Damien Daniel

This is tricky. From what I can gather regarding your injuries and surgeries (without having all the details) a fusion would be the first option. This will hopefully relieve the pain but may not take it all away. I've had both ankles done myself and still have some pain, mainly in one, but not enough to stop me doing things. There will be other consequences though - such as losing movement in your ankle to some degree (depending on the number of joints in the ankle fused). You should be able to walk easily with orthotics or custom made shoes. Running would be very difficult so it would limits some sports. A spinal cord stimulator is purely for pain and could be used in conjunction with either operation. The leads are inserted in an operating theatre and the current is tested and adjusted over a week in a trial. If it works the neurostimulator (a small computer in effect) is implanted. If not, the worse are removed. It a last resort in pain management and only works for some people with specific types of pain. An amputation should be an absolutely final resort. Unfortunately amputees can get 2 types of pain - phantom limb pain, and stump pain - as well as phantom limb "sensation" which is not painful but can be uncomfortable. For a trans tibial (below knee amputation) you are looking at at least 3-6 months to get your final prosthesis (leg) and to be fully functional with it. Amputees can get pain at various times after the surgery and during the rehabilitation phase. If all went perfectly well and there were no pain issues careful maintenance of the stump is needed to ensure no skin breaks down. There is a newer option called osseointegration, where the attachment for the prosthesis is cemented into the bone that has been amputated so you "click" the leg on. That is still a very specialised procedure. Amputation is a complicated and involved process and you'd be best to get your surgeon to introduce you to people who have been through it learn as much from them as you can before you decide to go through with it. You can't go back. Personally, I'd consider less the invasive options first.

The simple answer is yes, but how much is unknown. Strength exercises require resistance and repetition. The resistance (to the movement of the muscle, like a dumbbell in a biceps curl) should be gradually increased as you get stronger. The repetition is vital for neuroplasticity - so your brain can build new pathways to work your hand. Occupational therapists treat upper limb issues and some have sub specialised to become Hand Therapists. I'd advise seeing one of these professionals. They use material like putty and sand to provide residence and can teach you the exact exercises for the specific muscles you need to build. But the answer is yes, and a lot of "how much" depends on your determination and dedication. All the best.

It depends on a lot of the details of how the stroke has affected her, but the general principles are the same for people who haven't had a stroke. The muscles to be strengthened should be isolated as much as possible, resistance should be added, and the exercise should be repetitive. For a stroke patient the repetition helps neuroplasticity - the building of new neural pathways to bypass those damaged by the stroke. Walking, either outdoor or on a treadmill (scare), and pool based hydrotherapy or swimming are the best exercises for strengthening the large muscle groups (e.g.. quads and hamstrings in legs and biceps, pec major in the upper limb). A good physiotherapist (physical therapist), especially one who works with stroke patients will be able to design and monitor a graduated exercise program for your mother. Good luck. NOTE: The weakness may also be a manifestation of fatigue which is a very big factor after a stroke. Again exercise (and time) is the best treatment.

Being fully recovered is difficult to predict as some people may never achieve that after such an injury if it is severe enough. However, if your sister's jaw has been wired shut rather than required full reconstructive surgery, that is a positive sign. The 6 weeks is just to let the bones heal. After the 6 weeks the jaw will be stiff and it will take time to get back to where it was. She may require some physical therapy to improve her mouth opening range and strength. At times people get issues with their Temperomandibular joints (TMJs) which are the small joints on the side of your face that move the jaw. There are physical therapists that specialise in this area. Some people regain their function but may have the odd, fairly rare issue such as subluxing the TMJ (a partial dislocation that goes back in immediately - not dangerous but painful). All in all most people who have an injury that requires wiring of their jaw do make a full recovery. I'd estimate 12 weeks as an average, depending on whether you need physical therapy or not.

Physiatrists generally work with a team that includes physical therapists anyway. Certainly that's how it works in Australia. A good physical therapist with experience in joint surgeries are great for straightforward cases with no medical complications or issues, and as long as they progress without issues. My preference would be for a treatment team, but if you are confident it should be straight forward (i.e. you are not elderly, are healthy otherwise, and physically active before the surgery), then a physical therapist should be fine. An experienced one should get you to see a physiatrist, if there are any concerns anyway.