New Advances in Prosthetics Mean New Hope for Amputees
by Cathy Corcoran
John Griffith certified prosthetist and orthodist* at Braintree Rehabilitation Hospital has worked with thousands of patients in his nearly 30 years in clinical practice, but he says that technological advances in the past few years have resulted in dramatic improvements for those who lose a leg through amputation.
“In the old days, prostheses (artificial limbs) used to be difficult to wear and difficult to control,” he says, “but now, new technology and new materials mean that people can recover greater stability and a much more natural gait after amputation.”
According to the Amputee Coalition of America, more than 185,000 amputations occur each year in the US and more than 1.7 million Americans are living with limb loss. Diabetes and vascular disease are the leading causes of limb loss, and smokers with those conditions are at particularly high risk. Other causes of amputation include cancer and trauma. Lawn mower accidents account for a significant percentage of limb loss, especially among children.
“Loss of a limb is a particularly traumatic event,” says Bran Heckathorn, area practice manager for Hanger Prosthetics and Orthotics. Heckathon is based in South Easton, MA, and works with patients south of Boston. He is also a certified prosthetist/orthodist. “Our goal is to help our patients improve their quality of life and recover as much of their functional mobility as possible after amputation.”
Patients are typically referred to a certified prosthetist prior to amputation. The initial consultation often involves educating the patient on options available to them after amputation, but a thorough evaluation usually occurs four to six weeks after surgery. “The would site is healing, scar tissue is forming, and edema (swelling) is subsiding by then,” Griffiths says.
The prosthetist then measures the residual limb in order to prepare the socket that will be fitted to the artificial limb. Computer assisted design programs (CAD) allow for precise measurements, and new plastics, acrylics and silicones are then custom-molded to produce a socket for the artificial limb that’s a near-perfect fit. “These new materials allow us to build a socket that’s rigid enough to bear the person’s weight and support the prosthesis, but flexible enough for comfort and adaptability,” Heckathorn says.
The prosthetist also evaluates the patient’s lifestyle, mobility and overall health in order to determine the best prosthesis for him or her. The patients is fitted with a temporary device for the first several months, and is then fitted with a “definitive” prosthesis three to six months after surgery. Prosthetists usually see patients several times a year to evaluate fit and comfort and make any necessary adjustments to the socket and prosthesis. The average prosthesis lasts approximately four years, depending on the patient’s activity level and overall health. After that, most patients require a new socket fitting and a new prosthesis.
“An intimate fit is crucial,” Griffith says. “We can’t have the residual limb moving around inside the socket, and we need the patient to be as comfortable as possible. Otherwise, they’re less likely to walk on the prosthesis, and their condition will decline.” Individuals who have a leg amputated above the knee require much more complicated devices than those whose amputation takes place below the knee. “With an above-the-knee amputation, we’re dealing with a prosthesis that must account for foot, ankle and knee joint movements,” says Heckathorn. “They’re very sophisticated devices.”
The newest of these devices are controlled by computer microprocessors that adapt to an individual’s gait, and provide electrical feedback to let the patient know where the new foot is as he walks. They also allow for changes in terrain and fluctuations in body temperature and swelling that occur naturally throughout the day. The batteries controlling the microprocessors must be recharged daily, though some can hold a charge for two days or more.
“These devices ‘examine’ themselves 50 times per second in gait pattern,” Griffith says. “Energy storing feet actually store the energy created by the pressure of each step, then release it, allowing the individual to take the next step more easily. They even have what we call ‘stumble recovery.’ If a patient trips, the knee joint automatically locks to try to prevent a fall.” The prostheses allow for a more natural gait, helping not only the patient’s mobility, but overall body alignment as well. “They’re better for the back, the hips, the whole body,” Griffiths says.
Most insurance plans cover the cost of prostheses, but costs and coverages can vary widely, depending on the individual patient’s needs. “We work hard to match the patient with the right prosthesis,” Heckathorn says. So much depends on a patient’s lifestyle and overall health. If a person is essentially homebound, she’ll need a different prosthesis from someone who takes public transportation and goes to work every day.” “Sometimes patients ask me if they’ll be able to run with their new prosthesis,” Griffiths says. “I always ask them how much running they did before their amputation. If they were a runner before, they can be a runner again. The most sophisticated devices allow people to climb mountains or run marathons, but those are for people who could do those things before amputation.”
Both Griffiths and Heckathorn say that each patient reacts differently to a new prosthesis, and attitude is a key component in recovery. Griffiths says he has a 92 year-old woman patient with a new prosthesis who’s an inspiration. “She gets out every day, goes shopping, goes out to lunch with her friends,” he says. “She’s just thrilled with her new leg.” Other patients have a more difficult time adjusting to life with an artificial limb, and most must cope with some degree of emotional trauma and depression.
Heckathorn is active with a group called Amputee Empowerment Partners (www.EmpoweringAmputeesorg), that provides a forum for amputees, their families and medical practitioners to share information and encouragement. Their peer to peer program offers in-person or on line contact between new amputees and those who are more experienced with using prostheses. Amputee peers answer a range of basic questions about the recovery process, using a prosthesis, and the concerns of daily living. They also share information and resources and provide emotional support, including an understanding of the grieving process. Patients often meet with therapists or social workers as part of their recovery process after amputation.
The Amputee Coalition of America predicts that, as the overall population ages, and the rates of obesity and diabetes increase, more amputations will likely occur, and the need for prostheses and prosthetists will grow. Prosthetists complete a one-year program of study after a bachelor’s degree, and a second one-year program is study for orthodist’s training. They then complete a one year residency in each discipline and pass rigorous testing to achieve certification.
Both Griffiths and Heckathorn say they’re excited about new development in the field, and look forward to even better prostheses in the future. “The new stuff coming down the pike will even give you the sensations of hot and cold,” Griffiths says. “When I think back to what this field was like when I started my career, it’s just amazing.”
“Some of my friends are jealous at how much I love my job,” Heckathorn says. “Every day, I get to see patients go from sitting in a chair all day to being able to walk. These are life changing events, some of the most gratifying things I’ve ever experienced.”
For more information: Prosthetists fit prostheses (artificial limbs) for patients. Orthodists fit braces.