Case Report: Decreased Heart Rate in a Geriatric Client Following Physical Therapy Intervention and Accommodation With the C-Leg

In this case report, a deconditioned, 82-year-old man underwent transfemoral amputation secondary to chronic infection after knee resurfacing. He was initially fit with a nonmicroprocessor knee as part of the preparatory prosthesis. Nine months after amputation, he was fit with a C-Leg as a component of the definitive prosthesis. As part of the first year of rehabilitation, the patient underwent four separate physical therapy (PT) programs that included strengthening, conditioning, and patient education interventions. Following accommodation on each of the two prostheses, the patient performed a distance-based, 75 m fastest possible walking speed test while wearing a heart rate (HR) monitor. HR, target HR, gait velocity, and physiologic cost index were measured or calculated to determine the physiologic outcomes of rehabilitation. There was a marked decrease in both resting and working HR after the fourth PT program and accommodation to the C-Leg. Target HR was also more appropriate after rehabilitation, which confirmed the decreased HR response. Because of the magnitude of HR reductions while resting and working, it is possible that the patient gave a submaximal effort in addition to experiencing a training effect. The physiologic cost index seemed to diminish the difference observed in HR because of the structure of the equation and was not found to be complementary to the HR data. As a result of PT intervention, the C-Leg knee prosthesis, and personal goals, the patient retained the ability to care for his dependent wife in the home.