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Last Updated: Monday, 10 July 2006, 13:43 GMT 14:43 UK
Step by step
By Megan Lane
BBC News Magazine

Picture courtesy of Blatchford, makers of artificial limbs
Getting used to a new leg
Learning to walk involves trial and error, finding your balance and discovering what the body can do. It's a process that has to be repeated after losing a leg. How does an amputee relearn this basic skill?

The patients at a limb fitting clinic are a diverse bunch. There are those with a newly unfamiliar body after an accident or disease claimed a leg, waiting to be cast for an artificial limb.

Others have begun the arduous process of learning to walk, and there are those who became amputees years or even decades ago, returning every so often for refits or upgrades.

And last year, the four limb fitting centres that ring London admitted a new category of patient, the 12 victims of the 7 July bombings who lost a limb, or limbs.

Martine Wright, whose legs were amputated above the knee following the blast at Aldgate station, has compared learning to walk on her state-of-the-art 20,000 legs to being a toddler. "I am relearning it quite like a baby. I am getting up, falling down. It is a new thing every day."

AMPUTATIONS
Fitting a leg
Each year 5,400 new patients referred to NHS limb centres with amputated legs
Just 8% suffered an accident - majority lost leg to disease
About 40,000 amputees of all types in the UK
Figures from Amputee Statistical Database
For many weeks she spent six hours a day in the gym at the specialist Douglas Bader Unit at Queen Mary's Hospital, Roehampton. "They say it is 300% more difficult for me to walk than an able-bodied person. If I had my knees it would only be 100%."

Five of her fellow survivors ended up at the Stanmore Limb Fitting Centre in north London. Consultant Dr Linda Marks says most of the equipment used will be familiar to anyone who has spent much time in a gym - plinths and resistance bands, balance boards and gym balls.

When the patient first gets mobile - within seven days if their general health allows - parallel bars provide support until they're ready to move on to a walking frame, crutches or walking sticks. Exercises are also done to develop the trunk and upper limbs, and a "shrinker sock" will be worn on the stump to reduce swelling.

Balancing act

This pre-prosthetic work is typically done at the hospital where the patient had their amputation. Once they are ready to be fitted with a new leg, they visit the limb centre to be cast for their new prosthesis.

7 July survivor Sue Harrison compares artificial legs with Rezo Shubitidze in Georgia
7 July victim Sue Harrison helps Oxfam raise funds in Georgia
"This is quite a landmark event. The person is recovering from their injuries and is ready to progress to the next stage. So there is a measure of excitement, but this is tinged with apprehension. A journey into the unknown with both physical and emotional overtones."

For the team, made up of doctors, therapists and prosthetic staff, help with more than just physical welfare - it is rehabilitation, to "turn the patient back into a person", says Dr Marks, quoting the late Lord Holderness, who lost both legs in World War II. Some patients take the opportunity to meet a long-time amputee, and can also get emotional support from an amputee counsellor or consultant psychologist.

Most learn to walk on a fairly basic prosthesis, which is usually ready to be fitted a fortnight after being cast.

"These allow the person to relearn how to walk with safety. The analogy of learning to drive on a Ford Fiesta rather than a Porsche can often be helpful," says Dr Marks.

"First donning this mechanical device that is going to become part of their daily routine can be emotive. The stark reality of using a prosthesis is now obvious, as well as the realisation that it is not a 'normal' limb. Support, empathy and patience are needed during this difficult adjustment."

Walk then run

It is now that the amputee begins walking practice in earnest, coming to the physiotherapy gym at least two or three times a week - a rigorous training programme with all the physical demands that entails.

Heather Mills, estranged wife of Paul McCartney
Heather Mills lost her leg after being hit by a police motorbike
"This process always seems unbearably slow to the amputee who just wants to get back to their normal life. However the energy cost of walking with a prosthesis is greater than walking with two normal legs. And the stump will be shrinking, necessitating adjustments, so life is a merry-go-round of appointments."

Dr Marks says it takes about three months for a below-knee amputee to feel "back in charge"; twice that if the leg came off above the knee. The whole of the first year is a period of adjustment - they may upgrade to a more advanced prosthesis, return to driving and to work.

But their link with the limb centre will be lifelong. "Prostheses, like cars, are mechanical devices which require regular servicing and maintenance to function optimally," says Dr Marks. "The stump is part of the body and will get thinner or fatter in concert with the owner - this affects the fit of the socket, which is critical to comfort and confidence."


Some of your comments:

I have been lucky enough to afford a cosmetic leg like Heather Mills - it has been transforming in terms of rehabilitation. The cosmetic leg takes me from being a patient to a woman. My most recent NHS limb, where cosmetic covers are unavailable, was also an atrocious shape: I could just fit it under my jeans. All the hardware was as good as that that I could find privately, but that last 10% to shape it correctly was lacking. Surely we need to fight for more funding?
AIleen Walsh, Cambridge

I have had two artificial legs since the age of 18 months in 1961. My first legs were hand-carved wood, this progressed to aluminium with corsets, then fibreglass and followed through to today with carbon fibre, magnesium alloy ankles, silicone, foam rubber and no heavy straps. The doctors and others at Roehampton and other regional offices are an example to us all. Kind, patient and caring; their praises cannot be sung high enough. With their help these later life amputees will come to walk in such a way that most of us (myself included) will pass them in the street without a second glance - that's the mark of a job well done.
Gary Grayson, Ipswich, Suffolk

I lost my left leg (above the knee) two years ago due to the recurrence of an osteosarcoma. It took me the best part of a year before I felt I was walking well again. But since then I've had my ups and downs due to blisters, changes to the stump which has affected the socket fitting, falls, etc. Through all that time I've had wonderful support from my local limb centre in Portsmouth. Such dedicated staff working in often difficult situations where budgets are very tight. Unfortunately a lot of the most advanced prosthetics are out of reach of most NHS budgets.
Mike Stoneman, Portsmouth

I lost my leg (above knee) through meningitis 40 years ago - I suspect that it could have been saved with today's medicine - and have followed the massive improvements in prosthetic technology over that occurred. New materials - my leg has bonded carbon fibre as the tib/fib - and computer aided design has revolutionised prostheses to a stage where they are scarcely recognisable from those of 40 years ago. And the standing of the prosthetists has improved, with the subject being taught at university, but without losing the care for the patients. Don't get me wrong - stumps do rub, sockets don't fit - but the professionals do their utmost to help.
Pyers Symon, Worcester UK

I recommend reading Life and Limb by Jamie Andrew, who lost both hands and feet to frostbite in a climbing accident. It details the accident and immediate treatment, then his return to an independent and full life, sometimes using his stumps and sometimes false limbs, including returning to climbing and completing the London Marathon.
Andy W, Cheshire

Present day amputees certainly have more help, both physically and mentally than people such as me who lost a leg 35 years ago. Then, I never had the chance to walk for 8 months, never had counselling either physically or mentally, it was just a case of getting on with it. It may seem an obvious thing to say, but an amputation is such a major injury, no-one can have any idea of the impact it has on you for the rest of your life. Even now, I cannot come to terms with it. I so wish I could and mourn my loss to this day.
Phil Hardy, Salisbury

I would like to add the fantastic jobs that occupational therapists do in helping adapting the house, and teaching patients to transfer from wheelchair or any seat to other surfaces. They do vital work with amputees
AP, England

Good to finally see it pointed out that the link with the limb centre is lifelong - obvious, but too often overlooked. I am a 51-year-old through-knee patient of 50 years, er, standing, with experience of limb centres that ranges from excellent (as now) to indifferent. Will you be following up on efforts to make prostheses appear as normal or (as desired by some people) as different as possible?
Dr Lesley Stone, Union Mills, Isle of Man




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