Your First Visit to an Artificial Limb Centre

Finding the Best Artificial Limb

Referral to an Artificial Limb Centre is generally arranged by the hospital staff who take into account your general health and the condition of your stump. However, it may be that you will need to contact an Artificial Limb Centre yourself. If there is some doubt as to whether you are able to wear a limb, you are still entitled to an assessment as it may be appropriate for you to have an artificial limb for cosmetic or transfer purposes. The first appointment to a Limb Centre is commonly 3-6 weeks following surgery.
On your first visit to the Limb Centre, you will meet the orthopaedic surgeon, the clinical prosthetist, and a physiotherapist, and together you will work out which type of limb is best for you. Your first limb is usually of a basic type and is unlikely to last very long due to stump shrinkage, which will necessitate a new limb within the first few months.
Although all artificial limbs are made to the same basic principles, a large range of components and materials are available. The type of limb that the specialists prescribe for you will depend on your age, how active you are, whether or not you play sport, the type of amputation you had, and any medical problems you may have. More than one type of limb might be suitable for you. Ask your prosthetist if any other options are available. If any special kinds of limb interest you, ask about these.
Making the Artificial Limb
The traditional method of making a limb is by taking a plaster cast. On your first or second visit, a plaster of paris mould and a series of measurements are taken of your residual limb - this takes about an hour. Later the prosthetist will use this hollow cast to make a solid plaster cast of your stump, so that the finished socket will fit well. Whether you have an upper or lower limb loss, the same process applies.
Some artificial limbs can also be made using the Tracer CAD method. This is a very sophisticated and advanced process for artificial limb manufacturing that is more convenient, cleaner and time-saving for amputees. Tracer CAD provides a number of ways to capture the shape of the residual limb, with measurements being entered on a computer. A digitised image is then sent to a carver where a model is carved in polystyrene and used to make the socket.
Lower limb amputees will be requested to take to the Limb Centre a pair of shoes that they feel comfortable to walk in. As it is difficult to adjust the leg to fit a variety of different heights, the artificial limb is generally adjusted to one heel height.
Lower Limb Amputees
Other technologies have come into play in recent years which your prosthetist may use depending on what socket you will have. One is to take the plaster cast whilst weight bearing through your residual limb. Another new method is the direct socket. This technology allows for your prosthetist to make your new socket directly over your limb which will enable you to have your socket that day. No one method is better than another and what you have will depend on a number of factors. It is unlikely that the socket will be perfect on first fitting and may need minor adjustments to ensure that it is comfortable. In the early stages, the socket is attached to a metal rod onto which a foot is fitted to allow you to stand and take your first few steps between parallel bars.It is important that the socket is a good fit. You will be working closely with the prosthetist to ensure that this is achieved. If there is any discomfort, you must let your prosthetist know. Your mobility depends on a good fit and a leg which functions well for you.
Trial Socket
With AK amputees, a prototype socket is often made. This is made of a transparent material like Perspex to allow the prosthetist to see how the socket is fitting and to identify and correct any pressure points. This trial socket is generally worn only at the Artificial Limb Centre. Once it feels comfortable, the final socket is made of a more solid plastic material and the leg is shaped to match the existing limb.
Upper Limb Amputees
It is important to discuss your lifestyle and occupation with your prosthetist so that the most appropriate componentry and socket are prescribed. The fitting of an upper limb prosthesis is often a complicated process involving setting up a harness system and cable to operate the hook or hand (commonly known as the terminal device). It is very important that the harness is correctly positioned and tensioned to allow easy operation of the hook/hand. The socket is designed to allow maximum movement but may feel fairly restrictive due to the need to suspend the prosthesis. This may need a very enclosed type of socket. The fitting stage of an artificial arm is often the final stage of the construction and it can then be taken home for practice. Occupational therapy is often required for fine-tuning the use of the prosthesis.

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