HOW TO MEASURE BILATERAL AMPUTEE?1. Use Antropometric data.

Anthropometry is the study of the measurement of the human body in terms of the dimensions

of bone, muscle, and adipose (fat) tissue. Measurements of these fat tissues are also important because

individuals with large values are reported to be at increased risks for hypertension, adult-onset diabetes

mellitus, cardiovascular disease, gallstones, arthritis, and other disease, and forms of cancer

2. Use the BMI Calculator Tool Enter your height and weight using standard or metric measures. Weight must be taken without use of prosthesis, walker or wheelchair. When determining height, if you are a bilateral lower-limb amputee, use pre-amputation height. Select your level of amputation. Click the “Calculate” button and your BMI will be generated.

Important body segment and whole body parameters;

Dimensions (e.g., length, density, and mass) Segmental center of mass location Whole-body center of mass location Moment of inertia (angular inertia

FITTING AND TRAINING THE BILATERAL LOWER-LIMB AMPUTEE

The bilateral lower-limb amputee presents a special challenge to:Provide a degree of mobility, that would provide a normal place in society.Patients with high-level amputations or congenital limb deficits can

occasionally walk without a prosthesis by using crutches and a swing-through gait.

This requires very good trunk and upper-body strength, sense of balance, and muscle control.

In most cases, assistive devices are necessary to stand, walk and to move from place to place.

The remarkable degree of functional restoration permits the bilateral leg amputee to participate in his normal activities of daily living that helps to overcome his physical handicap.

FITTING The volume of the residual limb is expected to decrease rapidly in the near

future or if a gradual reduction of joint contractures will require repeated prosthetic realign-ment.  This is common in simultaneous bilateral amputees who cannot advance their weight bearing as quickly as unilateral patients.

Component choice is carefully prescribed in consideration of the particular patient's needs. Patient comfort will make the decisive difference between acceptance and rejection of the prosthesis and is therefore a high priority.

Example

 A, 92-year-old male with peripheral vascular disease and well-healed bilateral transtibial amputations. B, preparatory en-doskeletal prostheses with SACH feet and light fiberglass cast sockets. C, definitive bilateral supracondylar, suprapatellar hard sockets with removable medial wedge suspension and standard SACH feet.

IMPROVING OUTCOMES FOR BILATERAL AMPUTEES: A GRADUATED APPROACH TO PROSTHETIC SUCCESS

GOALS

Figure 3: Anatomically contoured transfemoral sockets accommodate the bone, muscle, vascular, and nerve structures of the residual limbs.

Phase 2: Walking on Short Legs ("Shorties") with Training Feet

- After many years of clinical experience, the authors have come to believe that it is counterproductive to expect bilateral transfemoral amputees to move directly from a wheelchair to wearing full-length prosthetic legs.

-  A more practical and realistic step is to focus on getting patients out of the wheelchair by fitting them initially with short prosthetic legs with custom-designed training feet.

- The absence of pylons and knees have numerous benefits, including stabilizing balance and reducing the risk of injury from falls.

- Patients will experience significant energy expenditure as they begin walking on "shorties," it still requires substantially less energy than walking on full-length legs.

- Using short legs without prosthetic knees can reduce heart rate and oxygen use by 7-23 percent and can increase walking speed by up to 25 percent.

Anatomically contoured transfemoral sockets accommodate the bone, muscle, vascular, and nerve structures of the residual limbs.

prosthetic facilities that train patients on short legs, it is often customary to use actual prosthetic feet that are turned backwards, providing less forefoot for the person to deal with while learning to walk.

Some patients feel unsafe and discouraged by the appearance of backward foot. In the graduated-fitting approach, the small training feet that are custom made for each patient receive a

favorable response and also increase functional ability By committing to the use of shorties all day, every day, patients quickly improve their physical condition

and develop daily routines that do not involve a wheelchair.

Patients may believe that using a wheelchair will be better.  Though this may be true, it actually works against their goal of becoming independent prosthesis users. Sitting in a wheelchair puts them in a position that can cause flexion contractures in the residual limbs.

Encouraging patients to stop using a wheelchair completely and wear the shorties full time, regardless of how long it might take to do certain tasks, is one way that family members and friends can help patients make progress.

An ongoing physical therapy program should continue and will also help patients improve their mobility on shorties.

REFERENCES https://www.oandp.org/AcademyTODAY/2009Mar/2.asp http://www.betterlimbs.com/_uls/resources/downloads/Transtibial_Manual-2.

pdf https://books.google.co.th/books?id=2KIqqHS5fVoC&pg=PA189&lpg=PA189

&dq=TSB+supracondylar&source=bl&ots=k6tR8s9hjK&sig=U1f_zexkWFCgdQXnv3099EhHnx4&hl=en&sa=X&ved=0ahUKEwjVnbGB3Z3MAhVEj5QKHZfTCrgQ6AEIODAG#v=onepage&q=TSB%20supracondylar&f=false

http://www.oandplibrary.org/alp/chap24-01.asp?mode=print