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The Power of Prosthetics
A closer look at the science of prosthetics.
By Cynthia McFarland - Tuesday, August 30, 2016
There’s no denying it. The loss of a limb is life changing.
Across the United States, there are currently about 1.9 million people living with limb loss. That number is projected to double by the year 2050 because of the increasing rates of diabetes and vascular disease.
According to the Amputee Coalition, a nationwide voluntary health organization based in Manassas, Virginia, an estimated 185,000 amputations take place in the United States each year.
54 percent of amputations are due to complications from vascular disease (including diabetes and peripheral arterial disease).
45 percent of amputations are due to traumatic accident.
1 to 2 percent of amputations are due to cancer.
Lower-limb amputations are significantly more common than upper-limb amputations. Bringing this closer to home, 8,787 lower-limb amputations (well over 90 percent) were performed in Florida in 2012, compared to 698 upper-limb amputations that same year.
“One of the most common things people worry about is losing their independence due to amputation, but there is life after amputation. Once they’re through the process of getting a prosthetic, most patients are able to get on with their lives,” says Jeff Insco, CPO, a board-certified prosthetist and orthotist with Hanger Clinic, which has over 750 offices across the country. Insco works with patients in the Ocala and Inverness offices; he has been designing, manufacturing and fitting prosthetics for over 35 years.
Common Amputation Terminology
Trans-femoral (above the knee amputation)
Trans-tibial (below the knee amputation)
Trans-radial (below elbow amputation)
Trans-humeral (above elbow amputation)
Beginning The Process
Once a patient knows he or she wants a prosthetic, the first step is determining what is needed. This is highly individualized and depends on multiple things, including the types of activities the person wants to do, whether or not running is something they will want to take part in and the appearance of the prosthetic.
“Generally, I will be coming in after the amputation, but sometimes I’ll consult with the patient beforehand. We can show them a prosthetic device and explain how we’ll proceed through the process,” says Insco. “Sometimes a patient just thinks all they want is to be able to walk and get around, but later on they want to be much more active. A preparatory prosthesis just gets them up and walking, but a few months down the road their outlook has changed and they may want to run a triathlon. Some people overcome and are actually empowered by the situation.”
Timing for receiving a prosthetic can vary greatly. For example, it’s not unusual for some patients to be fitted with a temporary prosthetic right after amputation or within a couple weeks. For other patients, fitting doesn’t begin for several months.
Following amputation, the residual limb must fully heal before a prosthetic can be worn regularly. Once the incision is healed and the swelling has gone down, the prosthetic fitting can take place.
“No two patients are alike,” says Insco. “When a patient has vascular problems, they may also have a lot of other issues, such as being overweight. A military case often involves someone who was 100 percent healthy before their accident, so they don’t have the same issues to overcome as someone who required amputation because of diabetes or cancer.”
One of the most valuable aspects of the process is pairing the patient with a peer counselor, who is also an amputee. The counselor provides priceless support from a been-there-done-that perspective through programs such as AMPOWER, offered by the Hanger Clinic.
Getting The Right Fit
Every artificial limb is custom-made. It’s not like shopping for shoes and pulling a specific size off the shelf.
In order to fabricate a prosthetic that fits properly, the first step is measuring for the socket into which the residual limb will fit. This is usually done using a CAD (computer aided design) system to create a digital 3D scan.
“From that, we make a clear plastic diagnostic socket. We make proper adjustments with this and can heat and mold it to make sure all the pressure points are in the right spots,” explains Insco, noting that multiple fittings may be necessary to get it right.
Using the diagnostic socket as a model, the definitive socket is then manufactured out of a material like carbon fiber or thermo-plastic. Other components (knee, foot) are then attached to the socket. If the patient desires, a cover can be added to make the prosthesis match the existing limb.
“We choose the most appropriate components based on the activities the patient wants to accomplish,” Insco adds. “For example, there are hundreds of different types of feet available.”
In order to have a good outcome, physical therapy is an important part of the process. It helps with strengthening the muscles the patient will be using, overall balance, range of motion and gait training.
“From when the doctor says the patient is ready, it’s generally a couple weeks to when they are through the fitting process. Some patients walk out like they’ve been wearing it all their life, but a wheelchair and crutches are often part of the process for a lower-limb amputee.”
Once the patient is correctly fitted with their new prosthetic, it’s common to come back periodically so the prosthetist can check fit and wear and perform necessary maintenance to the device.
The lifespan of a prosthetic limb ranges from months to years. Obviously, if the patient is a child, it will need to be changed often as the individual grows.
Artificial limbs have come a long way from the earliest incarnations, which were made from wood, iron, copper or steel. Today, patients are being fitted with prosthetics made of lightweight materials including carbon fiber, lamination and titanium, as well as high-tech components, such as robotics, bio-sensors and microprocessor knees and feet. Such versions are basically controlled by an internal computer, which is able to know exactly how the wearer is moving. These prosthetics can be charged at night when you take them off, similar to how you charge a cell phone.
Imagine having a prosthetic leg with a microprocessor knee or ankle that has internal Wi-Fi capability. It’s not futuristic science; it’s here now. This technology not only allows the leg to function more like a real leg when walking on uneven surfaces, but adjustments can be made by a technician off-site. There are even sport-specific feet—think of the “blades” you see Paralympians competing on—such as the Flex-Foot Cheetah.
Upper-limb amputees may also take advantage of cutting-edge technology with myoelectric hands. Often described as “bionic” hands, these include prosthetic hands such as i-limb and bebionic. Prosthetic hands can use muscle signals in the patient’s residual limb through electrodes that are placed on their skin or implanted into their muscles. When the patient contracts those muscles, the electrodes send signals to a microprocessor in the hand, telling it to open or close.
Multi-articulating myoelectric hands like bebionic offer a variety of different grip patterns and hand positions, so the user can handle tasks such as eating, typing, carrying bags and shaking hands.
Prosthetics that can be controlled by the user’s thoughts are currently in development and will likely be available in the next few years. Researchers are also studying robotic exoskeletons that may give “superhuman” strength to the user.
Double amputee Regas Woods of Dunnellon is a national champion runner and 2015 world championship bronze medalist. As of this writing, he made the Paralympic team and was preparing to compete at the 2016 Paralympic Games in Rio de Janeiro, Brazil.
Now 35, Regas had a congenital limb deficiency that required the amputation of both legs above the knee when he was 2 years old.
In elementary school, his classmates thought his artificial legs were “cool.” That changed in middle and high school when he was bullied because of them.
Driven to run because he was told it would be impossible, Regas has excelled. In 2015, he broke the U.S. record in the 200 meters. He also competes at the 100 meter and in the long jump.
For normal use, Regas has prosthetic legs with microprocessor knees, but when he competes, he runs on “straight” prosthetics with “blade” feet. Being a bilateral amputee, his start is slower than unilateral (single leg) amputees, but once he gets going, the 200-meter distance is usually enough for him to make up that time lost at the start.
“When I was a child, I got a new set of legs at least once a year because I was growing,” recalls Regas. “As an adult, I usually get a new set every year or two, but my running legs endure a lot of stress, so those are replaced more frequently.”
He is co-founder of the Never Say Never Foundation (neversayneverfoundation.org), with Nick Stillwell, whom he helped as a peer counselor when Nick lost both legs in an accident. The foundation uses 100 percent of its funds to help secure prosthetic limbs for child amputees, as the full cost of such devices is often not covered by insurance.
A member of the U.S. Paralympic national team, Regas trains and competes full time. He hopes to obtain a sponsorship that will enable him to continue reaching his athletic goals.
Regas learned to overcome adversity and to embrace the fact that he is different.
“I had to deal with the cards I was dealt and make the best of it,” he says. “My disability is now a blessing because I can compete and inspire people all over the world.”
Before she became a trans-femoral amputee, Patsy Delp was one of the most active people in her community of Citrus Springs, Florida. She not only played golf several days a week but also worked for the golf course. Life was good.
In 2012, when a dime-sized spot on her right shin was diagnosed as cancerous, she followed the doctor-prescribed protocol of antibiotics and wound care, but the lesion got worse. So much so that in June, her leg was amputated above the knee. Five months later, she was fitted with her first prosthetic leg.
“I wasn’t going to sit in a corner and feel sorry for myself,” says Patsy, now 62. “There was so much pain associated with the leg when I was going through the cancer. Once it was amputated, that pain was gone. I’ve never had phantom pain, blisters or any problems.”
Patsy’s sister, Jo Ann Heller, stayed with her to help after the amputation, promising Patsy she would be playing golf again.
“We were playing while I was still in a walker before I got the prosthetic,” smiles Patsy.
Her first prosthesis was, as she puts it, “a pretty basic model,” but it served its purpose. The following year, she stepped up to a more high-tech version complete with a microprocessor knee. (“There are actually USB ports in my leg!” she laughs.) The new-and-improved leg bends at the knee, which is able to sense whether Patsy is moving backward or forward and where she is in her gait cycle, enabling her to walk much more naturally.
Patsy found that adjusting to life with a prosthetic limb was as much about attitude as the physical challenge.
“It’s really a choice. Do you want to go forth in life or just say, ‘Forget it’? I was active before, and I wanted to remain that way,” she says.
“I can see why someone would be depressed if they didn’t have a support system. Between my family, Citrus Springs Golf and Country Club and Chicks with Sticks, a group of women golfers who really came together and helped support me, that’s the reason I made it through. I had good doctors, and my body adapted well; I think I’m very fortunate.”
Today, Patsy can be found working as a ranger at Citrus Springs Golf and Country Club two days a week. The other five days, you’ll find her on the course, playing golf.
“I just wanted to live, and that’s what I keep trying to do,” she says.
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