Clinical Monitoring of Dysvascular Lower Limb Amputees During Initial Gait Training

Abstract

Previous studies have found exercise ECG abnormalities in dysvascular amputees who showed normal resting ECGs. The purpose of this pilot study was to investigate whether similar abnormalities would occur in such patients during initial walking using a pneumatic post-amputation mobility (PPAM) aid. Ten patients, seven with below-knee, two with through-knee and one with trans-femoral amputation participated in a standardised exercise session. Data were obtained from continuous ECG and pulse oximeter readings, together with resting and post-exercise blood pressure (BP). Seven of the ten patients had abnormal ECGs prior to the study, and additional irregularities were found during walking in three patients who showed significant (> 1 mm) ST segment depression, although this may have been drug-related rather than due to myocardial ischaemia. Several months after the study, these three patients died from myocardial infarction. Findings of normal BP elevation in nine patients and group mean age-predicted maximum heart rate (HRmax) of less than 70% suggest that exercise levels were generally appropriate. However, five patients reached age-predicted HRmax of over 70%. In view of the multiple pathological profiles of this type of patient, and their diverse medications, it is recommended that therapists should pay closer attention to patients' exercise heart rates and cardiac status during rehabilitation. Previous studies have found exercise ECG abnormalities in dysvascular amputees who showed normal resting ECGs. The purpose of this pilot study was to investigate whether similar abnormalities would occur in such patients during initial walking using a pneumatic post-amputation mobility (PPAM) aid. Ten patients, seven with below-knee, two with through-knee and one with trans-femoral amputation participated in a standardised exercise session. Data were obtained from continuous ECG and pulse oximeter readings, together with resting and post-exercise blood pressure (BP). Seven of the ten patients had abnormal ECGs prior to the study, and additional irregularities were found during walking in three patients who showed significant (> 1 mm) ST segment depression, although this may have been drug-related rather than due to myocardial ischaemia. Several months after the study, these three patients died from myocardial infarction. Findings of normal BP elevation in nine patients and group mean age-predicted maximum heart rate (HRmax) of less than 70% suggest that exercise levels were generally appropriate. However, five patients reached age-predicted HRmax of over 70%. In view of the multiple pathological profiles of this type of patient, and their diverse medications, it is recommended that therapists should pay closer attention to patients' exercise heart rates and cardiac status during rehabilitation.