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  • Home
  • Gait Video eBook
    • Table of Contents
    • Normal Gait
    • Foot Deviations
    • Ankle Deviations
    • Knee Deviations
    • Hip Deviations
    • Pelvis Deviations
    • Trunk Deviations
    • Temporal-Spatial Deviatio
    • Gait Assessment Form
    • Gait Comparison Chart
    • Case Study - CVA
    • Case Study - COVID-19 Neu
    • Case Study - TBI
    • Case Study - Bilateral Am
    • Sample Video - CP
    • Sample Video Brain Injury
    • Sample Video Spina Bifida
    • Sample Video SCI Incomple
    • Sample Video Rh Arthritis
    • Sampl Vide Sensory Ataxia
    • Video- Unilateral TT Ampu
    • Video- Bilateral Amputati
    • Video - TF Amputation
    • Video- Bilateral TF Amput
    • Practice VideoProsthetics
    • Practice Video Orthotics
    • Practice Video Neurologic
    • Practice Video Orthopedic
    • Appendix A Types of Gait
    • Appendix B Insturctor Res
  • Resources
  • GAIT App
  • Research
  • Contact Us
  • More
    • Home
    • Gait Video eBook
      • Table of Contents
      • Normal Gait
      • Foot Deviations
      • Ankle Deviations
      • Knee Deviations
      • Hip Deviations
      • Pelvis Deviations
      • Trunk Deviations
      • Temporal-Spatial Deviatio
      • Gait Assessment Form
      • Gait Comparison Chart
      • Case Study - CVA
      • Case Study - COVID-19 Neu
      • Case Study - TBI
      • Case Study - Bilateral Am
      • Sample Video - CP
      • Sample Video Brain Injury
      • Sample Video Spina Bifida
      • Sample Video SCI Incomple
      • Sample Video Rh Arthritis
      • Sampl Vide Sensory Ataxia
      • Video- Unilateral TT Ampu
      • Video- Bilateral Amputati
      • Video - TF Amputation
      • Video- Bilateral TF Amput
      • Practice VideoProsthetics
      • Practice Video Orthotics
      • Practice Video Neurologic
      • Practice Video Orthopedic
      • Appendix A Types of Gait
      • Appendix B Insturctor Res
    • Resources
    • GAIT App
    • Research
    • Contact Us

Call: 7542726264

Enability

Signed in as:

filler@godaddy.com

  • Home
  • Gait Video eBook
    • Table of Contents
    • Normal Gait
    • Foot Deviations
    • Ankle Deviations
    • Knee Deviations
    • Hip Deviations
    • Pelvis Deviations
    • Trunk Deviations
    • Temporal-Spatial Deviatio
    • Gait Assessment Form
    • Gait Comparison Chart
    • Case Study - CVA
    • Case Study - COVID-19 Neu
    • Case Study - TBI
    • Case Study - Bilateral Am
    • Sample Video - CP
    • Sample Video Brain Injury
    • Sample Video Spina Bifida
    • Sample Video SCI Incomple
    • Sample Video Rh Arthritis
    • Sampl Vide Sensory Ataxia
    • Video- Unilateral TT Ampu
    • Video- Bilateral Amputati
    • Video - TF Amputation
    • Video- Bilateral TF Amput
    • Practice VideoProsthetics
    • Practice Video Orthotics
    • Practice Video Neurologic
    • Practice Video Orthopedic
    • Appendix A Types of Gait
    • Appendix B Insturctor Res
  • Resources
  • GAIT App
  • Research
  • Contact Us

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Chapter 14

CASE STUDY ON BILATERAL AMPUTATIONS

This Case Study describes the gait of a patient who underwent bilateral lower limb amputations, a transtibial amputation on the Right and a transfemoral amputation on the Left 

Amputation Case description
Gait deviations observed
Intervention with new components
post-intervention deviations
gait comparison - pre & post intervention

Case Description

Patient's Medical History

Mr. NL is a 34 year old male bilateral amputee with a Right Transtibial amputation and a Left transfemoral amputation due to traumatic injuries. At the time of gait assessment, he was fit with an ischial containment socket along with a mechanical knee with a SACH foot on the Left side. On the Right side, he was using a thigh lacer type of prosthesis with a SACH foot.  

Clinical Examination Findings

 LEFT Hip: Patient has moderate weakness in the hip flexor and abductor muscles (Flexor strength grade 3-/5, Abductor strength grade 3+/5) as well as moderate weakness in the hip extensors and adductor muscles (Extensor strength 3-/5, Adductor strength 3+/5). Passive range of motion was within normal limits and active range of motion was limited to 90 degrees of hip flexion and 30 degrees of extension. 

Right Hip: Muscle strength was grade 5/5 for all muscles tested and the range of motion was within normal limits. 

Right Knee: Knee extensor muscle strength was grade 3+/5 while the knee flexor muscle strength was grade 5/5. Active and passive range of motion was within normal limits. 

Upper Extremities: For both right and left arms, muscle strength was 5/5 for all muscles tested and the range of motion was within normal limits. 

Patient's Gait Video:

Video of a patient with bilateral amputations, showing the sagittal and coronal views

Gait Deviations Identified with the G.A.I.T. Form

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Description of Intervention

Patient's Intervention

The initial gait assessment identified several deviations at the ankle, knee, hip and the pelvis. These deviations affected all the 5 gait functions of: 

(i) Balance/stability (as the patient is walking with a cane); 

(ii) Equality/symmetry (asymmetrical step length); 

(iii) Energy Conservation (trunk lean); 

(iv) Progression (forceful knee extension) and 

(v) Shock Absorption (limited knee flexion). 

Gait assessment also revealed that the majority of these deviations were due to prosthetic causes, i.e. due to the type prosthetic knee and foot used by the patient. 

  

As a result, the patient was prescribed a microprocessor controlled knee joint along with a dynamic response prosthetic foot. Along with the prosthetic components, physical therapy and gait training were also recommended to address the deviations at the hip and pelvis. The following video shows the patient’s gait with the prescribed prosthetic components. Note: there was a significant time difference (10+ years) between the initial and follow-up gait assessment of this patient. 

Patient's Video with a Microprocessor Knee and Dynamic Foot

Video of the patient with bilateral amputations with a microprocessor controlled knee and a dynamic response foot, along with physical therapy

Gait Deviations with Microprocessor Knee and Dynamic Foot

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Gait comparison - Before and After the Intervention

Change in Patient's Gait

Following the interventions, there was a significant improvement in the patient’ gait. The most notable improvement is the absence of a cane post-intervention. The patient’s balance and stability improved with the intervention, and he was able to walk not only without a cane, but also with symmetrical step length and stance time. There was also a moderate improvement in progression and shock absorption with the microprocessor knee. The energy consumption didn’t change after the intervention, as the patient was still walking with a trunk lean and a wide base of support. Overall, the intervention was effective as 3 out of the 5 functions showed improvement. The long period of time between the initial and follow-up gait assessments (10+ years) may have also contributed to the improved gait pattern.

  

It is recommended that the patient should continue with the same prosthetic components and seek physical therapy as needed. The deviations observed post-intervention, such as a wide base of support and trunk lean, are typical of bilateral amputees. These deviations may not see a significant improvement with therapy. 

Gait Comparison Chart - Pre and Post-Intervention Changes

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Gait Assessment Forms can be downloaded from Chapters 9 & 10

Chapter 9 - Gait assessment form
Chapter 10 - Gait Comparison Chart
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Chapter 12 - Case study on post covid neuropathy

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