Treating bilateral trans femoral amputees are certainly a bit different than unilateral patients.
Bilateral amputees are not really a common occurrence.
If I had to generalize bilateral amputations mostly occur after unusual trauma accidents or in diabetic patients.
But again in my experience even diabetic patients don't usually lose the second limb.
Generally the two stumps heal differently, so one stump might be ready for prosthetic fitting while the other still needs healing time.
We have been using the following treatment protocol very successfully for the last few years.
Because amputation is a bit of a shock to the system we focus our patients attention on the stump that is ready for prosthesis. You would be surprised at the functionality of a single prosthesis amputee in a wheelchair. It makes moving the chair around (especially in confined spaces) and transfers from car to wheelchair or wheelchair to normal chair so much easier. More important the patient can see for themselves the benefits of using this device.
If the facilities are available and the patient possesses the physical ability to walk and or stand on the prosthesis between parallel bars, as much as possible should be done to use this limb functionally. The method in the madness is the following.
Once the second limb is fitted to a patient that is already functional on the first limb the improvement in functionality is truly with leaps and bounds. Most patient find this improvement inspiring and everybody knows that an inspired patient is usually a successful one.
By waiting for both stumps to heal and then suddenly supplying an amputee with two prostheses could be a bit overwhelming and you could run the risk of presenting the patient with what could seem as an impossible task making them a bit negative.
Secondly shoulder, wrist and elbow joints could run the risk of overload while just using one prosthesis. And do be careful with stability - the last thing you want is for the patient to fall on the other stump!
In my experience Bilateral Trans Femoral amputees usually surprise themselves at just how mobile and functional they become in a short period of time!