Bilateral Transtibial Amputations Research Articles

Aided gait of people with lower-limb amputations: Comparison of 4-footed and 2-wheeled walkers

Tsai HA, Kirby RL, MacLeod DA, Graham MM. Aided gait of people with lower-limb amputations: comparison of 4-footed and 2-wheeled walkers. Arch Phys Med Rehabil 2003;84:584-91. Objectives: To test the hypotheses that prosthesis-wearing people with lower-limb amputations, using 2-wheeled walkers (TWW) versus 4-footed walkers (FFW), (1) walk faster, (2) walk with fewer interruptions, (3) walk no less safely, and (4) prefer the TWW. Design: Within-subject comparisons. Setting: Rehabilitation center. Participants: Twenty prosthesis-wearing people with lower-limb amputations (13 men, 7 women) with a mean age [plusmn] standard deviation of 69[plusmn]13 years. Of the subjects, 11 had unilateral transfemoral amputations, 7 had unilateral transtibial amputations, and 2 had bilateral transtibial amputations. Intervention: Participants were trained to use both walkers. Main Outcome Measures: Five-meter walking velocity, gait pattern, need for spotter intervention, foot position with respect to the base of support of the walker, and subject preference. Results: Subjects walked 28.5% faster when using the TWW ( P[equals].000). During gait cycles, 100% of subjects brought the FFW to a complete halt, whereas only 55%, particularly subjects with transfemoral amputations, halted the TWW ( P[equals].008). There was no difference in the need for spotter intervention. Subjects with unilateral amputations placed their feet significantly more anteriorly within the walker base of support when using an FFW ( P[equals].000). Fourteen subjects preferred the TWW, and 6 chose the FFW (not significant). Conclusion: The TWW allows prosthesis-wearing people with lower-limb amputations, especially those with transtibial amputations, to walk more quickly and with less interruption, but no less safely, than the FFW. The findings have implications for ambulation training and the prescription of ambulation aids.

Functional outcome of rehabilitated bilateral lower limb amputees.

The functional outcome of rehabilitated bilateral lower limb amputees was studied. The study included 31 amputees who were admitted during 1980-1990 to a rehabilitation centre in the north of the Netherlands. The clinical notes made during the patients' admission were studied to obtain information about their characteristics, while mobility and prosthetic use were studied at discharge. The patients who were alive and willing to participate in the study were interviewed by a physician at their residence in November 1992, using among other things, the Sickness Impact Profile (SIP) and the Life Satisfaction questionnaire. Some 25 of the 31 patients were amputated for vascular reasons, 1 patient primarily for traumatic reasons and secondarily for vascular reasons, 5 patients for traumatic reasons. Eight patients had a bilateral trans-femoral amputation, 18 patients a bilateral trans-tibial amputation, 2 patients a combination of trans-tibial and knee-disarticulation amputation, 3 patients a trans-femoral/trans-tibial amputation. Mean age at second amputation was 66.3 years. Of the 31 amputees 21 were men and 10 women, 25 amputees were prosthetically rehabilitated during admission, 3 of them died during admission and 5 did not achieve mobility at discharge. In their activities of daily life 22 of the 28 patients alive at discharge were almost independent. At the time of the follow-up evaluation 17 of the 31 patients had died. For several reasons only 8 patients could be included in the follow-up, 6 vascular amputees and 2 traumatic amputees.(ABSTRACT TRUNCATED AT 250 WORDS)