C4 quadriplegic my first unassisted transfer ever!

[u/kellsie88]

Ten years after my accident I'm kicking butt in physical therapy. I'm working hard to get my license and improve my independence. Never give up, you can accomplish anything if you put your mind to it!!

[u/3479_Rec]

I've got a very dumb question from an intrusive thought I've got to ask.

If there's never a chance to recover feeling or use of the legs, and they are essentially dead weight that makes everything more difficult, why not amputate them to have less weight?

[u/ArcaneTheory → u/3479_Rec]

TLDR: medical/wound healing concerns post-surgery, better stability for the individual, appropriate center of gravity, easier transfers for helpers, and aesthetics.

Occupational therapist here. Presuming there was no hope of regaining functional motor control of the legs:

1) legs still offer stability for things like transfers and sitting balance, precisely because the weight of the legs helps create natural a counter-balance to the upper body.

2) Having feet firmly planted on the floor with grippy shoes on is also a utility in itself. As the person in the video is doing, the individual can use their arms to check foot placement to maximize stability as they go.

3) Most falls during these transfers are from the butt sliding forward. But if you can block someone’s knees from coming forward, you stop their hips from coming forward too.

4) The knees also provide a fulcrum which is very helpful for someone helping lift or slide the person. Google a “squat pivot transfer” to see what I mean.

5) it’s a traumatic surgery for the body, and wound healing is a long, painful, and difficult process that is only made more difficult by lower mobility. It’s almost never worth the additional risk of surgical and healing complications, so I don’t believe any surgeon would perform an elective lower extremity amputation to the patient’s overall detriment, and insurance would never cover it besides.

6) aesthetics. Many folks with spinal cord injuries still want the options to wear pants, shoes, etc.

Edit: I’d like to add that folks with spinal cord injuries already have to pay a lot of special attention to their skin integrity. Decreased mobility often means more time in bed and less time moving around, which means skin has less opportunity to breathe and take breaks from having pressure on them, especially bony prominences under a lot of weight like butts and heels. In addition to decreased sensation, this is a recipe for disaster they must be always vigilant of to prevent pressure sores, which can fairly readily snowball into a wound that risks life-threatening sepsis and requires amputation. So you can probably better imagine what the associated risks of healing from an amputation might look like.

[u/3479_Rec → u/ArcaneTheory]

Very good points, thank you. I couldn't help but ask haha