Renee Wenger, MPT, CLT, MBA and Lisa Sibits, MPT
Patient is a 71 year old male s/p L BKA who presented to OP PT five months after his amputation. PMH includes osteoarthritis, L BKA: 3/10/10, L TKR: 1/15/10. Please note that this patient did not have any pain complaints throughout his OP PT sessions, although he did have one episode of L knee catching sensation and often commented about fatigue and/or a heaviness in his L LE during ambulation.
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Patient had ROM goals established at the time of his initial evaluation (8/9/10):
- Increase L knee extension flexibility to -63 degrees supine to optimize LE alignment for improved fit of prosthesis
- Increase L hip extension flexibility to – 20 degrees sidelying to optimize LE alignment for improved fit of prosthesis
- PT able to perform LE stretching therex frequently throughout the day with assist of family members as needed
Progressed to the functional goals below when prosthesis was ready (10/26/10):
- Patient will perform sit to stand from 18? chair without arm support with modified independence with LBQC with equal foot position (L/R)
- Patient will ambulate for 6 minutes for total of 500 feet with LBQC with supervision on level surfaces with L LE prosthesis
- Patient will perform Four Square Step Test with LBQC in 1 minute
- Patient will perform timed up and go with LBQC in 20 seconds
Functional outcome measures noted below were tracked pre-, 4 weeks post- and 6 weeks post-initiation of AlterG during OP PT:
- Timed Up and Go
- 6 Minute Walk
- Amputee mobility predictor
- Four Square Step Test
- Patient-Specific Functional Scale
History / Progression
Patient was initially seen in OP PT for his below the knee amputation rehabilitation approximately two times per week for eight weeks with emphasis on increasing PROM/AROM of L hip extension and L knee extension to decrease contractures, improve fit of prosthesis, and increase performance and independence with functional mobility at an ambulatory level. The patient’s OP PT was transitioned to more functional mobility once patient’s L LE below knee prosthesis was ready at seven months post-op. Patient initiated ambulation with AlterG for his physical therapy exercise the following weeks and was intended to continue AlterG two times per week for four weeks with the goals of increased gait speed, improved endurance/tolerance for ambulation, and better gait mechanics on level surfaces. Due to weather and a scheduling error, patient completed eight sessions on AlterG within six weeks and was extended for four additional sessions on AlterG within three weeks for a total of 12 sessions on AlterG. See table below for details re: AlterG parameters utilized during OP PT sessions.
The patient was seen for a total of 11 physical therapy sessions for the above described treatment, 1-on-1 with the physical therapist. In addition, he attended 7 sessions for exercise and AlterG walking. He achieved post-operative knee ROM of 0/125. He had a good gait pattern and good strength of his R LE after physical therapy. He was able to climb stairs with proper gait mechanics. He was able to work without increased in pain or swelling.
Pain level at initial evaluation was 4/10 and decreased to 0/10 upon discharge. He felt ready to begin his return to the golf course at 8 weeks post-op. The rehabilitation program incorporating the AlterG enabled this patient to return to golf and pain-free function faster than similar patients on a traditional rehabilitation program.
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