The Rehabilitation of a Traumatic Above-elbow and Bilateral Above-knee Amputee: A Case Report

Case Diagnosis: A 52-year-old female with a history of traumatic above-elbow and bilateral above-knee amputation initially thought not to be a prosthetic candidate who progressed to a contact guard level of ambulation with bilateral prostheses

Case Description or Program Description: Patient had a history of left above-elbow and bilateral above-knee amputations in 2011 after a trauma in which she was a pedestrian struck by a motor vehicle. She completed an inpatient rehabilitation program after her accident and subsequently followed with the outpatient amputee clinic. Initially she was thought not to be a prosthetic candidate given the extent of her amputations, however over the years her mobility significantly improved and she became independent at a wheelchair level with the ability to transfer without assistance. She was deemed a K1 prosthetic user and was prescribed a bilateral prosthesis with a locked single axis knee. She was admitted to an inpatient rehabilitation program for prosthetic training.

Setting: Tertiary care hospital

Assessment/Results: At the time of discharge from inpatient rehabilitation, the patient was ambulating with minimal assistance of 1 person and wheelchair follow-up. She was able to transfer sit to stand with minimal to moderate assistance. Upon discharge she continued outpatient physical therapy and progressed to walking contact guard with a center-handled walker.

Discussion (relevance): An upper extremity amputation combined with bilateral lower extremity amputation is rare and requires significant energy expenditure to ambulate with prosthetic limbs. During the rehabilitation of a triple amputee it is important to take the individual patient into account and to realize that goals may change. While a patient may not seem to initially be a candidate for prostheses, this can evolve over time with long-term follow up.

Conclusions: Traumatic triple amputation is rare and presents a challenge in the rehabilitation of these individuals. It is important to reassess whether an individual may be a candidate for prostheses as this may change with time and can result in improved quality of life and independence.