Influencing factors and ambulation outcome in patients with dual disabilities of hemiplegia and amputation

Objective: To determine the ambulatory outcome and predictive factors of su ccessful ambulation training in patients with both hemiplegia and lower ext remity amputation. Design: A retrospective study. Setting: A rehabilitation center of a university hospital. Patients: Twenty-three patients with dual disabilities consecutively admitt ed to the rehabilitation center from 1984 to 1994. Main Outcome Measures: Ambulatory outcome was measured using physical thera pists' and physicians' notes at discharge or the last available clinical vi sit. Ambulation ability was graded as community and noncommunity ambulation , which included indoor ambulation and nonambulation. Several clinical feat ures were reviewed to assess their association with ambulation outcome. Results: About two thirds of the 23 patients could be trained to be ambulat ory: 10 (43.8%) achieved community ambulation and 5 (21.7%) achieved indoor ambulation. Of the clinical factors, only mental status showed a statistic ally significant association with good ambulation outcome (p <.05). When od ds ratios were considered,several factors, including mild motor involvement , transtibial amputation, amputation before cerebrovascular accident, age y ounger than 60 years, and the presence of ipsilateral hemiplegia and amputa tion, showed trends toward association with increased ambulation achievemen t, although these associations were not statistically significant. Conclusion: Impaired mental status seemed to be the most influential negati ve predictive factor of achieving community ambulation. If subjects with du al disabilities are properly selected, satisfactory results of ambulation G raining will be obtained.