The main objective in the rehabilitation of people following amputation is to restore or improve their functioning, which includes their return to work. Full-time employment leads to beneficial health effects and being healthy leads to increased chances of full-time employment (Ross and Mirowskay 1995). Employment of disabled people enhances their self-esteem and reduces social isolation (Dougherty 1999). The importance of returning to work for people following amputation the- fore has to be considered. Perhaps the first article about reemployment and problems people may have at work after amputation was published in 1955 (Boynton 1955). In later years, there have been sporadic studies on this topic. Greater interest and more studies about returning to work and problems people have at work following amputation arose in the 1990s and has continued in recent years (Burger and Marinc ?ek 2007). These studies were conducted in different countries on all the five continents, the greatest number being carried out in Europe, mainly in the Netherlands and the UK (Burger and Marinc ?ek 2007). Owing to the different functions of our lower and upper limbs, people with lower limb amputations have different activity limitations and participation restrictions compared to people with upper limb amputations. Both have problems with driving and carrying objects. People with lower limb amputations also have problems standing, walking, running, kicking, turning and stamping, whereas people with upper limb amputations have problems grasping, lifting, pushing, pulling, writing, typing, and pounding (Giridhar et al. 2001).

The main objective in the rehabilitation of people following amputation is to restore or improve their functioning, which includes their return to work. Full-time employment leads to beneficial health effects and being healthy leads to increased chances of full-time employment (Ross and Mirowskay 1995). Employment of disabled people enhances their self-esteem and reduces social isolation (Dougherty 1999). The importance of returning to work for people following amputation the- fore has to be considered. Perhaps the first article about reemployment and problems people may have at work after amputation was published in 1955 (Boynton 1955). In later years, there have been sporadic studies on this topic. Greater interest and more studies about returning to work and problems people have at work following amputation arose in the 1990s and has continued in recent years (Burger and Marinc ?ek 2007). These studies were conducted in different countries on all the five continents, the greatest number being carried out in Europe, mainly in the Netherlands and the UK (Burger and Marinc ?ek 2007). Owing to the different functions of our lower and upper limbs, people with lower limb amputations have different activity limitations and participation restrictions compared to people with upper limb amputations. Both have problems with driving and carrying objects. People with lower limb amputations also have problems standing, walking, running, kicking, turning and stamping, whereas people with upper limb amputations have problems grasping, lifting, pushing, pulling, writing, typing, and pounding (Giridhar et al. 2001).

This is a reference for clinicians working with patients in acute care, rehabilitation, long-term care and home care settings.

Implement TMR with Your Patients and Improve Their Quality of LifeDeveloped by Dr. Todd A. Kuiken and Dr. Gregory A. Dumanian, targeted muscle reinnervation (TMR) is a new approach to accessing motor control signals from peripheral nerves after amputation and providing sensory feedback to prosthesis users. This practical approach has many advantage

The phenomenon of phantom limb was described in medical literature at least as early as 1545 by Ambroise Pare, according to the notes in the translation of Lemos' dissertation, "On the Continuing Pain of an Amputated Limb", by Price and Twombly [9]. This strange experience was brought to public attention by a popular essay anonymously published 1866 by Mitchell concerning the story of George Dedlow, a quadriamputee who described his invisible limbs [7]. In 1871 Mitchell wrote under his own name, and was the. first to use the term "phantom limb" [8]. In this work, he also corrected some erroneous beliefs that had arisen from his 1866 essay [13]. Most amputees report feeling a phantom limb almost immediately after amputation of an arm or a leg [11]. It is a positive sensation, usually described as tingling or numbness, which is not painful. The most distal parts of the limb, particulary the digits, thumb, and index, are the strongest and most persisting phantom sites, and may be the only parts to appear even after removal of a whole limb. The elbow or knee is sometimes involved, the forearm or lower leg rarely, and the upper arm and thigh almost never [5]. The phantom thus appears to consist predominantly of those parts which have the most extensive representa tion in the thalamus and in the cerebral cortex.

Phantom pain is an intriguing mystery that has captured the imagination of health care providers and the public alike. How is it possible to feel pain in a limb or some other body part that has been surgically removed? Phantom pain develops among people who have lost a limb or a breast or have had internal organs removed. It also occurs in people with totally transected spinal cords. Unfortunately, phantom pain is a medical night mare. Many of the people reporting phantom pain make dispropor tionately heavy use of the medical system because their severe pains are usually not treated successfully. The effect on quality of life can be devas tating. Phantom pain has been reported at least since 1545 (Weir Mitchell as related by Nathanson, 1988) and/ or experienced by such diverse people as Admiral Lord Nelson and Ambroise Pare (Melzack & Wall, 1982; Davis, 1993). The folklore surrounding phantom pain is fascinating and mirrors the concepts about how our bodies work that are in vogue at any particu lar time. Most of the stories relate to phantom limbs and date from the mid-1800s. The typical story goes like this: A man who had his leg ampu tated complained about terrible crawling, twitching feelings in his leg. His friends found out where the leg was buried, dug it up, and found maggots eating it. They burned it, and the pain stopped. Another man complained of a swollen feeling with frequent stinging or biting pains.

Phantom limb pain is one of the most intractable and merciless pains ever known—a pain that haunts appendages that do not physically exist, often persisting with uncanny realness long after fleshy limbs have been traumatically, surgically, or congenitally lost. The very existence and “naturalness” of this pain has been instrumental in modern science’s ability to create prosthetic technologies that many feel have transformative, self-actualizing, and even transcendent power. In Phantom Limb, Cassandra S. Crawford critically examines phantom limb pain and its relationship to prosthetic innovation, tracing the major shifts in knowledge of the causes and characteristics of the phenomenon. Crawford exposes how the meanings of phantom limb pain have been influenced by developments in prosthetic science and ideas about the extraordinary power of these technologies to liberate and fundamentally alter the human body, mind, and spirit. Through intensive observation at a prosthetic clinic, interviews with key researchers and clinicians, and an analysis of historical and contemporary psychological and medical literature, she examines the modernization of amputation and exposes how medical understanding about phantom limbs has changed from the late-19th to the early-21st century. Crawford interrogates the impact of advances in technology, medicine, psychology and neuroscience, as well as changes in the meaning of limb loss, popular representations of amputees, and corporeal ideology. Phantom Limb questions our most deeply held ideas of what is normal, natural, and even moral about the physical human body.