Motio Case Study 3: A Comprehensive Analysis of James Swinton's Motio Functional Report
Meet James Swinton, whose life took a transformative turn with the beginning of peripheral arterial disease, leading to the loss of his left leg above the knee in early 2022. As he got on his prosthetic journey later that year, the initial stages proved to be challenging. Struggling to adapt to his prosthetic device, James gained weight and decreased physical activity, relying on a short-distance cane and a mobility scooter for longer ones.
To better understand how to help James get back on track with prosthesis use, improve his general health, and effectively communicate with him and the rehabilitation team, the prosthetist decided to evaluate James' daily activities. Twelve days were spent on the analysis using the Motio StepWatch System.
In-Clinic Tests
AMPPRO®: K2 (29 out of 47)
PLUS-M™: 54.4 (Indicative of a level of mobility better than 67.0% of people with unilateral lower limb amputation)
TUG: 20.8 seconds (>19 seconds is indicative of fall risk)
Results and Analysis
Figure 1 - James Swinton Daily Highlights.
Analyzing James’s daily activity highlights, it is possible to understand that he was not very active:
The average daily step count was around 70% lower than previously found as for a TF22 amputee (even though they are not reference values). Even on the best day, the step count was about half of this same value.
Top Speed and Top Cadence indicate that the person is walking slowly and with a low-medium top cadence.
The maximum continuous walking distance was also too short in comparison to the minimal distance of ≈984 feet for community ambulation (K3)[2-4].
Figure 2 - James Swinton Active Time.
Figure 3 - James Swinton Daily Steps Graph.
Even though he was active for approximately 1 hour per day, more than half of that time was spent at a low-intensity level of activity (1-30 steps per minute) [5]. It was also possible to understand that he was not consistent during the evaluation: every day that he demonstrated more activity (more steps, more time spent in various activity intensities), the next day he had the need to rest and became less active.
Figure 4 - James Swinton Blind Outcome Evaluations.
The blind outcome evaluations also show a lower performance - just 20 occurrences of 2-minute continuous walk were observed, and the patient never achieved 6-minute continuous walk. When the 10-Meter Continuous Walk is analyzed, the value aligns with the reference value for a K2 patient [6-10].
With these visuals already in mind, and as observed earlier on the Timed Up and Go test result, these results suggest that James tends to adopt a slow and steady walking pattern, possibly indicating a hesitancy to venture outside his perceived safe environment, such as a K2 ambulator. However, it is still important to look at the Daily Step Activity Graph to understand the patient’s potential to ambulate, his cadence variability and energy level. Remembering that multiple varying peaks and valleys are a visual representation for high potential.
Figure 5 - James Swinton Daily Step Activity Graphs.
In these two daily step activity graphs, we can observe that James has some difficulty changing cadence throughout the day (typical of a K3 ambulator), which is noted by bars consistently remaining at a low-medium level. However, he tries and shows some potential to achieve higher cadences. Looking at the energy level, it’s possible to observe that his activity is spread during the acquisition period (long bands of inactivity), only with small periods of higher energy to ambulate observed.
With this analysis in mind, it was time to recommend a functional level for James to finally get the Motio Functional Level and fully understand his activity and potential. The prosthetist recommended a K2, which, when averaged with the activity scores, resulted in a Motio Functional Level of 2.1.
Figure 6 - James Swinton Clinician Recommendation, Activity Scores and Motio Functional Level.
Conclusion
After analyzing the Motio Functional Report, the prosthetist concluded that James needed to enhance his strength, confidence, and stability in order to facilitate his participation in community activities and increase overall activity. The prosthetist recommended that James needed a new and more personalized training rehabilitation program, with different day-to-day training situations, to improve James' daily quality of life.
“Even though James demonstrated on this evaluation to be a K2 patient, I truly believe that he has the full physical and psychological potential to achieve more, to get back on track and to be active in his community. This evaluation clearly demonstrated he needs better prosthetic rehabilitation training and better orientation during the full process. This is work that needs to be done by the entire Rehabilitation Team. There is a clear need for improved communication and mutual support to elevate the standard of patient care. I believe that this type of real-world evaluation and objective data can play a pivotal role in facilitating this progress and ultimately enhancing the quality of life of our patients. ”
References
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