Jill, the military soldier: Amputee Case Study

Title

Jill, the military soldier

Abstract

Jill is a logistics officer in the military. She lost her right leg in a car accident and had trouble realizing that she had to relearn the basics in order to succeed with her prothesis. After a lot of education and information, Jill began to realize that she needed to start from scratch in order to reach her goal of running again. It took a lot of patience and determination, but in the end, Jill was able to be a competitive athlete again.

Key Words

Transfemoral, military, depression, psychological issues, determination

Client Characteristics

Jill is a 39-year-old female logistics officer in the military. She was driving home from work one evening in a rainstorm when she hydroplaned and hit the guardrail. Shaken and confused, she got out of her vehicle and while trying to cross the road, was hit by an oncoming vehicle. Jill was rushed to the hospital where it was decided the best chance of survival was to amputate her right leg above her knee. She also sustained a nasty left ankle fracture and would have an open reduction, internal fixation of it at the same time as the amputation.

Jill woke up dazed and confused post amputation. She had also suffered a concussion and many bumps and bruises from the crash. Other than her injuries suffered in the accident, her medical status was unremarkable. She did have some issues with the scar on the stump healing, but when the doctor's amputated, they made sure they had lots of skin flap to help decrease the odds of major infection.

Jill was transferred to the rehabilitation wing when her stump and ankle had healed. She wanted to be running as soon as possible. She refused to work on basic skills such as transfers, balance and walking on a basic prosthetic, as she wanted to be further along than she was at all times. She was discharged based on her ability to complete her activities of daily living, and was referred to me 8 months post injury.

Examination Findings

Jill was irritated that she was told her gait was not ""good enough"" to warrant her a running leg. She was adamant that she wanted to run and that was her goal.

Her social support system included her husband and parents, who were all very supportive. They would either all be at appointments or take turns depending on work schedules. They were very well versed in amputee rehab and felt that in order for Jill to succeed, they would need to be involved on every little decision.

Gait:

  • Hip hike on the left to clear the right prosthetic leg.
  • Poor single leg balance on the right
  • Poor foot clearance after toe off.
  • Stump was healed well and the prosthetic fit snuggly. It was a vacuum seal which Jill said was the best for her to ""feel"" like she still had her leg.


Body Functions and Structures:

  • Right stump
  • Lack of dorsiflexion on left ankle joint


Impairments:

  • Weak right glut muscles, circumducts as she walks
  • Poor proprioception
  • Poor core stabilizers


Activity Limitations:

  • Unable to run
  • Unable to walk with normal gait pattern for longer than 1 minute
  • Unable to clear stairs in a normal pattern


Participation Restrictions:

  • Jill is unable to return to playing hockey and running


Environmental Factors:

  • Jill feels like she is not part of the team anymore. She cannot complete her normal Army training, take part in Unit fitness training, or return to her competitive sporting teams.

Clinical Hypothesis

Jill wants to skip the basics of learning to walk with a prosthetic leg and instead start running. She hasn't completely dealt with the fact that she is an amputee now who has to learn how to do things over again, but sees herself as an elite athlete who is above simple balance and gait exercises. She cannot reach her goals of running again until she comes to terms with being an amputee, and learning how to walk with a prosthetic.

Intervention

My sessions with Jill focused on a lot of education and making mundane exercises appear more advanced then they really were. After many sessions of explaining why we had to start with basic bridges, hip strengthening and gait training on stairs, we came to an understanding that in order for Jill to want to do it, we would make it into a competition. We would time and videotape our sessions, which allowed her to see why she was succeeding, or why she did not do as well as she had the session before. From this information, we were able to show Jill her weaknesses and would increase exercises to correct it.


We were able to utilize Bob Gailey's videos and books to allow Jill to watch and read on her own to see why we were doing what we were doing. If she liked a certain exercise she read about or saw, we would test her to see if she was strong enough to do it, and incorporate it into her program.

Outcome

Jill finally recognized that she couldn't skip the basics of rehabilitation just because she was fit and young. She needed to build on a base that started with the basics, and this would allow her to achieve her goal of running again. By speaking with her as an amputee athlete and not just as an amputee, she started to come around. She realized that we were all in agreement to get her running again so she could reach her goal, and that we were on her side, and not against her. This took some time for her to see this, but when she did, it made all our sessions that much better.

Jill would start every day by working on her balance, doing her basic core exercises and upper body strengthening. She became very focused on the basics so that when the time came, she would be ready physically to face the challenge of running on a prosthetic running leg, or blade.

Jill became an advocate for other amputees and explained the importance of the basics being so important in an amputee's independence. She really understood why we were doing the training we were with her and it made her reach her goal sooner than we all thought.

Discussion

Jill was a very active and fit woman who had a demanding job. She was part of the military and was proud of her ability to be a soldier alongside her male and female peers. When this accident occurred, her entire self-identity was thrown for a loop and she did not know how to handle the loss of her limb, and the person she used to be. After consultation with psychologists, she was able to start to learn to rebuild herself with this new identity[1].

Her interest in running again helped her be able to find the courage and the determination to start the long road to recovery. She enjoyed the aspect of still being referred to as an athlete, and she found the part about becoming an amputee athlete encouraging for her future endeavors[2].

Once Jill realized that she had to start focusing on the basics, her gait pattern improved dramatically, and she wasn't as tired as she used to be after working with her prosthesis[3]. The use of videotaping her gait also was of benefit as it gave her instant feedback and how she looked when she walked with her prosthesis, and showed her where her muscle weakness was.

Overall, Jill did very well with her rehabilitation, and has returned to work and is training for triathlons. She is happy, and enjoys her training. She takes great care of her residual limb and when in doubt, she seeks my help.

References

  1. Engstrom textbook Chapter 3 (pages pp. 68-92) Psychological impact of amputation
  2. Bragaru M, Dekker R, Geertzen JH, Dijkstra PU. Sports Med 2011, Sep 1; 41 (9): 721-40
  3. Gait deviations in amputees. www.physio-pedia.com/gait_deviations_in_amputees. Viewed on 11 Jul 15