Physical activity should be accessible to all amputees

Republished from the Toronto Star's Doctors Notes

“Can I return to being physically active, the way I was before my accident?”

That’s a common question I get asked in the Amputee Rehabilitation Program at West Park Healthcare Centre. Happily, I am most often able to answer “yes.”

My patients may have lost a limb, but they have not lost their desire to be physically active and regain a sense of independence. For some, the goal is to get their lives back and have the confidence to walk again and one day return home. Others have their eye on a bigger prize — to return to recreational activities and sport. Not just in the gym, but also on the world stage. A handful of my patients are now Paralympic athletes, representing our country with pride.

What has spurred this interest among patients with amputation to reach greater levels of physical activity? High-profile sporting events featuring athletes with disabilities have given rise to the growing numbers of amputees who dream to compete on an elite level — or even just want to be physically active on a daily basis.

The popularity of international competitions, starting with the inception of the Paralympic Movement in 1948, provided momentum to the creation of other international sporting events — such as the upcoming Invictus Games in Toronto. These events feature people with disabilities participating at a high level of sports, doing things amputees once didn’t think possible.

There are currently 200,000 people living with limb loss in Canada, of which 110,000 are under the age of 65. The reasons for amputations are often due to vascular disease, diabetes or trauma (for example, industrial or vehicular accidents).

For most amputees, the goal is to get out of the wheelchair and start walking with a prosthetic limb. But for some, there is the desire to do even more: to run, swim and play basketball, golf or resume downhill skiing or snowboarding. All of this is now possible and more than one prosthetic device may be prescribed to accommodate various athletic demands. Prostheses are now available with computerized knees and ankles, and specialized lightweight, durable and waterproof parts for sport. There are hand devices for throwing a baseball or holding a hockey stick. We’ve come a long way from the prosthetic technology used by Terry Fox to inspire a nation. As Terry taught us though, there is no substitute for courage, drive and determination.

Yet, the road to increased physical activity on an ongoing basis is not accessible for everyone. Literature suggests that 11 to 61 per cent of people with lower limb amputations participate in sports and/or physical activities. Older patients who have lost a limb due to vascular disease would often benefit from ongoing cardiovascular rehabilitation or supervised walking programs. Unfortunately, many have a hard time getting these services. I am currently sitting on a working group for CoreHealth Ontario to hopefully improve this situation.

To overcome these barriers, we need to do a better job of educating the public, front-line health-care professionals and those in power about disability, the health-related risks these patients face and what they can do to optimize their health and well-being. It will save the health-care system money in the long run. A decline in activity level after amputation can lead to conditions such as obesity, diabetes, cardiovascular disease and low self-esteem. Participation in sports and recreational activities has many physical, psychological and emotional benefits, making exercise a vital part of a successful rehabilitation process and reintegration into society.

Here is a list of helpful tips for amputees and their families to consider when it comes to rehab:

• Start a conversation with your family physician about your goals to re-engage in physical activity.
• Seek out health-care facilities that specialize in amputee rehab where you can consistently work toward those goals.
• Discuss those goals with your prosthetist so they can tailor a device to meet your needs.
• Get involved and try a sport or recreational activity because you don’t know what you’re capable of until you give it a chance.
• Be open-minded.
• Look for peer-support groups to keep you motivated.

For more information about amputee rehabilitation and a list of resources go to westpark.org.

Dr. Steven Dilkas is an assistant professor in the Division of Physical Medicine and Rehabilitation, Department of Medicine, at the University of Toronto. He specializes in amputee rehabilitation and sport medicine at West Park Healthcare Centre and the Canadian Sport Institute Ontario. He is co-chief medical officer for the Invictus Games Toronto 2017. Doctors’ Notes is a weekly column by members of the U of T Faculty of Medicine. Email doctorsnotes@thestar.ca .