inMotion Magazine

Being Informed 15 by Chad Simpson, BS, BOCP, LP, and Randy Richardson, ABC-CPA, RPA A New Pathway to Function for Bilateral Above-Knee Prosthetics Users Individuals with bilateral above-knee limb loss face a devastating reduction of mobility. Initially, a wheelchair is often used as the primary mode of transportation. A physical therapist will teach how to safely transfer to and from the wheelchair, maintain joint movement and overall strength, and help desensitize the limbs. An occupational therapist will help with accomplishing daily tasks such as personal hygiene and navigating daily life situations while using a wheelchair. In most cases, it takes several months for the surgical site to heal enough to begin the process of preparing for prosthetic use. During that period, the individual usually becomes accustomed to using the wheelchair and being in a seated position. Even family members will use the wheelchair to store and carry backpacks, purses, baby supplies, etc. The wheelchair becomes a vital device, not only to the amputee, but to the entire family. Once the limbs are healed, it can be difficult to focus on using prostheses after becoming comfortable with using a wheelchair. Unfortunately, due to lack of physical activity, individuals often experience substantial weight gain and develop flexion contractures and stiffness in the hip joints, limiting the range of movement of the residual limbs. This general lack of activity and mobility greatly reduces overall strength. All of these factors can have a negative impact on the physical and emotional ability to use bilateral above-knee prostheses. Individuals with bilateral above-knee limb loss using prostheses have shown a 27-88 percent increase in energy cost during walking compared to individuals without limb loss. The cardiovascular impact is significant and initially can be discouraging. Even the process of donning the prostheses can be physically exhausting. At this stage, many individuals feel overwhelmed and frustrated. Some express their feelings with statements such as, “There is no way that it will be possible for me to use prostheses,” or, “It’s just not a practical option; it takes too long, uses too much energy and it’s easier to use a wheelchair,” or, “I don’t have time to deal with the hassle of learning to walk again.” Ultimately, the individual must decide whether to use a wheelchair or prostheses. Many bilateral above-knee amputees make the decision to use a wheelchair based on their own experiences, without knowing it’s even possible to be a full-time prosthetics user. When energy expenditure outweighs functional benefit, bilateral above-knee amputees primarily opt to use a wheelchair and prostheses for special situations. The majority of veterans with bilateral Individuals with bilateral above-knee limb loss using prostheses have shown a 27-88 percent increase in energy cost during walking compared to individuals without limb loss.