Expert Discusses New Approaches to Improve Outcomes for Bilateral Amputees

ORLANDO, Fla. — With a war still raging in Afghanistan and a number of troops still in Iraq, young men and women continue to come home with severe amputations, many upper and lower extremity bilateral. The people need to have support, motivation and strength to improve their quality of life, according to a presenter here.

“Each individual has a vision,” Kevin Carroll, MS, CP, FAAOP, vice president of prosthetics at Hanger Orthopedic Group Inc., said at the 2010 American Orthotic and Prosthetic Association National Assembly in Orlando. “Their vision is that they will get up and move.”

But what does it take to accomplish that? Carroll explained that in order to eventually walk, lower extremity bilateral amputees must strengthen their upper bodies and improve their conditioning. Sometimes we forget the amount of pain an amputee has to endure during the rehabilitation process, he said.

“Many of the older ones fail during rehabilitation, the younger ones too,” Carroll explained. “We would not think of the younger one failing. Their core muscles are going to be weak. They cannot just get up and go. They go right to their wheelchairs.”

If a practitioner notices the patient is donning their prosthesis less and less and seems unmotivated, Carroll recommended giving the patient short legs. Although their muscles may still be weak, they can get up and walk on short legs immediately.

“They would roll into the office with their wheelchairs and then walk out,” Carroll said.

While this may help with their confidence, when the patient tries to walk on long legs, it is almost an absolute certainty that they will fall, according to Carroll.

“They put their long prostheses on and then they will fall,” he said. “It is just like taking the training wheels off your bicycle.”

In order to protect the patient’s health, Carroll recommended that the patient learn to fall.

“You cannot avoid the ground,” Carroll said. “But you have to move forward. Get them past the fear of falling. Get them out to the golf course to learn how to walk steep inclines. Get them on ramps and stairs. These things are unavoidable. The faster they lose their fear, the faster they will gain confidence.”

Once they conquer going down steps, make them walk back up, Carroll recommended.

“What does it take? Determination and commitment,” he said.

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