March 7, 2019

Physiatrists with a specialization in amputation rehabilitation are becoming increasingly essential because of the rise in diabetes, peripheral vascular disease and subsequent amputations. Johns Hopkins physiatrist Mary Keszler is one of about nine physiatrists in the country with a fellowship in this field. In 2018, she joined the Johns Hopkins Department of Physical Medicine and Rehabilitation’s amputation care team, which has been in place for more than two decades. 

An estimated 2 million Americans were living with limb loss in 2008, and the number has been growing by more than 100,000 each year. Though the numbers are significant, most medical systems don’t have amputation rehab programs. Physiatrists who want to care for this patient population have had to practice on their own instead of on a team. In the past five years, though, two fellowship programs have begun in this specialty, both sponsored by the Department of Veterans Affairs. Keszler completed her fellowship at the University of Washington, Seattle. The other program with a fellowship is at the Veterans Affairs hospital in Richmond, Virginia.

As part of the care team at Johns Hopkins, which includes physiatrists Barbara De Lateur and Marlis Gonzalez-Fernandez, Keszler puts her training to good use. 

“Amputation rehabilitation is multifaceted and that’s reflected in our team’s makeup,” she says. “The physiatrists oversee it all and make sure the entire person is being cared for. We work with the surgeons on wound healing and pain control; we work with prosthetists and orthotists to select appropriate physical aids based on the patient’s lifestyle needs; we work with physical and occupational therapists to help patients regain functional independence; and we help them adjust psychologically and emotionally to their new condition, referring them to our rehabilitation psychologists when necessary.” 

Soon after arriving at Johns Hopkins, Keszler took her experience on the road to volunteer at a clinic that works with people with amputations in Querétaro, Mexico. "Although the U.S. has only recently formed academic amputation care programs for physicians, we have managed to get by because of on-the-job learning and specialized training offered to physical and occupational therapists and prosthetists," says Keszler. In Mexico, there is only on-the-job training.

Keszler was joined on the visit by Charles Dankmeyer, an expert prosthetist who collaborates with the Johns Hopkins care team in Baltimore and who orchestrated the visit. Dankmeyer has been visiting the clinic regularly since 1985 when there was an earthquake that caused limb loss in the local population. Four physical therapists from Johns Hopkins also went on the trip to help with patient care and share their knowledge about limb loss with the sole physical therapist and prosthetist at the clinic.  

“Growing up with a relative who suffered from limb loss, I know that a good prosthesis isn’t that helpful without the rehabilitation and physical therapy needed to use it well,” says Keszler. “That’s why I love the work I do at Hopkins and am looking forward to our future visits to Mexico.”

Read more: Rehabilitation Offers a Full Life After Limb Loss

Published in Restore Spring 2019