Abstract
Sir: It was with great interest that we read the article: The Locomotor Capability Index in diagram form: The Stanmore-Kinston Splat by Tom Geake, Rajiv Hanspal, David Wertheim and Jennifer Fulton in the December 2006 issue of Prosthetics and Orthotics International.
We would like to compliment the authors on their effort to introduce a new form of review of the goals of amputee rehabilitation patients. We agree with the authors that preferably all patients enrolled in rehabilitation programmes should have goals set and that they should have the outcome recorded using approved outcome measures. We do appreciate a graphic representation of rehabilitation outcome because it is clear and easy readable by the clinician and the rehabilitation team members.
The Locomotor Capability Index (LCI) is the theoretical construct of the Splat representation. We have some questions about the use of the LCI and thereby of the Splat concerning goal setting.
As indicated by the authors, the Splat shows the capability of the patient on delivery of the prosthesis and later in the rehabilitation programme. In the LCI literature, it is stated that the person has an ability to perform the activity (Rushton and Miller 2002; Franchignoni et al. 2004). This is not the same as performing the activity in therapy.
When a patient starts training after admission to the rehabilitation centre, who will set the goals to be achieved during the treatment that therefore represent the areas of the Splat? Does the Splat depict the goals set by the patient him/herself, or the expected activities set by the doctor and the rehabilitation team? This is of major importance since otherwise the performance of the amputee patient can be over or underestimated by the goal-setting terms and pictures of the Splat.
Another reflection about the Splat gives concern about the start of the measurements: The authors state that the first measurement is to be taken just after the delivery of the prosthesis. This is the basic point of the Splat and the improvement is measured from this zero point to indicate progression of the rehabilitation treatment. We are confused by Figure 2. Does this show the baseline of the measurement or the performance of a patient without a prosthesis with a lot of muscle power and good physical condition who is able to go up and down the stairs standing on one leg? This as shown in Figure 2 is with, according to the authors, a clinical anomaly. The physically better patient shows a high basic level of performance. In prosthetic training, all patients are trained to get up from the floor with or without a prosthesis. In our opinion this is an everyday performance and shows good adaptation to the performance of the physically active amputee patient.
We encourage the use of the Splat that reflects the performance of the amputee patient during rehabilitation training. One picture shows more than a lot of table data.
A graphical display of the goals gives the advantage of a quick review during follow-up, but we would like to emphasize the correct interpretation of the Splat and the importance of careful goal setting.