Anthropometric data and body mass index (BMI) calculations are important for bilateral lower-limb amputees. A BMI calculator tool allows users to enter height and weight to calculate BMI based on amputation level. For those with two leg amputations, a graduated approach to prosthetic training is most effective, starting with short "stubbies" that focus on balance and mobility without knees or long pylons before progressing to full leg prosthetics.

1. 1. Use Antropometric data.
 Anthropometry is the study of the measurement of the human body in terms of
the dimensions
 of bone, muscle, and adipose (fat) tissue. Measurements of these fat tissues are
also important because
 individuals with large values are reported to be at increased risks for
hypertension, adult-onset diabetes
 mellitus, cardiovascular disease, gallstones, arthritis, and other disease, and
forms of cancer
2. Use the BMI Calculator Tool
 Enter your height and weight using standard or metric measures.
 Weight must be taken without use of prosthesis, walker or wheelchair.
 When determining height, if you are a bilateral lower-limb amputee, use pre-amputation height.
 Select your level of amputation.
 Click the “Calculate” button and your BMI will be generated.

2. Important body segment and
whole body parameters;
Dimensions (e.g., length,
density, and mass)
Segmental center of mass
location
Whole-body center of mass
location
Moment of inertia (angular
inertia

4.  The bilateral lower-limb amputee presents a special challenge to:
Provide a degree of mobility, that would provide a normal place in society.
Patients with high-level amputations or congenital limb deficits can occasionally
walk without a prosthesis by using crutches and a swing-through gait.
This requires very good trunk and upper-body strength, sense of balance, and
muscle control.
In most cases, assistive devices are necessary to stand, walk and to move from
place to place.
The remarkable degree of functional restoration permits the bilateral leg amputee
to participate in his normal activities of daily living that helps to overcome his
physical handicap.

5.  The volume of the residual limb is expected to decrease rapidly in the near future
or if a gradual reduction of joint contractures will require repeated prosthetic
realign-ment. This is common in simultaneous bilateral amputees who cannot
advance their weight bearing as quickly as unilateral patients.
 Component choice is carefully prescribed in consideration of the particular
patient's needs. Patient comfort will make the decisive difference between
acceptance and rejection of the prosthesis and is therefore a high priority.
 Example

6. A, 92-year-old male with peripheral vascular disease
and well-healed bilateral transtibial amputations.
B, preparatory en-doskeletal prostheses with SACH
feet and light fiberglass cast sockets.
C, definitive bilateral supracondylar, suprapatellar
hard sockets with removable medial wedge
suspension and standard SACH feet.

8. GOALS

9. Fig
ure
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con
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red
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em
ora
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soc
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s
acc
om
mo
dat
e
the
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ne,
mu
scl
e,
vas
cul
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an
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lim
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Phase 2: Walking on Short Legs
("Shorties") with Training Feet
- After many years of clinical experience, the authors have come to believe
that it is counterproductive to expect bilateral transfemoral amputees to
move directly from a wheelchair to wearing full-length prosthetic legs.
- A more practical and realistic step is to focus on getting patients out of the
wheelchair by fitting them initially with short prosthetic legs with custom-
designed training feet.
- The absence of pylons and knees have numerous benefits, including
stabilizing balance and reducing the risk of injury from falls.
- Patients will experience significant energy expenditure as they begin
walking on "shorties," it still requires substantially less energy than walking
on full-length legs.
- Using short legs without prosthetic knees can reduce heart rate and
oxygen use by 7-23 percent and can increase walking speed by up
to 25 percent.
Anatomically contoured
transfemoral sockets
accommodate the bone,
muscle, vascular, and nerve
structures of the residual
limbs.

10.  prosthetic facilities that train patients on short legs, it is often customary to use actual prosthetic feet
that are turned backwards, providing less forefoot for the person to deal with while learning to walk.
 Some patients feel unsafe and discouraged by the appearance of backward foot.
 In the graduated-fitting approach, the small training feet that are custom made for each patient receive
a favorable response and also increase functional ability
 By committing to the use of shorties all day, every day, patients quickly improve their physical condition and
develop daily routines that do not involve a wheelchair.
 Patients may believe that using a wheelchair will be better. Though this may be true, it actually works
against their goal of becoming independent prosthesis users. Sitting in a wheelchair puts them in a position
that can cause flexion contractures in the residual limbs.
 Encouraging patients to stop using a wheelchair completely and wear the shorties full time, regardless of how
long it might take to do certain tasks, is one way that family members and friends can help patients make
progress.
 An ongoing physical therapy program should continue and will also help patients improve their mobility on
shorties.

11.  https://www.oandp.org/AcademyTODAY/2009Mar/2.asp
 http://www.betterlimbs.com/_uls/resources/downloads/Transtibial_Manual-2.pdf
 https://books.google.co.th/books?id=2KIqqHS5fVoC&pg=PA189&lpg=PA189&dq=T
SB+supracondylar&source=bl&ots=k6tR8s9hjK&sig=U1f_zexkWFCgdQXnv3099
EhHnx4&hl=en&sa=X&ved=0ahUKEwjVnbGB3Z3MAhVEj5QKHZfTCrgQ6AEIO
DAG#v=onepage&q=TSB%20supracondylar&f=false
 http://www.oandplibrary.org/alp/chap24-01.asp?mode=print