Modern aspects of rehabilitation after upper limb amputation

Abstract

Recovery following upper-limb amputation is one of the most demanding problems in modern medicine, resulting in lifelong disability, reduced quality of life and loss of social and vocational engagement. An increasing burden of trauma, industrial and household accidents, as well as war and blast injuries, continues to raise the proportion of upper-limb amputations, adding extra pressure on health-care and rehabilitation systems. However, there is wide variation in access to prosthetic and rehabilitation services, and high rates of prosthesis rejection together with substantial psychological morbidity highlight the importance of systematically reviewing the available evidence on contemporary rehabilitation.This review aimed to explore the current status of rehabilitation methods and opportunities for people following upper-limb amputation.A narrative review of recent scientific literature indexed in PubMed and Google Scholar was carried out, using keywords related to upper-limb amputation, prosthetic rehabilitation, mental health and social reintegration.The literature consistently reports that optimal rehabilitation is phased, long term and multidisciplinary, encompassing medical and nursing care, prosthesis fitting and training in its correct use, as well as structured psychiatric and psychological support to improve activities of daily living, pain control and overall quality of life. The needs of patients clearly extend beyond restoring voluntary motor control and include the management of phantom and residual limb pain, learning one-handed self-care, adapting home and work environments, provision of social and financial support and active family involvement, all of which strongly influence reintegration and long-term prosthesis use. Neurorehabilitation techniques that have shown potential for reducing phantom limb pain and improving prosthesis control include mirror therapy, virtual reality, motor imagery, robotic systems and brain–computer interfaces; however, the evidence base is still limited by small sample sizes and a paucity of robust randomised controlled trials. Clinical guidelines, particularly those developed in veteran and defence health-care systems, support a pre-prosthetic phase, prosthesis prescription and provision, intensive functional training and long-term follow-up, but their applicability is constrained in resource-limited environments, and upper-limb-specific recommendations remain incomplete. Outcome assessment is further limited by heterogeneous and only partially validated measures; at the same time, sensor-based monitoring has demonstrated “learned non-use” of the prosthetic limb, large individual variability in the comparative benefits of body-powered versus myoelectric devices and high abandonment rates related to discomfort, reduced functionality, technical issues and unmet expectations. Evidence also indicates that successful social and vocational reintegration requires early psychological assessment, rehabilitation tailored to amputation level and functional goals, access to vocational rehabilitation and employer support, while children and young people are particularly at risk of major long-term psychosocial sequelae in the absence of dedicated educational and rehabilitation programmes.In conclusion, rehabilitation following upper-extremity limb loss should be regarded as a long-term, context-adapted, multidisciplinary process, and more rigorous research together with implementation and localisation of international guidelines is warranted to optimise functional, psychological and social outcomes.