Independent Household Mobility Is Goal with Limb Amputations
One of the primary goals for patients with multiple limb amputations is to help them achieve Independent household mobility. While a wheelchair was traditionally used for that purpose, smaller houses with non-accessible spaces make that impossible.
One solution is the use of so-called “house legs,”  shortened prostheses, which allowed increased mobility and independence for individuals with bilateral above-knee amputations, according to an article published earlier this year in the Journal of Surgical Orthopaedic Advances. 1
The article describes lessons learned at Walter Reed National Military Medical Center in Bethesda, MD, about providing advanced therapy and prosthetics for combat casualties. With Army Col. Paul F. Pasquina, MD, chief of Walter Reed’s Integrated Department of Orthopaedics and Rehabilitation among the authors, it also provides guidelines for all providers involved in the care of individuals with amputation.
“Feedback has been overwhelmingly positive from patients and family members who credit the ‘house legs’ for allowing them to be more independent in performing routine household activities,” the authors write. “Moreover, shortened prostheses have been shown to require less oxygen consumption and cardiac response than full-length prostheses, advocating their use for elderly patients and civilians who would otherwise be considered poor prosthetic candidates.”
They recommend that house legs be designed to be lightweight, use anatomical suspension and allow for patients to be able to put them on and remove them quickly.
The article also discusses some of the unique challenges of injuries from Iraq and Afghanistan, noting that the “relatively high number of combat casualties with very proximal lower-limb amputations” is spurring efforts to find ways to help these patients walk upright.
In addition, issues such as hip disarticulation and/or hemipelvectomy coupled with a colostomy can make socket design and prosthetic fitting even more challenging.
For patients with high bilateral levels of amputation, walking with prosthetics may not be a possibility, the authors write, recommending, “Therefore, it is imperative that clinicians pay considerable attention to customizing seating systems and wheelchair fittings to achieve independent mobility.”
They suggest that future development of robot devices may provide more options for these patients in coming years.
The article also emphasizes the importance of an ongoing fitness program for wounded warriors with amputation. It notes that low-impact aerobic activities, such as cycling, provide the required safety and efficiency, adding that specially-designed bicycles are available, including hand crank, recumbent and upright models.
1. Harvey ZT, Loomis GA, Mitsch S, Murphy IC, Griffin SC, Potter BK, Pasquina P. Advanced rehabilitation techniques for the multi-limb amputee. J Surg Orthop Adv.2012 Spring;21(1):50-7. PubMed PMID: 22381511.