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By John F. Sarwark (ed.)

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Therefore, many transfemoral amputees never become very proficient with a prosthesis or may find wheelchair ambulation more efficient. The weight of a transfemoral prosthesis acts as an anchor and makes transfer more difficult. Therefore, to be a candidate for a prosthetic limb, a high-level amputee should have three skills: (1) the ability to independently transfer from bed to chair; (2) the ability to independently rise from sitting to standing; and (3) the ability to ambulate up and down parallel bars with a onelegged gait.

Early reports in the literature suggested that the incidence of chronic phantom limb pain was low, but it is now thought that as many as 55% to 85% of limb amputees continue to experience phantom limb pain from time to time. Fortunately, however, severe, persistent phantom limb pain is unusual. Phantom limb pain tends to be more episodic and more intense than nonpainful phantom limb sensations. Persistent symptoms are best controlled with antiseizure membrane-stabilizing drugs, such as pregabalin and gabapentin.

Motion of an injured or diseased joint may be painful. In such a situation, it is better to observe active motion first. The examiner will then know how much support to provide the limb when the passive arc of motion is analyzed. Muscle Testing Examination techniques used in muscle testing include placing the muscle in a shortened position and asking the patient to perform an activity that lengthens the muscle while the examiner resists the movement. For example, when testing the biceps muscle, the patient should position the elbow in flexion and supination; the examiner then tests the strength of the biceps by attempting to pull the elbow into extension as the patient resists (Figure 6).

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