Comprehensive Neuropsychological Assessment of Cognitive Functioning of Adults With Lower Limb Amputation in Rehabilitation

Arch Phys Med Rehabil. 2019 Feb;100(2):278-288.e2. doi: 10.1016/j.apmr.2018.07.436. Epub 2018 Aug 30.

Abstract

Objective: To establish a comprehensive profile of cognitive functioning in people engaged in lower limb amputation (LLA) rehabilitation.

Design: Cross-sectional study as part of a longitudinal prospective cohort.

Setting: A national tertiary rehabilitation hospital.

Participants: Adult volunteer participants (N=87) referred for comprehensive rehabilitation for major LLA were sampled from 207 consecutive admissions. Participants with both vascular (n=69) and nonvascular (n=18) LLA etiologies were included.

Interventions: Not applicable.

Main outcome measures: Demographic and health information and a battery of standardized neuropsychological assessments.

Results: Compared to normative data, impairment was evident in overall cognitive functioning (P≤.003). Impairment was also evident in particular areas, including reasoning, psychomotor function, information processing, attention, memory, language/naming, visuospatial functions, and executive functions (all P≤.003 Holm-corrected). There were also higher frequencies of impaired functions across most aspects of functioning in this group compared with expected frequencies in normative data (P≤.003 Holm-corrected). There were no significant differences in cognitive functioning between participants of vascular and nonvascular LLA etiology.

Conclusions: Findings support the need for cognitive screening at rehabilitation admission regardless of etiology. Administration of comprehensive neuropsychological assessment with a battery sensitive to vascular cognitive impairment is recommended in some cases to generate an accurate and precise understanding of relative strengths and weaknesses in cognitive functioning. Cognitive functioning is a potential intervention point for improvement of rehabilitation outcomes for those with LLA, and further research is warranted in this area.

Keywords: Amputation; Cognition; Lower extremity; Neuropsychology; Rehabilitation; Rehabilitation research.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Amputation, Surgical / psychology*
  • Amputation, Surgical / rehabilitation*
  • Cognition
  • Comorbidity
  • Cross-Sectional Studies
  • Executive Function
  • Female
  • Humans
  • Longitudinal Studies
  • Lower Extremity / surgery*
  • Male
  • Memory
  • Mental Health
  • Mental Processes*
  • Middle Aged
  • Neuropsychological Tests
  • Problem Solving
  • Prospective Studies
  • Rehabilitation Centers
  • Sex Factors
  • Socioeconomic Factors