May 14, 2018
Marlis Gonzalez-Fernandez helped Andrew Rubin prepare for an amputation and then supported him throughout his rehabilitation. He is now training for a triathlon.
For patients who lose a limb, amputation is just the first challenge—most then face a long road of recovery with a prosthesis. A comprehensive program in amputee rehabilitation led by Marlis Gonzalez-Fernandez, vice chair of clinical operations, helps patients avoid amputation becoming a lifelong disability.
One goal of the program is to help each patient use an appropriate prosthesis as soon as possible. The first step is a postsurgical appointment immediately after the amputation has healed. During that appointment, a multidisciplinary team that could include rehabilitation physicians, physical and occupational therapists and prosthetists, based on the patient’s needs, meets with the amputee and family members to help select the best prosthetic device.
“The work we do can’t be separated from the life that person wants to live,” explains Gonzalez-Fernandez. “You can imagine that the prosthesis for a 20-year-old who has been injured in combat and wants to walk again might be different from a geriatric patient who had a limited capacity to walk before an amputation happened.”
Patients have a wide range of prosthetic technologies to choose from. While prosthetics decades ago were only body-powered devices, many available today are technologically advanced, with sensors that enable the device to mimic the original limb’s function.
For example, prosthetic legs may include knees with microprocessor computers that use information from the other leg or the environment to move accordingly. Other prosthetic knees have accelerometers that allow wearers to change speed quickly without the knee buckling, or gyroscopes that help maintain balance. Robotic ankles can also aid in preventing falls on unstable terrain, such as gravel. Such components are appropriate for patients who want to maintain a high level of activity on a daily basis.
Similarly, high-tech hands—some developed in part by Johns Hopkins University’s Applied Physics Laboratory—are providing unprecedented control. To help control these devices, Johns Hopkins is one of a few hospitals that offer a technique called targeted muscle reinnervation (TMR). This surgical intervention re-routes nerves that once controlled the hand, making it possible for people who have undergone upper-limb amputations to have better, more intuitive control of electronic prostheses.
In addition to the services provided after amputation, the rehabilitation program provides pre-amputation evaluation for patients such as those who need an amputation for tumors or infections. By seeing patients before surgery, Gonzalez-Fernandez says, she and her colleagues can help patients better cope with the loss by understanding the options available for rehabilitation. She helps to shift the focus from the amputation to the functions that required use of the limb. This way, she can determine the best device that will allow the patient to continue performing activities.
“Although we can’t give them back their leg or their arm, losing a limb doesn’t have to limit what they do in life,” Gonzalez-Fernandez says. “When we get patients back to doing the things they really love, we’ve done our job.”