Memory and executive function predict mobility rehabilitation outcome after lower-limb amputation. 2009

Brian F O'Neill, and Jonathan J Evans
West of Scotland Mobility and Rehabilitation Centre, Southern General Hospital, Glasgow, Scotland, UK. brian.oneill@sgh.scot.nhs.uk

OBJECTIVE Post-amputation rehabilitation is physically and cognitively demanding. Understanding which specific cognitive domains mediate outcome is critical to the development of interventions. METHODS A cohort undergoing post-amputation rehabilitation was assessed before limb fitting and followed up at 6 months (n = 34). The average age was 60.69 years (SD = 13.98). 82.4% of the sample was male. 79.4% had amputations because of peripheral arterial disease. Memory, visuospatial function, executive function, praxis, emotion and language were assessed at Time 1 (first prosthetic clinic attendance). Time 1 data were also gathered on aetiology, level of amputation, comorbidities, pain and demographics. Six month outcomes were the locomotor capability index (LCI), the special interest group in amputee medicine (SIGAM) mobility grades and self reported hours of use. RESULTS The LCI at 6 months was significantly predicted in regression analyses by a measure of visual memory (figure recall) (adjusted R2 = 24.8%, df = 32, zbeta = 0.52, p = 0.002. Hours of use were predicted by the verbal fluency test total (adjusted R2 = 17.1%, df= 26, zbeta = 0.45, p = 0.017). SIGAM mobility grades were predicted by a combination of immediate verbal memory (story recall), age, level of amputation and presence of pain (adjusted R2 = 58.2, df = 30, zbeta = 0.52, p = 0.000). CONCLUSIONS Neuropsychological and clinical variables predict a large amount of 6 month outcome variance. Cognitive difficulties may be considered mediators of poor outcome.

UI MeSH Term Description Entries
D007866 Leg The inferior part of the lower extremity between the KNEE and the ANKLE. Legs
D008297 Male Males
D008568 Memory Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory.
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D003072 Cognition Disorders Disorders characterized by disturbances in mental processes related to learning, thinking, reasoning, and judgment. Overinclusion,Disorder, Cognition,Disorders, Cognition
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000671 Amputation, Surgical The surgical removal of part of, or all of, a limb or other appendage or outgrowth of the body. Amputation,Amputation, Multiple, Surgical,Multiple Amputation, Surgical,Surgical Amputation Procedures,Amputation Procedure, Surgical,Amputation Procedures, Surgical,Amputation, Surgical Multiple,Amputations,Amputations, Surgical,Amputations, Surgical Multiple,Multiple Amputations, Surgical,Procedure, Surgical Amputation,Procedures, Surgical Amputation,Surgical Amputation,Surgical Amputation Procedure,Surgical Amputations,Surgical Multiple Amputation,Surgical Multiple Amputations
D000674 Amputees Persons who have lost part of, or all of, a limb or other appendage of their body. Amputee,Multiple Amputee,Multiple Amputees,Amputee, Multiple,Amputees, Multiple

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