June 23, 2009

American Association of Nurse Life Care Planners Journal of Nurse Life Care Planning

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Amputation Part 3,Supplement

AANLCP Journal of Nurse Life Care PLanning issn 1492-4469 Winter 2009 Vol. IX No. 4

Journal of Nurse Life Care Planning is the official publication of the American Association of Nurse Life Care Planners. JOURNAL OF NURSE LIFE Articles, statements, and opinions contained CARE PLANNING herein are those of the author(s) and are not necessarily the official policy of the WINTER 2009 AANLCP or the editors, unless expressly stated as such. The Association reserves the Contributing Editor right to accept, reject, or alter manuscripts or advertising material submitted for publi- Victoria Powell cation. Journal of Nurse Life Care Planning is pub- lished quarterly in Spring, Summer, Winter, Table of Contents and Fall, or as needed. Members of AANLCP receive the Journal subscription 162 What Can Silver Do For You? Use of Silver electronically as a membership benefit. in Prosthetic Applications Please forward all address changes to Justina Smith CO BOCPO MEd FAAOP AANLCP marked “Journal-Notice of Ad- Robert W. Shipley dress Update.” Copyright 2009 by the American Associa- 163 Amputation Resources and Glossary tion of Nurse Life Care Planners. All rights Victoria Powell RN CCM LNCC CNLCP MSCC reserved. For permission to reprint articles, CEAS graphics, or charts from this journal, please 184 Immobility: Not a Great Idea; To Hop Or request to AANLCP headed “Journal- Not To Hop; LegSim, a Case Study Reprint Permissions” citing the volume John A. Tata MD number, article title, and author and in- tended reprinting purpose. 189 Volume management patient handout Neither the Journal nor the Association James Olin Young Jr. CP LP FAAOP guarantees, warrants or endorses any prod- uct or service advertised in this publication nor do they guarantee any claims made by Departments any product or service representative.

155 Editor’s Note Wendie A. Howland RN MN CRRN CCM CNLCP 156 Information for Authors 157 Contributors to this Issue 158 Certification Board News 192 Planning Ahead; Info for Advertisers

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American Association of Nurse Life Care Planners 3267 East 3300 South #309 Salt Lake City, UT 84109 Phone: 888-575-4047 Fax: 801-274-1535 Editor’s Note Website: www.aanlcp.org This is the third part of Vol. IX, no.4 of the Journal Email: [email protected] of Nurse Life Care Planning, Vol. IX, no.4. The pieces here are examples of resources available to 2009 AANLCP Executive Board patients and caregivers. We do not endorse the President Karen Apy-Cebulko BSN RN CNLCP LNCC products they describe and are not responsible for President Elect their content; they are presented so you may be Barbara Bate RN CCM CNLCP LNCC MSCC aware of some of the resources your patients or Treasurer clients might be seeing. We would appreciate other Linda Husted MPH, RN, CNLCP, LNCC, CCM, CDMS, CRC, MSCC resources or links from our readers. Any we receive Secretary will appear in the Letters to the Editor section in Kim Wages RN BSN BBA CRRN CNLCP MSCC the next issue. Past President Shelene Giles RN BSN BA MS CRC CNLCP MSCC Cordially, Wendie Howland Editor, Journal of Nurse Life Care Planning The American Association of Nurse [email protected] Life Care Planners (AANLCP) promotes the unique qualities the Registered Nurse delivers to the Life Care Planning process. We support education, research, and standards related to the practice of Nurse Life Care Planning.

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Information for Authors • any copyright holder, for copyrighted materials including illustrations, photographs, tables, etc. AANLCP invites interested nurses and allied professionals to submit article queries or manuscripts that educate and inform • All authors must disclose any relationship with facilities, the Nurse Life Care Planner about current clinical practice institutions, organizations, or companies mentioned in methods, professional development, and the promotion of their work. Nurse Life Care Planning within the medical-legal community. • All accepted manuscripts are subject to editing, which may Submitted material must be original. Manuscripts and queries involve only minor changes of grammar, punctuation, may be addressed to the Editorial Committee. Authors paragraphing, etc. However, some editing may involve should use the following guidelines for articles to be condensing or restructuring the narrative. Authors will considered for publication. Please note capitalization of be notified of extensive editing. Authors will approve Nurse Life Care Plan, Planning, etc. the final revision for submission. • The author, not the Journal, is responsible for the views and Text conclusions of a published manuscript. Manuscript length: 1500 – 3000 words All manuscripts published become the property of the Journal. • Use Word© format only (.doc) Manuscripts not published will be returned to the author. • Submit only original manuscript not under consideration by Queries may be addressed to the care of the Editor at : other publications [email protected] • Put the title and page number in a header on each page (us- ing the Header feature in Word) • Set 1-inch margins Manuscript Review Process • Use Times, Times New Roman, or Ariel font, 12 point Submitted articles are peer reviewed by prominent Nurse Life • Use double-spacing, using the Word formatting feature Care Planners with diverse backgrounds in life care planning, • Place author name, contact information, and article title on case management, rehabilitation, and the nursing profession. a separate title page, so author name can be blinded for Acceptance will be based on manuscript content, originality, editorial review suitability for the intended audience, and quality of the submit- • Use APA style (Publication Manual of the American Psy- ted material. chological Association) • Submit your article as an email attachment in Word, with document title articlename.doc, e.g., wheelchairs.doc

Art and Figures All photos, figures, and artwork should be in TIFF, EPS, or AANLCP Journal Committee for this issue JPG format. Line art should have a minimum resolution of Kathy Pouch RN CCM CNLCP LNCC 1000 dpi, halftone art (photos) a minimum of 300 dpi, and Editorial Committee Chair combination art (line/tone) a minimum of 500 dpi. Wendie Howland RN MN CRRN CCM CNLCP Journal Editor Each table, figure, photo, or art should be on a separate page, Shelly Kinney RN MSN CCM CNLCP labeled to match its reference in text, with credits if needed Newsletter Editor (e.g., Table 1, Common nursing diagnoses in SCI; Figure 3, Mariann Cosby MPA MSN RN PHN CEN NE-BC LNCC CCM MSCC Time to endpoints by intervention, American Cancer Society, Linda Husted MPH RN CNLCP LNCC CCM CDMS CRC MSCC 2003) Debbie James, RN, BSN, CNLCP, CSCC Cheryl Mathis RNC CLNC CNLCP Editing and Permissions Danielle Mayer RN LNC MSCC CNLCP Diane Pierce RN The author must accompany the submission with written re- Victoria Powell RN CCM LNCC CNLCP MSCC CEAS lease from: • any recognizable identified facility, or patient/client, for the use of their name or image • any recognizable person in a photograph, for unrestricted use of the image

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Contributing To this Issue

Robert Shipley (“What Can Silver Do For You?”) received his Bachelors Degree in Science with a double major in Energy and Power and General Technology from Illinois State University in 1991. Robert is cur- rently employed at Volt Design and Technical Services at Caterpillar, Inc. as a lab supervisor and is re- sponsible for the design, development and administration of various bench tests and experiments in sup- port of engine research efforts to meet tier 4 emissions standards. In addition he has worked with failure analysis, material selection and alternative energy activities. He lives in Illinois where he enjoys rebuild- ing cars and collecting antiques.

Justina S Smith CO, BOCPO, MEd, FAAOP (“What Can Silver Do For You?”) has been at Shriners Hos- pitals for Children for five years, presently as Director of Orthotics and Prosthetics at Shriners in Shreve- port, LA. She is a certified orthotist/prosthetist and licensed prosthetist/orthotist with over 20 years of experience with children and adults. Ms. Smith belongs to several professional organizations, including the American Academy of Orthotics and Prosthetics, the Association of Children’s Prosthetic-Orthotic Clinics, the Orthotic and Prosthetic Assistance Fund (OPAF) and the Board of Certification Orthotics and Prosthetics. She is active in her state organization (LAOP) where she has served on the executive board as program coordinator and is currently president-elect for the 2010-12 term. Justina has also published material in the JPO and does presentations on various topics in the field for many educational institutions and several community groups. She enjoys outdoor activities and leads a Boy Scout Troop in Benton, LA.

Victoria Powell (“Amputation Resources” and “Glossary”) is CEO/President of VP Medical Consulting. She is a Nurse Case Manager, Nurse Life Care Planner, Medical Set Aside Allocator, Legal Nurse Consult- ant, and Ergonomic Assessment Specialist

Dr. John A. Tata (Immobility,” “To Hop Or Not To Hop,” “LegSim”) assumed the position of Medical Di- rector of Hartford Walking Systems in 2007. As Director his role is to monitor all medically related mate- rials which are hosted on the Hartford Walking Systems website: www.legsim.net. He has authored several articles on topics including: mobility, complications of immobility and a sedentary lifestyle and joint pres- ervation which are featured on the website. He is currently involved in the organization and implementa- tion of clinical research projects at both academic institutions and rehabilitation facilities.

James Olin Young, Jr. CP LP FAAOP (Volume management patient teaching handout) is the owner and Ꮬ prosthetist of the Amputee Prosthetic Clinic in Tifton, Albany, and Macon GA.

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CNLCP Certification News from the CNLCP Certification Board

Certification October 2009 Certifications

Board The Certification Board would like to extend congratulations to the nurses who recently

passed the CNLCP certification exam in October 2009. 195 Goodrich Hill Road Janet Allen Fort Wayne, IN Patricia Miller Bisbee, AZ Fairfax, VT 05454 Allison Drakes Miami, FL Elizabeth Miloser Fombell, PA 802-849-2956 Elizabeth Lowe Durham, CA Margaret Van Ginneken Lake Stevens, W

Susan Maraglino Allen, TX Certification Board Members: All are now eligible to use the Certified Nurse Life Care Planner (CNLCP) designation.

Barbara Krasa, Chair Please extend congratulations and welcome these nurses. We encourage all to become

Glenda Evans-Shaw, Co- members of The American Association of Nurse Life Care Planners and the Nurse Life Chair Care Planner online list community. These are wonderful opportunities to network, ask Janice Skiljo Haris, Treasurer questions, and become part of a larger group of nurses who have a wealth of experience April Pettengill, Secretary to share. The AANLCP can be found on the web at www.aanlcp.org and the list can be

found at Yahoo Groups: “nurseLCPforum.”

The Certification Board would also like to thank those CNLCPs who renewed their

certification in 2009:

April 2009 Recertifications:

Amy Beth Baron Karen Klemme

Michelle Cataline-Barker Rhonda LeBeau

Sherry Brown Irene Metford

Linda Crawford Kathleen Metcalfe

Sheila Ann Curl Alicia VanGroninger

Janice Skiljo Harris Kim Wages

Ramone Kimmins Mary Virginia Walters

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October 2009 Recertifications:

Jill Aggersbury Ruth Hampton Kelley O’Reilly

Karen Apy-Cebulko Sheila Hayden Paula Paxton

Betsy Bates Nina Hoagland April Pettengill

Linda Curtis Robin Karns Kathleen Piatek

Jill deVries Shelly Kinney Patricia Reilly-Butcher

T. Jean Douglas Laura Kling Jan Roughan

Marion Easter Jan Klosterman Anne Sambucini

Marion Edwards Barbara Krasa Patsy Shaffer

Wayne Elkland Kelly Lance Rhonda St. Martin

Alvena Ferreira Andrew Lantz Lora White

Patricia Gafford Tracey Lombardi Debra Wright

Ellen Glusing Sandra Lowery

The CNLCP Certification Board and the AANLCP rely on recertification to maintain and grow the profession of

Nurse Life Care Planning. We especially encourage all of those who recertified to become involved in the many

opportunities in both organizations. Your knowledge and experience is invaluable to obtaining our goal of ABNS

accreditation. Please visit the CNLCP Certification Board website for more information at

www.cnlcpcertboard.com.

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What Can Silver Do For You? Uses of Silver in Prosthetics Applications

Justina S. Smith CO BOCPO MEd FAAOP Robert W. Shipley, Volt Information

The benefits of silver as tention occur, and the bacterial population is often an antimicrobial have been changed from the normal.... The skin … is never com- widely known in the medical pletely dry, and it often becomes soft and macerated community for thousands of from long-lasting sweat and therefore provides a years. The Romans were the warm, moist, favorable habitat for most bacteria."1

first to publish the healing Special Properties of Silver effects of silver in wound As an anti-microbial, silver is believed to disable the coverings. Settlers in the U.S. bacterial and fungal enzymes responsible for cellular used silver coins in their rain respiration, which effectively suffocates the affected barrels and canteens to kill cell. Mitochondrial DNA is attracted to the extreme bacteria. Silver has been in conductivity of the silver, effectively “wadding up” use since the late 1800s in the proteins so they are unable to perform intra- preventing infections in burn cellular transfer. Ionically, (colloidal) silver is ex- patients, first in foil form and later silver sulfadiazine posed to high voltages to expel two electrons, which and silver-impregnated gauzes and bandages. In upon contact, will effectively rip out protons from the 1881, Karl Crede, a gynecologist, began instilling cells of bacteria and fungi, rupturing the cell mem- doses of silver nitrate in the eyes of newborns, a prac- brane. Increases in temperature will accelerate the tice still widely used. More recently, silver has been rate of cell death as well as shorten the time of onset. incorporated into a variety of textiles to address mi- As toxic as silver is to pathogens, it has no effect on crobial proliferation in prosthetic devices. mammalian cells. Allergic reactions attributed to sil- In his authoritative book, Skin Problems of the Ampu- ver are due to association with silver alloys and nano- tee, the late S. William Levy, MD observed: "The am- particles, which will also attack beneficial bacteria. putation stump must be inserted into an airless plastic Correspondence to Justina S. Smith CO, BOCPO, MEd, container, where it remains all day. In this confining FAAOP, Director of Orthotics and Prosthetics, Shriners Hospi- tal for Children 3100 Samford Ave, Shreveport, Louisiana situation, abnormal patterns of heat loss and heat re- 71103 (318) 226-4279. Email: [email protected]

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Silver also is thermally conductive. When used in tex- tiles, it dissipates heat evenly throughout the garment, preventing hot spots that can cause blisters and pro- viding a cooling effect. An article incorporating sil- ver will also dissipate infrared radiation emitted by the body for additional cooling. Silver’s high electri- cal conductivity prevents static buildup. Some users have reported a reduction in phantom pain when us- ing stump socks with silver.

Silver from the Start Fig 1 Courtesy: Robert W Shipley woven into the garment, concentrating on the contact The benefits of silver can be an integral part of patient surfaces of the article (Fig 1). The coated fiber re- care from the beginning of amputation care, and even tains much of the tactile and tensile properties of the for the prevention of amputation. In a recent study by the Seattle Veterans Affair Medical Center, it was found that 73% of all lower level extremity amputa- tions occurred due to the causal sequence of minor trauma, cutaneous ulceration, and wound-healing failure.3 Optimal bacterial control of diabetic and other wounds with compression socks, ointments, and body washes containing silver disrupts this cycle and helps mitigate infections. If amputation is necessary, silver-impregnated fibers in sutures, dressings, and ointments can ward off bacterial infections. Once healing has occurred from amputation, products such Fig 2 Courtesy: Robert W Shipley as body washes and high performance prosthetic arti- fiber, and retains its potency for the life of the product cles can optimize clinical outcomes. (Fig 2). X-STATIC® eliminates 99.9 percent of bacte- High Performance Wear ria in less than one hour of exposure. Proven by Manufactures of O&P high performance products use NASA, the U.S. Army and by Johnson & Johnson, X- the X-STATIC® fiber technology for bacterial con- STATIC® offers both antimicrobial and anti-odor trol4. A patented non-inductive plating process is used benefits5. Ammonia and denatured proteins contribute to fully coat the fiber with 99.9% pure silver and then continued next page

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bial Silver, offers product for patients who require a to odor in footwear. Both bind readily with silver. Be- topical antimicrobial as part of their advanced wound cause silver is on the outside of the fiber, X-STATIC® management strategy. The company’s extensive re- allows for immediate binding with these odor-causing search showed that 1.4% content provided the ideal agents – resulting in instant odor reduction, according level of silver to achieve maximum antimicrobial ef- to the manufacturer. Prosthetic shrinkers, liners, and fectiveness. The silver ions in ALGICELL™ Ag are stumps sock are available with X-STATIC® technol- slowly released in a controlled fashion to provide ogy, and combined with DuPont’s CoolMax® fabrics constant protection and extended wear-times. (offering additional wicking effects), can provide the : prosthetic wearer with problematic skin conditions a References viable alternative to conventional garments. 1 Mark Levy SW, MD. 1983. Skin Problems of the

Skin Care Amputee, St. Louis: Warren H. Green, Inc. A wide variety of hygienic and medicinal skin care 2 WebMD Public Information from the U.S. National products are being developed utilizing silver com- Institutes of Health pounds, and should be considered in treating ulcera- 3X-STATIC® is manufactured by Noble Biomaterials, tions occurring from fit problems associated with Inc. Scranton, PA. prosthetic devices. One such product, ALGICELL™ 4 Ag is made up of 1.4% silver released in its ionic The Silver Institute, 1200 G Street, NW Suite 800, Washington, DC 20005, www.silverinstitute.org form and a proprietary blend of mannuronic and gulu- ronic alginic acids. FDA approved, ALGICELL™ Ag 5 Derma Sciences, 214 Carnegie Center, Suite 300, Calcium Alginate Wound Dressing with Antimicro- Princeton, NJ 08540 www.dermasciences.com Tired of Shrinkers falling off patients? Or being so uncomfortable that no one wants to wear them?

Both Shrinkers are made with X-Static Silver for anti-microbial protection.

Our BK Shrinkers are made with a Gel Locking System to keep them from migrating. The X-Silver AK Shrinker is made with a soft and flexible EasyWear™ belt that can accommodate waist sizes from 32” to 50”. Both versions are seamfree and provide 20mm-25mm Hg Medium Compression Available in 5 widths and 3 lengths

Call for more information: 800-822-7500 email: [email protected] The Innovation Leader in Knitted Orthotic and Prosthetic Products

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Amputation Resources

Victoria Powell RN CCM LNCC CNLCP MSCC CEAS

One of the most difficult parts of Life Care Plan development is locating informa- tion specific to the medical condition at hand. This is certainly not intended to be an exhaus- tive list of resources and references needed for development of a Life Care Plan for the ampu- tee. Although certainly not intended to be an exhaustive list of resources and references needed for development of a Life Care Plan for the amputee, these resources are intended to provide a starting point for much of the research required. Links can change without notice; please check to be sure links are current before distributing to clients.

Advocacy Independent Living Centers Di- Wrightslaw rectory www.wrightslaw.com American Association of People www.virtualcil.net/cils with Disabilities Publications 800.285.844 National Patient Advocate Foun- “Advocating for Your Child.” www.aapd-dc.org dation Rick Bowers. Expectations. 2005, 757.873.0438 pp.30-31. American Bar Association www.npaf.org www.amputee-coalition.org/expec 800.285.2221 tations/advocating.html www.abanet.org/disability SNAP: Special Needs Advocate for Parents “Taking Charge: How to Become Americans with Disabilities Act 888.310.9889 your child’s best advocate.” Jeni- Hotline www.snapinfo.org/home.html fer Simpson and Helen Rader. 800.514.0301 inMotion.May/June 2001, pp. 16- Voices for America’s Children 18. Amputee Coalition of America 202.289.0777 www.amputee-coalition.org/inmot 888.267.5669 www.childadvocacy.org ion/may_jun_01/childs.html www.amputee-coalition.org

Fair Housing Act Victoria Powell is is CEO/President of VP Medical Consulting. 202.708.1112 She is a Nurse Case Manager, Nurse Life Care Planner, Medi- cal Set Aside Allocator, Legal Nurse Consultant, and Ergo- www.hud.gov/offices/fheo/FHLa nomic Assessment Specialist. She can be reached at 1201 Mili- ws tary Road, Ste. 2 Box 214, Benton, AR 72015

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Active Living Magazine “NFMD: The Syme Ankle-Level Disarticulation: www.activelivingmagazine.com Heels and Healing.” Douglas G. Smith. inMotion. May/June 2003. In Motion Magazine www.amputee-coalition.org/inmotion/may_jun_03/me www.inmotionmagazine.com ddir.html “NFMD: The Transfemoral Amputation Level. Parts1- Journal of Prosthetics and Orthotics 5:” Douglas G. Smith. inMotion. March/April 2004, www.oandp.org/jpo May/June 2004, July/August 2004, September/October 2004, November/December 2004. O&P Almanac www.amputee-coalition.org/inmotion/transfermoral.ht www.oandp.org ml “NFMD: Transtibial Amputations: Successes and O&P Virtual Library Challenges.” Douglas G. Smith. inMotion. July/ www.oandplibrary.org August 2003. www.amputee-coalition.org/inmotion/jul_aug_03/med The O&P Edge dir.html www.oandp.com/edge “Prosthetic Primer: Partial Foot Amputation: Some- Upper Extremity Online Magazine times Less Means More.” Douglas G. Smith. inMo- www.upperex.com tion. March/April 2003. www.amputee-coalition.org/inmotion/mar_apr_03/pri Amputation Levels mer.html “Know your options: An explanation to the Rotation- plasty and Tibia Turn-up Procedures.” Kevin Carroll. “Support and Information for Upper-Limb Amputees: inMotion. March/April 2005. Just a few Keystrokes or a Phone Call Away!” Eric www.amputee-coalition.org/inmotion/mar_apr_05/rota Westover. inMotion. May/June 2005. Pp. 56-57 tionplasty.html www.amputee-coalition.org/inmotion/may_jun_05/upp er-limbsupport.html “Notes from the medical director (NFMD): Higher Challenges: The Hip Disarticulation and Transpelvic Assistive Devices Amputation Levels.” Parts 1-3. Douglas G. Smith. in- Abledata Motion. January/February 2005, March/April 2005, 800.227.0216 May/June 2005. www.abledata.com www.amputee-coalition.org/inmotion/jan_feb_05/high erchallenges.html Adaptive Driving Alliance 623.434.0722 “NFMD: The Knee Disarticulation: It’s Better When www.adamobility.com It’s Better and It’s Not When It’s Not.” Douglas G. Smith. inMotion. January/Febuary 2004. Association for Driver Rehabilitation Specialists www.amputee-coalition.org/inmotion/jan_feb_04/knee 800.290.2344 disartic.html www.driver-ed.org

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Automotive Safety Issues Easter Seal Society 888.327.4236 800.221.6827 www.nhtsa.dot.gov/cars/rules/adaptive www.easter-seals.org

The Center for Universal Design GovBenefits.gov 800.647.6777 800.333.4636 www.design.ncsu.edu/cud www.govbenefits.gov

Disabled Dealer Magazine Habitat for Humanity 888.521.8778 www.habitat.org/local www.disableddealer.com eBay – Disability Resources Limbs for Life foundation www.pages.ebay/disability resources.com 888.235.5462 www.limbsforlife.org Family Center on Technology and Disability 202.884.8068 Lions Clubs International www.fctd.info 630.571.5466 www.lionsclub.org National Mobility Equipment Dealers Association 800.833.0427 Medicaid www.nmeda.org Early & Periodic Screening, Diagnosis & Treatment 410.786.5916 National Resource Center on Supportive Housing and www.cms.hhs.gov/medicaid/epsdt Home Modification 213.740.1364 State Plans 877.267.2323 Community & Federal Services & Funding www.cms.hhs.gov/medicaid/sateplans Assistance American Association of People with Disabilities Medicare 800.840.8844 800.633.4227 www.aapd.com/links/linkscholarshipawards.php Helpful Contacts www.medicare.gov/Contacts Barr/United Amputee Assistance Fund Prescription Assistance Programs 561.394.6514 www.medicare.gov/Prescription/Home.asp www.oandp.com/organiza/barr/index2.htm The Medicine Program Benefits for Children with Disabilities 866.694.3893 800.772.1213 www.themedicineprogram.com www.ssa.goc/pubs/10026.html National Patient Air Transport Helpline 800.296.1217 Disabled Children’s Relief Fund www.npath.org www.dcrf.com

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New Beginnings Prosthetics Ministries American Podiatric Medical Association 949.230.1999 800.275.2762 www.newbeginnings2000.org www.apma.org

Partnership for Prescription Assistance CDC Diabetes Public Health Resource 888.477.2669 877.232.3422 https://www.pparx.org www.cdc.gov/diabetes

Prosthetics for Diabetics Foundation Diabetes Action www.expage.com/page/pfdfoundation 202.333.4520 www.diabetesaction.org Rotary International 847.866.3000 Diabetes Exercise and Sports Association www.rotary.org/services/clubs 800.898.4322 www.diabetes-exercises.org St. Jude Children’s Research Hospital 866.2STJUDE Joslin Diabetes Center www.2stjude.com 617.732.2400 www.joslin.org Shriners 800.237.5055 Juvenile Diabetes Research Foundation www.shrinershq.org/hospit.html 800.533.2873 www.jdrf.org U.S. Dept. of Veterans Affairs 800.827.1000 National Diabetes Education Program More Than 50 www.va.gov Ways to Prevent Diabetes 301.496.3583 Variety Clubs International www.ndep.nih.gov/diabetes/pubs/50Ways_tips.pdf 888.852.1300 www.usvariety.org National Diabetes Information Clearinghouse 800.860.8747 Vocational Rehabilitation www.diabetes.niddk.nih.gov 800.772.1213 www.ssa.gov/work/ServiceProviders/rehabproviders.h National Institute of Diabetes & Digestive & Kidney tml Diseases www.niddk.nih.gov Diabetes American Association of Diabetes Educators Publications 800.338.3633 Diabetes Forecast www.diabeteseducator.org 800.806.7801 American Diabetes Association www.diabetes.org/diabetes-forecast.jsp 800.342.2383 www.diabetes.org

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Diabetes Health Magazine Insurance Issues 800.488.8468 Georgetown University Health Policy Institute www.diabetesworld.com www.healthinsurance.info.net

Diabetes Self-Management HealthCove 800.234.0923 800.796.5558 www.diabetesselfmanagement.com www.healthcove.com

Health Information Insure Kids Now! American Amputee Foundation 877.543.7669 501.666.2523 www.insurekidsnow.gov www.americanamputee.org Amputee Resource Foundation of America Nutrition www.amputeeresource.org American Dietetic Association 800.877.1600 DisabilityInfo.gov www.eatright.org www.DisabilityInfo.gov Nutrition.gov HealthFinder.gov www.nutrition.gov/home/index.php3 www.healthfinder.gov USDA National Nutrient Database iSafetyNet 301.504.0630 202.842.9005 www.nal.usda.gov/fnic/foodcomp/search www.isafety.org Pain National Institutes of Health American Pain Foundation 301.496.4000 888.615.7246 www.nih.gov www.painfoundation.org

National Rehabilitation Information Center American Pain Society 800.346.2742 847.375.4715 www.naric.com www.ampainsoc.org

National Women’s Health Information Center The National Foundation for the Treatment of Pain 800.994.9662 713-862-9332 www.4woman.gov www.paincare.org National Library of Medicine Surviving Limb Loss 888.346.3656 www.survivinglimbloss.org www.nlm.nih.gov

Virtual Hospital Peer Support www.vh.org Friends Health Connection 800.483.7436 www.48friend.org

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Publication Weight Management “Peer contact for Parents of Children with Congenital Aim for a Healthy Weight Amputations.” Karen Neimanas. Fact Sheet. 2002 301.592.8573 www.amputeecoalition.org/fact_sheets/pc_congenital_ www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt amputations.html American Obesity Association Peripheral Vascular Disease 202.776.7711 American Heart Association www.obesity.org 800.242.8721 www.americanheart.org Shape Up America! Legs for Life www.shapeup.org www.legsforlife.org/main.shtml Youth and Children Vascular Disease Foundation Ability Online 866-723-4636 866.650.6207 www.vdf.org www.abilityonline.org

Prosthesis Association of Children’s Prosthetic-Orthotic Clinics American Board for Certification in Orthotics and 847.698.1637 Prosthesis www.acpoc.org 703.836.7114 www.abcop.org Birth Defect Research for Children, Inc. www.birthdefects.org/about.htm Board for Orthotist/Prosthesist Certification in Orthot- ics and Prosthetics Children with Diabetes 703.836.7114 www.childrenwithdiabetes.com www.abcop.org Cyberteens Publications www.cyberteens.com “Pediatric Prosthesis Care Requires Special Considera- tions.” Chris Perry. inMotion.May/June 2001. Disability Central www.amputee-coalition.org/inmotions/may_jun_01/pri www.disabilitycentral.com mer.html Generation Hope ”Prosthetic Rehabilitation and Technology: Options 215.872.7725 and Advances for Seniors.” Douglas G. Smith. www.genhopeusa.org inMotion.November/December 2005. Helping Hands Foundation “When are Prostheses the Right Choice for Older www.helpinghandsgroup.org Amputees-And when Are They Not?” Terrence O. Sheehan. inMotion.November/December 2005. Internet Resource for Special Children www.irsc.org

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LimbDifferences.org “Early Fitting Is Key to Success.” Diane Atkins. First www.limbdifferences.org Step-A Guide for Adapting to Limb Loss. Volume 2, 2001. On the Other Hand www.amputee-coalition.org/first_step/firststepv2_s1a1 www.ontheotherhand.org 3.html

Sibling Support Project “Parenting Primer: For Parents of Children with Dis- 206.297.6368 abilties.” Jenifer Simpson. inMotion. July/August www.thearc.org/siblingsupport 1999. www.amputee-coalition.org/inmotion/jul_aug_99/pare Special child nt.html www.specialchild.com “Promote a Postiive School Experience for a Child STARBRIGHT Foundation With Limb Loss.” Mary Vander Hoek. inMotion. 800.315.2580 Summer 1995. www.starbright.org www.amputee-coalition.org/inmotion/summer_95/scho ol.html SuperHands www.superhands.us Drug Information and and Pricing Drugs.com Unlimited Possibilities, Inc. www.drugs.com www.unlimitedpossibilities.org MedicineNet.com Winners on Wheels www.medicinenet.com/medications/article.htm 800.WOWTALK PDRhealth www.wowusa.com www.pdrhealth.com/drug_info/index.html

Publications U.S. Food and Drug Administration Drugs@FDA Exceptional Parent Magazine www.accessdata.fda.gov/scripts/cder/drugsatfda/index. 877.372.7368 ctm www.eparent.com Foot and Ankle YAZ (Youth Amputee eZine) American Podiatric Medical Association www.amputee-coalition.org/yaz www.apma.org

“Coping With a Sibling’s Disability.” Linda Lee Ratto. American College of Foot and Ankle Surgeons inMotion.June/July 1996 www.acfas.org www.amputee-coalition.org/inmotion/jun_jul_96/copsi bs.html American Diabetes Association www.diabetes.org

“A Survivors Guide for the Recent Amputee” 561.394.6514 www.oandp.com/barr continued next page

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Books America’s Athletes with Disabilities “Whole Again” An amputee’s awesome ten-year battle 800.238.7632 against continuous pain. By Lee Whipple. Caroline www.americasathletes.org House Publishers, Inc. Ottawa, Illinois & Ossining, New York. Copyright 1980. BlazeSports/U.S. Disabled Athletes Fund 770.850.8199 “A Mile In My Shoes” Two Parrot Productions. www.blazesports.com www.TwoParrot.com Copyright 2005. Challenged Athletes Foundation “It’s Just a Matter of Balance” A Very Personal Story 858.793.9293 of Amputee Rehabilitation. An autobiography, pros- www.challengedathletes.org thetic education, inspirational, surviving limb amputa- Disabled Sports USA tion, useful story for clinicians. Kevin S. Garrison 301.217.0960 Print Vantage Publishers Copyright 9/19/2005 www.dsusa.org

“Pre- and Post-Operative Services for the Amputee International Disabled Self-Defense Association with Diabetes: What the health care provider needs to 828.683.5528 know to prepare and care for amputee patients” www.defenseability.org By Sander Nassan Published by the ADA June 4, 2007 National Amputee Golf Association “The Making of My Special Hand: Madison’s Story” www.nagagolf.org By Jamee Riggio Heelan, Peachtree Publishers, Febru- ary 2000 National Center on Physical Activity and Disability 800.900.8086 Sports/Athletics www.ncpad.org Achilles Track Club 212.354.0300 National Disability Sports Alliance www.achillestrackclub.org 401.792.7130 www.ndsaonline.org Adaptive Sports Association 970.259.0374 National Wheelchair Basketball Association www.asadurazango.org 719.266.4082 www.nwba.org Adaptive Sports Center 866.349.2296 Universal Wheelchair Football Association www.adaptivesports.org 513.792.8625 www.rwc.uc.edu/kraimer/PAGE1.HTM American Amputee Soccer Association 302.683.0997 USA Wheelchair Tennis www.ampsoccer.org 914.696.7000*7291 www.usta.com/usatenniswheelchair/custom.sps?iType American Wheelchair Bowling Association =6251&custompageid=8934 434.454.2269 www.awba.org continued next page

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U.S. Handcycling Federation National Center on Secondary Education and Transi- 303.679.2770 tion www.ushf.org www.ncset.org

U.S. Ski and Snowboarding Association National Center on Secondary Education and Transi- 435.649.9090 tion www.usskiteam.com www.ncset.org

Water Skiers with Disabilities Association National Dissemination Center for Children with Dis- 863.324.4341 abilities National Directory www.usawaterski.org/pages/divisions/WSDA/main.ht www.nichcy.org/pubs/outprint/nd22.pdf. m Wheelchair Sports USA Resources for Adults with Disabilities 515.833.2450 www.nichcy.org/pubs/transum/adult.pdf www.wsusa.org National Transition Network Wilderness Inquiry Ici2.umn.edu/ntn 612.676.9400 www.wildernessinquiry.org Veterans Department of Veteran Affairs (VA) World T.E.A.M. Sports www.va.gov 617.779.0300 www.worldteamsports.org Center for Veterans Enterprise www.vetbiz.gov Technology Alliance for Technology Access Disability Employment 707.778.3011 In Home Products: Employment and Education Re- www.ATAccess.org sources www.inhomeproducts.com/Employment.html Job Accommodation Network (JAN) 800.526.7234 Just One Break www.jan.wvu.edu www.justonebreak.com

RESNA Technical Assistance Project Job Accommodation Network 703.524.6686 www.jan.wvu.edu/links/employ.htm# www.resna.org/tapproject/index.html WORKSUPPORT.COM Vocational Rehabilitation State Offices www.worksupport.com http://janweb.icdi.wvu.edu/SBSES/VOCREHAB.HTM Vocational Rehabilitation State Offices Student Transition Programs www.Janweb.icdi.wvu.edu/sbses/VOCREHAB.HTM HEATH Resource Center 800.544.3284 www.heath.gwu.edu continued next page

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Federal Employment of People with Disabilities Rights www.opm.gov/disability Stepping Back Into Life, Inc. www.LOIGNIN.org America’s Career InfoNet www.acinet.org/acinet The Patient Advocate Foundation www.patientadvocate.org/resources.php?p=36 America’s Job Bank www.ajb.org Health Rights Hotline www.hrh.org/cag/samintro.html CareerOneStop www.careeronestop.org Your Right To Representation www.ssa.gov/pubs/10075.html Job-Hunt.Org www.job-hunt.org Suggestions for Social Security Disability Applicants JobAccess www.amputee-coalition.org/fact_sheets/ssdapplicants.h www.jobaccess.org tml

American Association of People with Disabilities The Appeals Process www.aapd.com/links/linkscholarshipawards.php www.ssa.gov/pubs/10141.htm

FastWeb Lawyers.com www.fastweb.com www.lawyers.com

Financial Aid FindLaw FinAid www.findlaw.com www.finaid.org/otheraid/disabled/phtml Insurance/ Financial Aid for Students With Disabilities Reimbursement www.parentsinc.org/finaid/finaid.html Claims Examiner Not Covered for Prosthesis www.amputee-coalition.org/inmotion/jun_jul_97/exam Higher Education and Adult Training for People with in.html Handicaps 800.544.3284 Reimbursement Issues: Appealing to Your Insurance www.heath.gwu.edu Carrier www.amputee-coalition.org/inmotion/summer_95/insu International Center for Disability Resources on the rance.html Internet 919.349.6661 Prosthetic Costs www.icdri.org/Financial%20Aid/finaid.htm www.amputee-coalition.org/first_step/firststepv2_s3a0 8.html

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When Your Insurance Claim Is Denied Mental Help Net www.amputee-coalition.org/inmotion/may_jun_03/de www.mentalhelp.net nied.html National Center for Post-Traumatic Stress Disorder Reimbursement Issues: Persuasion + Persistence = www.ncptsd.va.gov Claims Approval www.amputee-coalition.org/inmotion/feb_mar_96/rei National Institute of Mental Health mbursement.html www.nihm.nih.gov

Benefits For People With Disabilities National Mental Health Association www.sss.gov/disability www.nmha.org

Have you read your Insurance Policy lately? Other www.amputee-coalition.org/inmotion/may_jun_03/ins National Limb Loss Information Center urance.html www.amputee-coalition.org/forms/nllicask/index.html healthinsuranceinfo.net www.healthinsuranceinfo.net Habitat for Humanity 229.924.6935, ext. 2552 Toll-Free Numbers Provide Health Insurance Informa- www.habitat.org/local tion www.amputee-coalition.org/inmotion/aug_sep_97/toll Legal Services Corporation free.html 202.295.1500 www.lsc.gov Choosing and Using a Health Plan http://personalinsure.about.com/gi/dynamic/offsite.ht Above Knee Amputee m?zi=1/XJ&sdn=personalinsure&zu=http://www.ahcp www.abovekneeamputee.com r.gov/consumer/hlthpln1.htm Hemi-pelvectomy & Hip Disarticulation Help National Association of Insurance Commissioners www.hphdhelp.org www.naic.org/index.htm Limbs for Life Foundation Mental Health 888.235.5462 American Psychiatric Association www.limbsforlife.org www.healthyminds.org Angels with Limbs American Psychological Association www.Angelswithlimbs.com www.apa.org Inner Wheel USA Foundation American Trauma Society http://innerwheelusa.com/foundation www.amtrauma.org Lions Club International Anxiety Disorders Association of America 630.571.5466 www.adaa.org www.lionsclubs.org continued next page

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The Barr Foundation Rehabilitation Engineering and Assistive Technology 561.391.7601 Society of North America The National Limb Loss Information Center 703.524.6686 888.AMP.KNOW www.resna.org www.amputee-coalition.org Variety Clubs International The Medicine Program 393.954.0820 866-694-3893 www.usvariety.org www.themedicineprogram.com Adapting Motor Vehicles for People with Disabilities National Mobility Equipment Dealers Association 888.327.4236 800.833.0427 www.nhtsa.dot.gov/cars/rules/adaptive/brochure/index http://www.nmeda.org/resources/otherfunding1.htm .html

National Patient Travel Center Administration for Children & Families 800.296.1217 866.674.6327 www.patienttravel.org www.acf.hhs.gov/acf_services.html#energy

National Rehabilitation Information Ctr. Alliance for Technology Access 800.346.2742 707.778.3011 www.naric.com www.atacess.org

Partnership for Prescription Assistance American Amputee Foundation 888.477.2669 501.835.9290 https://www.pparx.org www.americanamputee.org

Children’s Electronic Hand Assistance Project American Association of People with Disabilities 866.696.2767 800.840.8844 www.myoelectricprosthesis.com www.aapd-dc.org

Rotary International Amputee Resource Foundation of America 847.866.3000 612.812.7875 www.rotary.org www.amputeeresource.org

St. Jude Children’s Research Hospital Barr/United Amputee Assistance Fund 901.595.3300 561.391.7601 www.stjude.org www.oandp.com/resources/organizations/barr/index2. html Shriners 800.237.5055 Care Entrée www.shrinershq.org 888.411.3888 www.carentree.com SSI Benefits for Children with Disabilities 800.722.1213 continued next page www.ssa.gov/pubs/10026.html

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Disabled Children’s Relief Fund Little Fins 516.377.1605 www.littlefins.org www.dcrf.com Shriners Hospital for Children Disabled Dealer Magazine www.shrinershq.org/Hospitals www.disableddealer.com Texas Assistive Devices eBay – Disability Resources http://www.n-abler.org www.pages.ebay.com/disability-resources 800-532-6840 Hanger Prosthetics & Orthotics Elks of the USA 877-4HANGER 773.755.4700 www.hanger.com www.elks.org/lodges/default.cfm Georgetown Univ. Health Policy Inst. Otto Bock www.healthinsuranceinfo.net www.ottobockus.com

Govbenefits.gov ACA Programs 800.333.4636 Amputee Coalition of America www.govbenefits.gov/govbenefits Peer Visitation Helping Hands Support Group Network www.helpinghandsgroup.org Online Support Group Parent Support Group

Glossary Amputation level The location at which the limb is missing Acrylic Resin Thermoplastic resin used in fabrication Amputee care The safety and hygiene plan of care of an acrylic orthosis/prosthesis for a person that is mission a limb Adapter Device used to connect a prosthetic socket to Ankle block Connector between prosthetic foot and a pylon/foot shin Adjust Process of correcting a problem that may not Ankle-foot orthosis (AFO) Orthosis with functional fit right. May also refer to individual getting used to impact on ankle and foot the orthosis/prosthesis Arch support Orthosis used in a shoe to act as a sup- Air splint Orthosis that contains an air chamber to port for the arch of the foot customize fit Articulation Joint moving in multiple positions A.K. prosthesis Prosthesis after transfemoral amputa- ACA Amputee Coalition of America - Resources for tion amputees A.K. socket Above-knee (transfemoral) socket Alignment Attaching and assembling O&P compo- B.E. Below elbow nents in order for them to align the body in a correct Bench alignment Static alignment of prosthetic/ position orthotic components Aluminum A light-weight metal used in both orthotics/prosthetic componentry continued next page

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B.E. prosthesis Device used for an amputation be- Clam shell design When two pieces of material come tween wrist and elbow. together to support a specific body structure Biscapular abduction Bringing both shoulders for- Club foot Pes equino varus, a congenital or acquired ward, used in prosthetic control of upper extremity foot deformity conventional prosthesis C.O. Cervical orthosis, orthosis for neck immobiliza- Biscapular adduction Bringing both shoulders tion backwards, used in prosthetic control of upper ex- C.O. (Certified Orthotist) Orthotist who has passed tremity conventional prosthesis the certification standards of The American Board of B.K. Below knee Certification in Orthotics & Prosthetics, and main- Boston Brace Spinal orthosis developed in Boston, tains certification through mandatory continuing edu- USA to treat various back conditions cation program and adherence to the Canons of Ethi- Brace Another term for orthosis cal Conduct Brim Proximal trimlines of a socket or brace C.Ped. Pedorthist who is certified by the Board for Build-up (tech.) Area where plaster/other material is Certified Pedorthists. used to relieve an impingement or prominence C.P. (Certified Prosthetist) Prosthetist who has Bulbous stump Residual limb larger in circumfer- passed the certification standards of The American ence at the end than at the top Board of Certification in Orthotics & Prosthetics, and Burgess amputation Transversal surgical technique maintains certification through mandatory continuing according to Burgess: transtibial amputation building education program and adherence to the Canons of a long posterior flap Ethical Conduct C.P.O. (Certified Prosthetist-Orthotist) Prosthetist/ CADCAM Computer Aided Design, Computer Aided Orthotist who has passed the certification standards of Manufacture The American Board of Certification in Orthotics & CAD CAM mill Machine that carves to a specific Prosthetics, and maintains certification through man- shape datory continuing education program and adherence CAD CAM scanner Laser scanner used to portray to the Canons of Ethical Conduct specific body shape Collateral ligament Ligaments bridging the side of Calf band Band of material (plastic,leather,metal), joints usually a part of a brace, that wraps around back of Component General term to describe prosthetic and calf orthotic componentry Carbon fiber Structural reinforcement in plastic Conical stump A stump larger in proximal circum- composites ference than in distal circumference Casting and measurement taking Getting 3- Coronal plane Pertaining to the front (Observes dimensional body impressions and measurements abduction/adduction) Cavovalgus foot deformity Foot deformity present- Corset Lumbar brace made from textile material ing with high medial arch combined with heel valgus Cosmetic cover Soft or flexible cover used to protect Cerebral palsy Loss of neural muscle control by prosthesis as well as make prosthesis look real congenital brain damage C.T.L.S.O. Cervico-thoraco-lumbo-sacral orthosis. Check Socket A socket made of clear plastic used to C.T.O. Cervico-thoraco orthosis. evaluate the fit of the socket design to the residual Cuff Used in both prostheses and orthoses to provide limb a circular enclosure of arm, thigh, calf etc. Circumduction During gait the affected limb will Custom Fabricated/Made Orthosis Orthosis indi- swing outward and then back in through swing phase vidually made for a specific patient. Created using an

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impression generally by means of plaster or fiber cast, Extension assist Prosthetic /Orthotic knee joints a digital image using computer-aided design- have a mechanism to help put extend knee computer aided manufacture (CAD-CAM) systems Extension moment Force (torque) causing extension software, or direct form to patient. (straightening) of joints Cylindrical stump A stump similar in measurement at proximal circumference and distal circumference. Femoral channel The channel that runs just behind Carbon fiber foot Energy returning prosthetic foot the femur in a prosthetic socket made up of layers of graphite F.E.S. Functional Electrical Stimulation. Fitter-Orthotics Person who is trained and qualified Diplegia Affecting both sides of the body to participate in the fitting and delivery of pre- Disarticulation Amputation through a joint fabricated orthotic devices and/or soft goods Duchenne's disease Severe progressive form of Fitter-Mastectomy Person who is trained and quali- muscular dystrophy fied to participate in the fitting and delivery of breast Duchenne's sign Trunk bends lateral toward stance prostheses and mastectomy products and services leg during stance phase Floor reaction orthosis Orthosis utilizing floor reac- Durometer Term used to describe how soft, firm, or tion forces for patient stabilization hard something may be Folliculitis Inflammation of the hair follicles which may lead to deeper abscesses; often caused by bacte- Endoskeletal Design Construction technique that ria uses a pipe or pylon as the support structure. This al- Foot flat When the sole of the foot is in complete lows for the exchange of components and adjustment. contact with the ground An endoskeletal system can be covered with a cos- Foot slap Undesired result of the foot during stance metic foam that is shaped to match the sound side phase; the forward part of foot slaps the floor abruptly limb. after the heel of foot contacts the floor End cushion Pad-like construction, used in pros- Framed socket The rigid material encompassing the thetic sockets to improve end-contact and end-bearing flexible plastic of a prosthesis of stumps Functional levels Endoskeletal prosthesis Prosthesis made of pylon Degree of function a disabled patient still achieves. and components which are sometimes enclosed by a 0 Amputee not foreseen for prosthetic man- soft cover agement. Energy return A spring-like feeling of return from a 1 USA and Germany: Amputee - indoor ambu- specific type of foot lator. E.O. Elbow Orthosis Functional levels with prosthesis: USA and Ger- Equinovalgus foot deformity Congenital foot de- many: formity that appears with the bottom of the foot 1 Prosthesis satisfying minimal basic needs of turned out and the toes straight down ambulation and ambulatory safety only Equinovarus foot deformity As above, with the bot- 2 indoor and limited outdoor ambulator tom of the foot turned in 3 unlimited outdoor ambulator - average ac- ERTL's bony bridge Surgical bony fusion between tivity tibia and fibula resulting in a "bony bridge" 3 TF-prosthesis Prosthesis satisfying most E.W.H.O. Elbow wrist hand orthosis needs of mobility of the healthy, averagely active am- Exoskeletal Prosthesis without pylon or components, putee has hard finish with no internal componentry continued next page

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3-4 TT-prosthesis Prosthesis satisfying most H.O. Hand orthosis, hip orthosis, or heterotopic ossi- needs of mobility of the healthy, higher active ampu- fication tee Hyperextension orthosis A brace used to force a 4 unlimited outdoor ambulator - highly active. specific body part into more extension then normal Hypertonicity High muscle tension that appears as Gait analysis The study, evaluation or research of though the muscle is being contracted or tightened how a person walks Hypotonicity Low muscle tension which leaves the Gait deviation Undesired movements during walking muscles soft Gait pattern Specific trait of how a specific individ- ual walks I.C. Ischial containment Gel I.C.-socket Ischial containment socket, when a pros- Very soft jelly-like material, various durometers thetic socket incorporates part of the ischium to in- Genu Pertaining to the knee crease stability during gait Genu recurvatum Hyperextension of the knee Initial swing Part of swing phase when the leg begins Genu varum When the knee bows out and away to swing forward during walking from midline Insole Orthosis that is placed inside the shoe that the Genua valga When the knee bows inward toward foot stands on for support or cushion. midline Interface Material used between the orthosis/ Goniometer Tool used to measure angles/ROM/ prosthesis and the body part Contractures of a specific joint Inguinal truss Orthosis used to treat hernias Guillotine amputation Undesirable surgical tech- I.P.O.P. Immediate postoperative prosthesis. nique that cuts directly through the limb leaving no Ischial seat / shelf / support The part of a prosthesis muscle/tissue padding at end of residual limb or orthosis that supports the ischial tuberosity. Hori- zontal support at the dorso-proximal aspect of a tf- Halo brace Orthosis used for unstable cervical frac- socket. tures that have pins that immobilize the skull Ischial support brim Proximal weight bearing de- H.D. Hip disarticulation, or, heavy duty sign in a TF-prosthesis or orthosis H.D.P.E. High-density polyethylene. Ischial support socket TF-socket designed to trans- Heel off / Heel rise When the heel comes off the fer weight at the ischium. ground when walking Ischial weight bearing Weight transfer at the is- Heel strike The first step of stance phase when the chium in a prosthetic socket heel of the foot contacts the ground when walking Ischial weight bearing socket Quadrilateral socket Hemicorporectomy Amputation of the lower part of design in variations the body at the waist I.S.N.Y. Icelandic-Scandinavian Socket modified by Hemipelvectomy Amputation of half of the pelvis New York University Hemiplegia Paralysis of one half side of the body I.S.O. International Standards Organization Hip Disarticulation Amputation of the entire leg I.S.P.O. International Society for Prosthetics and Or- from the hip thotics Hip dysplasia When the hip becomes dislocated Hip hiking Undesirable gait habit when the person's K.A.F.O. Knee ankle foot orthosis hip is lifted too high while the foot/leg is in swing K.D. Knee disarticulation phase of walking K.D.-socket Socket for knee disarticulation H.K.A.F.O. Hip-knee-ankle-foot-orthosis Keel Inner component of prosthetic feet continued next page

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Knee sleeve A soft material that supports the knee Myoelectric Pertaining to muscle electricity joint Myoelectric impulse Neural electric impulse stimu- Kyphosis Undesirable curvature of the spine, rounded lating muscle contraction hump on top of back Myoelectric prosthesis An electrically controlled prosthesis that uses electrodes mounted within the Laminate Fabrication technique that uses resin to rein- socket to receive electrical signals from the muscle force a specific orthosis/prosthesis contraction to control a motor in the terminal device, Legg Calve Perthes Diagnosis that describes the lack wrist rotator or elbow of blood supply to the hip joint Myoplasty Procedure Performed during an amputa- Lever arm Term used in prosthetics to describe length tion, by connecting the opposing bundles of cut muscle of residual limb; the longer the lever arm, the more tissue. It adds good protection to the end of the cut leverage and stability bone and prevents future atrophy Limb salvage rate The rate of limbs salvaged by vas- cular surgery in relation to the number of limbs that Negative pressure Suction needed amputation surgery Neuroma A bundle of nerves that sometimes occur Liner A protective, often padding cover layer, poten- after an amputation in a residual limb, can be painful tially also providing adhesive or low friction capabili- and may require a surgical limb revision ties Night splint Orthosis used at night to keep specific Lisfranc amputation Amputation through the tarso- body part in a certain desired position metatarsal joint Nylon sheath Type of sock used directly against the L.S.O. Lumbosacral orthosis skin to cut down on friction when wearing a prosthesis

Metal band Material used to attach the side bars of a O & P Orthotics and Prosthetics brace. Usually are used to provide stability and Open end socket Prosthetic socket with an open strength to orthosis (non-suction) distal end. Mid stance When the foot is flat on the floor during Orthosis (n.) Custom-fabricated or custom-fitted walking brace or support designed to align, correct, or prevent Mid swing When the foot is in the middle part of neuromuscular or musculoskeletal dysfunction, dis- swing through during walking ease, injury, or deformity. Note: this does not include Milwaukee brace Type of brace that treats scoliosis supports or devices carried in stock and sold by drug m-l instability Lack of support in a side to side and other stores, corset shops or surgical supply facili- movement of a joint ties (e.g., fabric and elastic supports, corsets, arch sup- Modular III ™ Carbonfiber energy storing/returning ports, trusses, elastic hose, canes, crutches, cervical prosthetic foot also allowing in/eversion. collars, dental appliances) Monocentric joint Single axis joint Orthotic (adj.) The science and practice of evaluating, M.P.T. Midpatellar tendon measuring, designing, fabricating, assembling, fitting, M.T.P. Medial tibial plateau adjusting, or servicing an orthosis under a prescription Multi-axial Joint that can move into many different from a licensed physician, chiropractor, or podiatrist to angles (plantar/dorsiflexion and in/eversion) correct or alleviate neuromuscular or musculoskeletal Myodesis Procedure Performed during an amputa- dysfunction, disease, injury, or deformity. tion, by sewing the opposing bundles of cut muscle Orthotic band Medio-lateral reinforcement bands in tissue to small holes drilled into the end of the bone of orthoses the residual limb. Adds to performance of the muscles since it is a more secure attachment for the muscles to act on and also helps to prevent future atrophy. continued next page

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Orthotics The science and clinical service dealing Pes adductus Forefoot inverted, adducted, pathologi- with identifying clinical indication for orthotic treat- cal misalignment ment and the design, manufacture, fitting as well as Pes Calcaneus Present when the ankle is dorsiflexed clinical/technical maintenance as pertaining to ortho- and the toes are elevated, weight borne primarily on ses. the heel Orthotist Licensed person that measures, designs, fab- Pes Cavus Exaggerated height of the longitudinal arch ricates, fits, or services orthoses as prescribed by a li- of the foot censed physician, and who assists in the formulation of Pes Equinus Present when the ankle is plantar flexed an orthosis to support or correct disabilities and the heel is elevated, weight borne primarily on the Osteo-myoplastic See also myoplastic; muscles con- toes. nected to a bone Pes Planus Planovalgus, commonly known as flatfoot, Osteoplasty Restoration, repair, plastic surgery of the foot looks flat and is almost always bent outward bones Pes Valgus Talipes valgus, acquired deformity where Osteosclerosis the weight is borne on the inner border of the foot and Hardening of bones the sole is turned outward Pes Varus Talipes varus, deformity in which the Parapodium Frame to support a paraplegic patient in weight is borne on the outer border of the foot and the standing/walking sole of the foot is turned inward Passive motion prosthesis Controlled by using pre- Pirigoff amputation Hind foot amputation, capping positioning of a manually operated friction, free mo- the distal end with a segment of the calcaneus, thus tion, or locking type joint for the actuation and move- providing endbearing capabilities ment of a mechanical prosthetic component Phocomelias Refers to a missing segment or under Passive/Mechanical Components Mechanical shoul- developed, usually presents itself as very small, de- der, elbow wrist, hand and/or hook components with formed versions of normal limbs friction or positive locking joints controlled by manual Pistoning Undesirable up-and-down motion of stump positioning and/or static positioning for functional or in prosthetic socket that may cause breakdown semi-functional use of the components utilized in the Plastazote A material used for padding in O&P. Made design of the prostheses up of microcellular polyethylene foam. PAVLIK harness Plumb line Vertical reference line Orthosis used on an infant to control hip joint position Plumb line device Device representing the reference Pedorthics Design, manufacture, fit and/or modifica- planes (a-p and m-l) tion of shoe and foot orthoses to alleviate foot prob- Ply Thickness of a prosthetic sock; each ply equals one lems caused by disease, congenital condition, overuse eighths of an inch or injury Pneumatic joint control Cylinder/piston device con- Pedorthist Individual trained in the manufacturing, trolling prosthetic joint motion fitting and modification of foot appliances and foot- Positive mold A three-dimensional cast made of a wear for the purposes of alleviating painful or debili- plaster impression tating conditions and providing assistance for abnor- Post-Op Rigid dressing A protective cast applied in malities or limited actions of the lower limb surgery or very soon after amputation to control swel- P.E.-lite Type of foam material used in an orthosis/ ling and pain; used to promote shrinkage and shaping prosthesis. of the residual limb in preparation for a prosthetic fit- Perthes' disease Diagnosis that describes the lack of ting blood supply to the hip joint

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Prefabricated Orthosis manufactured in quantity prosthesis prescription for the replacement of exter- without a specific patient in mind, which may be nal parts of the human body lost due to amputation or trimmed, bent, molded, or otherwise custom fitted. A congenital deformities or absences. preformed orthosis is considered prefabricated even Prosthetist/Orthotist A person having gone through if it requires the attachment of straps and/or the addi- formal training and exam in orthotics and prosthetics. tion of a lining and/or other finishing work or is as- Protraction The forward movement of a body part. sembled from prefabricated components is consid- P.T.B. Patellar tendon bearing. ered prefabricated. Any orthosis that does not meet P.T.B. prosthesis A prosthesis designed for weight the definition of a custom fabricated orthosis is con- bearing at the patella tendon sidered prefabricated. Also referred to as custom- P.T.B./S.C. (prosthesis) PTB-supracondylar prosthe- fitted. sis; sc indicates supracondylar suspension. Prehension To hold, grasp or pinch. There are vari- Push off The last part of stance phase when the foot ous types. (three jaw chuck, lateral prehension). comes off the ground Preparatory (Temporary) Prosthesis An artificial Pylon Pipe-like structure used to connect the pros- limb that is designed, fabricated and fitted soon after thetic socket to the foot/ankle components surgery; the prosthesis is worn as the residual limb is healing Quadrilateral Socket Has a shelf about one inch Pre-preg Composite fiber reinforcement preimpreg- wide on the posterior wall of the socket on which the nated with resin ischial tuberosity rests, has four clearly defined sides Pronation The movement of the forearm so that the hand rests palm down on a surface Relief Area When fabricating an orthosis or prosthe- Prone Lying face downward sis, reliefs are made to provide space over a wound or Proprioception Sensation of body location, position bony prominence and changes Removable rigid dressing Removable wound dress- Prosthesis Artificial medical device that is not surgi- ing consisting of a rigid outer shell, as a plastic shell cally implanted which is used to replace a missing or plastic socket limb or appendage such as artificial limbs, hands, Replantation Reconnecting a limb lost by trauma fingers, feet or toes. Note: this does not include de- Retraction The backward movement of a body part vices, which do not have an impact on the musculo- Revision Surgical modification of the residual limb skeletal functions of the body (e.g., artificial eyes or Rib hump Scoliotic convexity, protruding rotated appliances for the eyes, dental plates, and largely aspect of rib cage cosmetic devices such as wigs, artificial breasts, eye- Rigid dressing A wound dressing consisting of a lashes, ears and noses) rigid outer shell, as plaster of Paris wrap or plastic Prosthetic alignment Science of assembling pros- shell thetic components in a desired relation to each other Rivet Nail-like object used to connect straps/buckles Prosthetic Sock Sock knitted to fit the shape of the on a prosthesis or orthosis residual limb worn inside the socket. The sock re- Rocker bottom sole A modification on the sole of a duces the friction between the residual limb and the shoe that removes material on the toe and the heel of socket and replaces lost volume in the socket due to the sole. Allows for a quicker rollover as well as dis- shrinking of the residual limb. tributes pressure through the stance phase. Prosthetist Rotator Prosthetic device providing vertical rotation. Licensed person who measures, designs, fabricates, fits, or services prostheses as prescribed by a licensed physician, and who assists in the formulation of the continued next page

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R.F.O.M. (Registered Fitter-Orthotics Mastectomy) S.E.W.O. Shoulder elbow wrist orthosis Fitter who has passed the American Board of Certifi- Sheath Type of sock used directly against the skin to cation in Orthotics & Prosthetics standards for both cut down on friction when wearing a prosthesis orthotic and mastectomy fitting and completes manda- Shock absorber Component used on a prosthesis that tory continuing education requirements and adheres to reduces vertical impact forces the Canons of Ethical Conduct Shoe insert Foot orthosis, arch support R.T.O. (Registered Orthotic Technician) Technician Shoulder elevation Movement used to control an up- who has passed the American Board of Certification in per extremity prosthesis to unlock/lock the elbow Orthotics & Prosthetics standards for both orthotic and Shrinkage Term used to describe when an extremity mastectomy fitting and completes mandatory continu- or residual limb loses muscle mass or volume ing education requirements and adheres to the Canons Shrinker Compression garment to reduce the edema of Ethical Conduct in a residual limb R.T.P. (Registered Prosthetic Technician) Technician Shuttle lock Locking mechanism used in a prosthesis who has passed the American Board of Certification in to keep the liner locked in the socket so the prosthesis Orthotics & Prosthetics standards for both orthotic and does not fall off the extremity mastectomy fitting and completes mandatory continu- Silesian belt Keeps/aids suspension in a prosthesis ing education requirements and adheres to the Canons Silicone Chemical material with rubber-like mechani- of Ethical Conduct cal properties R.T.P.O. (Registered Prosthetic-Orthotic Techni- Silicone liner Liner with suspension- or soft tissue cian) Technician who has passed the American Board replacement properties of Certification in Orthotics & Prosthetics standards Silicone suspension sleeve A device supporting or for both orthotic and mastectomy fitting and completes providing TT-socket suspension mandatory continuing education requirements and ad- Single axis (or uniaxial) foot Prosthetic foot with heres to the Canons of Ethical Conduct plantar-dorsiflexion axis only R.F.O. (Registered Fitter-Orthotics) Fitter who has Single axis joint Orthotic, prosthetic joints featuring passed the American Board of Certification in Orthot- one (transverse) axis only ics & Prosthetics standards for orthotic fitting and S.O. Sacroiliac orthosis completes mandatory continuing education require- Socket Prosthetic "container" for a residual limb or ments and adheres to the Canons of Ethical Conduct. stump R.F.M. (Registered Fitter-Mastectomy) Fitter who Solid ankle foot orthosis Ankle foot orthosis that has passed the American Board of Certification in Or- keeps the ankle in 90 degrees. thotics & Prosthetics standards for mastectomy fitting Spinal orthosis Brace used to support the back and completes mandatory continuing education re- Split Hooks Terminal devices with two hook-shaped quirements and adheres to the Canons of Ethical Con- fingers operated through the action of harness and ca- duct. ble systems R.G.O. Reciprocating Gait Orthosis; special HKAFO Spondylitis Inflammation of the vertebrae. that mechanically allows paralyzed persons to walk Spondylolisthesis Loss of spinal column alignment step over step; generally used with crutches or some- from one vertebra slipping forward on top of another times a walker for balance Stance Act of standing Stance phase Phase of walking while the foot is in Sacroiliac Orthosis Lumbo-sacral-pelvic orthosis contact with the ground SACH foot Solid ankle cushion heel. Stance phase control Prosthetic device controlling S.E.O. Shoulder elbow orthosis knee flexion S.E.W.H.O. Shoulder elbow wrist hand orthosis continued next page

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Static alignment Setting up a prosthesis in a prede- Transhumeral Through the humerus, TH termined alignment that does not specifically pertain to Transradial Through the forearm, TR the end user Transtibial Through the tibia, TT Stump shrinker Compression garment to reduce the edema in a residual limb Upright Vertical side bar used in an orthosis Stump sock A sock knitted to fit the shape of the re- sidual limb worn inside the socket. The sock reduces Valgus Deformity of the foot resulting in the outward the friction between the residual limb and the socket rotation of the foot so that it faces away from the me- and replaces lost volume in the socket due to shrinking dian, or midline, of the body of the residual limb. Varus Deformity of the foot resulting in the inward Suction chamber Distal space in a prosthetic socket rotation of the foot so that it faces toward the median, serving as (low-pressure) chamber (uncommon today) or midline, of the body Suction socket Prosthetic socket, suspension sup- Vaulting Undesirable gait deviation when walking ported by vacuum with an orthosis/prosthesis, an upward motion to walk Supination Movement of the hand. Palm of the hand on toes in order to get limb to avoid contacting ground facing down toward the ground and then turning the through swing phase palm upward Verrucose hyperplasia Discoloration of distal end of Suspension sleeve Fabric used to hold the prosthesis residual limb from lack of total contact in a prosthesis onto the leg. Also used to keep air from getting into due to negative pressure socket (suction) Volume fluctuation When edema in the leg causes Swedish knee cage Knee orthosis for hyperextended swelling or shrinkage within the residual limb knee joint Volume loss The loss of edema or atrophy of muscle Swing phase The phase of walking when the foot is throughout residual limb after an amputation not in contact with the ground Voluntary-closing A type of terminal device that Swing phase control Mechanism used in a prosthesis when relaxed is in the open position and is closed by a that controls the swing of the knee joint by increasing conscious effort by pulling on the control cable or decreasing the speed Voluntary-opening devices A type of terminal device Syme's amputation Amputation performed through that is opened by conscious effort by pulling on the the ankle joint control cable with body motion and closed by elastic bands Technician-Orthotic/Prosthetic Person trained to Weight activated safety knee A type of prosthetic fabricate, repair and maintain orthoses or prostheses knee that brakes when weight is applied under the supervision of an orthotist/prosthetist. W.H.O. Wrist hand orthosis Terminal swing The part of walking when the foot is Window Edema Fluid that collects in a certain area just about to contact the floor that does not provide contact T.F. Transfemoral, through the femur W.O. Wrist orthosis Ꮬ Tibial progression The forward movement of the tibia from heel contact to toe off T.L.S.O. Thoraco-lumbo-sacral orthosis Total contact or Total surface bearing socket Socket providing equal surface contact all over

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Immobility: Not a Great Idea, To Hop Or Not To Hop and LegSim John A. Tata MD

Immobility: Not a are available which help increase bone density. How- ever, the best defense is maintaining weight-bearing Great Idea mobility. There are times in one’s life Obesity when it is necessary and ap- It should come as no surprise that immobility is di- propriate to rest and stay rectly related to weight gain with or without limb loss. immobile, e.g., after major Researchers in the United Kingdom found that "obe- surgery or trauma. There sity is a well known complication of amputation but are other times when the thought of moving can more so in the patient with transfemoral and bilateral be so overwhelming that staying in bed seems amputations."i Nassar et. al. state that weight was a like a good idea. Immobility is not a great idea significant factor in determining the number of repairs for anyone for any length of time. It sets into in lower limb prosthesis.ii Weight gain often triggers a motion a whole set of medical conditions that cascade of other metabolic conditions that may impact may have major consequences, among them os- an individual’s overall well being. teoporosis, obesity, Syndrome X, deep vein thrombo- sis and pulmonary embolism. Syndrome X

Osteoporosis In 1988 researchers at Stanford University identified a syndrome complex linked to obesity, including ab- Mobility allows the vector forces of gravity to stimu- dominal obesity, hypertension, insulin resistance, ele- late bones to increase total bone mass. Conversely, vated triglycerides, and low levels of "good" choles- immobility results in a decrease in total bone mass. terol (HDL). It is felt to affect as many as two thirds This condition, osteoporosis, increases an individual’s of all Americans, up to 50 million people. Syndrome risk of fracture; fracture can occur with little or no X is believed to be the precursor of Type 2 diabetes, trauma. Hip and spine fractures are the most common; they cause more immobility which further decreases bone mass. Loss of bone mass occurs slowly in John Tata MD, Medical Director, and Joseph Schrader, younger individuals whose bones are strong and President of Hartford Walking Systems are committed to pro- dense. Older individuals, especially post-menopausal viding amputees with improved mobility, independence and females, can experience dramatic losses. Medications security. Contact him at [email protected]

AANLCP Journal of Nurse Life Care Planning ISSN 1942-4469 ….184 Winter 2009 Vol. IX No. 4 in which insulin becomes less effective in moving Abnormal vessel with a clot glucose into cells. Patients with Syndrome X are at When a clot is present in a vein or artery, it will fill in increased risk for arteriosclerotic heart and peripheral a portion of the vessel causing the blood to flow iii vascular disease. around the clot. This will appear as a filling defect on Lifestyle changes, largely weight loss and increasing either an ultrasound or CT scan. physical activity, are the main interventions in the treatment of Syndrome X. These goals are more chal- lenging for those living with limb loss. Another com- ponent of Syndrome X is hypercoagulability.iv The result is deep venous thrombosis (DVT), a potentially fatal condition..

Deep Vein Thrombosis (DVT)

DVT presents with painful swelling and often redness Figure 2 obtained http://www.wikipedia.com in the calf and lower legs. It can be easily diagnosed Pulmonary embolus (PE) using Color Doppler ultrasound. Sound waves are able to “see” blood flowing through normal veins. If Once blood clots develop in the lower legs, they may a clot is present, the normal flow pattern is disrupted become dislodged and travel through the major veins and a filling defect or clot is seen on the images. in the abdomen into the chest. Once in the lungs, the clots block the normal flow of blood through the Normal Color Doppler Ultrasound lungs restricting their ability to oxygenate the blood. This ultrasound image (Fig. 1) demonstrates a vein The resulting condition, pulmonary embolism, may (blue) and an artery (red/orange). The color is seen cause total cardiovascular collapse and oftentimes filling the entire structure of both vessels indicating death. David Bloom, NBC reporter embedded in Iraq that both artery and vein are free of clot or filling de- with the Armed Forces, died as a result of PE from a fects. lower leg clot.v This condition, if suspected, can be diagnosed by CT pulmonary angiogram. CT Pulmonary angiogram

Newer generation CT scanners are able to see the ma- jor vessels of the heart and lungs. The image below was obtained after a contrast agent (bright white mate- rial) was given to make the blood visible to the scan- Figure 1 ner. The darker structure outlined by the contrast is a obtained http://www.wikipedia.com

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AANLCP Journal of Nurse Life Care Planning ISSN 1942-4469 ….185 Winter 2009 Vol. IX No. 4 large clot (PE) within the main pulmonary artery.

This is a life threatening emergency. KEEP MOVING: SAFELY, COMFORTA- BLY AND PRUDENTLY

References i Naseer H. J. Haboubi, MBChB, MRCP; Michael Heelis, BSc; Ruth Woodruff, DIPT, MCSP; Imad Al-Khawaja, PhD, MRCP, The effect of body weight and age on frequency of repairs in lower-limb prostheses, Journal of Rehabilitation Research and Development,Vol. 38 No. 4, July/August 2001 ii Ibid. et.al. iii American Heart Association at www.americanheart.org. key- words, “metabolic syndrome.” March 8, 2007. iv Ibid. Figure 3 obtained http://www.wikipedia.com v ClotCare Online Resource, “David Bloom’s DVT Story: An Interview with Melanie Bloom,” April 8, 2007. Conclusion www.clotcare.com. Key words DVT obtained April 8, 2007 Mobility is a necessity if we are to maintain a healthy lifestyle. Individuals living with limb loss can choose from a variety of options: crutches, walk- ers, traditional prosthetic device or the LEGSIM. Each device has its own sets of pluses and minuses. Ꮬ The key point to keep in mind is that mobility is an imperative if we are to maintain our independence and overall sense of wellbeing.

“To Hop Or Not To Hop” Individuals who live with limb loss make many choices each day having to do with their mobility. Do I choose to move today or do I simply stay put? Do I use my walker, wheelchair, crutches, or prosthetic device? Or do I hop on my sound side as my primary mode of mobility? Unfortunately, many younger individuals choose to hop on their sound side unaware of the potential damage they may be doing to the joints. The reasons are simple: it is fast, easy, seemingly painless. There is no need to get into a wheelchair or take the time to put on prosthetic device. Most think of themselves as invincible. They seldom consider the future consequences to their hip, knee or ankle because of their choice to hop. The potential risks to their sound side joints are real and individuals with limb loss owe it to themselves to learn what they are. continued next page

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Why not hop??? Physicians, physical therapists and prosthetists all need to discourage patients from hopping around on one foot. Loss of a limb from amputation affects all the other weight-bearing joints in the body. The force of gravity is redistributed to the joints of the sound side: hip, knee, ankle and pelvis. The effects are more acute when an in- dividual chooses to hop on their sound side. because increased vector forces impact the joints on only one side. The added workload to the sound joints can cause accelerated thinning of the joint cartilage surfaces. The carti- lage thinning and resultant bone remodeling cause degenerative arthritis.

We are fortunate today to have a wide variety of options for mobility to avoid hopping. Crutches, walkers, wheelchairs and various prosthetic devices including the LEGSIM all provide useful options. Each device has its own strengths and weaknesses. None is likely to suit all of any given individual’s needs. Protecting joints from premature or accelerated cartilage thinning and damage should be a major priority for all indi- viduals. This is especially true for those who live with limb loss.

Conclusion Individuals living with limb loss can choose to “hop” or use any one of many assist devices to move from point A to point B. The reasons why an individual chooses one over another are personal, and may even change from one day to the next. The most important mandate is to protect joints each day.

HARTFORD WALKING was not an option as PW could not lift the device SYSTEMS LEGSIM with one arm. Case-specific solutions: The LEGSIM was Clinical Case Study modified, similar to a pendulum, allowing it to move PW is a 61 year old male who suffered a major forward and straight. It was rebalanced so that PW stroke 14 years ago because of a blood disorder. He was able to lift it with his sound hand. Lateral stabi- was left with a paralyzed left arm and leg. Two years lizers were added to address the problem of lateral later he required a left BK amputation because of a stability thereby compensating for his lack of depth blockage in his paralyzed leg. perception. Case-specific challenges PW was fitted with Case-specific results: PW found the modified a traditional prosthetic device with limited success LEGSIM a major improvement noting he felt "more because of pain and discomfort at the stump site. His secure," "less likely to fall," and "generally improved only secondary option for mobility was a wheelchair balance." The learning curve was short requiring as crutches and traditional walkers were not feasible minimal instruction and training before he felt com- because of his paralysis. The weakness in his left up- fortable. The narrow width of the device allowed him per extremity and generalized muscle atrophy failed to fit into narrow spaces in his home performing ac- to provide him with the lateral stability needed for tivities of normal daily life i.e. washing dishes. PW prolonged mobility. The stroke impaired his depth felt more confident in knowing he could exit build- perception limiting his ability to feel secure and con- ings quickly in an emergency situation arose. Ꮬ fident during movement. The traditional LEGSIM

AANLCP Journal of Nurse Life Care Planning ISSN 1942-4469 ….187 Winter 2009 Vol. IX No. 4




 

 
  
 
 
 







 
 
    
  



   
 


 
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AANLCP Journal of Nurse Life Care Planning ISSN 1942-4469 ….188 Winter 2009 Vol. IX No. 4

AMPUTEE PROSTHETIC CLINIC Tifton Macon Albany VOLUME MANAGEMENT

Studies have found that the size of an amputee’s residual limb (stump) changes 14 % in size while using a prosthesis over the course of a day’s use. In most cases the tightness of the prosthesis pushes fluid out of the residual limb. The result is the socket fits more loosely, and the residual limb drops deeper into the socket. SIGNS THAT YOU NEED TO ADD SOCKS ARE:

• It feels like you are hitting the bottom of the socket. = It hurts on the end of leg.

• It feels like your knee cap is being pushed on hard. (**For Below Knee Amputees)

• It feels like the prosthesis is pressing hard at your groin. (**For Above Knee Ampu- tees)

• The socket twists on your leg.

• Or it feels OK when you first put it on, but after 20 minutes or so of activity it be- comes uncomfortable.

These are fairly normal happenings for Prosthetic users. However, other symptoms may occur. The most proven and most effective way to manage this situation is to ADD PROSTHETIC SOCKS. By adding socks you are replacing the space created by the fluid change of your residual limb. In the white bag you received when you first received your prosthesis there are sev- eral types of socks.

The following describes the socks you have in the bag:

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Liners, very thin grey

One Ply Socks = Thin White Socks or Tan

Three Ply Socks = Yellow Seam or Markings

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should be your first action to resolve the dis- comfort.

If your residual limb swells or the prosthesis feels too tight, you may try reversing the proc- ess and REMOVE socks.

If the socks do not seem to help, CONTACT US IMMEDIATELY.

Adding socks is a proven means of VOLUME Five Ply Socks = MANAGEMENT, but other strategies can be Green Seam or effective. If you would like more information Markings on VOLUME MANAGEMENT ALTER- NATIVES contact us for more information. When you experience any or all of the signs mentioned earlier ADD A SOCK to determine ***If you use a Gel Liner the socks go on if it improves the comfort within the socket. OVER the Gel liner.*** ______***If you have a Gel liner with a pin ______mechanism the pin MUST COMPLETELY AN EXAMPLE: POKE through the hole in the bottom of the PROBLEM: It feels like your residual limb is sock. EXTRA CARE must be taken to en- hitting the bottom of the prosthetic socket. sure that the prosthetic sock NOT BE SOLUTION: Add one ply sock, -IF IT OVER THE PIN. It will result in FEELS BETTER, ADD ONE MORE SOCK-; If it feels better continue adding socks one ply a) The prosthesis falling off at a time until it goes from feeling better to OR worse, THEN REMOVE THAT SOCK. b) The lock being jammed making the prosthesis very difficult to take off. This process may need to be repeated several times throughout the day. The more active you are, the more this has to be done to optimize JAMES OLIN YOUNG, JR., the fit of the prosthetic device. CP, LP, FAAOP

Persons on DIALYSIS may have the residual limb swell or shrink more dramatically. James Olin Young is the owner and prosthetist of the Amputee Prosthetic Clinic in Tifton, Albany, and Macon GA. He can I suggest that any time you experience discom- be contacted at 2400 Pineworth Road, Macon, GA 31216 fort in the prosthesis the adding of socks 478-477-7703 [email protected]

AANLCP Journal of Nurse Life Care Planning ISSN 1942-4469 ….191 Planning Ahead Vol X-1 SPRING Pedi/Adolescent LCP Vol X-2 SUMMER Elder LCP

Vol X-3 FALL Multitrauma LCP

Information for Advertisers Rates Any submission electronically with photos, art, and text is acceptable. Quarter page, $100 per appearance Advertisers can submit any ad in a high-resolution PDF or JPEG. PDF Half page, $190 per appearance format is preferred. Full page, $375 per appearance We reserve the right to reject any advertising deemed to be in poor Submit copy 3 weeks before publish date, invoiced and paid before taste, libelous, or otherwise unacceptable. publishing. Mail checks payable to AANLCP to Please submit any ad for consideration to the Editor, AANLCP, 3267 East 3300 South #309 Wendie A. Howland RN MN CRRN CCM CNLCP, Salt Lake City, UT 84109 [email protected]

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