Without immediate and thorough rehabilitation, people with serious injuries can develop complications that can make it difficult or impossible for them to regain their mobility. Nowhere is this clearer than with the Nepal earthquake survivors who had legs amputated. Sunil Pokhrel, the Senior Physical Therapist at Handicap International Nepal, discusses how the organization is helping earthquake survivors with amputations to walk.
Under normal circumstances, rehabilitation begins before a patient undergoes surgery to have their leg or legs amputated. We counsel the person about the rehabilitation process and teach them upper limb exercises as well as breathing exercises to help them feel relaxed and energized. This was not always possible with survivors of the Nepal earthquake, but we tried to begin rehabilitation as soon as possible.
Right after surgery, a patient’s amputated stump must be bandaged properly to reduce swelling and the leg should be positioned slightly elevated with no bend in the joints. Without proper positioning the leg is at risk of contractures—a shortening of the muscles which can permanently restrict movement.
Patients also need to start moving and stretching or they may be bed ridden for a long time and develop pressure sores. Within a few hours of surgery we try to test the patient’s ability to sit comfortably. Within 24 hours we encourage them to try standing on one leg with support. If they can stand, we provide them with crutches and gradually introduce walking and other exercises.
Losing a part of the body is always mentally traumatic, and many Nepal earthquake survivors also lost family members, friends, and their homes. Therefore it has been very important for us to connect emotionally with our patients. We talk and listen to patients and their families, and tell them that they will receive a prosthetic leg, which gives them hope. However, we present a realistic picture of what they will able to do physically and let them know that they must take ownership of their physical therapy and health care in order to be able to walk. To inspire patients, I like to tell them the story of Reema, a Handicap International beneficiary who received a prosthesis and is now a famous dancer in Nepal.
When a person’s stump is healed, they can perform more rigorous exercises and stretching to increase their strength and flexibility. Typically it takes several months of physical therapy before a person can be fitted with a prosthesis.
Right now, the government of Nepal estimates that 40 to 60 people will need prostheses as a result of injuries sustained during the Nepal earthquake. So far, Handicap International has registered 34 patients for prostheses.
When they are ready, a qualified prosthetist will measure and fit each patient. Adjustments are made until they can take a few steps comfortably with their new prosthesis. Then they can begin user training. A physical therapist will teach each patient how to walk with their prosthesis on smooth and rough surfaces, how to climb stairs, how to take it off and on, and how to care for it.
We follow up with patients three to six months after their initial fittings and trainings to make adjustments to the prosthesis. In a hilly country like Nepal, the foot of a prosthesis usually needs to be replaced every six months and the whole prosthesis needs to be changed every one to two years.
Being a part of the team providing these vital services to earthquake survivors is my proudest moment as a physical therapist. I cannot wait to see them walking again on their own.