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 with that required for prosthetic ambulation in a person with bilateral transfemoral (TF) amputations. Design: Observational, single patient, descriptive. Setting: An 80-meter long rectangular hallway in a rehabilitation unit. Patient: A 41-year-old woman with bilateral TF amputations that were performed 79 days before her admission to the rehabilitation unit. Main Outcome Measures: The oxygen uptake, oxygen cost, heart rate, speed, cadence, and stride length of walking measured during a 4-month course of prosthetic rehabilitation. Five locomotion conditions were evaluated: (1) wheelchair propulsion, (2) walking with short-leg prostheses (stubbies) and a walker, (3) long-leg prostheses and a walker, (4) long-leg prostheses without knee mechanism and axillary crutches, and (5) long-leg prostheses with right polycentric knee and left locked knee and axillary crutches. A portable and telemetric system was used to measure the metabolic parameters. An arm ergometry graded exercise test was performed at the end of rehabilitation. Results: Oxygen cost (range, 466%-707% of that of wheeling) and heart rate (range, 106%-116% of that of wheeling) were higher during walking with various combinations of prostheses and walking aids. The speed of prosthetic walking was only 24% to 33% of that of wheeling. Our patient preferred using a wheelchair to prosthetic walking after discharge. Conclusions: People with bilateral TF amputations require very high cardiorespiratory endurance to fulfill the energy demand during prosthetic rehabilitation. The high energy cost of prosthetic walking will limit its application in daily activities.