People with amputations (also known as amputees) have a wide variety of responses to the loss of limb(s). The terms patient, wearer, and amputee will be used synonymously throughout this chapter. Persons who are born with a congenital limb deficiency (also referred to as limb difference) may possess concerns when labeled as an amputee because, technically, no body portion was amputated. The term stump has been associated with negative connotations and should be avoided. Health-care professionals are encouraged to refer to the person's remaining body region after an amputation as the residual limb (RL) to encourage patient acceptance versus disdain.
A prosthesis is an artificial limb. Prostheses are more than one artificial limb. Prosthetic is an adjective, not a noun. Hence someone may wear one prosthesis or two prostheses but they do not wear a prosthetic—they wear a prosthetic leg, prosthetic arm, or a prosthetic device. Prosthetics refers to the profession associated with making artificial limbs and the knowledge base contained therein. Prosthetists are the allied health-care practitioners who practice the art and science of making prostheses.
Prosthetists' Education and Credentialing
Prosthetists are far more than artificial limb makers and dispensers of devices. They must evaluate patients, generate and implement comprehensive treatment plans, and then follow up with those treatment plans. As a result, prosthetic education is moving to reflect the expansion of knowledge necessary for one to be a competent practitioner. As of 2012, the minimum educational requirement for clinical training in Prosthetics (and Orthotics) will be a master's degree. The highest level of national certification in Prosthetics (and Orthotics) is awarded through the American Board for Certification in Prosthetics, Orthotics and Pedorthics (ABC). After the student completes his/her primary training in Prosthetics (and Orthotics), a year of post-graduate residency training in the discipline (Prosthetics or Orthotics) is required to sit for the ABC National Board examination (there are separate examination tracks for each discipline). The Scope of Practice for Prosthetists, Orthotists and Pedorthists as well as a listing of states requiring licensure can be accessed on the ABC Web site (http://www.abcop.org).
Epidemiology of Amputation in the United States
Based on data from the Healthcare Cost and Utilization Project from 1988 to 1996, Dillingham reported that 82.0% of amputations were the result of dysvascular causes, 16.4% were from trauma, 0.9% were from cancer, and 0.8% were from congenital presentations. Furthermore, from the period 1988 to 1996, dysvascular amputation rates increased 26.9%, traumatic amputations decreased 50.2%, amputations secondary to cancer decreased 42.6%, and congenital deficiencies remained the same. The ratio of major lower limb amputations (those at or proximal to the ankle) to major upper limb amputations (those at or proximal to the wrist) is about 40:1.
Dillingham, TR, Pezzin, LE, and ...