Another very interesting case I’ve seen in recent weeks is a patient with bilateral LE amputations.
This particular woman has a number of complicating factors which make treatment pretty interesting. She consented to have a few of her details shared for this case study. I’ll list just a few of them:
It’s obvious, but the patient has an above-knee amputation (AKA) on the right and a below-knee amputation (BKA) on the left.
Her hands and upper extremities are also plagued with severe rheumatoid arthritis (RA). This makes donning and doffing the prosthetics incredibly difficult.
The amputations are a result of peripheral artery disease (PAD) which caused progressive degeneration of both lower extremities. She had a total knee replacement (TKA) on the right, forcing her to have an AKA. The surgeon reported that he would not give her a BKA with a TKA in place.
Don’t you love the alphabet soup?
The patient has decreased circulation in her residual limbs, making her skin extremely fragile. If any wound, bruise, or issue appears on the ends of the residual limbs, it requires a significant amount of time to heal.
The patient is unable to work and requires assistance for most transfers up or down. Financial constraints limit her participation in therapy.
Here are a few videos I shot of a recent treatment session. The patient agreed to be on camera to help clinicians learn how to deal with a case with multiple complications.
This video shows how difficult it is to don the sleeve holding the pin. This is the suspension system for the prosthetic.
This video shows the patient attempting to stand and walk. She was so anxious to stand that we didn’t get the gait belt on quick enough. We did keep the wheelchair extremely close for safety considerations.
A few follow-up questions—Would you know what to do?
How long would your treatment sessions last?
What would you give her as an HEP, considering that she cannot don the prosthetics independently?
The patient has bilateral hip flexion contractures and a left knee flexion contracture. What would you recommend?
What is the prognosis? Best case? Worst case?
What major issues would you watch for after a treatment session?
Would you know where to start?
These are all great questions to ask yourself. As a new therapist, I honestly felt a little lost when I first treated her. I now know at least a few of the most important things I would do to promote improved function while keeping the patient safe.
This is a good exercise to prepare yourself for the multiple choice questions on the NPTE. Be sure to check out some of my other case studies.
As always, I’d love to know what you think. Would you know what to do?