Rehabilitation of the bilateral amputee

Abstract

One hundred sixteen patients with bilateral amputation as a result of severe ischemia were reviewed to evaluate their rehabilitation potential. Seventy patients were male and 46 were female; ages ranged from 31 to 92 years (mean 68 years). The operative mortality rate after the second amputation was 9.5% (11 of 116 patients). The time from the first to second amputation ranged from zero to 144 months (mean 23 months). Follow-up from 1 to 14 years was available on all patients. Sixty percent of the patients surviving the postoperative period were alive at 2 years and 40% at 5 years. Of the 105 patients available for follow-up, only 27 (26%) were able to use bilateral prostheses. Twenty-three (85%) of these patients were ambulatory after their first amputation. Four patients not walking after their first amputation became ambulatory after their second. All four had bilateral below-knee amputations. Of the 78 patients unable to use a bilateral prosthesis, 68 (87%) were able to function independently and 10 became bedridden. Successful prosthetic rehabilitation in the bilateral amputee appears primarily dependent on the use of a prosthesis after the first amputation. The acceptable long-term survival and the number of patients who became independent in their activities justify an aggressive approach to the rehabilitation of the bilateral amputee. (

Long-Term Outcomes and Survival of Patients with Bilateral Transtibial Amputations After Rehabilitation

“…5 Also, previous studies have shown that those who had less time between their amputations had poorer outcomes. 1,5 We found no such correlation at long-term follow-up. Future studies should compare a larger number of patients with BTTA who abandon prosthetic use with those who continue to wear their prostheses, to examine prognostic factors related to long-term prosthetic use.…”

“…This survival time is similar to previous reports of 2.5-5 yrs after amputation in bilateral lower-extremity amputees. 4,6,7,9,10 Evans et al 1 and Inderbitzi et al 11 also have reported a 2-yr survival rate of 60%-62% and a 5-yr survival rate of 31%-40% 1,11 in patients with bilateral lower-extremity amputation of peripheral vascular causes from acute care. A study by Ebskov 17 examined 10,191 lower-extremity amputations and found that the median survival analysis (by Kaplan-Meier analysis) was 2.6 yrs in those patients with unilateral transtibial amputations from diabetic causes.…”

“…The incidence of patients with a unilateral amputation as a result of systemic disease going on to require bilateral amputation has been reported to be anywhere from 9.4% to 24%. [1][2][3] Despite the relatively large numbers of individuals who have undergone bilateral amputation, little is known about their long-term outcomes. A small number of studies have analyzed long-term survival and function of patients who have undergone bilateral lower-extremity amputations; however, most examine small numbers of subjects with amputations of various etiologies and different amputation levels, collectively making it difficult to generalize study results to specific patients.…”

Leg Laterality Differences in Persons with Bilateral Transtibial Amputation

“…Rehabilitation of patients with bilateral lower-limb amputation is challenging because of the degree of the structural loss and the need to replace both limbs with prostheses. The success rate of prosthetic rehabilitation in people with bilateral transtibial amputation has been reported to be in the range of 30% 7,8 to 50% 9 and even as high as 60% to 90%, 10 albeit patients tend to use their prostheses less and have lower mobility and lower rates of employment than do persons with unilateral amputations. In addition, the physiological cost of walking with bilateral prostheses is greater than with a unilateral prosthesis.…”

Virtual reality enhanced rehabilitation for a service member with bilateral lower extremity amputations: A case study

“…During the earlier years of amputee rehabilitation, when prostheses were not as advanced, prosthetic rehabilitation was suggested only for the population of young patients with bilateral lower extremity (LE) amputations due to level of fitness and motivation [2]. The literature for patients with bilateral amputations has a heavy focus on elderly vascular patients, encompassing several etiologies, who may not desire a high function level postamputation [3]. Many studies used questionnaires as an outcome measure for quality of life, confident prosthetic usage, and successful rehabilitation [4,[5][6][7].…”