state temperatures. Our current work involves developing active cooling systems and embedded sensor networks to monitor skin temperature.

Evaporative Cooling and Perspiration Removal

Amputees often complain about uncomfortably warm residual limb skin temperatures and the accumulation of perspiration within their prosthesis. This research will discover if a novel evaporative cooling system can provide ameliorate these problems.

Sometimes, when a limb is removed during an amputation, an individual will continue to have an internal sense of the lost limb. This phenomenon is known as phantom limb and accounts describing it date back to the 1800s. Similarly, many amputees are frequently aware of severe pain in the absent limb. Their pain is real and is often accompanied by other health problems, such as depression, anxiety, sleep disorders and a general decrease in quality of life.

What causes this phenomenon? Scientists believe that following amputation, nerve cells "rewire" themselves and continue to receive messages, resulting in a remapping of the brain's circuitry. The brain's ability to restructure itself, to change and adapt following injury, is called plasticity (see section on Plasticity).

Our understanding of phantom pain has improved tremendously in recent years. Investigators previously believed that brain cells affected by amputation simply died off. They attributed sensations of pain at the site of the amputation to irritation of nerves located near the limb stump. Now, using imaging techniques such as positron emission tomography (PET) and magnetic resonance imaging (MRI), scientists can actually visualize increased activity in the brain's cortex when an individual feels phantom pain. When study participants move the stump of an amputated limb, neurons in the brain remain dynamic and excitable. Surprisingly, the brain's cells can be stimulated by other body parts, often those located closest to the missing limb.

Treatments for phantom pain may include analgesics, anticonvulsants, and other types of drugs; nerve blocks; electrical stimulation; psychological counseling, biofeedback, hypnosis, and acupuncture; and, in rare instances, surgery.