- Welcome everyone to Wednesday Nite @ the Lab.
I'm Tom Zinnen.
I work at the University of Wisconsin-Madison
Biotechnology Center.
I also work for the Division of Extension Wisconsin 4-H.
And on behalf of those folks and our other co-organizers,
PBS Wisconsin, the Wisconsin Alumni Association,
and the UW-Madison Science Alliance,
thanks again for coming to Wednesday Nite @ the Lab.
We do this every Wednesday night, 50 times a year.
Tonight, I'm delighted to introduce to you Amy Paulios.
She works with UW Health here in Madison
in orthotics and prosthetics.
She was born in Neenah, Wisconsin
and went to high school in Neenah.
Then she studied biology at Luther College in Decorah, Iowa.
She got her advanced degree at Northwestern University.
Tonight, she's gonna speak with us about restoring mobility
to those who have experienced limb loss.
Would you please join me in welcoming Amy Paulios
to the Wednesday Nite @ the Lab?
- Thanks, Tom.
Hello, everybody.
I would like to talk to you tonight
about working in the field of prosthetics.
My 20-year career or so has been an enjoyable one,
for the most part, and I find when I meet people,
a lot of folks have a preconceived notion
about what prosthetics is, who makes prosthetic limbs,
and have a lot of curious questions
about what somebody like me does.
And so I'd like to share with you
what has gone into my career, what I do on a daily basis,
and what it's like to treat amputees.
So the word prosthetist is a tricky one,
as you might understand.
It's taken my mother at least a decade
to learn how to say it comfortably.
So the word, if you break it into three parts
is much easier, pros-the-tist.
So a prosthetist is somebody who fits artificial limbs,
and that's usually how I introduce myself
because it's a tricky word and some people might think
something else is gonna come outta my mouth.
It's a really unique niche in health care,
and I would love to teach you a little bit about it.
This is a billboard that a company that I worked for
circa early 2000s, mid 2000s, 2006 or so.
We created for the company that I worked for,
Prosthetic Laboratories,
to celebrate what we all believe in,
those of us who do this career,
which is taking the dis out of disability.
We have to think about what we can do
to restore somebody's ability to ambulate again,
to walk or to function even in the smallest capacity,
and celebrate those things so that we can get people
back to what they wanna do in their lives.
So this is really what I believe in.
I'm passionate about it, and I,
that's why I'm talking to you about this career.
So my normal work day is kind of all over the place
and it includes a various list of things,
such as patient care is obviously paramount.
I work for UW Health,
the Department of Prosthetics and Orthotics.
I work out of three different facilities,
both inpatient and outpatient.
So primarily, my day is filled with patient care.
When I'm not seeing patients, I'm working on cast work,
which is the beginning process of making a prosthetic device.
And I'll show you some pictures and explain that later.
Documentation is obviously necessary in the medical field
on every level, to document what we do
and to get paid for it.
I answer phone calls, return phone calls, answer emails,
return emails, do ordering of components
so that I'm getting the device, the components
that are necessary to build each prosthesis.
I do a bunch of teaching,
so various aspects of our affiliates
like physical therapy, nursing, even the surgical staff.
We bounce ideas off of each other all the time
and we all help each other learn
what the other parts of the team do
so that we can provide better care all around.
And then the side things: driving,
there are various companies that provide prosthetic care,
which have to drive to go to various clinics
or go to patients' homes, sometimes to nursing homes.
I don't currently do that within the UW system,
but I certainly drive between different offices.
I'm involved in the bioengineering department
and some studies that they're doing regarding prosthetics
and the development of different prosthetic feet.
That's the picture you see on your screen,
which also entails research.
We also do research within our department
and give case studies presentations each month
so that we learn about the latest interesting case
that our colleagues are working on
so that we can learn and better ourselves education-wise.
And then I'm also on the exam team,
and I'll get into this in a minute,
for ABC, the American Board for Certification,
which is the certifying body to credential those
that provide prosthetic and orthotic care like I do.
So I just mentioned ABC.
The American Board for Certification
is our national accrediting and certification board.
And it has its beginning way back in 1948.
It became the, it's the quality standard of care.
And you have to sit for exams
and go through these stringent requirements
to be able to provide care for patients
that we take care of and also to get paid for it.
ABC is the only credentialing body
with the recognition of ISPO, which is
the International Society for Prosthetics and Orthotics.
And it is closely affiliated
with the National Commission for Certification Bodies
and is heavily involved in education
and recognizing those that are ready
to get the credential to practice in our field.
ABC is recognized and deemed the authority
for facility accreditation by CMS,
the Center for Medicare and Medicaid Services
and the VA, the Veterans Administration,
as well as many health care insurance providers
throughout the country.
NCOPE is the education arm of the field,
and I'll get into that in just a second.
So ABC certified individuals like me
are considered leaders in the profession
and they are expected to provide the highest-quality patient care
and also be involved in research and device design.
ABC certified individuals
have to meet certain stringent educational standards,
clinical training, and complete an assessment of competency.
In other words, pass boards
to get certified to do what we do.
This is a very extensive list
of all of the certifications that ABC awards
for those that have met the standards required
for each part of the profession.
The two on the top
are those that I will describe most closely
because they go hand in hand.
So I am the second one listed, the ABC certified prosthetist.
I make artificial limbs for people
and I am involved in the design, the fabrication,
the fitting, the modification, and the maintenance
and the repair of prosthesis
to restore physiological function and/or cosmesis.
A certified orthotist works with what exists
on the body and helps change its function
to perform at an optimum level.
A certified prosthetist replaces what's missing
in an amputee population; the two work hand in hand.
Oftentimes when I'm treating an amputee,
an orthotist in my office will be called in
to treat a pathology perhaps on the patient's other leg,
or I have to work with them to work on alignment
or a pathology that involves both disciplines.
This speaks to why the profession
has now moved to a dual certification.
So most professionals coming out
of the master's level degree program at this time
are going to be dual certified.
They're gonna be certified,
or they're gonna earn their certification
in both prosthetics and orthotics.
Not one discipline or the other, like I did.
When I went to school in the early 2000s,
you could go to school for just one discipline
or the other or do both back to back.
And now the master's level programs
are for both disciplines.
Running further down the list,
the fourth thing listed is a certified pedorthist.
Those are very important practitioners
within our companies
that deal with just below the ankle issues.
So they're specialized in foot issues
and fitting specialized shoes.
Oftentimes those clinicians are the ones
who help patients with wounds on their feet heal
so that they don't become my patient ultimately.
And then further down the list,
we have certified fitters for mastectomy.
We have certified therapeutic shoe fitters.
Orthotic assistants and prosthetics assistants
are exactly what they sound like.
They can't do the entire job of a certified clinician,
but they can assist in their work.
And then technicians are those that are fabricating the devices
in the various laboratories,
or companies that make the devices themselves.
They may or may not be involved directly in patient care,
but they are involved very much so
in the fabrication of the devices that are used.
The ABC organization spans back to 1948,
and I thought this was a fun thing to share this picture,
where it was actually the beginning
of ABC as it stands today.
In the early early days, it's a CPO
and three orthopedic surgeons who decided
that they were gonna found this certifying body.
Of course, it's gone through many,
many, many changes since then.
But here is a picture in 1951
of one of the first ABC certification exams
administered in New York City in 1951.
In that first year,
51 individuals attained their certification,
and I bet you'll notice that everybody in that picture
is not like me in one way.
As you might guess,
the field at that time was extremely male-dominated,
and that has changed quite a bit over the past 60 to 70 years.
The abcop.org website is an extremely helpful one.
If anybody in the audience
wants to learn more about this profession,
the abc.org website is extremely helpful.
It would allow you to look up what the career is all about,
the certification requirements.
You can find facilities that are accredited
to take care of an amputee or an orthotics patient
that you might know about.
Anybody who is interested in the field
can learn a lot more about this field
of prosthetics and orthotics from this website.
NCOPE is the educational arm of the career.
So if anybody in the audience is interested
in becoming a clinician or a technician or an assistant
or a fitter in any realm of the previous list that I showed,
the ncope.org, N-C-O-P-E.org website
is where I would direct you to look up
any and all information you want to know
about the education program and the process
that it takes to get certified to do what we do.
This slide is a very interesting one
because it shows all of the educational programs
currently available for orthotics
and prosthetics education.
There aren't a ton of them,
but there are many more than when I went to school
at Northwestern University in 2000.
That was an easier trip for me because from my home,
I could ride the train to downtown Chicago.
But there are several in the Midwest,
including Eastern Michigan University,
and the Concordia University of St. Paul
and Century College up in Minnesota.
But there are a smattering of programs
across the country to choose from.
So let's talk for a minute about amputation itself
and how many amputees actually live within our community.
Not many people realize just how many amputees there are
within our everyday life.
In current, in the greater Dane County area,
you might come into contact with an amputee
every once in a while,
but within the three or four hospital systems
within Dane County system,
I believe we do between one and five amputations
every single day.
That is a far higher number
than most people generally realize,
and those are patients that I see a majority of,
because of my position within UW Health system.
Nearly 2 million people are currently living with limb loss,
and 3 in 500 people in the U.S.A.
have an amputation of some kind.
It is a fact that there are 500 amputation surgeries
done daily in the U.S., and the following reasons
are the reasons that account for people needing amputations.
A great majority of the patients that we help
are those that deal with vascular disease,
primarily diabetes and peripheral artery disease.
That accounts for 65% to 82%,
and a majority of the lower limb amputations that we treat.
Again, I'd like to emphasize here
that I am talking specifically to lower limb amputation.
I am not an upper extremity specialist by any means.
I am aware of upper extremity prosthetic care,
but I am primarily always treating lower limb amputees
in my practice.
Trauma is the next highest cause, and it's 16% to 45%.
The key factors in this would be age, gender, war, and jobs.
The third most common reason for amputation is cancer,
which is about less than 2%.
And congenital amputees are about 0.8%
of our patient population.
In the Madison area, the area that I treat amputees,
I would say I have a disproportionate number
of trauma, cancer and congenital amputees that I treat
because of being a level one trauma center.
I treat patients with reasons for amputations
such as motorcycle accidents,
falls from construction job sites.
And then I treat a fair number of cancer survivors
because of our cancer treatment center.
And I treat a fair number of congenital amputees
because we have a children's hospital.
So congenital meaning somebody who was born without a foot.
So let's talk for a second about prosthetic types
and the timing of when somebody gets a prosthesis.
This is something that is not very well understood.
When somebody first has an amputation,
the only goal within the first six to eight weeks
is to protect that limb and help that patient to heal.
So an immediate postoperative prosthesis
or a rigid removable dressing, which is a protective cast,
can be used in that early acute care phase.
We're basically protecting the residual limb
to help the patient safely navigate around,
transfer from a bed to a wheelchair,
transfer from wheelchair to toilet, things like that.
We're protecting that limb; that is paramount.
The very first prosthesis somebody gets
is not the one they're going to have forever.
And that's another common misunderstanding by people.
Some folks might think that you get one prosthesis for life
and that's it, and that's not true.
And it would be almost impossible
to keep one device fitting as the anatomy
in somebody's residual limb changes.
So the very first prosthesis somebody receives
is called a preparatory prosthesis,
and that can be fitted at the very soonest
about two months after surgery,
which is a quite aggressive timeline.
Generally speaking, we are right around three months
after surgery that we're fitting the very first prosthesis.
And that device will fit as long as we can modify
and keep that socket fitting somebody's anatomy
as it changes shape
within the first 6 to 9 to 12 months.
As somebody wears their first prosthesis,
because of the tension that the socket puts
on the soft tissue anatomy on the residual limb,
the residual limb will change
and the socket has to be adjusted
to accommodate those changes.
Ultimately, when the limb is more mature
and it has stabilized in size,
a definitive prosthesis is created
and that's intended to last a lot longer,
perhaps one, two, three, maybe five years.
It's all dependent on how much anatomical change happens
within the first several months of use of that prosthesis.
And that is another factor that people have to,
that you might wanna remember,
that somebody will not just get one
definitive prosthesis over the lifetime.
If they were to gain or lose 15 to 20 pounds
or their activity level changes, or perhaps, unfortunately,
they might have another medical issue
that changes the type of activity
that they are doing every day,
they might need a different type of prosthesis.
And then lastly are the questions I get most often
are about special use prostheses.
Many people will ask if they can get a prosthesis
that will allow them to run or to perhaps water ski
or to go swimming.
Those are all options,
but they're not often paid for by insurance for one thing,
and also might be above and beyond what an insurance
or a payer, paying source
would consider medically necessary,
which is a bit frustrating
for those of us who provide this type of care.
We wish we could provide everybody with a device
for every type of activity they want to do.
When it comes to coverage for prosthetic care,
generally speaking,
the number one issue is medical necessity.
What does somebody, what is medically necessary
to help somebody continue to thrive
and to live a healthy, safe life?
That is our primary goal
and hopefully we get that patient
back to nearly 100% of what they did before.
So as I mentioned before, the earlier goals
after amputation simply involve wound healing
and protection of that limb.
We do a lot of post-surgical management,
we do compression of the limb,
and I'll show you what that looks like in a second.
We are worried about preventing contractures in the body.
So if somebody sits in their wheelchair
while they're healing, their hips and their knee joints
might get really, really tight
and we don't want for that to become a permanent fixture.
So we encourage that they stretch out their knees
and their hips, and we have to manage edema
or swelling within the limb.
So application of a compression garment
such as a, what we call a shrinker sock,
is used after surgery.
Once the suture line is able to tolerate it,
we apply a compression garment
to help minimize the swelling within the limb
and aid in healing.
And then we're also concerned
that somebody get functionally independent much earlier,
which means we wanna protect that limb
so that they can move about safely
so they're not getting sluggish
and getting deconditioned and getting weaker
because they have to feel like all they can do is sit.
So the the ways we contend with that are twofold.
One is through what we call
an immediate postoperative prosthesis or an IPOP.
An IPOP is applied in the operating room.
The pictures shown are of my hands in the operating room,
where we're putting many layers of padding
and soft garments within a plaster cast,
which is actually attached to a prosthetic foot,
which will allow the patient to stand
and do minimal weight bearing the day of
or the day after their amputation surgery.
As you might imagine,
this is a very aggressive way of treating new amputees,
but it has a huge mental component.
So if somebody knows they have to undergo amputation,
but they can wake up wearing a prosthesis
and get up and stand up right away,
and again, this is not for everybody,
they might have a better understanding
that they're gonna be okay, they are gonna walk again,
they are gonna be active again
because they're getting up right after their surgery.
This takes a huge amount of coordination
between prosthetics and the physical therapy specialists
within the system because as you might imagine,
this takes a lot of guidance for the patient
to be told how to stand up, how to carefully maneuver,
and not to bear all of their weight on this cast.
It's for touchdown, lightweight weight-bearing at first.
The other option that we apply for somebody who's newly,
who has just undergone amputation,
other than a compression sock,
is called a rigid removable dressing.
And that's a lightweight cast,
a protective, removable device that's taken on and off
as needed to both protect the limb
and to allow the patient to check their wounds,
but also to protect them as they get up out of their chair,
use crutches or a walker or a wheelchair
so that, heaven forbid, they bump their limb,
they're not gonna break their suture line back open.
The pictures shown in the slides are what we call a donning tube.
So it's a means of applying a compression garment
without four hands.
These are my best friend when I go into fit a new amputee
and get them fitted with compression socks
so that the patient is not in a lot of pain
as I apply that garment.
An above-knee amputation
can also be fit with compression garments.
The difference is that that includes a belt
to help that garment stay in place.
So these are all acute care phase
or immediate postoperative phase items
that we do when we're first working with new amputees.
And when we talk about moving them
into their first prosthesis
or perhaps from their first prosthesis
to their second or their third to their fourth,
what we have to consider is what they're able to do
or what they're determined to get back to doing.
And that involves what we call K-levels
or ambulation levels is the Medicare determinant.
The function levels K zero through four
are the defined levels that we have to follow
when it comes to the components
that we can pick for somebody when we're fitting,
when we're creating and making their first prosthesis.
A level zero amputee ambulation level
means that they have no potential benefit
from use of a prosthesis.
And this does apply to some people, unfortunately.
It might be somebody who doesn't have the strength
or the wherewithal to push up from sitting in a chair
or lying in bed and can't get upright.
As you might imagine,
a prosthesis is not appropriate for that person.
However, moving on to level one,
this might be somebody who wants to stand
and use a prosthesis to simply take a step or two
or to pivot and transfer from their wheelchair to their bed
or their wheelchair to toilet, things like that.
Or maybe just take a couple steps across their kitchen
and at a very low level of ambulation safely.
That's a K-level one.
K-level two would be somebody
who can walk throughout the home and community at one speed.
And this applies to a lot of amputees in various age levels.
The difference between level two and level three
is that level three involves somebody
who can walk at variable cadence or different speeds.
If they were crossing the street, for example,
and the walk changed from walk to stop
and they could speed up to get across.
That would be an example of variable cadence,
and somebody who can perhaps walk across uneven ground
like across, up and down a curb or across grass.
Level four is somebody who runs.
This usually applies to the kids that I treat
or the, a lot of cancer survivors,
young folks that were previously very active
and get well again,
and plenty of our military survivors too from amputation.
I like to explain what goes into making a prosthesis
with a side note of an explanation
of why prosthetic limbs are so expensive.
This is a extensive list
of what goes into making a prosthesis,
and the dollar amount paid for a device
involves an extensive amount of behind the scenes actions
that not a lot of people understand,
and I'll explain what I mean.
So in making a prosthesis,
it involves the following: evaluation,
insurance authorization, the impression of the limb
and measurements taken, modifying a cast
that's taken of the limb, fabricating a practice socket
or a test socket, the fitting of the test socket,
fabricating the prosthesis itself
after the test socket is fitted,
the dynamic alignment of the socket after it's made,
the final delivery when the patient is seen
for actually getting the prosthesis,
and adding a cosmetic finish at the end.
That's most, but not all of the items
that go into making and fitting a prosthesis,
and all of that is wrapped up into the cost
or the price tag of a prosthetic device.
That's something that's not very well understood
because people often, their jaw drops when I tell them
that a moderately average cost for a prosthesis
might be in the mid teens to high teens,
thousands of dollars.
The reason that the devices are so expensive
is because it includes every single part
of everything that I just mentioned
and the components themselves, which can be,
I mean, a prosthetic foot can vary
between hundreds of dollars to tens of thousands of dollars
just for the prosthetic foot component.
So it's worth understanding that all of those things
go into the price tag on a prosthesis,
and then the adjustment and the follow up for 90 days
after somebody gets their prosthesis.
So I'd like to show a few pictures
of what making a prosthesis actually looks like from the lab
because these are kind of behind the scenes look
into what we do.
So evaluation and casting
involves taking anatomical measurements,
recording those on our measurement sheets
so that we get a full dimensions fill-out
of every limb that we're gonna make a prosthesis for.
So we're taking circumferences, medial-lateral dimensions,
anterior-posterior dimensions, length,
height that it needs to be.
We're measuring how much space there is
for a prosthetic foot.
We're measuring how much clearance somebody might have
if they need a knee joint, and we're measuring for the socks
that they're gonna need and the gel liners
that are gonna be the interface within the prosthesis.
Then what we'll do, well, there's two different ways
to capture somebody's shape, and by that I mean,
how do we get a negative impression
of a positive model of somebody's limb?
The picture on the right shows a plaster of paris model
or a positive model after a cast was taken
of a below the knee amputee's limb and filled with plaster,
which is then being modified to help shape that first socket
that's going to be made.
And the check socket,
or the first socket that's made for somebody
is made directly from that cast.
Another way of doing this is by digital tracing.
Technology nowadays is wonderful
and allows us to use scanners to take a shape capture
of a residual limb and avoid the mess and the time
that using plaster of paris creates
when we're physically casting somebody.
We can take a digital tracing
and it recreates that limb on the screen for us.
We can then modify the dimensions
of that positive model
right on a screen and send that information to a technician
to create the socket for us.
I as a, what somebody might call,
a more conventional clinician,
I still like hand-casting plaster models
of my patients' residual limbs
because I feel that gives me the most accurate shape
and an understanding of exactly how tight
I can make a socket, where it needs contour,
where they might need a relief for a bony prominence,
things like that.
Sometimes it's hard to break old habits.
After the cast is modified,
we make what's called a check socket.
And a check socket is generally a clear,
kind of crudely assembled practice socket
that we try on the patient
to see what changes need to be made.
The pictures shown are a variety of my patients,
some missing one limb, some missing two.
And as you can see, the ages of the patients I treat
vary greatly from infants to adults.
To date, my youngest patient
has been I think eight and a half months old,
and my oldest patient has been, is 98, I believe, years old.
And it's a great joy to treat patients
with that much variability in age.
But the check socket fitting is again
a trial of the shape that we've made.
Oftentimes, we have to make small changes to this stage
to help the patient get the right height,
get the right alignment, get the right fit.
Sometimes we do more than one of these fittings,
and then this prosthesis gets sent to finish
to look like a permanent device.
So we take the first, what we call check socket,
turn it into a finished laminated socket
so that it's a safe and permanent device
for somebody to use long-term.
And the progression is really, really exciting.
One of my favorite parts of what I do
is when I first meet a patient,
who I've seen only ever in a wheelchair,
and then at some point they come walking in the office door.
That is extremely gratifying.
And then the progression from check socket fitting
to lamination, and you can see
this patient went from a check socket pair of legs
to her first temporary pair of prostheses,
to her first definitive pair of prostheses,
and finally to her fourth pair of legs
and is running around independently,
and it's hard to keep up with her when she visits my office.
So again, a preparatory prosthesis
is the very first prosthesis somebody is fitted with
and takes home with them.
The goals of that first device are simply
to allow the residual limb to mature to get less sensitive.
Hopefully they're gonna become less painful
throughout the use of this preparatory prosthesis.
The limb is gonna change size and shape
as they mature and as they get more active.
The patient's gonna get stretched out a little bit more,
learn how to walk again,
learn how to use various gait aids, such as a walker
or a cane or crutches,
and then eventually return to some level
of functional independence.
From there, we go to the definitive prosthesis,
which again is meant to last a lot longer.
When we talk about prostheses, we talk about the terminology
applying to the various levels of amputation.
In other words, we don't just use one term
to apply to any level of amputation.
We get specific to where that amputation occurred,
and that's how we term the prosthesis
or the device that's needed.
So anything from a partial foot,
which is partway through either the toes
or the transmetatarsal bones,
which are the long bones in the forefoot,
to a midfoot amputation to a Symes,
which is an amputation at the ankle
where the bones are taken apart.
This is a unique amputation level
because it allows the patient to bear weight
through the end of the limb and it's a very, very active...
Those tend to be extremely functional
and very active amputees that have Symes amputations.
By far the most common level of amputation is below the knee
or transtibial level amputees.
70% or more of amputees across the country
are at the below the knee or transtibial level.
Those are the patients that we see by far most often
and are some of our most successful.
Retaining your own knee joint as an amputee
is extremely valuable,
and there's a very, very huge functional change
when it comes to somebody
who can use a prosthesis successfully
that has their own knee joint
to somebody who has to rely on a prosthetic knee joint,
which is anybody higher than a transtibial level amputee.
The one step up from a below the knee amputee
or transtibial level amputee
would be what we call a knee disarticulation.
And that is what it sounds like,
it's a disarticulation of the joint at the knee
or through the knee amputation.
So that patient has their entire femur
and is able to bear weight through the end of the femur,
which is an extremely advantageous fact
for that level of amputee.
They still do need a prosthetic knee joint,
but they can bear weight through the end of the limb.
Next is a transfemoral level,
which is above the knee or through the femur,
and then higher amputations would be through the hip
or at the hip or through the pelvis.
The highest level amputations
are generally due to some sort of a tumor situation,
is generally the reason why somebody
would have an extremely high amputation level.
These are pictures to show what residual limbs look like
at the below the knee or transtibial level amputation.
And as you can see, these people are all different ages,
all different ambulation levels, and all different capabilities.
The patient in the lower left was at one time
missing one leg and due to diabetes and poor circulation
ultimately lost the second residual limb below the knee.
So she was bilateral.
She went, if you can remember what we talked about earlier
with the ambulation levels or the K-levels,
she went from what I would have considered
to be a K two level, which is the single speed ambulation,
kind of getting around her house with a walker
to when she went from one prosthetic leg to two,
she was basically downgraded from a K level two
to a K level one, where it really went
from being able to get around her home
and maybe get out to the car.
She went from that to really needing a lot more assistance
and basically using both prosthetic legs
just to stand up and pivot transfer out of her wheelchair
to the bed or to the commode or to the couch
in very, very short distance ambulation.
That's a very common story
for somebody who has diabetic neuropathy
and loses one limb and then the other.
They may change ambulation levels up or down,
but generally it goes down.
The patient on the very right
is that is a fully finished cosmetic cover.
Very beautiful.
It looks obviously quite good, I have to say.
I really appreciate when somebody walks so well
and the cosmesis on the device is finished so well
that you wouldn't actually know that that's a prosthetic limb
unless you've really looked hard at the device.
But not everybody receives a fully finished prosthesis
for a number of reasons.
One can be cost; it is moderately expensive
to get a fully finished cosmetic cover
on the outside of a device, but some people just don't care.
I would say compared to 20 years ago,
many, many of my patients now
don't worry about how their prosthesis looks
as much as they used to.
And that might be just a more, a common understanding
about amputation and the prevalence of perhaps
the wounded war veterans that have come
and become much more active,
and they're more seen throughout the community.
The Paralympics has become really popular.
So I think for all the right reasons,
amputation is becoming a little bit more well understood
and a lot, and it's something that people can show
that they're able to wear a prosthesis and get on with life
and be proud of the things that they're able to do
rather than what they're limited from.
Here are a couple pictures of transfemoral prosthesis,
which are, again, that's an above the knee amputation level.
That is significantly more challenging
than if you retain your own knee joint in an amputation
because you have to use musculature above the femur
in your, mostly your gluteus muscles and hamstring muscles
to pull that knee joint back and control it
from flexion to extension.
The exceptional advantage of microprocessor knees
is shown in the picture on the right,
where somebody is carrying a baby down a slope.
This was something that would be unheard of 40 years ago,
50 years ago, for somebody to trust a prosthesis
with an artificial knee to do this.
But it speaks to the higher level technology
that we have available to us now, and it's very exciting
to be able to provide microprocessor knees to patients
that basically help them to control their knee joint
in ways that wasn't possible
before the technology that exists now.
Some of you might be wondering how much those things cost,
and they are extremely expensive.
I would say it's comparable to a pretty nice car,
but the change in quality of life
that people can enjoy
if they have the advantage of microprocessor technology
is quite significant.
I wanna point out before I finish
that there is an amazing organization
called the Amputee Coalition of America
that provides a lot of support and educational resources,
and I wanna make sure that people understand
if anybody in the audience needs any support or education
or wants to connect with amputee communities
throughout the U.S., this is a fantastic way to do so.
The Amputee Coalition
not only provides educational resources,
it provides peer to peer support.
A few years back, my group was able to help
about a dozen patients, amputee patients
undergo peer support training and get trained
so that when somebody new
is going through a limb loss situation,
they're able to call somebody within their community
and get education and resources and support that they need.
So anybody listening, if you need any sort of,
again, education, support, or advocacy,
the Amputee Coalition is a fantastic resource to turn to.
The mission is one that's quite well understood.
Their mission is to reach out
and to empower people affected by limb loss
to achieve their full potential through education,
support, and advocacy and to promote limb loss prevention.
I feel like this talk has allowed me
a little bit of a way to do that for you,
and I hope that you've learned a little bit
about prosthetics, about amputation,
about what somebody like me does on a daily basis.
And our goal is to get people back to living on two legs
and getting back to the life
that they wanna lead and being more active.
I really appreciate you listening,
and have a great night.