By Abdo Haidar Consultant Prosthetist at The London Prosthetic Centre
The measure of success of an amputee is not about the state of the art prosthetics, but how well the amputee can continue to live their lives.
What an amputee gets out of a prosthetic device depends on their goals, motivation, determination and skills of the prosthetist. Sometimes it’s about freedom of movement and independence and sometimes it’s about going further.
Having practised as a clinical prosthetist for over 20 years, I have acquired the experience and knowledge to prepare prosthetic expert witness reports for both claimants and defendants. The report is extremely important ensuring that amputees receive the support necessarily required for life. These considerations listed in my article offer guidelines when preparing an expert witness report. The main aim is provision of appropriate intervention and prosthetic prescription ensuring the claimant can reach as much of their independence following limb loss.
1. Early intervention
Early intervention is vital to ensure a speedy recovery. The earlier the amputee begins their rehabilitation and working with a skilled prosthetist, the better their outcome will be as a prosthetic user.
Amputation of a limb affects almost all aspects of an individual’s life. Amputees in addition to their physical disability suffer from countless psychological and psychosocial problems.
Amputation causes threefold loss in terms of function, sensation, and body image.
The majority of amputees are plagued by many doubts and fears. Most amputees do have the need for reassurance and constructive advice, but because amputation is a visible disability, there is usually hesitancy on the part of others to consider amputees as normal healthy individuals. Rehabilitation is a holistic process comprising of therapy, use of prosthesis, reemployment, and reintegration into the social roles.
With early intervention, cost justifications should be verified for:
• Objectives evidence/trial
• 6 year intervention plan with regular review by the team
• Interim funding for trials
• Well documented prosthetic intervention with video evidence
• Initial needs assessment by the team i.e. Prosthetist, Physiotherapist, Occupational Therapist, Pain Specialist and Psychologist
• Set short and long term goals
The ultimate goal of rehabilitation after limb loss is to ambulate successfully with the use of a prosthesis and to gain a high level of independence. Prosthetic rehabilitation is a complex task that ideally requires input from a multidisciplinary rehabilitation team.
• Amputees should at first instance attend a geographically convenient prosthetic centre to their home.
• Prosthetic rehabilitation requires the user to attend on multiple visits the prosthetic centre to achieve the desired outcome.
• Amputation is for life. Residual limb volume is constantly changing depending on weight loss or gain, muscle atrophy and swelling due to vascular problems. The socket is bound to be replaced frequently especially so in the early years following an amputation.
• It is vital that the user establish a long term relationship with their prosthetist to ensure that their prosthetic care is dealt with in a timely manner to consistently try to improve their mobility and independence.
• Pre-amputation rehabilitation and post-amputation prosthetic fitting together with physiotherapy and gait training, indoors and outdoors are necessary to ensure that the user becomes confident using their prosthesis.
3.Mobility - Consideration of prosthetic type
Depending on the claimant’s activity and mobility level prior to their limb loss, consideration is made to the type or design of prescribed prostheses. The prosthetic device should match the person’s needs and potential. Prescribing an expensive device is not necessarily an indication to improving the user’s mobility.
The history of the claimant should paint a picture of their functional and mental abilities and limitations on a typical day. The physical examination should focus on the body systems that are responsible for their ambulatory or limb difficulties or impact their functional ability. The claimant should be provided with a prescription for prosthetic components that are appropriate for their activity and mobility levels. Many amputees are able to walk without the need of any aids; others require aids such as a stick or crutches.
The prosthetic team will set specific goals for the user and as the user progresses and becomes more active, their prosthesis may need upgrading or updating.
4. Advanced technology vs costs
Advancements in prosthetic technology has enabled many amputees to live as normal a life as possible offering them more independence than would have been possible 20 years ago. But technology comes at a price. To make it clear, technology in prosthetics is not always a clear indication for improved mobility, activity or quality of life. Each user has different needs and therefore many considerations should always be made before prescribing these technologies
Weight, shape, cosmetic look, size, noise, water proofing, donning, doffing, maintenance, replacement, home environment, vocation, hobbies, sporting activities, ability to attend the centre as necessary and spares, are all factors that should be carefully considered before prescribing modern technologies.
Life span – A typical prosthesis life span is around 5 to 6 years and considerations of new prosthetics with costed inflation will always need to be included in the expert witness report. The lifespan also depends on the amputee’s activity and mobility. The prosthetic components such as the knee, foot, ankle or hand are mechanical items that require servicing, maintaining and eventually replacing.
This might start out at a sedentary lifestyle and increase as they grow more confident as a prosthetic user.
Spares – The unfortunate reality is that a single prosthesis cannot fulfil all the mobility requirements needed for daily functions like walking, showering or sports activity such as cycling or running. Most amputees will require different prosthesis for different needs.
Maintenance – Maintenance is important to ensure that the mechanical components such as the hand or knee are functioning optimally at all times overriding any catastrophic failure or mechanical problems.
6. Psychological body image - Cosmesis
In addition to the physical change, the amputation of a limb can generate unpleasant psychological feelings during the post-amputation phase. Amputees can suffer symptoms such as stress and depression and a general difficulty in accepting the new bodily condition. A functional prosthesis can offer improved mobility and function but at times amputees still struggle with the appearance of their prosthesis. The appearance of the prosthesis affects the acceptance of the device and improving the aesthetic quality of the prosthesis can consequently help to improve the self–body image and psychological wellbeing of the wearer. Silicone aesthetic handmade covers resembling the skin texture, colour and appearance of the sound leg are fitted in my clinic to improve the final prosthetic look and achieve a realistic appearance. Other amputees opt to have 3D printed covers that can be designed in many shapes and colours wishing to show off their prosthesis.
Some facts to consider
• You cannot put a price on a prosthesis for giving someone a chance to return to the life they would like to live.
• Prosthetic technology will continue to advance to amazing heights and the more advanced the prosthetic component the more expensive it is going to be
• Claims have escalated in the last 20 years in medical negligence and personal injury and will continue to rise in the future
• Many people who have suffered amputation have still gone onto achieving greater things in life.
• Prosthetic devices are not a luxury, they are a necessity.
Abdo Haidar HCPC Registered Prosthetist specialising in upper and lower limb prosthetics with over 20 years of NHS and private experience.
Founded the London Prosthetic Centre in 2008, presently lead Consultant Prosthetist and clinical director, clinically managing the prosthetic care of over 1000 amputee clients attending our centre from the UK and from all over the world. Abdo specializes in all aspects of lower and upper limb prosthetics with interest in silicone solutions to include digits loss and partial feet amputations. Abdo is currently the lead prosthetic clinician on SocketMaster Horizon 2020 research project developing a medical tool to optimize lower limb prosthetic fittings.
His commitment to providing the highest standard of care, emphasising the individuality of each person and their requirements is paramount to his success in amputee rehabilitation.
Abdo understands the complexities of amputations and with efficient, accurate and responsive intervention, his clients get to enjoy their everyday activities with complete confidence.
Attended a number of Bond Solon expert witness courses, awarded an Expert witness certificate from Cardiff University, member of the Expert Witness Institute, APIL and UK Register of Expert Witnesses. Abdo prepares many expert witness prosthetic reports following amputation.
Previous roles included Prosthetic Lead at Queen Mary’s Hospital, Roehampton where he was responsible for the prosthetic rehabilitation of over 1,500 lower limb amputees where he worked for 11 continuous years. Abdo is a nominated prosthetic clinical tutor for the University of Salford, UK for the last 20 years and LaTrobe University, Australia. Abdo have published peer review articles and given presentations in his speciality. Abdo is also an invited lecturer at the University of Surrey.
Tel: 0775 268 6439 Website: