Attending Physician, Associate Professor Shirley Ryan AbilityLab Chicago, Illinois, United States
Case Diagnosis: A patient with severe decompensated heart failure and a left transtibial amputation began ambulating after placement of Left Ventricular Assistive Device (LVAD) using a K3 level prosthesis.
Case Description: A 60-year-old male with a left transtibial amputation and severe heart failure was admitted three separate times for inpatient rehabilitation. His initial course, after left transtibial amputation, focused on pre-prosthesis amputation management. His second course, after placement of his LVAD, focused on LVAD management and prosthetic gait training. We believed that he would be able to ambulate unlimited in the community and was prescribed a K3 level prosthesis. Under close LVAD parameter monitoring and the use of the Borg Scale to guide therapy sessions, he was trained successfully without any complications during his inpatient stay. He was discharged at a supervision level, and progressed to modified independent in the outpatient setting.
Discussions: Advanced heart failure plays a major role in preventing successful ambulation in those with a major lower limb amputation. There has not been any literature to show that a patient with a transtibial amputation and an LVAD can ambulate at the K3 level. Given the metabolic demand of ambulation with a transtibial amputation, there is concern than the physiologic demand may not be met by placement of an LVAD. Exemplified by this patient, we hope to show that patients with LVAD for severe heart failure and major low limb amputations can successfully ambulate with a K3 level prosthesis.
Conclusions: We hope to show that lower limb prosthetic gait training at the K3 level can be safely initiated and successfully completed in those with LVAD. As physiatrists, we can provide the patient with the opportunity to walk independently, regain their functional abilities, and to be an integral, functioning member of society.