More than 5 million Americans live with limb loss and limb difference, and many of them rely on prosthetics to regain or retain their mobility.

But there’s a big difference between wearing a prosthesis and using it effectively, says UNLV clinical scientist Jenny Kent. 

For many patients, essentially starting over — learning how to stand, walk, balance, sit, and more — with artificial limbs is a skill that requires patience. But it’s also a skill that must be mastered to avoid long-term health concerns ranging from physical limitations to potential mental health impacts.

“You can make a great prosthesis with state-of-the-art materials and technology, but people still need to learn how to use it,” said Kent, an assistant professor with the UNLV School of Integrated Health Sciences. “At the moment, there is not much known about how to help people learn how to use those prostheses — a key factor in ensuring successful integration back into everyday life.”

Kent and department colleague, UNLV associate professor and physical therapy researcher Szu-Ping Lee, are on a mission to fill that informational void by launching a new training method: a walking regimen to discover if prosthetics users gain more confidence walking on uneven surfaces. Current rehabilitation practices focus primarily on navigating flat surfaces. 

UNLV’s work is supported by grants from the U.S. Department of Defense and the IDeA Networks of Biomedical Research Excellence (INBRE) through the National Institutes of Health. 

“This has greater implications than just a training program,” Kent said. “It might encourage clinicians to integrate different surfaces into their exercises and encourage individuals to attempt to safely walk on uneven surfaces rather than avoiding them.”

The professors say their research will be a boon to the roughly 1 in 59 Americans living with limb loss. More than 90% of cases are leg amputations, and researchers say a common cause is vascular issues brought on by the effects of diabetes. According to a 2017-20 study by the U.S. Centers for Disease Control and Prevention, over 38 million Americans, nearly 12% of the population, have diabetes. And on average, more than 150,000 will undergo an amputation annually. 

“We are seeing that more people recognize that amputation is a big problem and we need to do something about it,” Lee said. “Research is critical to helping patients adjust to limb loss, as well as improving their quality of life after amputation.”

Patients typically receive and start using a new prosthetic limb within a year after amputation. In addition to gaining independence and mobility, successful adoption of a prosthesis after amputation has many benefits, including reduced chances of depression and other mental health issues, Lee said.

Moving in a New Direction

The first step to developing UNLV’s new prosthetic training program is gathering intel from the very people it will serve. But recruiting participants for a study involving amputees is not easy — an issue that underscores the difficulty of the very issue Kent and Lee are trying to resolve.

“There is a relatively small population of individuals with major limb amputation, so it’s difficult to recruit for research. People with greater mobility limitations are also less likely to come to participate in our studies because it is hard for them to get around in the first place,” Kent said.

Members of Kent’s and Lee’s research teams meet monthly with the Las Vegas Amputee Support Group at Encompass Health Rehabilitation Hospital in Henderson, where Lee serves as a group coordinator, to speak with those living with limb loss to understand the range of issues that bother them.

The support group and the Southern Nevada limb loss community have been instrumental for Kent and Lee, who are able to hear directly from the population they hope to serve with their new research.

“They are helping us learn how to better target real needs instead of perceived ones,” said Kent. “We are going to test this new training method in a small group to find out what we need to modify so we can ensure the program is the best that it can be.”

Lee acknowledged that the current healthcare environment for those with amputations, specifically for a new amputee, is difficult to navigate and can cause frustration once the patient is out of rehab.

“In a lot of rehab settings, everything is safe and accessible. Think about those parallel bars. If you fall, you can grab those bars. But in the real world, you don’t have those bars, and a lot of the time, the patient falls on the ground. The rehab is somewhat disconnected to real-life situations,” Lee said. 

Hearing from each individual allows Kent and Lee to create a more thorough set of protocols for a population desperate for new information.

“Relearning how to walk is very difficult to do, and it’s easy to get frustrated and stop trying if you don’t know how to use your prosthesis,” Kent said. “It can also lead to more comorbidities that can worsen your quality of life.”

A Helping Hand

The research team is also investigating how peer support should be incorporated into post-amputation rehab. It’s a big part of what they hope to accomplish with their current and future grants, and Lee’s emerging data is already showing great promise.

“We’ve found that people who receive peer support have better mobility outcomes. They have told us they move around better,” Lee said. “These support groups are not a replacement for physical therapy, but at the very least, they are able to talk to people they can relate to.” 

Kent is encouraged by the work they’ve done thus far. And while the job is far from finished, every piece of new information helps, especially with amputations becoming more commonplace around the world.

“Not having that established healthcare pathway is a problem, which is why social support is massive in the recovery process,” she said. “We need things to be better through the entire process, because every person in recovery is different.”