Adventist HealthCare Celebrates a Legacy of Innovation in Limb Loss Care

For 25 years the Amputee Rehabilitation and Support Program at Adventist HealthCare has been at the forefront of caring for people with limb loss. The program continues to innovate by bringing together experienced clinicians, rehabilitation therapists, prosthetists, and others to care for patients with complex upper or lower extremity amputations (or both) across the continuum of care.

Pioneering Program

Led by Terrence P. Sheehan, chief medical officer for Post-Acute Care Services and founder of the Amputee Rehabilitation and Support Program, Adventist HealthCare collaborated with the nonprofit Commission on Accreditation of Rehabilitation Facilities (CARF) International and the Amputee Coalition to draft and initiate the first national standards of care for people with limb loss. In 2008 the Amputee Rehabilitation and Support Program became one of the first in the nation accredited by CARF.

Recently Adventist HealthCare staff spoke in support of a bill in the Maryland General Assembly that would provide insurance coverage for prosthetics and orthotics that allow people with limb loss to perform specific physical activities, such as swimming and running. The bill was signed into law and took effect in January.

The Amputee Rehabilitation and Support Program is known for innovating and advocating for people with limb loss, but its legacy is defined by the success of each person served. That legacy includes 68-year-old Hope Levy Kott of Rockville, Maryland, who regained her mobility and quality of life—and found a new community—with the help of the program.

Finding Her Footing

In 2015, physicians amputated Hope’s right leg above the knee because of the damage caused by infections following knee replacement surgery. Having built close relationships with the staff at Adventist HealthCare Rehabilitation Rockville during therapy following her knee replacement, Hope returned for rehabilitation after the amputation.

“My leg took 18 months to heal,” Kott said. “Initially I trained with the occupational therapy staff to get strong enough to move around and return to activities of daily living until I could get my prosthetic.”

The close partnership between Amputee Rehabilitation and Support Program clinicians and on-site prosthetists has been a boon to Hope, who’s been fitted for nearly 20 prostheses over the years.

“Recently I’ve been working with occupational and physical therapists to treat lymphedema,” she said. “My current prosthetic can get bigger or smaller based on the swelling in my leg. That’s a new and wonderful capability.”

Later this year, thanks to the new law on activity-specific prostheses, Hope plans to obtain a prosthesis that will facilitate one of her favorite pastimes: swimming.

Three Phases of Care

In 2023—the most recent year for which data are available—the Amputee Rehabilitation and Support Program served 60 inpatients with limb loss, 92 percent of whom provided positive satisfaction ratings.

Care typically occurs in three phases. In Phase One, which takes place in the hospital, the Amputee Rehabilitation and Support team conducts an initial inpatient assessment and addresses such issues as controlling pain, preventing depression, increasing mobility, and educating about preventing additional limb loss.

Typically, people served return to Adventist HealthCare approximately one month after amputation for a 10- to 14-day inpatient stay focused on learning to use a prosthesis. This is known as Phase Two. Compared with the average regional patient, amputees at Adventist HealthCare achieve a 35 percent higher daily improvement during their time in the hospital.

“Patients complete three hours of rehabilitation therapy each day focused on ensuring the prosthesis fits comfortably and learning to walk with it,” Sheehan said. “We address barriers to progress every day. By the end of their stay, we expect patients to be up and walking and have full ownership of caring for themselves and their prosthesis.”

The third or final phase takes place in outpatient rehabilitation and at the amputee clinic, where the team’s focus shifts to preparing people to thrive with a prosthesis for the rest of their lives. Each amputee clinic appointment is a seamless experience. Sheehan, the physical therapists, and prosthetists from one of three prosthetic companies see people and address their needs together.

“We ensure every provider of significance is in the room,” Sheehan said. “When a patient comes in, the professionals who made their prosthesis are there, and the physical therapists can update me on how the patient is doing in therapy. It’s a real-time team. Patients do not receive fragmented care.”

Kott, who attends the amputee clinic as needed, appreciates the continuity of care it provides.

“What makes Adventist HealthCare Rehabilitation different is that when you leave the hospital, they don’t leave you,” Kott said. “Dr. Sheehan follows patients for the rest of their lives and refers them for any additional services they may need, whether it’s lymphedema care or therapy or something else. There’s true coordination of services.”

Unwavering Support

The Amputee Rehabilitation and Support Program offers resources to help patients build community and share tips for adapting to life with a prosthesis. These include a monthly support group and Promoting Amputee Life Skills, or PALS, a multiweek education course.

A passionate advocate for people who are differently abled, Kott coordinates the support group, which has grown from five members to a mailing list of more than 150.

“I can’t begin to express how empowering the support group is,” Kott said. “After my amputation, members spent hours answering my questions, showing me how their prostheses worked and explaining what to expect moving forward.”

The support group hosts events throughout the year, including a picnic, sailing and sports outings, and speakers. In 2024 the group’s longtime 5K Walk, Wheel, Run fundraiser became the Triumph Trek, an event to celebrate the achievements of Adventist HealthCare Rehabilitation patients. Hope was honored to receive the patient community service award at the inaugural event.

For Kott, an experience at the support group’s annual picnic brought her amputation journey full circle and perfectly illustrated the Amputee Rehabilitation and Support Program’s mission.

“I brought my mom to the picnic one year,” Kott said. “She’d seen me as damaged since my amputation. I was a meeting planner for 30 years, and when my mom saw me directing the activities of the other amputees at the picnic, she finally saw me as a whole person again. Even something as ordinary as a picnic can be extremely empowering not just for amputees but also for their families, because it allows them to see we’re still the same people we’ve always been.”

The original version of this story was posted by Adventist HealthCare.