The Patient with Bilateral Lower Extremity Amputation

Question 1

Pre-prosthetic interventions for patients with bilateral lower extremity amputations: [5]

Answer 1

• Intensive strengthening of the upper and lower extremities
• Sleeping in prone (or at least some time during the day in prone
  
  • because highly susceptible to hip contracture
• Hip extension flexibility exercise
  
  • in prone or side-lying
• Balance activities:
  
  • weight shifting, playing ball, rotation in sitting and kneeling
• Residual lower extremity and upper extremity resistive exercises:
  
  • isotonic, isometric, PNF, isokinetic

Question 2

Pre-prosthetic interventions for those who will not be functional ambulators:

Answer 2

• Basic mobility
  
  • bed mobility while avoiding shear forces
  • rolling
  • supine or sidelying to sitting
  • weight shifting
  • scooting in sitting
  • transfers
  • wheelchair propulsion
• Advanced wheelchair skills
  
  • independent wheelchair propulsion on:
    
    • level and uneven surfaces
    • navigation in tight spaces

Question 3

Common socket and suspension for bilateral transtibial amputations (2):

Answer 3

• Patellar tendon bearing socket with supracondylar cuff suspension
  
  • (PTB + supracondylar cuff suspension)
• Total surface bearing socket with roll on silicone liner suction suspension
  
  • (TSB + silicone liner suction suspension)

Question 4

Advantages of “stubbies” with bilateral transfemoral amputations:

Answer 4

• Center of gravity lower to the base of support
• Rocker bottoms prevent backward falls
  
  • also have no articulated knee joints
• Require less energy output
• less cumbersome
• less fear of falling
• Decrease risk for hip flexion contracture
• Allows for physiologic effects of being upright

Question 5

Disadvantages of “stubbies” with bilateral transfemoral amputations:

Answer 5

• Slower ambulation
• Psychological acceptance
  
  • resulting from shortened stature

Question 6

Definitive prostheses that are (—–length in inches and cm—-) shorter than preamputation legs result in improved balance by lowering the center of gravity.

Answer 6

• 2-3 inches or 5-7 centimeters

Question 7

Knee type that offers maximum stance phase stability for individuals with bilateral transfemoral amputations:

Answer 7

• Bilateral Polycentric (four bar linkage)
  
  • Advantage of shortening during swing phase aiding in toe clearance

Question 8

Knee type that offers maximum efficiency for individuals with bilateral transfemoral amputations:

Answer 8

• Bilateral hydraulic
  
  • higher cost is a disadvantage

Question 9

If one residual limb is longer than the other in a bilateral amputation, then to ascend stairs and/or ramps:

Answer 9

• Longer limb ascends first
• Shorter limb descends first