Tell me about the typical prosthetic patient?
In our practice, we see prosthetic patients ranging from toddlers to the elderly. They come to us after losing a limb in an accident, or having to undergo an amputation due to a chronic disease like diabetes. And sometimes, with children, it can be because of a congenital anomaly.
In addition to their physical needs for a prosthesis, I imagine you have to deal with the psychological component of their recovery.
Yes, that’s right. The patient’s attitude about being fitted for a prosthesis is a very important part of the recovery process. Ironically, we have found that patients who lose a limb suddenly through an accident generally have more positive expectations about resuming normal activities and functionality. Even though they’ve been through a trauma, if they were reasonably healthy to begin with, these patients tend to do very well in adapting to their prostheses.
Unfortunately, patients who have gone through an amputation due to diabetes or some other chronic disease often have a more difficult adjustment with their prosthesis.
They’ve been worn down from the disease itself, physically and emotionally, and now they have to deal with a new challenge of adapting to a prosthesis.
Because we’ve had such extensive experience in the prosthetic field, we can anticipate the special needs of these patients. We work with them and their families to help them maximize the functionality of their prosthetic device.
How do you accomplish that?
First, we work very closely with the physicians involved in our patients’ care so that we have a complete understanding of all of the medical issues that have to be considered in the prosthetic design and fitting.
Then, we make sure they are referred to support services that they may need, like counseling, physical therapy, adult day care, etc. In our 42 years of in the prosthetics business, we’ve developed a very broad referral network of these types of services, so we can steer our patients to what will work best for them. And finally, our prosthetists are always there to coach and encourage our patients throughout the process
Does your involvement with your patients go beyond fitting a prosthetic device?
We want to do whatever we can to help our prosthetic patients regain as much of their normal function and activity level as they can. So if we can point them in the right direction for the resources they need, we’re glad to do it. That’s why we are active members of the ACA – the Amputee Coalition of America – which helps new amputees find the support groups and other resources they may need.
Can you give an overview of the process?
The first step is to make sure the patient’s stump or residual limb is ready to be fitted. Often it’s swollen after the amputation, so we go through a process of reducing that swelling with a compression type stocking called a shrinker.
Then, when the swelling has been resolved, we will cast the residual limb for its check socket. We use an inexpensive material for this socket as it is just being used to see if it fits comfortably, to check for pressure points, and so on. That takes about two days.
When we’re sure the check socket fits, we take that mold and make the permanent prosthetic socket from an acrylic resin that is embedded with carbon fiber. That results in a very, very rigid, thin, lightweight socket
We’ll attach the various components to that socket – different kinds of knees, ankles, feet, etc. depending upon the activity level of the patient. A young active person is going to have much higher functioning components than a sedentary elderly patient. It takes about a week to order and assemble these components.
The patient is brought back and that first leg, a temporary leg, is fit and aligned to the patient. An alignment is a series of walking exercises that the patient goes through to make sure the limb is correctly sized and aligned to their gait. Once that’s completed, we send the patient home with the temporary prosthetic leg. A follow-up appointment is scheduled for 2 and 4 weeks to check the fit and patient's comfort. The patient will use this for three or four months.
Then we bring the patient back and fit them with a permanent prosthesis. They may need a new socket because of sizing changes in their residual limb or some of the components can be upgraded because they’ve improved their functionality.
Are adjustments needed?
Of course. About four weeks after our prosthetic patients get their permanent legs, we ask them to come in for a follow-up visit to make sure there are no problems. Then we have follow-up phone consultations every six months or so. And, we ask our prosthetic patients to come in once a year for a check – most of them do come in at least once a year