Acute Inpatient Rehabilitation Interventions and Outcomes for a Person With Quadrilateral Amputation

Introduction Functional outcome reports for people with quadrilateral amputation are not common in the rehabilitation medicine literature. The literature describing functional outcomes that does exist focuses primarily on people with a single or bilateral lower limb amputation. This case report chronicles the interventions and outcomes in a single person with amputation of all 4 limbs during an inpatient rehabilitation admission.

Case Description The patient was a 59-year-old woman who had a quadrilateral amputation after developing disseminated intravascular coagulation. Her medical history and initial physical therapist examination, along with preambulation interventions, gait training, and scores from the Functional Independence Measure (FIM), are described. The results of the 10-Meter Walk Test (10MWT) and the Six-Minute Walk Test (6MWT) illustrate her progress from novice ambulator to community ambulator over the course of 1 year.

Outcomes The patient achieved her goal of community ambulation with her prosthetic limbs. Her 10MWT and 6MWT results revealed significant improvement at the 1-year postdischarge follow-up.

Discussion Despite the high energy levels necessary to ambulate with bilateral prosthetic limbs, the patient achieved 86% of the predicted distance for her age and sex in the 6MWT. In addition, she more than doubled her FIM motor score from inpatient acute rehabilitation admission to discharge. Closed-chain exercise and a focused approach to this patient's preprosthetic training were part of her success in becoming a community ambulator.