Supporting the Limb Loss Journey: Q&A with Dr. James J. Daley

More than 2 million people in the U.S. live with limb loss, and 185,000 amputations occur each year.

While those numbers are large, living with a limb loss or limb difference is a very personal challenge that requires individualized care for physical and psychological concerns.

Each person with limb loss needs tremendous support from family, friends and a team of medical experts. That’s why Good Shepherd Rehabilitation’s clinical teams take a holistic approach to caring for children and adults with limb loss or limb difference.

James J. Daley, MD, a Good Shepherd staff physiatrist and expert in limb loss, amputation, prosthetics, orthotics and complex medical rehabilitation, is one of a small number of physicians in the New York/New Jersey/Pennsylvania region who provides care for limb loss patients of all ages (birth through death).

In this Q&A, Dr. Daley discusses limb loss and how Good Shepherd’s experts help patients adapt and thrive.

Q: How prevalent is limb loss and what causes it?

Dr. Daley: “Congenital limb difference results when children are born without a limb or with a partial limb. In the U.S., diabetes-related issues remain the primary cause of acquired limb loss, or amputation. In fact, a majority of limb loss in the U.S. is from vascular disease, including peripheral artery disease and wounds, and infection from diabetic neuropathy.

“For young adults, the main cause of acquired limb loss is trauma from accidents and occupational hazards. For teenagers, bone cancer is the leading cause of limb loss. Males are at greater risk for amputation, and 83 percent of all amputations occur in the lower extremity.”

Q: What is the impact of limb loss on individuals?

Dr. Daley: “The impact includes psychological and physical challenges unique to each patient. There is a high incidence of depression for people with limb loss, which has the same psychological impact as losing a primary family member. For this reason, a holistic treatment plan for rehabilitation must include psychologists and mental health-care professionals to handle anxiety and depression before and after an acquired limb loss.

“Another common issue is the neurologic condition of phantom limb syndrome, which can cause the same pain and discomfort felt before amputation. Phantom pain for a lower extremity amputation can feel like walking on hot rocks or coals.

“Phantom limb sensations are a normal part of the healing process because nerves, though cut, still send signals to the brain. Phantom pain requires a desensitizing treatment plan that may include neurologic medication.”

Q: What else is involved in rehabilitation for acquired limb loss?

Dr. Daley: “In addition to caring for the patient’s mental health and well-being, the post-op/pre-prosthetic rehabilitation period focuses on healing the surgical site, managing pain and advancing the patient’s independent functionality. Every patient’s treatment and rehabilitation plan is individualized for lifestyle and level of limb loss.

“For example, Good Shepherd is committed to a truly holistic interdisciplinary approach, as recognized by our accreditation (Inpatient Rehabilitation Programs – Good Shepherd Rehabilitation Hospital: Amputation Specialty Program – Adults) by the Commission on Accreditation of Rehabilitation Facilities (CARF). 

“When patients complete the preprosthetic rehabilitation program — either inpatient at Good Shepherd Rehabilitation Hospital or outpatient by their surgeon — their next step is to transition to our interdisciplinary outpatient clinic, where we create a cohesive care plan that includes physicians, physical therapists (PTs), occupational therapists (OTs), prosthetists/orthotists and any additional beneficial services.

“At Good Shepherd, we take a genuine interest in each patient and conduct a thorough history of each person’s life, considering their particular social, living and work environments. A patient who works at a computer all day has different functional requirements than someone who provides child care or wants to return to outdoor recreational activities. Our PTs and OTs have specialized training in limb loss and prosthetic rehabilitation and work with each patient during the rehab program to simulate job and social activities. They help them set goals for returning to work, driving, traveling, and getting back to hobbies.

“For our patients at Good Shepherd Rehabilitation Hospital Emily Howatt Pliskatt Pediatric Unit, our team works under the leadership of Kimberly Kuchinski, MD, MPH, to ensure that children meet developmental milestones while receiving care for limb loss or limb difference. As young patients age, the Good Shepherd team remains available to coordinate a patient’s care and rehabilitation with their other medical providers and experts.

“Prosthetists, who fit patients of all ages with custom-made prosthetics for upper and lower extremity limbs, are important rehabilitation partners. With an engineering background and experience designing prosthetic components, I understand the physiologic, kinesiologic aspects of how prosthetic usage affects a patient’s body. That is why one of my roles is to help patients and family members understand the stamina required to safely use a prosthesis. With a lower extremity amputation, a patient may need to work 50% to twice as hard as they previously had to walk with a prosthesis. As such, some of my patients, due to other significant medical problems, choose not to risk using a prosthesis.

“I believe that it is important to realize that patients are not failing because they can’t or won’t use a prosthesis. In those cases, my team can then work with them on other adaptive mobility options.”

Q: What are some of the current and future advances for limb loss rehabilitation?

Dr. Daley: “The infinity socket has the potential to create a snugger prosthetic fit for difficult-to-fit residual limbs, which may help in control. Micro-processor-controlled prosthetic devices have advanced in the past few years to be more resilient in environments like water, while their batteries are taking longer charges. Prosthetists are using 3D scanners to develop the models they use to build sockets.

“About six facilities in the U.S. are trialing osseointegration limb replacement surgery, where a titanium rod is placed into the end of the residual limb’s bone so a prosthetic can connect without a socket. I am privileged to be working with some of these patients who received this promising surgery to manage their rehabilitation program, address potential complications, and coordinate with their prosthetists to solve problems.

“Active research is being conducted involving the intramuscular implantation of electrodes to control myoelectric prosthetic hands.

“Good Shepherd’s partnership with the Temple University Hospital Physical Medicine and Rehabilitation (PM&R) Residency Program is helping educate the next generation of physiatrists. Having residents work with Good Shepherd’s physicians in our inpatient and outpatient facilities will bring technological and medical advances to our patients from Temple’s world-renowned research.”

Learn more about Good Shepherd’s services and program for people with limb loss, limb difference or amputation or call 1.888.44.REHAB (73422).