Rehabilitation of the Geriatric Amputee*

Abstract

During a five‐year period, 90 patients who had undergone lower‐extremity amputations when aged 60 or older were treated at the Amputee Clinic of the Jewish Hospital of St. Louis. Seventeen of the 90 were not fitted with prostheses because of various medical contraindications. Thirteen of the remaining 73 patients who were fitted with prostheses had died by the time of follow‐up, and 23 others could not be located. Of the 37 known survivors, 23 wore their prosthesis for more than six hours daily and used it as their main mode of locomotion; 14 used it only occasionally or not at all. Sex and age at the time of amputation were of little value in predicting the success of prosthetic rehabilitation. Patients with below‐knee amputations fared much better than those with above‐knee amputations. Contraindications to fitting an aged amputee with a prosthesis are mental deterioration, congestive heart failure, severe angina pectoris, and advanced chronic obstructive pulmonary disease. Neurologic disorders such as parkinsonism or stroke with a significant neurologic residual are additional contraindications. Patients who have ulcerations or infections of the remaining extremity or who have severe contractures of the stump usually cannot be fitted with a prosthesis. The ability to use axillary crutches is not a realistic prerequisite for supplying an aged amputee with a prosthesis. A patient who has walked before the amputation and who afterward can walk with a walker, usually will be able to use an artificial limb. Amputees who cannot be expected to use a prosthesis can still be rehabilitated to an independent wheelchair existence.

Lower limb prosthesis utilisation by elderly amputees

“…Finally, some wore it only for aesthetic reasons, Different variables influence prosthesis use. For example, in regard to age (Kegel et al, 1978;Narang et al, 1984;Steinberg etal, 1985;Holden and Fernie, 1987;Pohjolainen and Alaranta, 1991) and level of amputation (Waters et al, 1976;Kegel et al, 1978;Narang et al, 1984;Steinberg et al, 1985;Holden and Fernie, 1987;Hagberg et al, 1992), most studies showed that younger unilateral trans-tibial amputees got better results. Gender was also studied but did not seem to influence prosthesis use (Steinberg et al, 1985, Helm et al, 1986Pohjolainen and Alaranta, 1991).…”

“…For example, in regard to age (Kegel et al, 1978;Narang et al, 1984;Steinberg etal, 1985;Holden and Fernie, 1987;Pohjolainen and Alaranta, 1991) and level of amputation (Waters et al, 1976;Kegel et al, 1978;Narang et al, 1984;Steinberg et al, 1985;Holden and Fernie, 1987;Hagberg et al, 1992), most studies showed that younger unilateral trans-tibial amputees got better results. Gender was also studied but did not seem to influence prosthesis use (Steinberg et al, 1985, Helm et al, 1986Pohjolainen and Alaranta, 1991). Some other variables were also explored, such as hand dominance (Kerstein et al, 1977), aetiology (Kegel et al, 1978), physical health (Bachynski and Cumming, 1985;Steinberg et al, 1985;Chan and Tan, 1990;Pohjolainen and Alaranta, 1991), mental health (Pinzur et al, 1988;Hanspal and Fisher, 1991), physical independence (Chan and Tan, 1990), rehabilitation (Steinberg et al, 1985;Beekman and Axtell, 1987;Pohjolainen and Alaranta, 1991), social support (Helm et al, 1986) and length of time since amputation (Kegel et al, 1978).…”

“…Most of them are descriptive and do not consider the question of why amputees wear their prosthesis or not. According to these studies, 68 to 98% of amputees wore their prosthesis (Kegel et al, 1978;Narang et al, 1984;Steinberg et al, 1985;Beekman and Axtell, 1987;Chan and Tan, 1990;Pohjolainen et al, 1990). However, these studies also showed that some amputees always used their prosthesis while others only used it some of the time.…”

“…Gender was also studied but did not seem to influence prosthesis use (Steinberg et al, 1985, Helm et al, 1986Pohjolainen and Alaranta, 1991). Some other variables were also explored, such as hand dominance (Kerstein et al, 1977), aetiology (Kegel et al, 1978), physical health (Bachynski and Cumming, 1985;Steinberg et al, 1985;Chan and Tan, 1990;Pohjolainen and Alaranta, 1991), mental health (Pinzur et al, 1988;Hanspal and Fisher, 1991), physical independence (Chan and Tan, 1990), rehabilitation (Steinberg et al, 1985;Beekman and Axtell, 1987;Pohjolainen and Alaranta, 1991), social support (Helm et al, 1986) and length of time since amputation (Kegel et al, 1978). However, more research is needed to clarify the role of these factors in prosthesis use.…”

Physical activity and lower-back pain in persons with traumatic transfemoral amputation: A national cross-sectional survey

“…However, the sample included TFAs of multiple causes, including vascular disease and malignancy, which could have confounded the results. People with vascular amputation are older [29] and less ambulatory [14,30], and the associated age-related comorbidities (e.g., cardiovascular problems) could influence both PA levels and LBP-related disability. In contrast, people with traumatic amputation are generally younger and more active prosthesis users than people with vascular amputation [30][31].…”