Physical therapy and occupational therapy management of a person with bilateral transradial amputations: a case report

Figures & data

Table 1. Patient background information.

Demographics and social history	Description
Past medical history	Thoracolumbar spinal fusion 2019, latent syphilis, coronary artery disease, obesity, end stage renal disease on hemodialysis, diabetes mellitus—type 2, hypertension, neuropathy
Precautions	Non-weight bearing to distal left residual limb (progressed to weight-bearing as tolerated during her stay) Limb restriction: Dialysis access left UE fistula
House type	Single level home
Home entrance	Four steps with bilateral rails; steep ramp available
Lives with	Alone prior to amputations; sister temporarily assisting^a
Currently owned assistive devices	Rollator for community ambulation Single point cane for household ambulation Rolling walker
Prior level of function	Assist with bathing, dressing, toileting* Otherwise independent

^aSince right transradial amputation.

This table lists the patient’s pertinent medical and social history, as it relates to her plan of care.

Table 2. Evaluation and discharge measurements.

Measurement	Evaluation	Discharge
Pain	4/10	3/10
Sensation	Baseline peripheral neuropathy, but sensation intact to light touch at residual limbs and feet	Baseline peripheral neuropathy, but sensation intact to light touch at residual limbs and feet
Proprioception	Intact—tested at great toe	Intact—tested at great toe
LE MMT	Globally 3+/5 Hip abduction 3–/5	Globally 4–/5
UE MMT	Globally 4/5 on R Globally 4–/5 on L	Globally 4/5 on R Globally 4/5 on L
Supine to/from sit	MinA^a	Independent
Sit to/from stand	MinA	Independent
Transfer (bed to/from chair)	MinA—stand step	Independent—stand step with rollator
Gait	MinA ×80 ft 6 min walk test: 80 ft	Independent ×200 ft with rollator 6 min walk test: 300 ft with rollator and supervision, but variable due to fatigue from dialysis
Stairs	ModA^b ×4 steps with left rail for forearm support	Min-modA ×4 steps with left rail for forearm support
Standing balance	Contact guard-MinA for trunk/pelvic stability Excessive lateral trunk motion due to weakness Timed up and go: unable 5 time sit to stand: unable	Independent with one UE support on rollator while reaching moderate-maximal excursions Timed up and go: 14 s 5 time sit to stand: 14 s
Grooming	Dependent for combing hair and brushing teeth, ModA for washing face	Independent for oral hygiene and washing face, MinA-ModA for combing hair
Bathing	Dependent at transfer-tub bench level	MinA-modA at transfer-tub bench level
Dressing	Dependent for UBD and LBD, including footwear	Supervision for footwear management, Set up MinA for t-shirts, modA for bras, maxA^c for LBD
Toileting	Dependent for hygiene and pants management	MaxA for hygiene. MaxA for pants management
Eating	Dependent	Independent with use of universal cuff

^aMinimal assistance.

^bModerate assistance.

^cMaximum assistance.

This table details the patient’s functional and impairment-level measurements that were taken upon initial evaluation and discharge.

Figure 1. UE prosthesis apparatus. Based on the positioning of the ring harness, straps, and triceps cuff on the posterior torso and upper arm, scapular protraction will increase tension on the control cable. This tension on the control cable facilitates opening of the mechanical hook. A neutral scapula slackens the control cable and the mechanical hook closes. Scapular retraction will allow the mechanical hook to remain closed. Upper Limb Prosthesis Devices. Teodiano Freire Bastos-Filho, Dinesh Kumar, Sridhar Poosapadi Arjunan. Devices for Mobility and Manipulation for People with Reduced Abilities (Rehabilitation Science in Practice Series). Poosapadi Arjunan, Sridhar; Kant Kumar, Dinesh; Bueno, Leandro; Villarejo Mayor, John J.; Bastos Filho, Teodiano F, 2014, by permission of Dr. John Jairo Villarejo Mayor. This image is not covered by the terms of the Creative Commons license of this publication. For permission to reuse, please contact the rights holder.