Tuesday, November 11, 2008
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I had an extremely bizarre experience with a bilateral shoulder disarticulation amputee. The patient is about 50 years old and is a congenital amputee. He has been wearing body powered prostheses for his entire life and has always struggled with getting maximum range of motion with both his elbow (E400) and terminal devices (aluminum hooks 5xa)due to the limited excursion he gets from being bilateral. With his most recent fitting of new arms we decided to go in a new direction with some of the newest technology. We decided to fit him with bilateral Dynamic Elbows from Otto Bock along with bilateral Speed Sensor terminal devices and wrist rotators on both sides. I must say that within 1 hour of our initial fitting, he was operating both the elbows and terminal devices beautifully. It was probably one of the most impressive uses of bilateral upper extremity prostheses that I have treated yet. Again, with in 1 hour, he was isolating each of his muscles in order to operate the elbow and terminal device independently of one another. I watched him leave that afternoon getting into his car and driving off ......independently! I received a phone call two days later after he had returned to work stating that he was getting "bizarre" activity from his elbows and hands. He stated that his office is located downtown and that throughout the day the hand would either lock closed or the controls would change and reverse operation. Very weird!! But, as soon as he got out of the city, everything went back to normal. Today was the first day I saw him back to discuss remedies. Of course the first thing I asked him jokingly was if retirement was in his future... Since it was not an alternative, we discussed the issue with Otto Bock. They had only heard of a couple other cases of this happening. They recommended applying a foil wrap on the wires as well as shorten the length of the electrode wires. So far so good, but we will not know for sure until he returns to work in 2 days. I will keep you posted.
Tuesday, July 08, 2008
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I must say that over the past few years I have noticed a big change in the service part of our O&P industry on the manufacturer's and distributor's part. I have been in the industry for over 15 years and can remember when restocking fees were the norm. If you ever had to return a part that the patient may not have been fond of or the item did not fit very well, we were always slapped with a 15-20% restocking fee. Or if the part was defective, there was rarely a warranty that would cover the item.
Although, in recent years there has been a tremendous change. Restocking fees have been virtually dropped, and most parts have at least a 6-month warranty and some even 3 years. Most importantly, some vendors are even providing trial periods. What this allows the practitioner and the patient is an opportunity to truly provide the best care and allow us to make an educated decision.
I hope the patients and end users appreciate this, because what it tells us is that the manufacturer of that part is definitely behind their product. I can not tell you how many times I have taken advantage of this wonderful service. I do know this will make my decision easier for me in the future when I have to decide which company and manufacturer I will use.
I hope the O&P Industry all read this and are proud of themselves for this! And, for those who have not begun this type of service, they should get on board soon!!
Friday, June 20, 2008
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I have been fortunate to attend my first ACA meeting and must say that I was very impressed with the event. I have attended many National meetings before and have never felt the electricity before that I felt here the past couple of days. From the attendees to the exhibitors and most importantly the ACA, I must congratulate and applaud for the excitement that each and every one portrayed throughout the weekend. You all have to understand what each and everyone of you do to help individuals with their specific issues. I was very glad to be a part of it and look forward to attending each year in the future.
Tuesday, June 17, 2008
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Every once in a while I am asked by a patient to provide them with a prosthetic foot that adjusts in heel height. I am actually surprised that I am not asked more often due to the advancements in this area. I am familiar with three of the newer feet that are available. 1. Accent from College Park 2. Elation from Ossur 3. Runway from Freedom Innovations. They have come a long way from the original Safe Adjustable heel Foot from over a decade ago.
I actually had the opportunity today to fit all three to a female 30 year old patient. She provided some great insight and evaluation to all three. She had actually been wearing the Runway for the past 2 years and has done very well but wanted to try a foot that had more locking positions. Both the Elation and the Accent have that ability. They all range from 0"-2 1/2" heel height. The Elation and Accent are both very easy to adjust compared to the Runway. However, out of all three, she stated that the Runway walked the smoothest, where the Elation foot had a dead spot at midstance, and the Accent foot fell right in between. The key to her final decision was the cosmetics. This was a no brainer for her. She immediately selected the Accent from College Park due to the sleek and low profile finish.
I find it very interesting that she chose cosmetics over the smoothness of the Runway foot. However, she did say, for her this is a fair trade. Better cosmetics for a less smooth foot. She also added that the fact that the Accent had multiple locking positions was also a winning point. She stated that she had trouble dialing in the Runway foots heel height to various pairs of shoes.
I would be interested to hear from you all your opinions on this matter.
Today was an interesting day because I had the opportunity to fit an I Limb to a 30 year old amputee. He had been wearing a prosthesis for 3 years due to a traumatic accident. The accident left the gentlemen a left wrist disarticulation. I have never met a more inspirational and positive individual. I encourage him to attend all of our support groups and any functions that he may be able to benefit someone else with his positive outlook on life post amputation.
He had been wearing a myoelectric prosthesis for the past 2 years and a body powered prosthesis for the year prior to that. He is highly functional and has all the recreational terminal devices that you can imagine from weight lifting to socket wrenches. But, I must say, after watching his face light up today after only 2 minutes of using the new ILimb, I must say I was intrigued. The new technology allows for such a real look and grasp as well as high function. Within 15 minutes he had mastered all aspects and features that the i limb had to offer. He found that tasks such as drinking from a water bottle had become simplified as well as picking up small items from a table. Even though he could do these tasks with his previous hand, the task just seemed to be less involved and far more realistic.
From my first experience, I am very impressed but am concerned with durability. However, this is a tool that should strongly be considered in the arsenal when treating the UE amputee
Monday, June 09, 2008
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Many view this as the most difficult patient to treat. It is true, but here is some insight that may answer why.
I have found that patients that suffer from a traumatic accident are normally the most concerned with cosmetics. When I say traumatic, I mean those that have resulted in limb loss due to car/motorcycle accidents, work related, and other accidents that may not have been their fault. These type of amputees are normally very angry that the accident had occurred because it may not have been their fault. Traumatic accidents comprise of about 20% of the amputee population in the United States.
The first thing I like to do is let the patient vent and discuss their emotions. Many times they fear the sudden change in their appearance and insist that whatever I do as the practitioner, they want it to look like their old leg/arm. Many times function and comfort fall to last on their list behind cosmetics. I personally like to provide them with the education about the entire process involved around the fabrication of the different types of prostheses as well as the pro's and con's of the various types of components. I have found that the best therapy for any patient especially a cosmetic conscious amputee is to meet with other amputees that have suffered similar injuries. This allows the patient to not feel alone and isolated that they are the only one that has suffered from this type of tragedy.
Once the amputee is educated and familiar with the process as well as have the opportunity to meet others that have suffered the same loss and have led fulfilling lives, the discussion about cosmetics is a bit easier. Now, I must say, cosmetics have come a long way which is why at our facility we have grasped cosmetic technology to the fullest. It is proven that a patient that feels fulfilled with the cosmetics of their prosthesis have had better outcomes as a functional amputee. This is why we have an artist on staff that shapes covers to match the sound side as well as custom paint and apply silicone restoration to match the sound limb as close as possible right down to the freckle and dirt under the nail.
With the right education and the evolving technology, the cosmetic conscious amputee does not have to be dreaded.