Amputation in Australia
More than 8,000 lower limb amputations are performed in Australia each year, according to Limbs 4 Life. Diabetes and vascular disease are leading causes and Australia has one of the highest rates of diabetes-related amputation in the developed world. Trauma, cancer and infection account for many others, particularly in younger people.
Why fitness matters so much
Walking with a prosthesis uses considerably more energy than walking without an amputation and the higher the amputation level, the greater the energy cost. Many people also have diabetes or heart disease, which can reduce fitness further. If fitness is low, prosthetic walking is exhausting and people tend to walk less, which leads to more deconditioning.
An exercise physiologist helps break that cycle and also manages the health conditions that often led to the amputation in the first place.
- Cardiovascular fitness using arm-cranks, seated bikes and progressive walking
- Strength for the hips, core and remaining leg, which do much of the work in prosthetic walking
- Balance and confidence training to reduce falls
- Blood glucose, blood pressure and weight management through exercise
- Protecting the remaining limb, including foot checks for people with diabetes
- Building a long-term routine in the community
Working with your prosthetist and physio: your prosthetist fits and adjusts the limb and your hospital or community physio may lead early gait training. EP and OT complement this with long-term conditioning and daily living support. We share progress with your team so everyone is working towards the same goals.
What occupational therapy does
- Daily living: dressing, showering and toileting with and without the prosthesis
- Home modifications: rails, step-free showers, ramps and kitchen setup for times the limb is off
- Equipment: wheelchairs, shower chairs, transfer equipment and daily living aids
- Upper limb amputation: one-handed techniques, adaptive equipment and prosthetic skills training
- Driving: referral to an accredited OT driving assessor for modifications such as left-foot accelerators or hand controls
- Work and community: planning a return to work, hobbies and social activities
EP builds the capacity
- Fitness so prosthetic walking is less tiring
- Strength and balance for safe walking
- Health management for diabetes and heart disease
OT makes it work day to day
- A home that works with and without the limb
- Equipment for bathroom, transfers and mobility
- Driving, work and community participation
Example: A 52-year-old with type 2 diabetes has a below-knee amputation. He tires after a few minutes of prosthetic walking and is nervous about the shower. The EP builds his fitness with arm-cranking and hip strengthening, then progresses to walks around his block while monitoring his blood glucose. The OT arranges a shower chair and rails, sets up a safe night-time routine without the limb and completes a driving assessment for a left-foot accelerator. He is back driving to work within four months.
Get moving with confidence
Exercare visits at home across Melbourne: exercise physiology in the south-east and east and occupational therapy in the north-east, east and inner suburbs. One NDIS intake form covers both.
Funding options
Where an amputation causes permanent and significant disability and you apply before 65, the NDIS can fund OT and EP. Both are usually funded from your Capacity Building budget, most often under Improved Daily Living Skills (Category 15). Exercise physiology can also be funded under Improved Health and Wellbeing (Category 12). Equipment and home modification recommendations from your OT are funded from your Capital budget. Prosthetic limbs are also usually funded as assistive technology.
If you are not an NDIS participant, exercise physiology may be available through a Medicare Chronic Disease Management plan (for example if you have diabetes), Support at Home, private health or WorkSafe for work injuries. Our OT services are available through the NDIS and Support at Home. Limbs 4 Life also offers free peer support and information for people with limb loss.
Evidence referenced in this article
- Australian amputation statistics. Limbs 4 Life.
- Metabolic costs of activities of daily living in persons with a lower limb amputation: a systematic review and meta-analysis. PLOS ONE, 2019.
- Burden of lower limb amputations due to diabetes in Australia. AIHW.
Written by the Exercare allied health team. This article is general information only and is not a substitute for individual medical advice. Exercare provides mobile exercise physiology and NDIS occupational therapy across south-east and eastern Melbourne.
OT services mentioned in this article:
Home modifications →
Frequently asked questions
Why is walking with a prosthesis so tiring?
Prosthetic walking uses more energy than walking before amputation and more again at higher amputation levels. Building fitness and hip and core strength with an exercise physiologist makes walking less tiring.
Can an OT help with driving after an amputation?
Not at the moment. Exercare doesn't currently offer driving assessments, but we can point you to accredited OT driving assessors and help you prepare.
Does the NDIS fund therapy after an amputation?
If the amputation causes permanent and significant disability and you applied before 65, the NDIS can fund occupational therapy, exercise physiology, equipment and prosthetics.
I have diabetes. Can exercise help protect my other leg?
Yes. Exercise improves blood glucose control and circulation. Your exercise physiologist will also check footwear and skin and teach you to monitor your remaining foot.