Slow rehabilitation of a traumatic lower limb amputee

A 65-year-old male (GM) was referred to the physiotherapy department of the regional limb fitting centre for outpatient rehabilitation following a right transfemoral amputation five weeks previously. He had been knocked down by a bus and suffered a crush injury to the right leg resulting in a stable fracture to the right pubic ramus, a fractured skull and orbital bone. Immediately following admission to the local district general hospital, his right leg was amputated at the transfemoral level. He was nursed post-operatively in ITU for three days and was ventilated during this time. GM was then transferred to the general orthopaedic ward. He received physiotherapy throughout his hospital stay by ward-based physiotherapists--not experts in amputee management but with access to specialist advice. Early physiotherapy was primarily concerned with respiratory care and maintenance of limb mobility and function in bed. Gentle, active stump exercises were commenced on the first post-operative day. GM sat out of bed on the sixth day and stood with the support of two people on the eighth day. His wound was healing well and treatment in the physiotherapy gym began the same day. Use of the pneumatic post-amputation mobility aid (PPAM aid) (Redhead, 1983; Marks, 1996) was started on day nine. However, progress with this early walking aid (EWA) was slow and GM achieved independent walking using parallel bars on the eighteenth post-operative day.