Amputee rehabilitation — finding the niche

Introduction I am very grateful to be given this opportunity to show my appreciation of Knud Jansen, who believed that the rehabilitation of the amputee was best organised by a clinic team. As one of the founders and the first president of ISPO he promoted the multi-disciplinary interest and membership of this society. The theme of this World Congress of technology and services in the field of prosthetics and orthotics for the different age groups reflects this wide interest. I shall be talking more about service than the details of technology, as I want to consider the nature of our rehabilitation goals and now these may be achieved. Another great orthopaedic surgeon, Sir Harry Platt, disliked the term rehabilitation, which he thought was a “mischievous word‘’, and he was extremely dismissive of rehabilitation medicine. I quote from a lecture, in which he said, “Rehabilitation medicine, so called, is a form of managerial medicine,” spoken with a downward inflection of the voice. Despite this condemnation, he was right in his choice of words, because rehabilitation of the amputee is the active management of his problems and disability. Let us consider the situation. The locomotor and manipulation capability of the human increases until maturity and falls off in old age. For an infant or child we should try to restore any abilities which have been lost and encourage normal increase in capability as the child’s mental and physical skills develop. The rehabilitation process for the adult should aim to restore an ability which matches the normal, even though it may be at a lower level, whereas the process for the elderly person has to recognise that their pre-amputation ability may