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

Publication date: Available online 30 August 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Richard Lombard-Vance, Fiadhnait O'Keeffe, Deirdre Desmond, Robert Coen, Nicola Ryall, Pamela Gallagher

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 non-vascular (n=18) LLA aetiologies were included.

Interventions

Not applicable

Main Outcome Measure(s)

Demographic and health information, and a battery of standardised 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 to expected frequencies in normative data (p≤.003 Holm-corrected). There were no significant differences in cognitive functioning between participants of vascular and non-vascular LLA aetiology.

Conclusions

Findings support the need for cognitive screening at rehabilitation admission regardless of aetiology. 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.

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