Multiple factors that must be considered in determining whether a patient is an appropriate candidate for a prosthesis include cardiovascular endurance, level of amputation, cognitive ability, mobility goals, and comorbidities.Cognitive learning refers to for an upper extremity amputee, especially a unilateral amputee, depending on the timing of fitting a prosthesis one may be more functional without a cumbersome prosthesis.Cognitive learning refers to others use their prosthesis only for a few hours a day as a tool to assist with certain activities. Early fitting for an upper limb amputation is essential because acceptance and compliance of wearing a prosthesis declines significantly after the third postoperative month.Cognitive learning refers to the atkins prosthetic functional adaptation rating scale rates compliance of using the prosthesis and how the prosthesis is used for bimanual tasks, and gross and fine motor tasks.Cognitive learning refers to

Lower extremity prostheses are more likely than upper extremity prostheses to be accepted, whereby appearance is often a factor. Function is more difficult to achieve with an upper limb prosthesis.Cognitive learning refers to patients should be fitted within the first 3 months after an amputation to ensure the best acceptance rate of wearing a prosthesis, otherwise they tend to learn to accomplish tasks without the need of a prosthesis.Cognitive learning refers to often patients require training for a new occupation that does not require using adaptive equipment. Driving should be achievable. Bilateral amputees are more likely than unilateral amputees to wear prostheses.Cognitive learning refers to

For lower limb amputees who may be bed bound or at a wheelchair level, especially for an AK, a prosthesis would not add any benefit for mobility goals, meaning that a prosthesis would not assist in transfers and only add weight and a cumbersome contraption.Cognitive learning refers to in this case the patient should focus on strengthening the sound limb and learning to transfer with a sliding board or walker. For a BK that is K1, a prosthesis may be helpful for transfers but ambulation may not be a realistic goal; for an AK transfers will not be enhanced or assisted with a prosthesis, and these patients transfer better with only an assistive device such as a sliding board or walker.Cognitive learning refers to

Energy expenditure and requirements increase significantly after an amputation, and are directly related to the length or level of amputation: the higher or more proximal the level of amputation, the more energy is required to ambulate with a prosthesis.Cognitive learning refers to bilateral amputees have the highest energy requirement; in these cases, a wheelchair provides a faster and more effective mode of mobility.

Cognitive learning refers to

Etiology also plays a role in the amount of energy that is expended in amputees. For amputations that occur from trauma, patients are often younger and healthier so their baseline level of activity is higher and can compensate better, reducing the amount of energy required to use their prosthesis.Cognitive learning refers to for amputations that occur from vascular disease, the baseline level of activity is typically much lower and, therefore, the energy requirement is often higher because these patients do not compensate as well from an endurance and cardiovascular standpoint ( table 1 ).Cognitive learning refers to

CMS requires the physician to document many items in the medical record to justify providing a prosthesis to a medicare beneficiary. For specific documentation requirements, a recommended template is currently being discussed to establish what information is needed in the physician’s note.Cognitive learning refers to the required information is listed in the physician clinic checklist ( appendix 1 ). Key objective outcome measures are used to identify the potential of a patient, which are addressed in an article by heinemann and colleagues elsewhere in this issue.Cognitive learning refers to some suggested measures include the following.

Prosthetic fitting usually can be done within the first 3 to 6 weeks postoperatively with a preparatory or provisional prosthesis, with a definitive prosthesis at 6 to 8 months; a definitive prosthesis can eliminate the need for a preparatory one if aggressive shrinking is done in the first few weeks after sutures are removed.Cognitive learning refers to after continued shrinking occurs in the first year to 18 months, only replacement of the socket may be needed.