Volume 19 · Issue 4 · July/August 2009 –
by Kevin Carroll, MS, CP, FAAOP, and Randy Richardson, RPA –
People who have experienced limb loss know that it only takes a moment for your life to be completely redefined. Yesterday, you were standing and walking. Today, you are in a hospital bed or a wheelchair. Tomorrow – well, tomorrow is uncertain and hard to even think about. Any amputation is life-altering, but people with bilateral above-knee amputations face a particularly complicated process of physical and emotional rehabilitation. The long-term goal is usually being able to walk again with prosthetic legs. However, even after months of rehabilitation, many people lose confidence that they will ever walk comfortably and independently. What can bilateral above-knee amputees do to increase the likelihood of getting their feet back on the ground? They can follow a graduated, four-step approach to becoming a prosthesis user.
Foreshortened Prostheses (Stubbies)
Last updated 01/2008 –
For bilateral leg amputees, rehabilitation should be emphasized as early as possible to maximize ambulatory potential and to help alleviate possible gait or motion control problems associated with contracture (the tightening of muscles around the residual joint, which can restrict an amputee’s range of motion). Other problems could result from abduction (the movement of the residual limb away from the center or mid-line of the body which can lead to excessive reductions in locomotion).1 Once this process has begun, the bilateral leg amputee, with the help of the medical team, will need to consider his or her respective levels of agility, balance, endurance and stability, since these are key considerations during the initial stages of ambulatory rehabilitation (relearning to walk or ambulate). Also relevant is the high amount of metabolic energy (heart rate, oxygen use, etc.) required to measure ambulatory potential (the potential of the patient to rehabilitate in conventional prostheses). These factors, along with other variables such as level and cause, are especially important for the elderly and/or physically unfit patient who will experience greater difficulty in achieving proper ambulation, especially if affected by diabetes and/or other vascular/cardiorespiratory conditions.