Rehabilitation of a quadruple amputee with leukemia: A challenging endeavor

Abstract

Making a person with quadruple amputation walk again is a challenging task for the rehabilitation team. Quadruple amputation secondary to symmetrical peripheral gangrene is a rare clinical scenario posing challenges in rehabilitation. Literature regarding rehabilitation of persons with multiple amputations is limited. This case describes the rehabilitation of a 57-year-old lady suffering from acute myeloid leukaemia who underwent quadruple amputation. She had undergone bilateral transtibial and bilateral transradial amputation after vasopressor-induced symmetrical peripheral gangrene. In view of expected guarded level of functional independence, ambulatory independence was the primary goal at admission to Department of PMR. The various steps taken in rehabilitation and modifications made to assistive devices are described in this article. Challenges faced during various phases of training, and subsequent ambulation are detailed in this article. Overcoming limitations, the client was made to be an indoor ambulator with appropriate prostheses and mobility aids. She was partially independent for activities of daily life after in-patient rehabilitation. The background of leukaemia and subsequent chemotherapy also affected the rehabilitation of this patient. Although various studies have described cases of quadruple amputation rehabilitation achieving functional independence and ambulation, the absence of specific guidelines and protocols make rehabilitation of persons with multiple amputations inefficient. This case study also shows the need for personalized goal setting for persons with multiple amputations. Realistic goal setting, psychological counselling, and an interdisciplinary approach are imperative in rehabilitation of persons with quadruple amputation. Flexible functional scales specific to persons with multiple amputations are necessary to evaluate such persons objectively. Studies with larger sample size, longer follow-ups, and comprehensive review of existing literature are needed to standardize rehabilitation of quadruple amputation and evaluate the various factors that may affect rehabilitation outcome.