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Case Report - 2800: Tracking Functional Development
II. Case Presentation
III. Discussion
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III. Discussion

The subject was able to achieve mobility much sooner than other patients who displayed the same type of hip flexion contracture.    The widely-used physical therapy interventions for hip flexion contracture were utilized with this patient: backlying with neutral hip extension, lying prone with six inch diameter rolled towel placed under the patient at mid-femur, and stretching in the form of forward pelvis rotation while in approximate midstance.  After low-load continuous stretching, more aggressive contract-relax exercises were employed to lengthen the hip flexor.  These exercises reduced the angle of the hip by 5° after the first session.  Use of sagittal isometric contract-relax treatment of a contracted muscle with an amputee was not found in the literature review.  Traditionally, the flexion contracture can only be addressed therapeutically, but the recent development of the Flexcon offset plate allows the prosthetist to immediately reduce the negative effects of flexion contracture on gait, so the patient can begin gait training with the prosthesis much sooner.  Therapeutic interventions continue, and as seen with this patient, the Flexcon plate is removed when the patient has improved range of motion at the hip.

IV. Consent

Written informed consent was obtained from the patient for publication of this case report and accompanying images.  A copy of the written consent is available for review by the Editor-in-Chief of this journal.

IV. References

1.     Gailey R, Allen K, Castles J et al. Review of secondary physical conditions associated with lower-limb amputation and long-term prosthesis use. Journal of Rehabilitation Research and Development. 2008; Vol. 45, No. 1: 15-30.

2.     Deans S, McFadyen A, Rowe P. Physical activity and quality of life: A study of a lower-limb amputee population. Prosthetics and Orthotics International. June 2008; 32(2): 186-200.

3.     Van der Linde H, Hofstad C, Geurts A et al. A systematic literature review of the effect of different prosthetic components on human functioning with a lower-limb prosthesis. The Journal of Rehabilitation Research and Development. July/August 2004; Vol. 41, No. 4:555-570.

4.     Ip, David. Orthotic rehabilitation, assessment, and enablement. 1st edition. New York: Springer; 2007:647.

5.     Taylor S, Kalbaugh C, Cass A et al. ‘Successful Outcome’ After Below-Knee Amputation: An Objective Definition and Influence of Clinical Variables. The American Surgeon. July 2008; Vol. 74:607-13.

6.     Munin M, Guzman M, Boninger M et al. Predictive factors for successful early prosthetic ambulation among lower-limb amputees.  Journal of Rehabilitation Research and Development. July/August 2001; Vol. 38 No. 4:379-84.

7.     Kendell C, Lemaire ED, Dudek NL et al. Indicators of dynamic stability in transtibial prosthesis users. Gait Posture. March 2010; 31(3):375-9.

8.     Gauthier-Garnon C, Grise M. Tools to Measure Outcome of People with a Lower Limb Amputation: Update on the PPA and LCI. Journal of Prosthetics and Orthotics. 2006; 18:1.

9.     Condie E, Scott H, Treweek S. Lower Limb Prosthetic Outcome Measures: A Review of the Literature 1995 to 2005. Journal of Prosthetics and Orthotics. 2006; 18:13. \

10.  Lawton, M.P., and Brody, E.M. “Assessment of older people: Self-maintaining and instrumental activities of daily living.” Gerontologist 9:179-186, (1969).

11.  Esquenazi, Alberto. Amputation rehabilitation and prosthetic restoration.  From surgery to community reintegration. Disability and Rehabilitation. 2004; Vol. 26, No. 14/15:831-6.

Appendix I.  Details of Patient’s Prosthetic Components

Component

Manufacturer

Part #

Quantity

Vacuum Chamber Socket Design

Prosthetic Design, Inc.

AK-4

1

EVLS Locking Kit

Prosthetic Design, Inc.

EVLS-CAUC

1

Custom Seal-Mate Liner

Prosthetic Design, Inc.

SM-CUST

1

Vacuum Manifold with Release Valve

Prosthetic Design, Inc.

EV-MAN-VLV

1

Aura Locking Sheath

Evolution Industries, Inc.

HSSN-8-18-6

1

Manual Locking Knee

Otto Bock

3R41

1

Rotating Receiver

Otto Bock

4R51

1

30mm Pylon

Prosthetic Design, Inc.

P30

1

15° Flexcon

Prosthetic Design, Inc.

FC15-TD12CFI

1

Offset Plate

Prosthetic Design, Inc.

OP3/4-4C4TCF

1

Multiflex Foot Size 26cm

Endolite

519128

1

Appendix II. Instrumental Activities of Daily Living Scale by M.P Lawton and E.M. Brody (attached below)

Attachments:
FileDescriptionFile size
Download this file (2800 Apendix II.pdf)2800 Apendix II.pdfInstrumental Activities of Daily Living Scale79 Kb
Download this file (2800 edit.pdf)Case Report - 2800 (PDF format)Download this case report as a PDF document.2355 Kb


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