title: Functional Outcomes of Service Members With Bilateral Transfemoral and Knee Disarticulation Amputations Resulting From Trauma.
abstract: As longitudinal studies for those with bilateral transfemoral amputation (BTFA) or knee disarticulation (KD) are lacking, it is important to quantify performance measures during rehabilitation in an effort to determine reasonable expectations and trends that may influence the rehabilitation process. At initial evaluation (date of first independent ambulation) and follow up (median 135 [range = 47-300] days later), 10 participants with BTFA/KD completed 6 minute walk testing and Activity Specific Balance Confidence and Lower Extremity Functional Scale questionnaires. Of these, six participants also completed stair ambulation; ascent time and stair assessment index (SAI) scores were calculated. Patients utilized their prescribed prostheses at each visit. Participants were able to cover a significantly greater distance (135.3 [70.1] m) in 6 minutes at the follow-up visit (*p = 0.005). The change in SAI scores for stair ascent and descent was not statistically significant (p = 0.247). Stair ambulation confidence scores were significantly greater at the final visit (*p = 0.034). Stair negotiation appears to plateau early; however, confidence builds despite absence of functional gains over time. Service members with BTFAs/KDs are able to achieve functional community ambulation skills. Thus, this investigation suggests that clinicians can realign rehabilitation paradigms to shift focus towards community distance ambulation once safe stair ascent and descent is achieved.
authors.affiliation: Department of Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889-5611.
authors.forename: Barri L
authors.initials: BL
authors.lastname: Schnall
authors.affiliation: Department of Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889-5611.
authors.forename: Yin-Ting
authors.initials: YT
authors.lastname: Chen
authors.affiliation: Department of Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889-5611.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Bell
authors.affiliation: Department of Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda MD 20889-5611.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Wolf
authors.affiliation: Extremity Trauma and Amputation Center of Excellence, 2748 Worth Road, Suite 29, Fort Sam Houston, TX 78234.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Wilken
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000534:rehabilitation*; D001696:Biomechanical Phenomena; D001753:Blast Injuries / Q000150:complications / Q000534:rehabilitation; D004188:Disarticulation / Q000534:rehabilitation*; D017079:Exercise Tolerance / Q000502:physiology; D006801:Humans; D007718:Knee Injuries / Q000150:complications* / Q000534:rehabilitation; D008137:Longitudinal Studies; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data; D063868:Patient Outcome Assessment; D019736:Prostheses and Implants / Q000592:standards; D011795:Surveys and Questionnaires; D016138:Walking / Q000502:physiology