Neuropsychological functioning and prosthetic and psychosocial rehabilitation outcomes in people with lower limb amputations

摘要

People with lower limb amputations often face challenges in rehabilitation and returning to normal living. Peripheral vascular disease and diabetes are the most prevalent precipitating causes of lower limb amputation in economically developed countries. Both of these aetiologies are associated with a range of deficits in cognitive functioning. Deficits in cognitive functioning have the potential to impact rehabilitation engagement, and rehabilitation outcomes. The first aim of the present research was to establish a comprehensive profile of cognitive functioning in people engaged in lower limb amputation rehabilitation.The second aim was to examine relationships between selected cognitive functions, rehabilitation engagement, and prosthetic, mobility, and psychosocial rehabilitation outcomes. Comprehensive neuropsychological data was collected from 87 participants with lower limb amputations on admission to comprehensive rehabilitation.udProsthetic (use, satisfaction), mobility, and psychosocial (activation, adjustment, distress, social support, community participation) outcomes were examined at discharge, six months, and 12 months post-discharge. Clinician-rated rehabilitation engagement was examined at discharge. Impairments in overall cognitive functioning, estimated premorbid cognitive functioning, reasoning, psychomotor function, information processing, attention, memory, visuospatial functions, language, and executive functions were evident. Aetiology was not related to cognitive functioning. Outcomes were generally longitudinally stable. Higher rehabilitation engagement was related to favourable discharge and six month outcomes, and higher overall cognitive functioning, information processing, delayed recall, and visuospatial construction abilities (but not cognitive flexibility or planning). Generally, cognitive functions were not predictive of rehabilitation outcomes when controlling for rehabilitation engagement. Findings support the need for cognitive screening at rehabilitation admission, including of persons with non-dysvascular amputations. Administration of comprehensive neuropsychological assessment with a battery sensitive to cerebrovascular disease sequelae is recommended. Rehabilitation engagement may be a potentially modifiable contributor to outcomes. Cognitive functioning is a potential intervention point for improvement of rehabilitation engagement. Understanding precise relationships between outcomes and executive functioning warrants further research.