By Kim Ousley
Some amputees receive their first prosthesis without ever receiving the physical therapy needed to use it safely. Others are discharged from rehabilitation as soon as they can walk with a cane, long before they’ve achieved the independence they’re working toward.
Neurologic physical therapist Jackie Garcia saw both scenarios repeatedly while working in a clinic that treated people with limb loss, spinal cord injuries, and strokes. What united her patients was the need to improve their gait, but she noticed that traditional rehabilitation often ended before patients had reached their goals.
“A lot of our patients with amputations required more than just the one to two hours in the clinic,” Garcia said. “They needed guidance, accountability, and support that the healthcare system simply doesn’t have time to provide.”
Across the United States, many amputees never receive physical therapy, either before or after being fitted with their first prosthesis. The reasons vary: insurance limitations, geographic barriers, a shortage of trained clinicians, and misconceptions about what amputees need to succeed.
That gap inspired Garcia to launch Nxt Stride Rehabilitation in 2024, a virtual coaching program designed to help amputees build strength, confidence, and mobility from wherever they live. Unlike traditional telehealth physical therapy, her program focuses on coaching, goal setting, troubleshooting, emotional support, and personalized mobility programs tailored to each client’s home environment.
Garcia now works with amputees around the world, including those in rural communities where specialized prosthetic rehabilitation is scarce.
“I’ve had people from Hawaii, Dublin, India—places where they don’t have someone who understands the process.”
Prosthetic mobility, she explains, is far more complex than many people realize. Daily fluctuations in socket fit, skin integrity, phantom pain, nerve pain, and residual limb volume can dramatically affect how well someone walks. Over time, Garcia noticed that patients who made the greatest progress were often those who remained active outside the clinic. Yet many lacked the access, support, or therapy time needed to do so.
“If all you had to do was wear the prosthetic, it’d be easy,” she said.
Garcia also emphasizes the physical demands of walking with a prosthesis, something she believes is rarely explained early enough in recovery.
“You need to be stronger than you were before your amputation to walk really well because there’s less muscle now, so the demand is higher.”
But physical strength is only part of the equation.
Garcia also addresses the emotional and psychological challenges that can accompany limb loss. While many of her virtual clients have embraced their prostheses and feel proud to show them, newer amputees in the clinic often struggle with body image or fear of being seen. A lack of support at home can intensify these feelings, particularly when mobility and independence have changed.
Without adequate training, amputees may feel ashamed, frustrated, or discouraged by their progress. They may believe they are failing when they simply haven’t received the tools or guidance they need.
Garcia reminds clients and their families that “no amputation is the same.”
“People may not understand how the body works and how those differences impact mobility.”
Comparisons, especially from family members, can be damaging. Without understanding the challenges involved, loved ones may unintentionally pressure amputees to do more than they’re physically ready to attempt.
Setbacks are also part of rehabilitation. Progress is rarely linear, and changes in socket fit, skin issues, and fatigue can interrupt even the most consistent routines. Garcia encourages clients to adjust their activities rather than abandon movement altogether.
She describes recovery as a roller coaster, reminding clients that challenges are something they can work through together. The goal isn’t uninterrupted progress but learning how to adapt when circumstances change.
Community support, Garcia believes, is equally important. Still, she encourages amputees to choose their support groups carefully. Some spaces can become focused on comparing hardships, while others offer the encouragement, practical advice, and connection that help people move forward.
Looking ahead, Garcia hopes to expand Nxt Stride Rehabilitation by adding a prosthetist, a mental health coach, and more educational resources, including a YouTube channel.
Her work has also deepened her appreciation for the determination amputees bring to rehabilitation, particularly when they face barriers to receiving the care they need.
“They constantly show what’s possible.”
