Enhanced services for amputees

Issue: BCMJ, vol. 47, No. 9, November 2005, Page 501 WorkSafeBC
By: Don Graham, MD, CCFP

Here’s what WorkSafeBC has to offer patients suffering from work-related amputations.

Each year in BC approximately 50 people suffer work-related injuries that result in significant amputation above or below the elbow or the knee.* For those individuals, WorkSafeBC offers the following enhanced services:

Amputee specialist in the Richmond Visiting Specialist Clinic (VSC)

Physiatrist Dr Rhonda Willms has joined the VSC as an amputee specialist. The services she provides include:

• Supervising the treatment care plan in consultation with the treatment team.
• Ongoing assessment of stump and stump-care issues.
• Prosthetic prescription, including assessment for C-leg and myoelectric prosthesis.
• Recommendations for medical interventions.

Amputee Multidisciplinary Program

The Amputee Multidisciplinary Program is a pilot program provided at only the Langley location of Columbia Health Centre. The goals of the program are to maximize the injured worker’s functional recovery and return the worker to productive employment.

The multidisciplinary team—including a VSC physiatrist, physiotherapist, occupational therapist, dietician, and psychologist—works closely with a community prosthetist to assist the injured worker in obtaining an appropriate prosthetic or orthotic device (or both).

For admission to the program, a worker must have suffered one of the following as a result of a work-related injury:

• The loss of three fingers and one thumb (or more) in the upper extremity.
• The loss of five toes or one hallux in the lower extremity.

Core services of the Amputee Multidisciplinary Program include:

• Physiotherapy and occupational therapy.
• Individual and group psychology treatment sessions.
• Education.
• Stump care.
• Pain management.
• Mentor/support program.
• Diet counseling.

The program consists of four treatment phases:

• Phase one—Pre-prosthetic management.
• Phase two—Prosthetic training.
• Phase three—Functional restoration.
• Phase four—workplace re-integration.

Following a screening assessment by the VSC physiatrist, an injured worker may enter at any of the four treatment phases.

Prosthetics/orthotics management

Only a WorkSafeBC or community physiatrist/orthopaedic surgeon may prescribe a new prosthetic device for an injured worker with an amputation. An attending physician or WorkSafeBC or community physiatrist may prescribe an orthotic device for an injured worker. The VSC offers a Lower Limb Orthotic and Footwear Clinic for physiatrist consultation for orthotics prescriptions.

All prosthetic and orthotic devices must be fabricated by a certified prosthetist or orthotist and, in the case of orthotics, by a certified pedorthotist. Prior written approval must be received from WorkSafeBC and the physician’s prescription, if required, must be on file with WorkSafeBC.

Referring to amputee services

To refer a patient with a work-related amputation to any of the above amputee services, please contact a medical advisor or case manager in your nearest WorkSafeBC office or use a Form 11.

—Don Graham, MD
WorkSafeBC Chief Medical Officer

* This does not include amputations of fingers/toes which do not result in a need for a functional prosthesis or significant loss of upper/lower limb function.

Don Graham, MD, CCFP. Enhanced services for amputees. BCMJ, Vol. 47, No. 9, November, 2005, Page(s) 501 - WorkSafeBC.


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