Excellence in Amputee Rehabilitation and Support

Since 2000, under the leadership of Terrence P. Sheehan, MD, chief medical officer for Post-Acute Care, the Amputee Rehabilitation and Support program at Adventist HealthCare has evolved into one of the premier care centers for people with limb loss in the U.S. Led by experienced clinicians, rehabilitation therapists, prosthetists and more, the program helps patients with limb loss regain their mobility. Together, the team addresses the most complex cases, helping patients living with osseointegration, hemipelvectomy and hip disarticulation successfully adapt to life with a prosthesis.

When Dr. Sheehan arrived in Maryland nearly a quarter-century ago to open Adventist HealthCare Rehabilitation Rockville, he wasted no time in establishing a world-class amputee program.

“I trained in spinal cord injury in Boston and Philadelphia, two cities rich in acute rehabilitation services,” Dr. Sheehan said. “Through that training, I was oriented toward and learned the care of patients with limb loss. When I arrived in Maryland, I found no center was coordinating or specializing in the care of this patient population. The Amputee Clinic was one of the first clinics I established.”

Led by Dr. Sheehan, Adventist HealthCare collaborated with the Commission on Accreditation of Rehabilitation Facilities (CARF) and the Amputee Coalition to draft and initiate the first national standards of care for people with limb loss. In 2008, the Amputee Rehabilitation and Support program became one of the first in the nation accredited by CARF under the standards.

Helping Patients Envision What Is Possible

A patient-centered approach to care is what defines the Amputee Rehabilitation and Support program. Like all members of the care team, many of whom have been part of the program for more than 20 years, Farhad Ostovari, PT, DPT, CBIS, clinical director for Amputee Care and Prosthetic Services at Adventist Healthcare Rehabilitation Rockville, embodies this approach.

“We do not focus on what we envision for patients, but rather on what they envision for their life going forward,” Farhad said. “We tell them amputation is just a bump in the road. They will get back to their prior level of functionality.”

The patient journey begins prior to amputation, when representatives of the Amputee Rehabilitation and Support program meet with patients to start educating them about what to expect from life after surgery. Care begins with postsurgical training known as Phase One, when the Amputee Rehabilitation and Support team conducts an initial inpatient assessment of the patient and addresses issues such as controlling pain, preventing depression, increasing mobility and educating about preventing additional limb loss.

Inpatient peer visitation is especially helpful. Trained former patients of the program meet with new patients and share their personal experiences with limb loss and prosthesis use.

“There is nothing more powerful for patients than a peer coming to the bedside and answering their questions,” Dr. Sheehan said. “Peer visitors receive training according to Amputee Coalition standards. They help patients create a vision for what is next.”

Preparing for Life With a Prosthesis

Typically, patients return to Adventist HealthCare Rehabilitation approximately one month after amputation for a second, 10- to 14-day inpatient stay focused on learning to use a prosthesis. This is known as Phase Two.

“During Phase Two, patients complete three hours of rehabilitation therapy each day focused on ensuring the prosthesis fits comfortably and learning to walk with it,” Dr. Sheehan said. “We address barriers to progress every day. By the end of their stay, we expect patients to be up and walking and have full ownership of caring for themselves and their prosthesis.”

During Phase Two, in addition to training on using their prosthesis, patients work with therapists to increase mobility and build proficiency in activities of daily living. Upon completing this phase, patients begin outpatient rehabilitation and visit the Amputee Clinic for monthly appointments.

Continuing Care

After Phase Two, the team’s focus shifts to preparing patients to thrive with a prosthesis for the rest of their lives. Each Amputee Clinic appointment is a seamless experience, with Dr. Sheehan, the physical therapists and prosthetists from one of three prosthetic companies seeing patients and addressing their needs together.

“We ensure every provider of significance is in the room,” Dr. Sheehan said. “When a patient comes in, the professionals who made their prosthesis are there, and the physical therapists are also present to update me on how the patient is doing in therapy. It’s a real-time team. Patients do not receive fragmented care.”

Eventually, when patients have comfortably reintegrated back into their normal routine, the frequency of their visits to the Amputee Clinic reduces to every six months. That, Dr. Sheehan said, “is a good sign when we get there.”

The Amputee Rehabilitation and Support program offers resources to help patients build community and share tips for adapting to life with a prosthesis. These include a monthly support group and Promoting Amputee Life Skills, or PALS, a multi-week education course. Both groups continue to ramp back up in the wake of the COVID-19 pandemic.

The success of the Amputee Rehabilitation and Support Program is evident not just in the stories of patients who return to work, attend college or travel internationally following limb loss, but also in the data. Time spent wearing the prosthesis, for example, is a key indicator of patient success, and a data point the program tracks closely – with gratifying results.

“Based on 2022 data, 75% of our below-knee amputees were wearing their prosthesis more than eight hours a day,” Farhad said. “Fifty-eight percent of above-knee amputees were wearing their prosthesis more than eight hours daily.”

The Amputee Rehabilitation and Support Program also collects data on falls and skin breakdown.

“We are quite successful at all the data points we track,” Dr. Sheehan said. “Our patients’ longevity is much better than what’s predicted in this population.”