title: Special Considerations for Multiple Limb Amputation.
abstract: It has been estimated that more than 1.6 million individuals in the United States have undergone at least one amputation. The literature abounds with research of the classifications of such injuries, their etiologies, epidemiologies, treatment regimens, average age of onset (average age of amputation), and much more. The subpopulation that is often overlooked in these evaluations, however, is comprised of individuals who have suffered multiple limb loss. The challenges faced by those with single-limb loss are amplified for those with multiple limb loss. Pain, lifestyle adjustment, and quality of life return are just a few key areas of concern in this population. Along with amputations resulting from trauma, many individuals with multiple amputations have endured them as a result of dysvascular disease. Over recent years, amputations as a result of dysvascular disease have risen to comprise more than 80 % of new amputations occurring in the United States every year. This compares to just 54 % of total current prevalence. Those with diabetes comorbid with dysvascular disease make up 74 % of those with dysvascular amputations, and these individuals with diabetes comorbid with dysvascular disease have a 55 % chance of enduring an amputation of their contralateral limb within 2-3 years of their initial amputation. With the well-documented aging of the nation's population and the similarly skyrocketing prevalence of dysvascular disease and diabetes, it can be expected that the number of individuals with multiple limb loss will continue to increase in the United States. This article outlines the recommended measures of care for this particular subpopulation, including pain management, behavioral health considerations, strategies for rehabilitation for various levels and variations of multiple limb loss, and the assistive technology and adaptive equipment that might be available for these individuals to best enable them to continue healthy, fulfilling lives following amputation.
authors.affiliation: Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA ; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD USA ; Center for Rehabilitation Sciences Research (CRSR), Uniformed Services University of the Health Sciences, Bethesda, MD USA.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Pasquina
authors.affiliation: Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA ; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD USA ; Center for Rehabilitation Sciences Research (CRSR), Uniformed Services University of the Health Sciences, Bethesda, MD USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Miller
authors.affiliation: Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA ; Center for Rehabilitation Sciences Research (CRSR), Uniformed Services University of the Health Sciences, Bethesda, MD USA ; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Carvalho
authors.affiliation: Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA ; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD USA ; Medical Orthotics and Prosthetics, Silver Spring, MD USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Corcoran
authors.affiliation: Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA ; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD USA ; Advanced Arm Dynamics, Bethesda, MD USA.
authors.forename: James
authors.initials: J
authors.lastname: Vandersea
authors.affiliation: Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA ; Center for Rehabilitation Sciences Research (CRSR), Uniformed Services University of the Health Sciences, Bethesda, MD USA ; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Johnson
authors.affiliation: Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 USA ; Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD USA ; Center for Rehabilitation Sciences Research (CRSR), Uniformed Services University of the Health Sciences, Bethesda, MD USA.
authors.forename: Yin-Ting
authors.initials: YT
authors.lastname: Chen
keywords: Adaptive technology; Amputation; Assistive technology; Behavioral health; Multiple limb amputation; Multiple limb loss; Pain management; Prosthetics; Rehabilitation