Energy expenditure of wheeling and walking during prosthetic rehabilitation in a woman with bilateral transfemoral amputations

Objective: To compare the energy expenditure of locomotion by wheelchair wi th that required for prosthetic ambulation in a person with bilateral trans femoral (TI;) amputations. Design: Observational, single patient, descriptive. Setting: An 80-meter longs rectangular hallway in a rehabilitation unit. Patient: A 41-year-old woman with bilateral TF amputations that were pel fo rmed 79 days before her admission to the rehabilitation unit. Main Outcome Measures: The oxygen uptake, oxygen cost, heart rate, speed, c adence, and stride length of walking measured during a il-month course of p rosthetic rehabilitation. Five locomotion conditions were evaluated. (1) wh eelchair propulsion, (2) walking with short-leg prostheses (stubbies) and a walker, (3) long-leg prostheses and a walker, (3,) long-leg prostheses wit hout knee mechanism and axillary crutches, and (5) long-leg prostheses with light polycentric knee and left locked knee and axillary crutches, A porta ble and telemetric system was used to measure the metabolic parameters. An arm ergometry graded exercise test was performed at the end of rehabilitati on, Results: Oxygen cost (range, 466%-707% of that of whet ling) and heart rate (range, 106%-116% of that of wheeling) were higher during walking with var ious combinations: of prostheses and walking aids. The speed of prosthetic walking was only 24% to 33% of that of wheeling. Our patient preferred usin g a wheelchair to prosthetic walking after discharge. Conclusions: People with bilateral TF amputations require very high cardior espiratory endurance to fulfill the energy demand during prosthetic rehabil itation. The high energy cost of prosthetic walling will limit its applicat ion in daily activities.