Factors related to high-level mobility in male servicemembers with traumatic lower-limb loss

Abstract

The purpose of this study was to examine the possible relationship between factors modifiable by rehabilitation interventions (rehabilitation factors), other factors related to lower-limb loss (other factors), and high-level mobility as measured by the Comprehensive High-Level Activity Mobility Predictor (CHAMP) in servicemembers (SMs) with traumatic lower-limb loss. One-hundred eighteen male SMs with either unilateral transtibial amputation (TTA), unilateral transfemoral amputation (TFA), or bilateral lower-limb amputation (BLLA) participated. Stepwise regression analysis was used to develop separate regression models of factors predicting CHAMP score. Regression models containing both rehabilitation factors and other factors explained 81% (TTA), 36% (TFA), and 91% (BLLA) of the variance in CHAMP score. Rehabilitation factors such as lower-limb strength and dynamic balance were found to be significantly related to CHAMP score and can be enhanced with the appropriate intervention. Further, the findings support the importance of salvaging the knee joint and its effect on high-level mobility capabilities. Lastly, the J-shaped energy storage and return feet were found to improve high-level mobility for SMs with TTA. These results could help guide rehabilitation and aid in developing appropriate interventions to assist in maximizing high-level mobility capabilities for SMs with traumatic lower-limb loss.

Functional and Mental Health Status of United Kingdom Military Amputees Postrehabilitation

“…The cohort of amputees reported in this study had a mean NISS of 40AE15, which we believe constitutes the highest severity of traumatic amputee injury in the available literature. 11,12 Despite this, upon completion of a comprehensive and intensive rehabilitation pathway, these patients had functional and mental health status comparable with that of the general population. Patient mobility is a critical component of successful rehabilitation and vital in aiding ADL.…”

Predicting Walking Ability Following Lower Limb Amputation: An Updated Systematic Literature Review

“…Hamamura et al reported, in a high quality study, no significant difference between the successful and unsuccessful ambulator groups when considering amputation level (17). Guanard et al., in a high quality article, reported on the importance of an intact knee joint for providing the TTA patient with the ability to return to high-level mobility activities following rehabilitation (31). Stineman et al reported ADLs and mobility (physical functioning) using gains in motor FIM™ scores achieved by rehabilitation discharge.…”

“…van Eijk et al, in a medium quality article, reported that functional ambulation (Functional Ambulation Catagories (FAC) score, which measures the independency of gait) was significantly positively associated with prosthetic use (20). Guanard et al, in a high quality article, reported rehabilitation-related factors, such as lower limb strength, standing and dynamic balance, and ability to displace the center of mass over the base of support, were all significantly related to ability to perform high-level mobility activities (31.) Sansam et al previously reported that two medium to high quality studies with the same first author have looked at physical fitness and its relationship to walking ability following unilateral above knee amputation.…”

Mobility analysis of amputees (MAAT 3): Matching individuals based on comorbid health reveals improved function for above-knee prosthesis users with microprocessor knee technology

“…There has been recent literature that has supported this (Gaunaurd et al, 2013;Knezevic et al, 2016;Stineman et al, 2010;van Eijk et al, 2012;Webster et al, 2012), and literature that has refuted this assumption (Czierniecki, Turner, Williams, Hakimi, & Norvell, 2012;Gremeaux et al, 2012;Suckow et al, 2012). Notably, the impact of advanced knee joint technology on walking ability was only reported in one of these publications (Gaunaurd et al, 2013) while older publications preceded the commercialization of MPKs. Fortington et al (Fortington et al, 2012) recently noted "poorer performance by people with a transfemoral amputation versus a transtibial level was apparent where compared".…”