Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 1
Disclosures: Punit M. Patel, DO: Nothing to disclose
Case Description: The patient underwent OHT, and 6 weeks later developed right lower extremity distal limb ischemia with associated compartment syndrome requiring right trans-femoral amputation. Pre-prosthetic training focused on residual limb healing under strict cardiac parameters of a transplanted heart.
Setting: Academic Acute Inpatient Rehabilitation Hospital
Patient: 50-year-old male status post orthotopic heart transplant (OHT) complicated by right lower extremity compartment syndrome requiring trans-femoral amputation.
Assessment/Results: The patient was admitted to inpatient rehabilitation with a K3 level prosthesis for training under strict cardiac monitoring and thorough warm up and cool down period. Having a denervated heart, a BORG scale (rate of perceived exertion) was used for monitoring metabolic demand and energy expenditure during therapy sessions with goal levels between 13-16. Within 3 weeks he was successful in his prosthetic training, at a modified independent level for mobility, without sustaining any cardiac complications.
Discussion: Following OHT, patients have lower exercise capacity and health-related quality of life compared to the general population. Typically, exercise restrictions are placed on these individuals because of a denervated heart, especially in the first year. Relevant to our case, unilateral transfemoral prosthesis increase the energy requirements for gait by at least 65% at half the normal walking speed. Balancing the need for prosthetic rehabilitation against the metabolic limits placed on this patient highlights a unique challenge to the physiatrist. By careful cardiac parameter monitoring and progression during the inpatient admission, we were able to successfully progress his mobility with the prosthesis in the setting of his cardiac limitations. Of note, this patient was highly motivated during therapies which is proven to show improved outcome with both cardiac rehabilitation and prosthetic training.
Conclusion: With close cardiac monitoring along with a highly motivated individual, this case can lead by example that patients with amputations and heart transplants can be K3 level community ambulators under the optimal settings.
Level of Evidence: Level V
To cite this abstract in AMA style:Patel PM, Reger C. A New Heart, a New Leg: Prosthetic Training for an Individual Following an Orthotopic Heart Transplant: A Case Report [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/a-new-heart-a-new-leg-prosthetic-training-for-an-individual-following-an-orthotopic-heart-transplant-a-case-report/. Accessed September 22, 2023.
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