To characterize the type and magnitude of lower extremity
physical performance deficits in military service members who have undergone rehabilitation after limb salvage
or transtibial amputation
Level I trauma
military medical and rehabilitation center.
Service members with lower extremity trauma
resulting in limb salvage
(n = 20) or unilateral transtibial amputation
(n = 14) compared with uninjured actively training service members (n = 123).
Control participants and individuals with amputation
were tested during a single session. Participants with limb salvage
were tested with and without the use of a custom carbon fiber orthosis
Main Outcome Measurements:
Physical performance as measured using four-square step, sit-to-stand 5 times, and timed stair ascent tests. Secondary outcomes included the associations between these lower extremity
activity measures to determine the interrelationship of activity limitations.
The ability of service members to rapidly ascend stairs, a demanding lower limb mobility task, is limited after amputation
and limb salvage
. However, performance on an agility test similar to the four-square step test approximated normative levels. Differences between individuals with amputation
or limb salvage
were less than 1 second for all tests and were not statistically significant. Correlations were observed among the physical performance measures
in the tested patient populations, particularly between the sit-to-stand and timed stair ascent tests.
Severe limb trauma
significantly affects performance, particularly during tasks requiring lower extremity
strength and power. Individuals with amputation
or limb salvage
who were provided a custom carbon fiber orthosis
and intensive rehabilitation had similar performance.
Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.