Pre-Prosthetic Rehabilitation Involving Strength and Positional Tolerance for the Complex Geriatric Amputee: A Case Report

Background: Pre-prosthetic rehabilitation guidelines directing the treatment of geriatric amputees remain under-represented in the literature, especially secondary to other medical and musculoskeletal conditions. Rehabilitation prior to prosthetic prescription most commonly occurs in the inpatient rehabilitation setting. Care involves strengthening of residual limb and sound limbs, balance training, and positional tolerance. Case Description: This case report highlights the treatment of a sixty-five-year-old patient who underwent a transmetatarsal amputation followed by a below the knee amputation (BKA) due to poor wound healing. Evidenced Based Treatment: Treatment involved integrated strengthening and positional tolerance to develop proximal muscular stability as well as balance training for future prosthetic use. Outcome Measures: The primary outcome measure used to assess functional mobility and self-reliance in this case study was the Functional Independence Measure (FIM). The patient demonstrated improvement in all sections of mobility and maintained or improved in all areas related to activities of daily living. Discussion: Prior to the prescription of a prosthetic device, physical therapy plays a vital role in preparing the amputee for normal gait mechanics and performance of functional activities. Additionally, the current literature does not address modifications required when musculoskeletal conditions, such as osteoarthritis, impact the patient’s care. It is the role of the physical therapist to formulate a plan of care centered around improving quality of life based on patient presentation