Fitting with an electronic knee for a schizophrenic patient with bilateral amputation of lower limbs: What's the point?

OBJECTIVE: The replacement of a mechanical knee with prosthetic class I foot fitting by an electronic knee with prosthetic class II foot was proposed to a 54-years-old schizophrenic patient, active, with right femoral and left tibial traumatic amputation. This fitting evolution was assessed both quantitatively and qualitatively.

OBSERVATIONS/METHOD: Compared evaluation of electronic knee with prosthetic class II foot versus mechanical polycentric knee with prosthetic class I foot (fitting unchanged moreover) in: - functional abilities and quality of life using standardized scores (Functional Ambulation Classification, Houghton, Functional Independence Measurement, B.A-BA, MOS-SF36), satisfaction VAS, walking perimeter, stair climbing abilities, crutches use; - walking and balance analysis using GAITRITE system, stabilometric platform, Get up and Go test.

RESULTS: Functional abilities: walking perimeter was increased by approximately 2km; walking outdoors was now performed with a single crutch; walking indoors without crutches was made possible on short perimeter, leaving both hands free for everyday or leisure tasks; walking downstairs was realized in a continuous sequence of steps. Quantified analysis of gait and balance: spatiotemporal parameters recorded on GAITRITE with 1 single crutch improved (speed, cadence, step length and support time), no improvement with 2 crutches. No improvement in static balance recorded on stabilometric platform. Get up and Go test improved (14.85 s vs. 19.77 s with mechanical knee). Standardized scores: improvement of Houghton's score (10/12 vs. 6/12), of FAC score (7/8 vs. 6/8), of B.A-BA (15/20 vs. 13.6/20). Slightly modified FIM score (123/126 vs. 120/126), yet there is an improvement of the SF36-MOS for physical scores (55.8/100 vs. 43.1/100) as well as mental scores (64.3/100 vs. 47.1/100). Global satisfaction improved (90/100mm vs. 32/100mm) using the VAS.

DISCUSSION/CONCLUSION: This new fitting allowed an objective improvement of walk and quality of life. Compliance for the new femoral prosthesis is total although this schizophrenic patient was not spontaneously asking for prosthetic improvement initially. This is pleading for a systematic information of active patients, even non-demanding ones but regularly followed and evaluated, on fitting techniques evolution that might improve their daily lives.