Rehabilitation of elderly patients after major amputation of lower extremities

The rehabilitation of older vascular patients after major amputation of lower limbs is very complicated. It is limited by individual patient abilities as a result of multiple chronic conditions and also individual constraints. It is not the functional status or the independent establishment of a prosthesis but the restoration of the opportunity to participate in social life that best defines rehabilitation following major amputation. Rehabilitation goals are primarily self-sufficiency, self-determined living and the correct use of a suitable locomotive device (including appropriate wheelchair provision). The correct use of a prosthesis after amputation in older patients requires not only largely intact sensory perception in the contralateral leg, as well as sufficient muscular strength to allow development even of the upper extremity, but also a sufficient ability to learn. This necessitates an adequate long-term attention span, as well as concentration and mood stable enough to deal with the loss of the limb and simultaneously to generate enough motivation for the long-term process of rehabilitation. Diabetic complications, such as diabetic neuropathy and wound healing deficits, visual loss, deafness, malnutrition, primary and secondary changes in the large joints and cognitive disorders, such as dementia and depression, all have an effect on the rehabilitation outcome. A pre-operative assessment in relation to these domains, current functional limitations and psychosocial factors, should improve the individual's rehabilitation outcome, as well as improve the selection of prostheses which would increase the value and the use of a prescribed prosthesis.