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Suffering an amputation injury following an accident is life changing, and trying to get your health and life back on track can be daunting. Our Q&A is aimed at answering some of the common questions we get asked as lawyers specialising in these types of claims.
We deal with any form of amputation injury, but concentrate in this guide on leg (above and below the knee), foot, and arm amputations.
Usually before discharge from hospital, an occupational therapy assessment will be carried out followed by one at your home to assess what aids and equipment you might need. They will then be fitted ready for you to come home to you or on the day you return home.
If you need care, the occupational therapist (OT) will help you complete an application for a care package and your local authority social services department will provide this to you.
If you have a claim, it may be that a case manager will be appointed early on by the third party insurers and they can provide additional assistance in terms of rehabilitation.
The hospital will provide these or they can be hired from the local Red Cross office at the hospital.
The care of your stump is of vital importance. You should follow the advice of your treating medical advisers very carefully to avoid sores and infections.
It's a feeling of pain from a limb when no limb is present. This pain is often sharp, stabbing and severe. Phantom pain often starts within the first two weeks after an amputation and for some people remains with them despite treatment. There is effective treatment, however, which can include medication, massage, hot and cold therapy, mirror bow treatment and hypnotherapy.
The residual limb will also take time to heal and will be painful. It will change in shape and size over a period of 12-24 months and it's important to recognise that fitting prostheses is an evolving process over this period.
The importance of rehabilitation cannot be over-emphasised. This should be carried out locally by your NHS services, or if there is private health insurance or solicitors acting in a claim, by them utilising Immediate Needs Assessments and case managers paid for by the third party insurers.
A good case manager will bring swift and effective rehabilitation services to you.
Applications for benefits should be made as soon as possible, and you should consider all these:
Your OT can help you fill in the forms at hospital, or you can do it at your local benefits office after you've been discharged. As far as a care package is concerned, you should apply to your local social services department, which will carry out a full assessment and advise you what it's prepared to offer you.
If you have a claim, your solicitor will carry out an independent assessment, and it may be that a private care package can be set up by a case manager and paid for by the third party insurers.
Generally, a return to work is a good thing at the right time. Everyone is different and will follow their own rehabilitation path.
You have rights as far as your existing employers are concerned. They cannot simply dismiss you. They have to assess your suitability for your existing employment and if you cannot manage this any other form of suitable employment.
It's also important to appreciate that under the Disability Discrimination Act it's unlawful for an employer to discriminate against disabled people in their recruitment and selection procedures if you have to apply for a new job or are starting out in the world of work.
Rehabilitation should be focused not only on physical and psychological health, but also on ensuring that the quality of life that enables an individual to get back in to work or education is restored, if that's what the individual wants.
Local job centres and Job Centre Plus offices have disability employment advisors (DEA) who can discuss employment opportunities and provide support finding work, or keeping the work that an amputee was in before the amputation.
As far as training courses and education are concerned, Access to Work (ATE) is available for people in, or about to start, paid employment, to assist with discussions with a training provider and with equipment in the work place.
Yes, unless you've another source of funding. The NHS is able to supply up-to-date prostheses where it has the funding to do so. Unfortunately, the provision varies from area to area. If local funding isn't available, then private provision may need to be considered.
If you've a claim, your solicitor should be obtaining a full prosthetic report detailing specific prosthetic requirements and getting an interim payment to allow the recommended prescription to be obtained privately if the NHS/DSC cannot fund the recommendations.
Every person needs to be individually and carefully assessed for their prosthetic prescription, because no amputation is the same. There is no general rule as to suitability.
By self-referral via a private health insurer or via solicitors, in a claim.
One company we have had personal experience with is PACE Rehabilitation, based in Cheadle, Cheshire; and Chesham, Buckinghamshire. We can recommend their services. For more information, please visit www.pacerehab.com.
The prosthetic provision will extend to providing bespoke limbs that allow an individual to return to the type of normal everyday activity, work activity or leisure activities that he or she enjoyed before the amputation. They can now be obtained for sports including running, cycling, motorcycling, windsurfing and scuba diving.
There is, however, a difference between a water activity leg and a leg for swimming, something often not appreciated by insurers. An everyday prosthesis is not waterproof. It can be safely used in wet weather, but isn't intended for wearing in water, such as a shower or in the sea.
Water activity limbs (WAL), also known as 'wet legs', are especially designed to be safe and durable in a wet environment. They're not intended for swimming with, but rather for walking and standing in and around water. They have advantages and disadvantages, but generally they're functional and simple, and you'll not be advised to walk any distance in a water activity leg. Some fill up when immersed in water so they don't float away and will empty through a hole when you exit the water.
Most people find that it's easier to swim without their water activity prosthesis on, and so remove it once they're in the water. It can be put back on to climb out of the water.
Prosthetic services can also provide cosmetic covers that assist in returning an individual to a position where questions aren't asked about the amputation, and where legs and arms can be matched to those that haven't been lost.
A trans-tibial, or below-the-knee prosthetic, is used when the patient has a stump of the leg remaining. They are designed with a socket, shin and a foot. Because the knee is still in place, the patient can usually find better mobility than those with an above-the-knee prosthetic.
The trans-femoral, or above-the-knee prosthetic, is for a patient that has lost their knee and the rest of their leg. These prosthetic legs are made of a socket, knee system, a shin and a foot. The above-the-knee prosthetic can be difficult for the patient to manoeuvre because of the detailed functionality of the artificial knee.
There are always new advancements to improve prosthetic legs. Otto Bock Healthcare has created the 'C-leg', a very expensive prosthesis system that allows the patient to program it for running and cycling, along with other athletic capabilities.
There is also the 'POWER KNEE', developed by a company called Ossur. This is the second generation of the world's first powered bionic prosthesis for above the knee amputees, replacing the lost muscle function required to flex and extend the knee. A motor within the knee assists the user by providing controlled power during various phases of walking, sitting, standing, and even climbing stairs and ramps. The aim is to reduce the additional energy expenditure that wearing any prosthesis demands. The hope is that it will mean the user can walk further and/or with reduced effort.
There are a large range of hand/arm prostheses, both cosmetic and functional, and some that are electronic and controlled by residual muscles (myoelectric), for example opening and closing a hand.
Again, the choice is down to funding. If you've private funding we'd recommend specialist physiotherapy from someone who deals with amputees on a regular basis and who's aware of the issues normally faced with shrinkage of the stump and prosthesis fitting.
When we handle a claim, we can also obtain interim payment funding from the third party insurers to obtain specialist private physiotherapy for clients.
You should be assessed at a driving assessment centre, which can be found across the UK. You can self-refer direct to your local centre.
People in receipt of the high rate mobility component of the Disability Living Allowance are able to take advantage of a free assessment through Motability. Provided you're interested in having a vehicle on its lease scheme, you can apply to Motability direct and be assessed at a centre once it receives a referral from Motability.
If this doesn't apply, you can pay privately, but if you've a claim your solicitors should be able to obtain an interim payment to fund an assessment.
Assuming you've purely physical limitations, then a vehicle control trial or car adaptation assessment is usually appropriate. This includes an assessment for specific vehicle modifications which will assist with the control of the car.
For a list of all of the centres, please follow this link.
Existing vehicles can sometimes be adapted with various controls. You can obtain hand controls, left foot accelerators and steering aids.
Again, if you have the high rate mobility component of DLA you can apply to Motability for an adapted vehicle. Through Motability you simply turn all or part of that allowance into the car of your choice.
Contract hire or hire purchase arrangements are available, and repayments are made direct from the DLA. The costs of many adaptations are free, while insurance, servicing, tyres and breakdown cover are included in your monthly payments.
There are numerous options available, and we advise you visit the Motability website to discover which is best for your circumstances.
In our experience, lower limb amputees often prefer vehicles with a slightly higher driving position, as it helps them get in and out.
You will be referred to an OT, who usually arranges for NHS provision of aids and equipment to use in the home, including raised toilet seats, grab handles, stair rails, and bath raises. But how do you go about getting ramps, alterations to door frames to accommodate wheelchairs, a level access shower, or other adaptations?
If you've a claim, your solicitor will get OT and disability architect reports on the suitability of adapting your home. However, your current home may not be suitable for adaptation, so part of the claim might involve selling it and buying a more suitable property with the help of a large interim payment.
Some people will need to move to a single level access property, such as a bungalow. The interim payment will cover the costs of internal adaptations to a new house or for the provision of fixtures and fittings in a new property.
There's no reason why not if you've access to the right prosthetic provision. There are prostheses available for all sorts of sports, including running blades, water activity prostheses, cycling and motorcycling prostheses and even scuba diving.
Are there rehabilitation organisations I could use, and charities/support groups I could join?
A new development is rehabilitation through challenging adventure activities. This is run by a company called Adventure Rehab. Run by an ex- Royal Marine and below-the-knee amputee Jim Bonney. It delivers demanding, tailored rehabilitation plans with first class prosthetic support in a residential group setting for recent and more established amputees. The whole package is delivered in some unforgettable environments and makes an amputee's rehabilitation journey something to remember.
All documents should be read and used in accordance with the terms and conditions. This document is for your general information only and is not a detailed statement of the law. It is provided to you free of charge and should not be used as a substitute for specific legal advice. If you require specific legal advice please contact our helpline on 03700 86 86 86.