Comorbidities in amputation: a systematic review of hemiplegia and lower limb amputation

Abstract

Purpose: The purpose of this review of the scientific literature was to investigate the incidence and prevalence of hemiplegia with lower limb amputation, and to identify outcomes following the dual disability of hemiplegia and amputation.

Methods: Electronic searching of the literature identified major studies examining the effects of hemiplegia on rehabilitation following amputation. Data were extracted and levels of evidence assigned for each subtopic area.

Results: The summary conclusions are Level 4 evidence. The prevalence of amputation and hemiplegia is 8-18% and amputation and hemiplegia occur most often in the same leg. Once individuals with hemiplegia and lower limb amputation are selected for prosthetic rehabilitation, rate of successful functional ambulation is greater than 58%. In general there is a lower rate of prosthetic success and independence with hemiplegia than without. Predictive factors associated with success include less severe hemiplegia, laterality of hemiplegia (ipsilateral and right side), transtibial level of amputation and absence of impaired mental function. There is wide variation in length of hospital stay, but a specialty multidisciplinary team reduces length of stay.

Conclusions: Patients with dual disability of hemiplegia and amputation generally benefit from a prosthetic rehabilitation program. Further study on predictive factors for outcome would be beneficial.

Implications for rehabilitation: • The prevalence of hemiplegia with lower limb amputation ranges from 8 to 18%, most frequently affecting the same leg. • The majority of patients attain successful functional levels of ambulation with prosthetic rehabilitation, although lower rates than nonhemiplegic patients. • Predictive factors associated with greater success include less severe hemiplegia, ipsilateral hemiplegia, transtibial level of amputation and absence of impaired mental function.