Getting a prosthesis or orthotic device is only one part of the journey after limb loss. The real challenge often begins afterward - finding the right rehabilitation and making sure insurance actually covers the care and devices you need. This series opens with the first task: finding a therapist who genuinely understands limb loss.
To guide us, we spoke with Linsey Porter, an occupational therapy assistant based in Northwest Indiana who has spent nearly 12 years across the full spectrum of rehabilitation care - six years in inpatient rehab and skilled nursing (latterly as a director overseeing an orthopaedic rehab unit serving amputees), and nearly three years running telehealth visits that provided medical justifications for prosthetic and orthotic devices to clinics nationwide, a program supporting 10,000-15,000 patients a year. She also holds a billing and coding certification, giving her a rare understanding of the administrative side of care. Her work is personal, too: her daughter was born with an extra toe on each foot that affected her growth plates, requiring years of orthotics and surgeries. “It hits home for me,” Linsey says.
The Foundation: A Relationship That Puts You at Ease
When Linsey talks about finding the right therapist, she doesn’t begin with qualifications or clinic reputation. She begins with something much simpler - the relationship.
“That one-on-one conversation, making sure the therapist and the patient can connect, that the patient feels seen, the patient feels heard - if the patient feels comfortable, then they’re going to be calmer mentally. They’re going to be more apt to push themselves, to work a little bit harder, and that’s when you’re going to see the outcomes.”
She has also seen the opposite, particularly in skilled nursing facilities where therapists are under constant time pressure. When patients feel rushed or unheard, anxiety builds and progress slows. The therapists who succeed are often the ones willing to take a few extra minutes to listen - even if it means the patient doesn’t complete every exercise that day. Sometimes what a patient needs most isn’t another activity. It’s reassurance and understanding.
“It really is 90 percent mind over matter,” Linsey says. “It’s not about what you can’t do. It’s about remembering that you can.”
Why Specialisation Matters
There is a significant difference between a general therapist and one who specializes in limb loss rehabilitation. In school, physical and occupational therapists learn about many areas - strokes, cardiac care, orthopaedics, pediatrics, and more. But prosthetic and orthotic devices require understanding that goes far beyond the basics.
A therapist unfamiliar with these devices may unintentionally teach movement patterns that work for someone with all their limbs but are counterproductive, or even harmful, for someone using a prosthesis. When that happens, patients often return to their prosthetist with habits that need correcting. As Linsey explains, the prosthetist often ends up becoming the therapist because the therapist “isn’t educated enough.”
Prosthetic devices are neither simple nor inexpensive. Therapists working with limb loss patients need to understand how the device functions, how to recognize when something isn’t fitting properly, and when to involve the prosthetist. That expertise usually comes only with experience and specialization.
Questions to Ask Before You Commit
Linsey encourages patients to ask direct questions when evaluating a therapist or rehabilitation program - and not to worry about offending anyone in the process.
Start with experience.
Have you worked with limb loss patients before?
Approximately how many limb loss patients have you treated?
If the answer is one or two, it may be worth continuing your search. And if the therapist appears offended by the question, that’s often an even clearer sign they may not be the right fit.
You should also ask:
Do you have experience working with prosthetic or orthotic devices?
A knowledgeable therapist should be able to describe the types of devices they’ve worked with and how they approach rehabilitation with them.
It’s also worth asking your prosthetist for recommendations. Prosthetists and orthotists work with many therapy providers and often know which clinics consistently produce good outcomes. Their insight can be invaluable.
Ultimately, there is no such thing as the wrong question. If you’re unsure, ask. The right provider will welcome the conversation.
Red Flags to Watch For
One of the most concerning warning signs is a therapist who dismisses issues with your device. If you tell your therapist that your prosthesis is rubbing, causing pain, or simply doesn’t feel right, and their response is to mention it at your next prosthetist appointment, that should raise concerns.
A good therapist - even if they can’t fix the issue themselves - will take action. They may call the prosthetic clinic directly or advocate for an earlier appointment. Patients should never be expected to struggle with a painful or poorly fitting device for weeks or months simply because their next scheduled visit hasn’t arrived.
It’s Never Too Late
One thing worth saying clearly before anything else in this series: it doesn’t matter whether your limb loss happened last month or ten years ago. If you still need therapy, you’re still entitled to it.
“If a patient is in need, a patient is in need,” Linsey says.
The same standard of care should apply whether it’s day one or year ten.