Surviving the First Year After Amputation

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Surviving Amputee Coalition Celebrates 25th the First Anniversary in 2011 Year

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Amputee Coalition Commemorates 25 Years of Service to the Limb Loss Volume 21, Issue 1 Community in 2011 (1986-2011) Published six times a year by Amputee Coalition of America This year, the Amputee Coalition proudly (For more details, see “The Amputee 900 E. Hill Ave., Ste. 205 Knoxville, TN 37915-2568 commemorates 25 years of service to the limb Coalition Logo: What Does It Symbolize?” at 865/524-8772 loss community. Even more importantly, we amputee-coalition.org/NewLogo) 888/267-5669 are dedicated to making our next 25 years “Our new, proactive brand principles will guide Fax: 865/525-7917; TTY: 865/525-4512 even more beneficial to the people we serve. us in all of our interactions with our constituents E-mail: [email protected] Web site: amputee-coalition.org To begin with, we spent 2010 learning about in the future,” says Kendra Calhoun, Amputee the needs and desires of our constituency, Coalition president & CEO. “We will alter or President & CEO Kendra Calhoun from our constituency. We know that if we develop our numerous programs and services Chief Communications Officer & want to better serve people at risk for or with the goals of proactively reaching out to Public Policy Director Sue Stout affected by limb loss, we need their input. our constituents, following up with them, and Communications & Public Relations Manager Rick Bowers As a result, we recently developed a revital- making a significant impact in their lives. Our Print & Electronic ized set of proactive brand principles to better five core values of Service, Respect, Encourage- Communications Coordinator Bill Dupes reflect our enhanced plans for serving our ment, Excellence and Integrity, driven by our Communications & Media constituency. Our new logo (see below), effec- Passion, will also inform everything that we do.” Relations Associate Élan Young Communications & Media tively symbolizes these new brand principles. In fact, the Amputee Coalition’s new, proactive Relations Specialist Scott McNutt The logo’s main element, a swirling sun, brand principles are already impacting the Advertising & reflects our goals to reach out to people at risk direction of the organization. See page 9 to learn Marketing Assistant Kim Phillips for or affected by limb loss and to significantly about one of our exciting new efforts to meet Graphic Design Michael Shannon impact their lives throughout their lifespan to the needs of our constituents. Throughout the Advertising 865/524-8772 help them achieve their maximum potential. It year, we will also be announcing several special Board of Directors also signifies that we will strive to “be there” events and other significant changes in our Executive Board: for them every step of the way. We will first programs and services (see page 8). Chairman Marshall J. Cohen strive to prevent the loss of limbs and then As we evolve throughout 2011 to meet more Vice Chair Pat Chelf follow up with those who do lose limbs to help of your needs, we definitely don’t want you to Treasurer Jeffrey S. Lutz, CPO them rebuild their lives. We will accomplish miss any of our exciting announcements and Directors: these goals through excellent service and offers. It is, therefore, essential that we Jeffrey Cain, MD high-quality professional programs. have your contact information, especially David McGill Leslie Pitt Schneider Just as the sun is the main star in our uni- your e-mail address. If we don’t already Terrence P. Sheehan, MD verse, the Amputee Coalition strives to be the have this information, please visit Kathy Spozio main organization in the lives of people at risk amputee-coalition.org/friends-update Tami Stanley for or affected by limb loss. Like the sun, the and give it to us today. Also, visit our Web Charles Steele Amputee Coalition: site at amputee-coalition.org regularly Scott Stevens, MD Dennis Strickland tProvides a source of light to our con- throughout the year to stay informed. stituents by supplying them with reliable Don’t forget: We’re here for you – even when Medical Advisory Committee Terrence P. Sheehan, MD, Chair, Medical Director information you don’t know it! Scott Cummings, PT, CPO, FAAOP tIs a source of energy and comfort during Rachel Evans, Lt. Col., PT cold, difficult periods in their lives Natalie Fish, PT tHelps them find their direction when they Robert Gailey, PhD, PT are lost Nancy Payne, MSN, RN Bruce Pomeranz, MD tActively impacts their lives in many ways Christina Skoski, MD tIs there for them every day throughout Douglas G. Smith, MD, Emeritus Member their lifespan – even when they don’t know it. saving limbs. building lives. Charles E. Steele, ACA BOD Stephen T. Wegener, PhD, ABPP

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 3

Our Mission To reach out to and empower people affected by limb loss to achieve their full potential through education, support and advocacy, and to promote limb loss prevention.

A Publication of the Amputee Coalition Contents The Amputee Coalition recognizes the following 12 ‘Biggest Loser’ Star Says Weight Loss Starts in the Mind National Sponsors for their valuable support. 16 Invasion of the Body Fatteners

Gold Sponsors 19 What You Might Expect During the First 12 Months as a Lower-Limb Amputee

21 Tips for Enhancing Your Success as a User of a Lower-Limb Prosthesis

23 The First 12 Months After Upper-Limb Amputation

30 Surviving Is Everything

34 The Importance of Gait Training

38 The Mind as a Weapon in the Fight Against Chronic Pain Bronze Sponsor 41 Identifying and Managing Skin Issues With Lower-Limb Prosthetic Use Ohio Willow Wood Patron Sponsors 46 One Prosthetist’s Solution to Information Overload Purdue Pharma L.P. RSLSteeper 47 A Journey Through Darkness Touch Bionics 48 The Definition of Humor Affiliate Sponsors Arimed O&P Board of Certification/Accreditation, International Cardinal Hill Rehabilitation Hospital Endolite North America Ltd. Departments Faith Prosthetic Orthotic Services, Inc. – Cabarrus Center Freedom Innovations, LLC 3 Message From the 10 Advocacy Update 51 Technology Lawall Orthotic & Prosthetic Services Amputee Coalition Showcase Muilenburg Prosthetics, Inc. 25 Upper-Limb Nascott Rehabilitation Services 8 Message From the Perspectives 52 inMotion Index OrPro Prosthetics & Orthotics Chair Scheck & Siress O&P Inc. 44 In Our Own Words 54 Advertiser Index SCOPe Orthotics & Prosthetics, Inc. 9 Special Snell Prosthetic & Orthotic Laboratory Announcement South Beach Orthotics & Prosthetics, Inc. Surgi-Care Inc.

inMotion (Permit Number 80096; ISSN 1529-6350) is published six times a year by the Amputee Coalition of America, 900 E. Hill Avenue, Suite 205, Knoxville, TN 37915-2568. Send address changes and other requests to the Amputee Coalition at this address. Print subscriptions to inMotion are $24 per year. This publication is partially supported by cooperative agreement # 5U59DD000347 from the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC, the sponsoring organizations, or the Amputee Coali- tion. It is not the intention of the Amputee Coalition to provide specific medical advice but rather to provide readers with information to better understand their health and healthcare issues. The Amputee Coalition does not endorse any specific treatment, technology, company or device. Consumers are urged to consult with their healthcare providers for specific medical advice or before making any purchasing decisions involving their care. No funding from the CDC is used to support Amputee Coalition advocacy efforts. ©2011 by Amputee Coalition; all rights reserved. This magazine may not be reproduced in whole or in part without written permission of the Amputee Coalition.

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 5 Contributors Cindy Charlton is a triple amputee, a single mom of two boys, Jason T. Kahle CPO, LPO, is a certified and licensed a substitute teacher, a certified child and family investigator prosthetist/orthotist. He is the director of lower-extremity and an author. She is active in her children’s sports and prosthetics at Westcoast Brace & Limb and Faculty in the different nonprofit organizations. A member of the Colorado School of Physical Therapy & Rehabilitation Sciences at Coalition of Working Amputees, she helped pass Colorado’s the University of South Florida in Tampa, Florida. Prosthetic Parity Bill in 2000. An Amputee Coalition-certified peer counselor, she helps people adjust to living with limb loss. Shawn Swanson Johnson, OTR/L, joined Advanced Arm Dynamics (AAD) in 2009 as national director of occupational therapy. Her work is focused on enhancing training protocols Dan Conyers, CPO, national clinical director, supervises a for patients in the use of upper-limb prosthetics. Johnson has nationwide team of prosthetists at Advanced Arm Dynamics’ more than 10 years of experience in prosthetic therapy, Centers of Excellence. Conyers has more than 28 years of including work with the rehabilitation teams at Walter Reed experience in prosthetics and orthotics and has been an Army Medical Center and Brooke Army Medical Center. upper-extremity specialist for 16 years. He is involved in international research and development projects, design consulting, and beta testing with scientific groups, Todd Norton, CP, LP, FAAOP, graduated from Florida State component manufacturers and individual researchers. University with a BS Degree in Rehabilitation Services. Upon completion of his internship at Bremer Brace of Florida, Inc., he was hired as a prosthetic assistant. Norton then attended Scott D. Cummings, PT, CPO, FAAOP, is employed by Next Northwestern University’s prosthetic program in 1995. Step O&P in Manchester, New Hampshire. He received a BS in Physical Therapy from Northeastern University before completing his orthotic and prosthetic education at the Patrick Prigge, CP, is the clinical manager of Advanced Arm University of California, Los Angeles (UCLA). Although a Dynamics’ (AAD’s) Midwest Center of Excellence in general practitioner in O&P, he specializes in pediatric and Waterloo, Iowa, and the North Central Center of Excellence geriatric prosthetics and pediatric orthotics with an emphasis in Minneapolis, Minnesota. He has been an upper-limb in scoliosis management. He is a member of the Amputee specialist with AAD since 2008. Coalition’s Medical Advisory Committee.

John Peter Seaman, CP, CTP, spent 30 years in the forestry Dawn M. Ehde, PhD, is a clinical psychologist and professor and paperboard packaging industries. He chose to make a in the Department of Rehabilitation Medicine at the career change and attended Century College in White Bear University of Washington School of Medicine, Seattle. For Lake, Minnesota, to become a prosthetist. After completing the past 14 years, she has provided care to people with limb his residency in 2009, he passed his certiﬁcation exams and loss at Harborview Medical Center. She has conducted moved to Newark, Delaware, where he is now employed by chronic pain treatment research in several populations, Independence Prosthetics-Orthotics, Inc. including amputees. She also collaborated with the Amputee Coalition and Johns Hopkins University on the Promoting Amputee Life Skills (PALS) program. Sarah J. Sullivan, PhD, is a postdoctoral fellow in the Department of Rehabilitation Medicine at the University of Washington School of Medicine, Seattle. She received her James Highsmith, MD, MS, practiced as a physician PhD in Clinical Psychology from the University of California, assistant in dermatology at James A. Haley VA Hospital Los Angeles (UCLA) and completed her clinical internship at (Tampa, Florida) prior to medical school. Currently, he is a UW. She has worked with individuals coping with a variety of resident physician at the University of South Florida. health conditions, including chronic pain and cancer.

M. Jason Highsmith, DPT, CP, FAAOP, is a physical AHRQ Agency for Healthcare Research and Quality (ahrq.gov) therapist and certiﬁed prosthetist. He is an assistant professor in the School of Physical Therapy & Rehabilita- tion Sciences at the University of South Florida. Allsup (allsupinc.com)

Advertising Policy The National Limb Loss Information Center does not support, or take position on, pending legislation or legislative proposals. The views expressed in inMotion do About the Cover not necessarily reﬂect those of the Amputee Coalition or the National Limb Loss Information Center, nor does inMotion endorse any speciﬁc technology, company Design by Michael Shannon or device. Consumers are urged to consult with their healthcare providers before Surviving Photo by Bill Waldorf Amputee Coalition the First making any purchasing decisions involving their care. Celebrates 25th Anniversary in 2011 Year

Ashley Johnston from NBC's The Biggest Loser

6 inMotion Volume 21, Issue 1 January/February 2011 We were with John. Every step of his way.

JOHN KENNEY, BOCO -RKQ LV RQH RI WKH PDQ\ %2&FHUWL¿HG SUDFWLWLRQHUV PDNLQJ D GLIIHUHQFH WR WKHLU SDWLHQWV DQG WKHLU SURIHVVLRQ HYHU\ GD\ Background: Bachelor’s degree from The University of California, Santa Cruz. Master’s degree from The University of Hawaii. More than 20 years as a healthcare executive.

Achievements: Holds seven U.S. patents for orthotic devices WKDWKDYHEHQH¿WHGWHQRIWKRXVDQGVRISDWLHQWV Impact: In 2010, more than 1,000 practitioners attended John’s educational courses on contracture management and rehabilitating knee braces. Service: Past Chairman of the Region D Medicare Advisory Committee; member of the BOC Board of Directors.

I would not be a practicing clinician and Vice President of Ongoing Care Solutions/NeuroFlex if it were not for BOC. The next few years will be “critical for O&P, and I am excited about BOC’s expandingg role in the O&P community.community. ”

BOC is proud to have walked alongside John in his career. We are here to support you in your journey, too.

BOCinternationaO.orJpro¿Oes 877.776.2200 | 410.581.6222

2 3&HUWLÀFDWLRQ DMEPOS Accreditation MESSAGE FROM THE CHAIR

We will celebrate our 25th anniversary organization reaching out to our much at our 2011 National Conference, which broader community of people affected by we hope to be our biggest and best con- limb loss, their caregivers, support groups ference yet, bringing new amputees and and the communities in which they live. their caregivers to learn about the newest Anyone who has visited our Web site, innovations in prosthetic devices, the chal- who has expressed an interest in our lenges and inspirations of living life to the publications, who has reached out to our fullest as an amputee, and the medical, call center for help or advice, or who has social and psychological resources avail- otherwise shared their contact informa- able to achieve these goals. The National tion with us will now be considered a Conference has always been perceived “friend” or “constituent” and will receive by its attendees as an event with great our communications without the burden This year – 2011 – the Amputee Coali- IMPACT on their lives as amputees. of a membership fee. We will continue to tion reaches its 25th anniversary, and, Through our new Bridge to Ability Fund – have professional memberships and will with this first issue of inMotion during this founded in this past year and funded by be working to advance our professional anniversary year, we will both begin the our national sponsors – we are hoping to program through providing continuing edu- celebration of our past and look forward impact more new amputees by providing cation, our peer visitor clinics, and patient to our future. Anniversaries not only scholarships to the conference to those education materials to our professional represent milestones and celebration of who may not have the means to attend. members. achievements, but also thresholds to be We will also celebrate our 25th anniver- The thresholds we are crossing are both crossed – thresholds of new possibilities, sary by honoring today’s and yesterday’s the size of the constituency we can reach new challenges and greater successes. war fighters who have lost limbs defend- with our message and the technology that We have much to celebrate and to look ing America. We are inspired by their makes this possible. The Amputee Coali- forward to as we continue the pursuit courage and achievements, and we have tion will continue its print publications, of our key aims in our 2015 Strategic resolved to address their special needs including our inMotion magazine, but will Plan – Awareness, Impact, Mission and and to increase the Amputee Coalition’s supplement them with electronic media Sustainability – on behalf of the limb loss impact on their path to reintegration into products. The challenge of the new con- community. civilian life or continuing participation in stituency model will be to SUSTAIN our In 25 years, the Amputee Coalition has the military. To this end, we are especially programs by reaching out to our expanded become and remained the leading support pleased to have received a grant from the constituency and seeking their support. and advocacy organization for people Veterans Administration to develop a spe- We are excited by both the challenge and affected by limb loss. We aim to cel- cial program to train peer visitors for the the potential of increasing our philan- ebrate this achievement with an important caregivers of amputee veterans, and we thropic footprint. symbolic act, the designation of April as are developing a military advisory group to Of course, every threshold is crossed in “Limb Loss Awareness Month,” both at guide our increasing impact on this special a particular context, and we are aware of the federal level and in as many states constituency. the challenges presented by the present with gubernatorial proclamations as we As exciting and rewarding as the economic conditions we now face as a can achieve. Over these 25 years, through celebrations will be, we are equally nation and as individual citizens. We are our nationally recognized Limb Loss Infor- focused on the thresholds we are crossing confident, however, that as we mature mation Center, Peer Visitor Program, our during this 25th anniversary year and the as an organization and as we nurture our excellent publications, including inMotion, opportunities they present. As you will expanded constituency, you will be there and our new media outreach, we have learn in this issue of inMotion (page 9) with your support. So stay with us, grow succeeded in raising public AWARENESS and through other communications from with us, and together we will create more of our work and of the contributions our the Amputee Coalition, we are making awareness, we will have more impact and constituents make to improve the lives a major change in our outreach model we will sustain the Amputee Coalition’s of people affected by limb loss, including – changing from a dues-paying member- MISSION for the next 25 years. their caregivers and their communities. ship organization to a constituency-based Happy New Year.

8 inMotion Volume 21, Issue 1 January/February 2011 SPECIAL ANNOUNCEMENT The Power of One, Community of Many…Expanded

Our goal for 2011 is to grow to 25,000- Will I lose any of my benefits if I am a people strong! To celebrate our 25th anni- current paid member? versary, the Amputee Coalition will launch No. You will still receive the discount to a historic organizational change by moving the conference and print copies of inMo- from a traditional fee-based membership tion. However, you may elect to help save model to an open community “Friends” resources and the environment by “going organization for people with limb loss, green” now and choosing to receive future their families and support groups across issues of inMotion electronically. the country. We want you to be part of How will this change affect support this growth and ask that you visit our Web groups? site and update your e-mail and contact All support groups, large and small, will information so that we can provide you be part of the Support Group Network and with the new features and benefits of will be listed on our Web site with full being a Friend of the Amputee Coalition. contact information. We will work closely This new “Friends” model will enable with each group to ensure they have what us to reach more people and provide they need to serve the local limb loss com- more services to all people with limb loss munity in their areas. when they need them most, without the Does this change affect professional barrier of a membership fee. In the coming and facility memberships? months you will see many changes in our No. Our professional community support Web site, materials, our colors and logo, will continue with professional and facility but be assured that you will receive the members. same high-quality service and resources t More opportunities to meet and We hope that these healthcare provid- that you have come to know and trust. network with other people who have ers and companies will collaborate with All individuals and their families will experienced limb loss through local and us to ensure that all new patients leave automatically become Friends of the regional events and activities their office with Amputee Coalition infor- Amputee Coalition. This change will t A stronger voice and larger influence mation in hand. provide you and your family with the fol- on all levels within the limb loss commu- lowing resources and benefits. nity, on Capitol Hill, with federal agencies, This new initiative will provide help and t An electronic copy of inMotion collaborators and other national organiza- support through the process of rehabilita- six times per year to share with those tions to protect your rights and fight for tion and beyond. It will strengthen our involved in your care and adjustment (If fair access to quality care community, provide you with more options you are a current member, you will also t More opportunities to become for resources, and expand the reach of our continue to receive print copies of inMo- involved and give back to the community programs and services to those who need tion until your memership expires. Paid through an expanded Community Volun- them most. Please visit our Web site at subscriptions will also be available for teer Program open to all Friends amputee-coalition.org/friends-update to those who prefer a print copy.) t Comfort in knowing that you have a register your e-mail address for benefits t Important information when you need lifelong relationship with a national orga- and for more information and regular it through our new monthly e-news alerts, nization that is there for you when you updates on our 2011 events and opportu- keeping you informed of the latest news need it to help and support your life goals. nities. For more information, you may also and events from the national office call toll-free 888/267-5669.

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 9 ADVOCACY UPDATE Gearing Up for an Active 2011

Groundwork Laid for Action on Pennsylvania, South Carolina, Tennessee The Lead Advocates include: Gloria State and Federal Initiatives and Wisconsin. The following states have Price, Delaware; Bill Moses, Florida; Jeff Over the past 4 months, the Amputee Coali- organizing activities and we hope to see Damerall, Missouri; Teri Ross, Kentucky; Dr. tion’s Government Relations Department bills introduced: Arizona, Georgia, Kansas, Doug Doty, Tennessee; Aaron Holm, Min- has prepared for major activity on the 2011 Kentucky, North Carolina and Washington. nesota; Don Davis, South Carolina; and Bob legislative front: state and federal pros- Thurman, Ohio. We hope to add more Lead thetic parity bill introduction; gubernatorial Florida Is the First State to Advocates for 2012 and plans are underway proclamations to declare April as Limb Loss Introduce Prosthetic Parity to hold the next Amputee Action Network Awareness Month in all 50 states; and train- Legislation for 2011 training session at the national conference ing key advocates for the Amputee Action As a direct result of grassroots support and in Kansas City. Among our Lead Advocates Network to lead their state’s activities. Amputee Action Network efforts in Florida are Tami Stanley of Utah and Marifran led by Bill Moses, the Amputee Coalition’s Mattson of Indiana, veterans in the ﬁght for Mobilizing Grassroots Support Lead Advocate in that state, a parity bill, parity. Both were the leaders in their states’ of Parity in State Legislatures HB 5, has already been introduced. Rep. successful parity passage. Their comments In fall 2010, the Amputee Coalition held Joseph Gibbon’s (D-105) bill would ensure and insights were valuable throughout the organizing meetings to mobilize grass- the Florida limb loss community has access training. roots support in a number of states where to prosthetics. prosthetic parity bills are expected to Gubernatorial Proclamation be introduced. With the help of support Federal Parity Legislation in the Goal: Declare April as Limb Loss groups, O&P societies and enthusiastic U.S. Congress Awareness Month in advocates, these meetings resulted in The 2010 midterm elections resulted in All 50 States strategic planning for 2011. Through live a major change in the composition of the In January, the Amputee Coalition submit- and virtual meetings, the Amputee Coali- U.S. Congress. Although federal prosthetic ted a resolution to each of the 50 governors, tion’s government relations coordinator, parity bills were introduced in the House and asking them to declare April as Limb Loss Dan Ignaszewski, spoke to advocates and Senate last year, the healthcare reform bill Awareness Month in their respective volunteers about what it takes to get a (Patient Protection and Affordability Care states. The electronic submission of these parity bill through the legislature. Act – PPACA) took front and center stage. packets include: an individual proclamation using Amputee Coalition proclamation lan- Seven organizing meetings have been held, Inaugural Class of the First guage for each state; letters of support from to date: Delaware, Minnesota, Nebraska, Amputee Action Network support groups in each state; and letters of Pennsylvania (two were held), South Completes Training support from O&P societies in each state. Carolina and Washington. Several more In fall 2010, the Government Relations When your support group receives the are expected to take place early this year: Department trained amputees designated letter, please be sure to sign on early and Florida, New York, Ohio and Tennessee. We as the Amputee Coalition’s Lead Advocates return the letter to the Amputee Coalition. expect to build on these meetings during in their respective states. These activists Please consider writing your governor to the 2011 legislative year and look forward learned the basics of how to pass a parity ask for his or her support. to our state prosthetic parity initiatives bill, how to garner and maintain grassroots moving forward in state legislatures. support, the pros and cons of hiring a lob- We need your help and support in 2011! byist, setting up advocacy funds, recording To learn what you can do to advocate for We expect the following states to introduce support group and volunteer hours and prosthetic parity and gubernatorial proc- parity bills in their 2011 legislative ses- working with the media. This group is lamations in your state, contact Amputee sions: Alabama, Connecticut, Delaware, excited, and they are currently mobilizing as Coalition Government Relations Coordina- Idaho, Michigan, Minnesota, Nebraska, the legislatures begin. tor Dan Ignaszewski at 202/742-1885 or New York, North Dakota, Ohio, Oklahoma, [email protected]. ■

10 inMotion Volume 21, Issue 1 January/February 2011 “...BUT SUPERHEROES FLY”

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“I woke up one day weighing 374 pounds, and I said, ‘How did this happen?’” she remembers. “On one hand, I was very aware of my life. I knew what I was doing. But on the other, I was doing it subcon- sciously.”

At that size, Ashley couldn’t buckle a car by Scott McNutt seatbelt. She suffered severe sleep apnea and Ashley Johnston, second-place fin- feared she might go to isher on the ninth season of NBC’s bed The Biggest Loser, has a fond memory of the show’s season finale. Standing behind a life-size poster of herself at her starting weight of 374 pounds, seconds before she burst through it to reveal her slimmed down figure to a national TV audience, she was struck by a profound self-realization.

“I am strong; I did this,” she recalls thinking. “I am the girl who fell off the treadmill, who puked throughout the entire season, and I am standing here 187 pounds lighter. And for the ﬁrst time in my life, I am completely happy with who I am. Coming to that realization was my best moment one on the show – probably one of the night best moments of my whole life.” and never get up. She ﬁnally Worried About Survival accepted that her life ate and drank too For the 28-year-old Tennessean, depended on shedding weight. much, but dieting never worked, reaching that milestone was a matter despite trying “everything out there of life and death. Like many people, “It wasn’t about missing out on fun possible.” With her health – and Ashley put on pounds over time, things; I was worried about my survival,” perhaps her life – on the line, Ashley rationalizing away the weight gain she says. was ready to take extreme measures and failing to recognize her addiction to confront the insecurities that led to to food. The young esthetician – a self- her overeating. So she and her mother, described “party girl” – knew she Sherry, tried out for The Biggest Loser,

12 inMotion Volume 21, Issue 1 January/February 2011 eight Loss Starts in the Mind

selected but were invited back later. even more determined to drop the The rest, as Ashley puts it, “America pounds. knows. There’s nothing unrevealed now. I left it all on the ranch.” “I don’t want to have the struggles my dad had,” Ashley says. “And I Sherry was eliminated midway didn’t want to take any more years through the season (she con- off my life than I already had – I tinued to lose weight, going was 27, and they told me I had the from 218 pounds to 138), inner body of a 57-year-old. After but Ashley made it to the that, I monitored my blood sugar, end, shedding 187 pounds and as I lost weight, I actually got to (49.83 percent of her body see me healing myself of diabetes. I weight), more weight than felt almost lucky to have something any other female contestant wrong with me that I could ﬁx, not to that point. with drugs, not with surgery, but The winner, with changing my lifestyle.” Michael Ven- The Mental Battle Ashley now gives talks on her experiences. While many want to know her diet secrets, she says that shouldn’t be the focus.

“Everybody wants to know, ‘What trella, do you eat?’ I understand that,” she trimmed explains. “It’s simple: You count your 264 calories (she generally eats 1,200- pounds, 1,400 calories per day), you eat a or 50.19 well-balanced diet and you exercise percent of his – but ‘simple’ is not easy, because it’s body weight. a mental battle. It’s about a lifestyle change and ﬁguring out how you got Although there to the weight you are.” may be nothing unrevealed She attributes her lack of success now, something was dieting over the years to not con- in which teams compete to lose the revealed to Ashley at the season’s fronting the underlying reasons for most weight, both individually and as start: She had diabetes. Her father her eating addiction. She had never a group, under the care and guidance struggled with diabetes in his later fully faced painful experiences, such of a team of no-nonsense professionals years, but Ashley had never been as her father’s death from cancer on an isolated ranch. diagnosed with it, despite her when she was a teenager. Rather than obesity. The news was shocking. face stressful subjects, Ashley would Revelations When she learned that diabetes was “stuff them,” or eat to repress them, The Johnstons were not initially reversible with weight loss, she was just as those addicted to nicotine

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 13 was different. I came back to the same room that I left, to the same clutter, to friends that weren’t living a healthy lifestyle. I had to ﬁnd balance in my life.”

So she reduced her stressors and temptations. She moved out of her mom’s house – a decision she terms “great for both of us” – got her own house, reduced time spent with friends following unhealthy lifestyles and surrounded herself with people who want to live healthy, happy lives. But these changes don’t mean her life is without challenges.

Photo by Joy Kimbrough, provided by D1SportsTraining.com “This is reality; this is the hardest test,” Ashley says. “I’m working full healthy responses to stress allowed time. I’m traveling – I’m still con- And for the first Ashley to combat her addiction and quering (maintaining healthy habits) time in my life, transform her life. and traveling. That’s hard. But I don’t I am completely have all those other mental problems “When I’m stressed out, all I want to holding me down anymore.” happy with who I do still is eat a carb,” she observes. am. Coming to that “But now I find different ways to Giving Back “realization was my release that stress. Instead of eating, Ashley currently works as a spokes- best moment on the I’m working out – I take a great kick- person for The Biggest Loser’s new show – probably one boxing class – and I feel even better activewear clothing line, BL Body. when I’m done.” And she’s mapping out how to give of the best moments back to her fans. of my whole life. The Hardest Test Ashley acknowledges that she was In addition to doing inspirational fortunate to have the assistance and speaking engagements, Ashley is guidance of physicians, psychologists crafting a plan to fulfill numerous turn to cigarettes when stressed. and trainers on The Biggest Loser. Yet, requests to help fans with diet since leaving the show, she’s kept the plans and workout routines. She has “I found comfort when I was full,” “ weight off. She did it by simplifying pitched the idea of doing it through she explains. “I was happy for that her life (she calls it “decompress- a combination of personal visits moment. It was a vicious cycle ing”). and videoconferencing, which has because then it was, ‘Omigod! I’ve received enthusiastic support. eaten all this, and I’m gaining all this “I’m grateful for being on the ranch, weight!’ To stuff that feeling, I would where my job was to heal myself, “The response was overwhelming,” eat more.” but you still have to figure out how she says. “Hundreds of people were to decompress your life when you ready to sign up. I’m just trying to Identifying her stressors, confronting get home,” she explains. “When I figure out how I can do all of this. them, forgoing the emotional crutch got home, it was like a time warp. I I’m working on trying to give back to of eating and instead developing was very different, but nothing else everyone.”

14 inMotion Volume 21, Issue 1 January/February 2011

Illustration and article by Scott McNutt hunger and extreme thirst, blurry vision, tingling or numbness in the feet, and sexual dysfunction. If you exhibit these Save yourself! Only you can help prevent symptoms, consult your healthcare provider immediately. diabetes and its devastating complications If diabetes has already infiltrated your body or you believe Like the invading alien pods in the 1956 science-fiction you’re in danger of being affected, you must keep it from movie classic, “The Invasion of the Body Snatchers,” risk fac- taking control and putting you at risk for amputation and tors that contribute to type 2 diabetes (including a sedentary many other devastating health problems. The Centers for lifestyle, poor eating habits, high blood pressure and choles- Disease Control and Prevention (CDC) estimates that 7.8 terol, family history, genetics and age) make diabetes a silent, percent of the U.S. population, or 23.6 million Americans, insidious threat. Without proper care, diabetes can consume currently have diabetes (including 5.7 million with undiag- your body from the inside, working its way up your nerve nosed diabetes). This is up from 18.2 million in 2003. As this endings, ravaging your limbs, and leading to amputation. If number rises, diabetes continues to be the leading cause of you’ve already had an amputation because of diabetes, and nontraumatic lower-limb amputations (LLAs) in the U.S. you don't take action to control the disease, it can infiltrate your organs and take control of your life – or end it. In 2008, more than 50,000 Americans lost a lower limb due to diabetes-related complications, representing nearly half of Unlike the alien pods, however, risk factors for diabetes can the LLAs performed in the U.S. Members of minority groups, be detected and combated. Eating sensibly, exercising and including Hispanic/Latino Americans, African Americans, avoiding smoking are reliable defenses against diabetes. If American Indians/Alaska Natives, and older Americans are at you’re at risk for the disease, you can minimize its effects especially high risk. About half of all diabetes-related LLAs by staying alert for warning signs, such as fatigue, sudden occur among people age 65 or older. weight loss, frequent urination, wounds that won't heal, "They're here already! You're next! You're next!"

For people with diabetes who have undergone amputations, most ulcers that lead to amputation can be prevented through current data is not encouraging. Studies show that people with daily foot inspection and care, foot-care education, wearing diabetes who undergo an amputation are at significant risk of proper shoes and early recognition and treatment of any sus- additional amputations within 5 years, and as many as one in pected trouble areas. All people with diabetes should undergo three may be dead after 10 years. annual foot examinations to identify high-risk foot conditions. Healthcare providers of people with diabetes should be able to The Amputee Coalition (amputee-coalition.org) is fighting conduct simple screening exams of the neurological, vascular, amputations from diabetes complications with the most effec- dermatological and musculoskeletal systems. tive tool available: knowledge. Experts contend that anywhere from one-half to four-fifths of all diabetes-related amputations If no action is taken to stem this disease's looming threat, could be prevented by people being aware of diabetes’ effects the CDC forecasts that up to 33 percent of all Americans will and taking measures – such as getting their feet examined have diabetes by 2050 – an epidemic that could overwhelm regularly – to prevent them. All people with diabetes, whether the U.S. healthcare system. If you're not currently at risk for they have undergone amputation or not, should develop daily diabetes, you can curtail its invasion by not smoking and self-management practices. Early detection and treatment are following healthy diet and exercise regimens. If you’re at risk, the keys to preventing amputation. contribute to the fight by stopping or not starting smoking, losing weight if you’re overweight, eating right, exercis- Diabetic neuropathy (loss of sensation in the feet and legs) and ing and following your healthcare providers' advice. If you poor circulation in the lower limbs are two of the main compli- already have diabetes, make sure that you apply your daily cations from diabetes that lead to amputation. Poor circulation self-management practices and visit the appropriate health- causes skin and tissue to be easily damaged and interferes with care providers regularly and follow their advice. Taking these healing, while loss of feeling allows damage to go unnoticed steps will help prevent "The Invasion of the Body Fatteners" until wounds have become infected and ulcerated. Fortunately, from devastating your life. ■ Surviving the First Year After Amputation

While people come to limb loss by many different routes, This section – a partial roadmap – includes tips for the first 12 they often face similar problems along the path to healing and months after limb loss for both upper- and lower-limb ampu- rebuilding their lives. Regardless of whether the loss is of an tees; information for bilateral upper-limb recovery; stories of upper or lower limb, and whether it is caused by illness or physical and emotional survival; information about gait training injury, the experience will undoubtedly change a person’s life. for lower-limb amputees; and overviews of current pain treatments and skin conditions that can threaten recovery. The first year following an amputation is critical, and it can be an especially difficult period, both physically and emotionally. We hope that the experiences of the amputees and experts who While the loss is felt acutely by the amputee, it is also extremely have contributed to this section will help you reach many of the difficult for the person’s closest family members to accept the important “landmarks” on your individual path to recovery. loss and adjust to new daily routines. For more information on surviving with limb loss, please contact The time needed for healing and rebuilding will vary with each the Amputee Coalition at 888/267-5669 or visit the Web site at person – often depending on physical health, age, available amputee-coalition.org. support systems, emotional outlook, and other factors. It is also important that individuals have a roadmap to help them achieve the most successful recovery possible.

18 inMotion Volume 21, Issue 1 January/February 2011 should start pre-prosthetic physical therapy soon after your amputation, working on your upper body strength and your lower limbs to maintain good What You Might range of motion in your hips and knees and strength in your leg muscles. You should also start desensitizing your Expect During the residual limb by rubbing it and manually moving your tissue around with your hands to loosen any scar tissue that First 12 Months might develop inside your limb. You will also meet your prosthetist multiple times, first for a consultation/evaluation and as a Lower-Limb then to be fitted with a “stump shrinker” (an elastic stocking) that will start shaping your residual limb for initial Amputee prosthetic fitting. by John Peter Seaman, CP, CTP this reason, you should do everything in Once your incision has your power to find a prosthetist that you completely healed, your As a recent amputee, you’re not alone if are comfortable with. stitches have been removed you feel clueless about what to expect and your doctor has during your first year as an amputee. Following your amputation, provided a prescription for a preparatory While there are no set guidelines that you and your residual limb prosthesis, you will meet with your will fit every amputee’s individual situ- will start your respective prosthetist to be measured and “cast.” ation, there are some generalities that psychological and physical Depending on how your prosthetist may apply. One certainty is that you will healing processes. Depending on how works, he or she will either cast your see your prosthetist many times during fast your limb heals, you should expect residual limb or create a digital image of your first year as an amputee, possibly as to have your stitches/staples removed it by scanning or taking pictures of it. many as 15 to 20 times, if not more. For within 3 to 4 weeks of your surgery. You Once your prosthetist has a positive

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 19 model of your limb, it will be used to good habits while you relearn how to through the use of a variety of assistive create a diagnostic (check or test) socket walk, using a prosthesis. You will devices (walker to a 4-prong cane to a for test fitting purposes. This socket will typically start walking using a walker as single-prong cane) to the point where be connected to a knee (for transfemoral you work to regain strength, balance, you can ambulate without an assistive amputees) or just a pylon (for transtibial endurance and confidence. device. However, not all lower-limb amputees), which in both cases will then amputees are able to function safely with- be connected to a prosthetic foot. When Your residual limb will out the use of an assistive device, you see your prosthetist for a test fitting, continue to go through depending on their overall health, this might be completed in one visit or it physiological changes as you determination and confidence. Be aware could take multiple visits. Once a use your prosthesis more, that for some amputees, prolonged use of diagnostic socket is deemed to fit typically resulting in volume loss. If your an assistive device can enhance safety “comfortably,” your preparatory socket rehabilitation process proceeds well, you and reduce the potential for falls. will be fabricated and connected to your might see your prosthetist on a monthly other prosthetic componentry, resulting or bimonthly basis during this time As you approach the end of in your first prosthesis. Adjustments to period. It might become necessary for the first year since your this prosthesis may be required during your prosthetist to fit you with a socket amputation, you will the first month or two that you wear it, replacement during this timeframe due to hopefully have become fairly leading to follow-up visits to your significant volume loss in your residual comfortable with life as an amputee: You prosthetist. After you are fitted with your limb, which can cause your original will have mastered using a prosthesis – first prosthesis, your doctor should preparatory socket to become too large putting it on (donning), taking it off provide a prescription for physical and adversely affect its fit. If so, you may (doffing), making adjustments to the therapy. Usually, you will see a physical be test fit again before you are fitted with number of socks being worn, etc.; your therapist two to three times a week for another downsized laminated socket. phantom pain will have subsided and 1-hour sessions. These sessions are This process can take a few visits to your your phantom sensations will have important to ensure that you develop prosthetist to complete. Be aware that lessened or become more tolerable; you every socket you are fit with will feel will have found that you are able to do different, which may require some many of the activities of daily living NEW getting used to and possible adjustments (ADLs) that you did prior to your following fitting. If your rehabilitation amputation, but possibly in different has proceeded well to this point, you ways; and you will have established a might not need continued physical good relationship with your prosthetist, therapy. who you’ve seen many times during the past year and will continue to see on a By now, your residual limb regular basis in the future. may have stopped shrinking and reached a somewhat If you have any questions about this article, mature state. At this point, please contact John Peter Seaman at your physician might prescribe that you [email protected]. amputee supplies be fit with your definitive (final or permanent) prosthesis, assuming your Buy Direct and Save Online preparatory socket no longer fits inti- mately. This may require test fitting again Buy Prosthetic Supplies Direct and additional visits to your prosthetist before a new laminated socket is fabri- Save Money and Valuable Time cated. Your prosthetist will also incorpo- Socks, Shrinkers, Skin Care, & more rate componentry into your definitive prosthesis that matches your current and/ * Apply Coupon Code AS2010 during checkout and receive 10% Discount. Minimum $25.00 Purchase. or potential level of activity, assuming your activity level has changed since www.AmputeeSupplies.com originally being fit with your preparatory prosthesis. You may have progressed

20 inMotion Volume 21, Issue 1 January/February 2011 Tips For Enhancing Your Success as a User of a Lower-Limb Prosthesis by John Peter Seaman, CP, CTP 1. Be compliant – Properly clean the inside of your liners after wearing them, examine your residual limb each Even for the most experienced wearers of lower-limb prosthe- day to be sure you don’t have any issues that need to be ses, using a prosthesis can result in daily inconveniences, if addressed (skin breakdown) and, when needed, wear not worse. So what can recent amputees do to enhance their prosthetic socks to enhance your socket fit. You might also experience after being fitted with a prosthesis? First, accept that want to wear a shrinker while you sleep to help shape your successful prosthesis use involves a 50/50 effort between the residual limb and reduce swelling overnight, especially if amputee and his or her prosthetist. Second, amputees need to you are a recent amputee. understand that their prosthetist, in 2. Don’t procrastinate – If you have most cases, is not a miracle worker. an issue with socket fit, comfort or In simplest terms, the prosthetist’s prosthetic function, schedule an role is to assess the amputee’s physical appointment to see your prosthe- potential, select appropriate prosthetic tist right away. Don’t let what seems componentry, and provide a tool, in like a small issue grow into a major the form of a prosthesis, for the ampu- one, especially if you have diabetes tee to use to achieve his or her desired and have skin breakdown that could ADLs (activities of daily living). Once become infected or your prosthesis is this is accomplished, it is up to the not functioning in a safe manner. amputee to do the many things neces- 3. Establish personal goals – Set sary to maximize the benefits offered some goals involving physical activities by a comfortably fitting and properly that gradually increase your prosthesis functioning prosthesis. use as time goes by. Don’t be satisfied with today’s level of activity. Constantly Listed below are 10 of the more impor- stretch yourself and strive to achieve tant things you can do as an amputee more each day while being safe. to help ensure that your experience as 4. Wear and, more importantly, use a prosthesis user is maximized. your prosthesis every day – As a new amputee, you may wonder how long you should wear your prosthesis 7. Control your diet – As a lower-limb better. Most lower-limb amputees each day. A standard answer would amputee, in many cases, you will are able to return to very full life- be, “As much as possible.” If your initially be less active than you were styles after they become accustomed prosthesis fits comfortably, you prior to your amputation. Such a to using a prosthesis and understand should be able to put it on in the sedentary lifestyle will often result in that being a successful prosthesis morning and wear it until you go your gaining weight. It is important user can be as dependent on dealing to bed at night. Also, by wearing it to understand this and to adjust successfully with mental adjust- all day, you will be more inclined to your nutritional intake to match ments as physical ones. use it more regularly. Your prosthesis your activity level so that you do not 9. Strive for independence – Imme- will not do you any good if it is sit- gain appreciable amounts of weight diately after your amputation, it ting in a closet collecting dust. during this period of transition. If is normal to seek out and receive 5. Become experimental – As an your weight fluctuates significantly assistance from family members amputee, you will have to learn how after being fitted with a prosthesis, or friends to help you during this to successfully use a prosthesis, and, intimate socket fit can be compro- transition. However, at some point – yes, it requires work on your part. mised. the sooner, the better – you should Your residual limb will not fit in the 8. Accept and embrace your situa- strive to become as independent prosthetic socket the same way each tion – Everyone deals with amputa- again as possible. With a comfort- day or even throughout the day. You tion in his or her own way, some ably fitting and properly functioning need to be sensitive to what you are more smoothly than others. The prosthesis, you should be able to do feeling in the socket and learn what sooner you can come to grips with many, if not all, of the things you did you can do to effect positive changes the fact that you’re an amputee and before becoming an amputee. in your socket fit, like adding or that your life has not ended, the 10. Focus on the future – Few, if any, taking away full-length amputees are thrilled with or partial-length pros- having become amputees thetic socks or removing and having to rely on a and redonning a liner prosthesis to live their that has slipped due to normal lives. Those who a build-up of perspira- do well accept their situation. tion and make a conscious 6. Exercise regularly – As decision to not let it get in a new lower-limb ampu- the way of living life to the tee, you have lost some fullest. Don’t be misled, musculature in your however; not every day affected leg, so you have as an amputee will be a fewer muscles to use walk in the park. Often, when standing, walk- you’ll need to exhibit ing or running. You’ll an immense amount of need to strengthen those patience and perseverance. remaining muscles to However, if you focus on stand in a stable manner the positives in life versus and walk with an effi- dwelling on the negatives, cient gait. This will take with sincere effort and several weeks or months determination, you should and require a lot of be able to live a long, effort. Working with a fulfilling life as a prosthe- physical therapist soon sis user. after your initial prosthetic fitting to shorten Please forward any questions the learning process is or comments to the author at ■ highly recommended. Photo courtesy of Bill Nessel [email protected].

22 inMotion Volume 21, Issue 1 January/February 2011 The First 12 Months After Upper-Limb Amputation by Dan Conyers, CPO, and Pat Prigge, CP part of your care team will work closely with this physician to manage your Good communication Your life has changed – you’ve lost an rehabilitation. While you are the central between the arm. Now what? What will you be able decision-maker on your team, the PM&R to do? How will others see you? Will life physician is the director that gets you the upper-limb patient ever be “normal” again? While it is over- services you need. and the prosthetist whelming to face so many unknowns, be is essential to reassured that there are many people and Emotional Challenges becoming a organizations that can help guide you Limb loss has a signiﬁcant emotional and your family along the path of recov- impact on both the individual and his successful ery and rehabilitation. Over the next or her family. It is important to under- prosthesis user. 12 months, your life is likely to include stand the range and intensity of feelings several recurring themes: medical care, emotional challenges, prosthetic care, and occupational and physical therapy.

Medical Care The starting point for your rehabilitation is medical care. A few days after surgery, your medical care transitions from suture and staple removal to wound care and pain management. Once you leave the hospital, you will become more responsible for monitoring the physical aspects of your recovery and reporting this to your doctor at regular follow-up visits. At some point during the first 3 months, your surgeon will probably transition your care to a physical medicine and rehabilitation (PM&R) physician, or physiatrist. The PM&R physician focuses on pain management and medications you may experience during the first and is your main referral source for 12 months, and perhaps longer. Many emotional healthcare, prosthetic treat- people overlook or avoid the opportunity ment, occupational and physical therapy, to talk with a counselor and address the social services and return-to-work issues. reality of the grieving process. Emotional Your relationship with this physician will recovery is a highly personal experience likely continue throughout your life, so with no set timeframe. Some people feel take the time to build a good rapport. that they quickly reach a level of accep- The other professionals who become tance following their injury or surgery, only to find themselves pulled back into of your life. To get the best possible out- ing your work, family and recreational feelings of grief when they least expect come, be sure the prosthetist you choose activities. it. Establishing a comfortable, honest has extensive upper-limb experience. dialogue with a licensed counselor, social Occupational or Physical worker, psychologist or support group In one of your earliest meetings with Therapy should occur within the first 3 months of a prosthetist, while your residual limb An occupational or physical therapist will your recovery. is healing and creating new circula- play a key role in guiding your rehabilitation pathways, you may be fit with a tion. The therapist and the prosthetist Prosthetic Care “shrinker” that is made from fabric or work together to create a treatment plan Most new amputees are referred to a silicone. It looks like a sock but its func- that moves you through the three phases prosthetist after their surgical sutures tion is to help reduce swelling in the of therapy: pre-prosthetic, interim- or staples have been removed. In some residual limb, compress the tissue and prosthetic and post-prosthetic. During hospitals, an immediate post-operative build tolerance to pressure. Even after the first month, the focus is on preparing prosthesis (IPOP) is applied by a pros- you begin wearing a preparatory prosthe- you to wear a prosthesis. In the second thetist in the operating room so that sis, you will continue to use a shrinker or third month you begin learning to from the moment a person awakens from during the first year when you’re not use a preparatory prosthesis and work amputation surgery, he or she is wearing wearing a prosthesis. on repetitive drills and controls train- a prosthesis. In either case, it is impor- ing. More complex tasks are added after tant to understand that you will probably The first month of your recovery is often you receive your final prosthesis and are be working with a prosthetist for the rest when you learn the most about integrat- moving toward the 12-month mark. ing a prosthesis into your life, before Building a positive working relationship with your therapist gives you a secure place to practice both new and familiar tasks before trying them in the real world. This will help build confidence with your body and with the use of your prosthesis. Let your therapist know the goals you have for your recovery and stay open- minded about trying different exercises and prosthetic components to accomplish your goals. After the first 12 months of therapy have been completed, it is important to remember that you can revisit therapy later, when you try new activities or prosthetic components.

One year after losing your arm, you will have learned a great deal about adjust- ing to life as an amputee and a prosthesis user. You will have discovered new ways you get used to doing things without to approach both simple and complicated Upper-limb patients a prosthesis. The prosthetist you select tasks. And, most importantly, you will will work closely will spend a signiﬁcant amount of time have a team of supportive people – with an occupational discussing your goals, learning about professionals, family and friends – that therapist to learn to your history, and teaching you about will continue to help you set and reach use their prosthesis. prosthetic options and components. It new goals in your rehabilitation. is vital to establish open communication and trust with your prosthetist. Help him Photos courtesy of Advanced Arm Dynamics or her understand your life by discuss-

24 inMotion Volume 21, Issue 1 January/February 2011 UPPER-LIMB PERSPECTIVES Bilateral Upper-Limb-Loss Rehabilitation An Occupational Therapist’s Perspective by Shawn Swanson Johnson, OTR/L bilateral upper-limb amputation is that for addresses the following issues: wound some period of time, the patient is likely care, scar management, edema manage- Upper-limb loss is ment, desensitization, a rare occurrence. range of motion and Consider this fact: psychosocial concerns. for every incident of For bilateral limb-loss upper-limb amputa- individuals, early occu- tion, there are 30 pational therapy will incidents of lower-limb also include a unique amputation. Bilateral focus on stretching and upper-limb loss is even strengthening the lower rarer, and is extremely limbs and strengthening challenging, as there the core of the body. is not a remaining arm Balance and fall recov- to perform daily self- ery are also addressed, care tasks. as these patients do The loss or absence not have arms to help of both hands or arms them with balance or to places the individual protect them when they and his or her family fall. in a very difﬁcult Bilateral upper-limb patients should be trained how to do tasks both with and without their prostheses Prior to receiving situation. Yet specialized, long-term to be completely dependent on someone a prosthesis, there are numerous tools rehabilitation can help people regain their else for his or her most basic and personal and techniques that can help facilitate ability to care for themselves, participate needs. Using the bathroom, bathing, get- independence. These include but are not in leisure activities or hobbies, drive a ting dressed and eating are all important limited to: car and return to work. The guidance of a aspects to address early on in rehabilita- t A universal cuff that slips around the multidisciplinary team that includes both tion. Occupational therapy is the best way residual limb and can hold a fork or spoon an occupational therapist and a prosthetist to start regaining some independence t Eating utensils that swivel and are who specialize in upper-limb rehabilitation prior to receiving a prosthesis. Occupa- easier to grip or provide the appropriate is essential. Other factors that contribute tional therapy also prepares the individual angle to bring food to the mouth to better outcomes include a strong sup- to become a prosthetic user, which will t Bidets, which remove the need for port system of family and friends and a increase his or her options for self-sufﬁ- toilet paper management positive, motivated attitude on the part of ciency. It is important to note that patients t Devices such as gooseneck clamps and the limb-loss individual. should be taught how to perform daily suction cups to hold personal grooming tasks both with and without prostheses. items like shower brushes, hair dryers and Initial Concerns and Challenges Early occupational therapy in both toothbrushes One of the most challenging aspects of unilateral and bilateral upper-limb loss t A “dressing tree” that makes dressing

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 25 easier with a system of hooks placed in Learning to put on and take off the strategic places on a wooden or PVC stand prostheses – donning and doffing – is an t A mouth stick that enables a person important part of prosthetic training. The to flip switches and press buttons or occupational therapist (OT) works with keyboards the patient on learning to don and doff t Speakerphones or voice-activated cell the prostheses without the assistance of phones another person. No matter the level of t Electronic, hands-free devices that limb loss, independence with this task is help the individual call for help and control possible. his or her home environment, such as The OT also helps the patient learn to lighting, room temperature, appliances actually use the prostheses in a par- and TVs. ticular method or sequence of steps that While these tools are helpful in the include controls training, repetitive drills home environment, some are not easy to and bimanual functional skill retrain- take along when reentering the commu- ing. Controls training includes basic nity or traveling. movements like opening and closing the terminal device (hand or hook), operat- Getting Familiar With Prosthetics ing the wrist, flexing and extending the Becoming a fluent user of bilateral upper- elbow, and manipulating the shoulder limb prostheses takes time. How much A dressing tree can support clothing or joint. After consistency and accuracy are time depends on the complexity of the prostheses, enabling bilateral upper- achieved with speed and device position- injury, the length of the residual limbs, and limb amputees to get dressed or don ing, repetitive drills begin. This includes the individual’s overall attitude and level their prostheses independently repetitively grasping and releasing items of motivation. It is not unusual for it to of various shapes and sizes and moving take 1 to 2 years or even more to become them in different areas around the body. comfortable and capable. It also includes learning to pre-position It is preferable that the prosthetic sock- the terminal device to pick up objects in ets are pre-flexed with radial deviations of an anatomically correct way rather than the forearm and wrist that help position twisting or bending the body in awkward the arms toward the center of the body. or harmful ways. After the patient has Additional components that allow for demonstrated consistency and accuracy elbow, wrist or shoulder movements are with repetitive drills, it is appropriate added to the prosthesis as the individual is to move on to bimanual functional skill able to tolerate the additional weight and retraining. This includes basic gross motor complexity. skills like folding a towel and progresses Prosthetic training for bilateral upper- to fine motor skills, such as manipulating limb-loss individuals requires a special buttons. approach where each arm is trained independently. The residual limb that is longer Living in a New Way or more mobile becomes the dominant Adapting to life with bilateral upper-limb arm and hand. Prosthetic training should loss usually happens over a period of occur on the dominant side first, with the months or years, not weeks. Smaller entire process repeated separately on day-to-day accomplishments lead to more Shower modification with wall- the non-dominant side. Finally, training independence over the long run. If it is mounted sponges for washing the continues with the individual wearing both financially feasible, home modifications, body, soap dispensers controlled by a prostheses and attempting bimanual daily especially in the bathroom/shower, are foot pedal, and a full-body dryer tasks. extremely beneficial. Smaller

26 inMotion Volume 21, Issue 1 January/February 2011 day-to-day accomplishments lead to more ist who has experience with bilateral is helpful to a handyman. independence over the long run. If it is upper-limb-loss individuals or those with t Using electric prostheses on both sides financially feasible, home modifications, a spinal cord injury, it is often possible to is becoming more common, versus the tra- especially in the bathroom/shower, are become a licensed driver. ditional approach of using body-powered extremely beneficial. Smaller modifica- In closing, consider these key points on the dominant side and electric on the tions around the house, such as changes that have emerged from healthcare non-dominant. to drawers, handles, doors, containers and practitioners over years of working with t Attendant care is typically required and light switches, are easier to make and also bilateral upper-limb-loss individuals: ranges from part-time to full-time. less expensive. t Most individuals are motivated and t If individuals choose not to wear pros- Most individuals have a hobby, job inventive/creative in how they adapt. theses and use their feet or other parts or other activity they want to return to. t Having a strong support system is a of their body for various activities of daily Whether it’s shopping for groceries, work- vital part of being successful. living, anecdotal evidence shows that they ing in the yard or driving a car, there are t It is essential to have a backup set of will develop problems with their neck, bilateral upper-limb amputees who have arms in the event of repairs and mainte- back and especially their hips. found new ways to do these and other nance on the primary prostheses. activities. Being able to drive again is a t Having multiple terminal devices gives All photos courtesy of Advanced Arm reachable goal, and, by working exten- the patient the ability to complete a vari- Dynamics. sively with a driver rehabilitation special- ety of daily tasks, much like a box of tools

Additional Resources

Workshops Notes From the Medical Director: Introduction to Upper- International Society for Prosthetics and Orthotics (ISPO) Limb Prosthetics: Part 1 by Douglas G. Smith, MD. Knox- Skills for Life 3, October 12-16, 2011 ville, TN: Amputee Coalition, 2007. The program will feature a series of workshops devoted spe- ciﬁcally to issues faced by individuals with bilateral upper- Notes from the Medical Director: Upper-Limb Prosthetics: limb loss. Presenters will include therapists, prosthetists, Part 2: Insights from Those Who Have Lost One Arm by physicians and others living with bilateral upper-limb loss. Douglas G. Smith, MD. Knoxville, TN: Amputee Coalition, usispo.org/skills_for_life.asp 2007.

Skills for Life 2, Video Upper-Limb Prosthetics: Part 3: Insights About the Loss of resrec.com/store Both Arms by Douglas G. Smith, MD. Knoxville, TN: Ampu- search skills for life tee Coalition, 2007.

Upper-Limb Prosthetics: Part 4: Insights About Acquired Videos Loss of Both Arms by Douglas G. Smith, MD. Knoxville, TN: The Use of Upper-Extremity Prostheses by Art Heinze Amputee Coalition, 2008. armamputee.com Body Dryer Research Institute of Chicago Video Library: tornadobodydryer.com lifecenter.ric.org click on Videos & Media at the top of the page Bidets Toto Articles in the Amputee Coalition Online Library totousa.com (http://catalog.amputee-coalition.org) search bidet

Notes From the Medical Director: Grasping the Importance Lubidet of Our Hands by Douglas G. Smith, MD. Knoxville, TN: lubidet.com Amputee Coalition, 2006.

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 27 VVVBKDFRSNQHDRBNL Trust. It’s part of the reason why Aaron and his prosthetist, Bob, work so well together—and why they were able to create such an amazing outcome. It’s also why the C-Leg® microprocessor knee has become the standard for prosthetic knee joints worldwide.

To learn more about their success story—and how to take the C-Leg out for a free, no obligation test drive—visit us at www.clegstories.com. You’ll be sure to create your own amazing story.

!ARON "ILATERAL# ,EGWEARER -INNEAPOLIS -. "OB4ILLGES #0/ 3T0AUL -. Great Partnerships. Great Stories. # ,EG.OTHING%LSE#OMES#LOSE by Elan Young

Molly French, ever the doting teacher, never missed school for anything – certainly not for something as minor as a cold. But when her cold got worse and her energy ﬂagged, Molly’s colleagues had to practically force her to see a doctor. The kids in her classroom were shocked that their dedicated teacher was sick enough to miss school.

The doctor told Molly she had a virus, and said to get some rest. “Did I listen?” she jokes. Well, she might have, but the next day was class picture day at school, and she knew the kids couldn’t have their class picture without a teacher, so she went.

That weekend, though, Molly didn’t get off the couch, and by Monday her husband Jamey said she needed to see the doctor again. He knew she was really sick when she not only agreed, but told him to grab her emergency lesson plans because she was too weak to write a new plan. Her students may have ended up with a class picture of Mrs. French, but little did anyone know that that would be her last day as a teacher and that the next 3 weeks would be a battle for her life.

Critical Care This time, on the way to the doctor, Molly began experiencing trouble breathing. Unfortunately, when she ﬁrst went, she wasn’t exhibiting the classic signs of strep throat, which by now had turned septic. To complicate matters, her breathing problems were due to a deadly condition called Adult Respiratory Distress Syndrome (ARDS), which was brought on by the sepsis. This came with a grim statistic: no more than a 5 percent survival rate.

Thanks to Jamey’s childhood friend, Troy, a respiratory specialist at the Uni- versity of Michigan Medical Center who lived 2 hours from Molly’s hospital in Dayton, Ohio, she is able to share her story. She tells of the night when Troy, hearing the news that Molly had ARDS, drove straight to see her – against Jamey’s wishes – after working his long shift. “Jamey said, ‘He didn’t listen to me as a kid,’ but I’m glad he didn’t listen,” says Molly. Troy knew how grave her situation was, but he didn’t tell Jamey at ﬁrst. When Troy arrived at Good Samaritan Hospital in Dayton, he didn’t have any privileges, but the doctors worked with him on the medications and ventilator settings.

Then the critical moment came when Jamey had to decide whether to keep Molly at Good Samaritan or ﬂy her to the University of Michigan hospital where Troy knew she would have a better chance of survival – if she could survive the ﬂight. Jamey chose Michigan. “We joke that as Buckeyes, Jamey sent me to the land of the Wolverines,” kids Molly, referring to Ohio State and University of Michigan college team rivalries.

30 inMotion Volume 21, Issue 1 January/February 2011 talks they give to churches, Waking Up to a schools and organizations to New Life help others in the aftermath Not only did Molly sur- of trauma. Their message is vive the flight, but when simple, and they call it the she came out of her coma, Steps to Hope: (1) Prayer, Jamey knew she was the or for someone who doesn’t same person he had mar- pray, they recommend reflect- ried. Molly says: “I looked ing on what’s happening in at the calendar on the wall their life; (2) Be grateful; and said, ‘That calendar is and (3) Let people help you. wrong.’ He said, ‘No, honey, Molly also tells new amputees it’s not.’ And then I shot up the thing she knows is hard- in bed and said I needed to est to hear – because she has do my lesson plans!” been there too. “I tell them that they have to be patient,” As she was weaned off of she says. her IVs, there came another Jamey and Molly French at the Achilles Run-Walk at the difficult decision: amputa- 2009 Amputee Coalition Conference Molly wasn’t always patient tion. The doctors had done in her process to return to everything they could to save normal life. She couldn’t her legs, but they told her that she would return to teaching full-time because always have to wear leg braces and be The Journey to Acceptance of a spleen condition that makes her at risk for injuring herself, considering As most amputees experience, this was unable to fight off infections – which was the level of damage due to the sepsis not the end, but the beginning. Now that discovered after her illness. As a result, and ARDS. The quality of her life was at Molly had survived her illness and its she can’t be around kids all day. Never- stake. She agreed and chose amputation. painful aftermath, she had to orient her- theless, volunteerism sustains her, both Shortly afterward, they also amputated self to surviving the emotional aftermath at her school and church, and now as a her thumb and index finger on her left and learning one of the hardest lessons support group leader. hand. of her life: accepting help from others. People naturally wanted to extend their “Being so close to death just made me In the aftermath, her life was all physi- financial support, something she and look at my life differently,” says Molly, cal therapy – 6 to 8 hours a day. Molly Jamey would have been glad to do for who still has bad moments but never lets had to have hand therapy because her others going through a hard spell, but it them ruin a whole day. “The bottom line muscles had tightened up due to the lack was devastating to come to the realiza- is every day I am just thrilled with the of oxygen. “My hands were completely tion that their finances were in peril. fact that I can breathe,” she says. “I wish closed, and I couldn’t open them,” she “As Jamey put it, ‘First Molly was on life everybody could feel that way in their recalls. To open her hands again, the support, but now our checkbook was on lives.” therapists had to pry her fingers apart. “I life support,’” says Molly. would have gone to physical therapy all Jamey French is the Amputee Coalition's day to not have gone to hand therapy,” It was such an important lesson that it development director. He was hired in 2010. she says. “I just cried, it was so painful.” has now become part of their message in Photo provided by Jamey and Molly French

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 31 Beauty is everywhere. Find your best look, your best fit, your best life.

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Get your application today for the 2011 Amputee Coalition Paddy Rossbach Youth Camp!

The Amputee Coalition’s Paddy Rossbach Youth Camp is a 5-day traditional summer camp experience for children ages 10 to 17 who have lost arms and/or legs or who were born with limb differences. The camp offers challenging activities that build campers’ confidence regardless of skill level. Download a copy of the application at: amputee-coalition.org/youth_camp.html

If you would like to request an application, please contact Derrick Stowell, Development Coordinator – Youth Camp Program, at 888/267-5669, ext. 8130, or e-mail [email protected]. Inspiration comes through our doors every day.

ARE YOU READY?

For 30 years, we’ve been helping people around the Nation’s Capitol overcome IN VIRGINIA: 8330 Professional Hill Drive physical challenges. Every one is an inspiration. Fairfax, VA 22031 (703) 698-5007 Come visit one of our offices, or we’ll do a video evaluation from wherever IN MARYLAND: 5810 Hubbard Drive you live and work. We’ll help you find the right solution, get the best fit, Rockville, MD 20852 and live life to the fullest. (301) 770-6246 Patient Coordinator: [email protected] www.opc1.com As seen on Discovery Health Come see us now or ask about Online Video Evaluation! The Importance of Gait Training by Scott Cummings, PT, CPO, FAAOP the person with a higher amputation a way as to optimize the gait pattern. At level typically has a less stable and less the same time, initial gait instructions are It is the goal of most every lower-limb energy-efficient gait pattern compared to also provided by the prosthetist so that amputee to walk “normally” again. In a person with a lower amputation level. the person wearing the prosthesis is able the context of this article, “normal” is Almost all lower-limb amputees will to stand and walk with enough stabil- defined as a symmetrical gait pattern that benefit from gait training at some point ity to ensure safety. This process usually falls within the “average” range in terms in their recovery to help normalize the starts in the parallel bars, often using a of posture, step length, rate of speed, gait pattern. It is widely accepted that gait belt just in case the new amputee limb positioning, etc. But being a lower- recent amputees have the most to gain loses his or her balance. At this stage, it limb amputee presents many different because using a prosthesis is such a new is best to involve a physical therapist for challenges when it comes to ambulating challenge. Aside from pre-amputation regular gait training sessions. Once it is safely and without exerting excessive exercises done under the supervision of determined that stability is consistent, energy. Generally, the higher the amputa- a physical therapist, the initial training is the parallel bars can be traded in for a tion level, the more we can expect to see provided by the prosthetist as part of the gait deviations, or what some would call care during the fitting of the prosthesis. limps. This is because with each segment This care includes aligning the prosthesis of the anatomy that is lost to amputa- to ensure that the components or parts tion, more muscle, sensory receptors of the prosthesis are positioned in such and leverage are also lost. As a result,

34 inMotion Volume 21, Issue 1 January/February 2011 while carrying bulky items, or even learn to run. An exercise program will also be prescribed to increase strength and range of motion. This will improve the chances of reaching the functional goals. Many different techniques can be be adjusted more carefully. Also, quicker incorporated into the gait training ses- gains can be made if the amputee has at sions, but two seem to stand out. The least a basic understanding of how the first involves the teaching of “splinter prosthesis and its components work. skills,” where the gait pattern is broken Gait training provided by an experi- down into a sequence of events that are enced physical therapist is available in a practiced individually before putting variety of settings. For the new amputee, them all together to build the gait pat- training with the recently fitted prosthe- tern. The second technique is more of sis will probably occur in a rehab hospi- a “whole walking” approach so that the tal or skilled nursing facility (SNF). Here, gait pattern is practiced all at once with walker or crutches. Eventually, many the basics will be covered, including such little concentration on the individual prosthetic wearers will progress to a things as side-to-side weight shifting, events, instead relying on the body’s single cane or even no assistive device at marching in place, balancing on one leg, natural tendency to find the most stable all! It should be noted that using some and side-stepping. These techniques are and energy-efficient way to walk. The type of assistive device is not a sign of usually performed with the parallel bars, physical therapist and prosthetist may try disability; instead, its use indicates that often with the use of a full-length mirror either or both of these strategies to get the person can be more functional with so that posture and foot position can be the best outcome. the extra stability it provides. observed. Sometimes, the training will Communication and teamwork Even amputees who have worn a take place in the amputee’s home by between prosthetists and physical thera- prosthesis for years can benefit from a visiting physical therapist. Although pists go a long way in helping amputees gait training. This could be in the form there is no access to parallel bars and reach their goals with a prosthesis. A per- of occasional visits to the therapist for a other equipment, some view the oppor- son’s ability to ambulate with a prosthesis “tune-up” or it could be to learn a new tunity to learn in a familiar environment partially depends on confidence, and that skill such as walking step-over-step with real obstacles as a worthwhile can be developed with practice. Unfor- up stairs, walking on uneven terrain, tradeoff. Another option is to travel to tunately, insurance coverage sometimes or even running. It is important that an outpatient physical therapy clinic to tends to limit treatment options, but it the prosthetist and therapist remain in receive gait training in a more progres- is important that a person is willing to close communication when gait train- sive setting. Here, the focus is usually advocate for the best care – then make ing is occurring since any changes to the on more advanced tasks such as walking the most out of the opportunity by work- prosthesis will affect the gait pattern, and without an assistive device, climbing ing hard and working smart. vice versa. This becomes critical when stairs, traversing inclines, and walking considering the sophistication of today’s at varying speeds. Some amputees will Photo courtesy of Next Step Orthotics & prosthetic components and their need to eventually master uneven terrain, walk Prosthetics, Inc.

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 35

Join us for the 2011 Amputee Coalition National Conference June 2-4 2011

Come early and stay late. Enjoy what Kansas City has to offer:

Westin Crown Center – Kansas City, Missouri

Jazz – During the roaring ‘20s and Fountains – Check out over 200 BBQ – With over 100 establishments to through the early 1940s, jazz reigned in fountains that flow in Kansas City, with choose from, you just have to experience Kansas City. Don’t miss the Historic Jazz magnificent symphonies of water, light Kansas City’s world-famous barbecue for District at 18th and Vine. and sculpture. yourself.

Join us by registering today: Go to amputee-coalition.org/conference Call 888/627-8538 to reserve your room saving limbs. building lives. Deadline for room reservations is May 10 For more information about the conference, Conference attendees receive a reduced rate of $112 single/double per night plus tax Accessible rooms and shower stools are limited – reserve yours now! call toll-free 888/267-5669, ext. 8102 Pre- and post-conference events on June 1 and June 5; see registration form for details Goin’ to Kansas City: visitkc.com The Mind as by Sarah J. Sullivan, PhD, and Dawn M. Ehde, PhD from direct injury to skin, muscle or bone. Finally, more than just unpleasant to live with, chronic pain can be related to a As children, we come to know the unpleasant sensation we number of other problems, including difﬁculties with mood, call pain through scraping knees, stubbing toes and bump- sleep, relationships, employment and enjoyment of life. For ing elbows. In these cases, pain is typically short-lived and these reasons, it’s important to let your healthcare providers easily mended with some help from a caring adult. In con- know about any pain you’re experiencing so that they can help trast, as many of you reading this article know, following an you address the problem. amputation, pain is sometimes severe and can be long-lasting. This article offers some general information about chronic Just as chronic pain is complex, so too must treatments for it pain in people with amputation, introduces how the brain is address different areas of your body, mind and daily life that involved in the experience of pain, and describes a cutting- pain may affect. Even in the simple scenario of a child who falls edge approach to treating chronic pain that may be able to help and scrapes a knee, “treatment” will likely involve a number of reduce pain and its impact on your life. layers: perhaps some antiseptic and a bandage, comfort from a family member, problem-solving about how to avoid future Pain is experienced by virtually all people with amputation at falls, and support for the child in moving on with the rest of the some point in the healing process. In fact, studies have found day. As an ongoing and complex health challenge, chronic pain that up to 90 percent of people experience pain after amputa- after amputation requires an even more multi-layered approach tion. For some, pain resolves as the wound heals, but for many to treatment. people, pain becomes a chronic issue. Chronic pain is deﬁned as pain lasting longer than the expected healing time of injury The good news is that researchers and healthcare providers are or pain lasting longer than 6 months. For many, pain after working on developing new treatments to combat chronic pain. amputation comes and goes, whereas for others, pain is present Some of these treatments involve medications or procedures, nearly every day. So, if you’ve had surgery some time ago and while others involve strategies that you can learn to use on your are still living with pain on a regular basis, you are not alone. own. Strong evidence now exists that several “talk therapies” offer many people both pain relief and reduction in the negative For a number of reasons, chronic pain following amputation toll that pain can have on other areas of life. But wait – how is particularly complex. It can come and go without warn- can talking make pain better? Does this mean that pain is all in ing and can occur in a number of different locations, includ- your head? Absolutely not. Pain is a real experience that should ing the residual limb and other parts of the body, particularly be taken seriously. But, for a moment, think about someone the opposite, non-amputated limb, hips, back and neck. One having surgery under general anesthesia. Typically, surgeons study found that 70 percent of people had pain in two or more perform acts, such as cutting the skin, nerves and bone, that locations after limb loss. In addition, many people experience would be painful if the person were conscious. Yet, because the what is called “phantom pain,” pain perceived in the part of patient is unconscious due to anesthetic, the person experi- the limb that is no longer present. Phantom pain is considered ences no pain. This example shows us that the conscious mind to be neuropathic because it results from injury to the nervous is crucially involved in the experience of pain. Fortunately, this system itself as opposed to musculoskeletal pain, which results role that the mind plays in the experience of pain points to pos- Fight Against

38 inMotion Volume 21, Issue 1 January/February 2011 a Weapon in the sible strategies for alleviating pain – without general anesthetic! helps you manage your pain, but you might also notice that you sometimes overdo it and that your pain is worse at these How can we harness the mind to reduce the experience of pain times. A self-management therapist can support you in continu- and its impact on quality of life? Researchers have investigated ing your exercise program and, at the same time, in learning a number of approaches for using the mind as a weapon in the strategies for avoiding overdoing it or under-doing it. Self- fight against pain. Self-management is one such treatment that management interventions have been tested and shown to be is delivered with words instead of a needle or pill. Rather than effective in large research studies where treatment was delivered an intervention that is delivered to a patient, self-management by a trained therapist in person on either an individual or group is an intervention in which an individual with pain actively basis. The research community is working hard to understand participates and guides treatment based on the specific and more about how and why chronic pain develops and the most unique nature of his or her pain and life situation. For instance, effective ways to address it. Self-management interventions offer one person may be bothered by difficulty sleeping due to pain, an opportunity to combine the wisdom you’ve acquired through another person may be bothered by pain while at work, and yet firsthand experience with chronic pain with the latest scientific another person may experience both of these problems. Self- information about chronic pain in a treatment where you work management interventions allow you to work with a therapist with a trained therapist to tailor a plan that is right for you. to learn about strategies that address the specific challenges you face. For example, whereas learning healthy sleeping habits Studies have demonstrated that self-management is an effective promotes sleep quality, learning about appropriate activ- treatment for people who have chronic pain due to something ity pacing supports coping with pain at work. Furthermore, other than amputation, such as chronic headaches, back pain different strategies work better for different people, and your and jaw pain. Self-management is also being used to help people therapist will work with you to figure out what works best for with other health problems, such as diabetes or hypertension, you: One person’s sleep may benefit from establishing a bed- to manage the diseases and their effects. However, self-manage- time routine and another’s may benefit from avoiding afternoon ment interventions are often delivered in person; access to this naps. No one is in a better position than you to become an kind of treatment can be difficult for some people, particularly expert on your pain and the best way to manage it. Self-man- those living with limb loss. Therefore, researchers are explor- agement interventions recognize your already-existing expertise ing how to increase the accessibility and convenience of self- in living with chronic pain and seek to build on and expand management interventions. One such study is the University of your knowledge and skills, and to support you in integrating Washington’s Telephone Intervention for Pain Study (TIPS). This new knowledge and skills into your daily life. study is comparing two different telephone-delivered self-management interventions for people with disability pain, including Self-management interventions involve arming yourself with the pain after limb loss. latest knowledge about chronic pain and how it can affect different areas of your life. In addition, you work with a therapist Chronic pain is a health issue that many amputees encounter to identify strategies that already work well for you in manag- and is one that can have far-reaching effects on a person’s life. ing pain and try out new pain management strategies as well. Although living with chronic pain presents many challenges, For instance, you may already have found that regular exercise there are steps that anyone can take to manage pain. In addi- Chronic Pain

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 39 tion to the other treatments that you’re already working with your healthcare providers to implement, self-management interventions can offer new strategies for reducing chronic pain TIPS Study and the impact it has on your life. Every TIPS participant receives eight 60-minute treatment sessions conducted over the telephone by one of the Related Resources study’s clinicians who is a trained clinical psychologist. Because we’re interested in understanding and comparing American Pain Foundation two different approaches to self-management delivered painfoundation.org by phone, participants in the study are randomly assigned to one of two self-management treatment interventions. American Psychological Association – Psychologist Locator Both treatments involve educating you about pain and dis- locator.apa.org cussing the impact of pain and different ways to manage it in hopes of decreasing your pain and its impact on your University of Washington Telephone Intervention for Pain life. Furthermore, both treatments are commonly used in Study (TIPS) pain clinics and have been used in the past to treat pain in rehab.washington.edu/research/studies/pain.asp amputees. Participants are encouraged to think about and use the information they’ve learned outside of treatment Pain Management and the Amputee to help manage pain between sessions and even after amputee-coalition.org/fact_sheets/painmgmt.html the treatment has been completed. For more information, please call 866/928-2104 or e-mail [email protected]. American Medical Association – Doctor Finder (Find a pain medicine or physical medicine and rehab specialist) https://extapps.ama-assn.org/doctorﬁnder/home.jsp

Promoting Amputee Life Skills The Amputee Coalition’s Promoting Amputee Life Skills (PALS) program is an eight-session self-management course for people with limb loss. The PALS program CCrruuttcchhAAbbiilliittyy teaches people with limb loss important self-management (A Subsidiary of Award Prosthetics) skills, including new problem-solving skills, to better manage the effects of limb loss. It is provided in a group For more info on our products please visit our website www.CrutchAbility.com or eMail : [email protected] format so that amputees can learn from one another, in addition to learning from the course leaders. In a FASTR™ joint study by the Amputee Coalition, Johns Hopkins Crutches University Bloomberg School of Public Health, and the University of Washington, the PALS course was found to have a signiﬁcant effect on the quality of life of people Anita with limb loss. Of those participants who completed the says:

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40 inMotion Volume 21, Issue 1 January/February 2011 Identifying and Managing Skin Issues With Lower-Limb Prosthetic Use

by M. Jason Highsmith, DPT, CP, FAAOP, sive tension, friction or heat. James T. Highsmith, MD, and Jason T. Additionally, the skin reacts Kahle, CPO to increased temperature with perspiration, which is unable Fitting a prosthesis is complicated to evaporate because of the because parts of the human body are closed prosthetic environ- used for tasks for which they are not ment. This results in more designed. The skin/prosthesis interface heat and moisture softening is at fault for many complications. Here, the skin, thereby disrupting a synthetic material, such as silicone or normal integrity (maceration). plastic, is in constant contact with the Figure 2. Allergic contact dermatitis skin. Skin is not well-suited for this type Pressure is another mechanical issue introduced in a prosthetic users. Either of these can occur when the socket. Certain parts of the skin is exposed to a material that creates human anatomy are well- a skin aggravation. If a known irritant suited to disperse pressure, or allergic component exists in the such as the fat pad of the patient’s prosthesis, it should be switched heel. With amputation, the to another material. Furthermore, both normal pressure-distributing conditions can be treated with topical anatomy is missing or steroids or a barrier cream. Several altered. Therefore your pros- over-the-counter (OTC) topical prepara- thetist must use anatomic tions are available for these conditions, areas not well-suited for such as hydrocortisone and zinc oxide. weight-bearing pressures. Figure 1. Bony prominences with decubiti Untreated, dermatitis can lead to chronic (pressure sores) Improper socket fit can inflammation, cellular damage and carci- increase pressure and accel- nogenesis (cancer). Therefore, we urge all of material contact. Skin problems are erate skin breakdown. Pressure sores one of the most common conditions can often be corrected with affecting lower-limb prosthetic users minor prosthetic adjust- today. Skin problems are experienced by ments. However, sometimes approximately 75 percent of amputees pressure areas can be more using a lower-limb prosthesis. In fact, significant and require amputees experience nearly 65 percent recovery time out of the more dermatological complaints than the prosthesis and/or a complete general population. new socket fit.

Abnormal mechanical and thermal Irritant contact dermatitis conditions are introduced in a prosthesis, and allergic contact derma- Figure 3. Irritant contact dermatitis with exco- such as socket contact against the skin. titis are two more common riation (excessive scratching which breaks the This can traumatize tissue by exces- problems affecting prosthetic surface of the skin – circled)

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 41 prosthetic users to see a physician when specialist (see ﬂow diagram). breakdown can lead to more severe prob- they have failed conservative therapy lems, such as infection, cancer, osteo- or have a lesion that won’t heal. It is Skin issues are very common among myelitis (bone infection), and ultimately imperative that these lesions are evalu- amputees. Because amputees require an revision surgery. Start with your prosthe- ated so that various forms of cancer can unusually high demand from their skin, tist to determine, and hopefully resolve, be ruled out. and because not wearing a prostheses the problem. If your prosthetist cannot is often not an option, they sometimes ﬁnd a solution, you may need to consult Avoiding skin complications begins with dismiss the importance of hygiene and a specialist, such as a dermatologist. good hygiene and daily skin inspections. monitoring of their skin. Skin issues Photos provided by James Highsmith, Jason Clean all parts of your prosthesis daily need to be taken seriously. A simple skin Highsmith and Jason Kahle that contact your skin. The reverse is also true: Inspect and clean all parts of your skin daily that contact your prosthesis. Don’t rely on feeling a problem as your primary means of detecting skin problems. Many patients are desensitized and can’t feel damage to the skin. The best inspections make use of a mirror or a spouse who can view all aspects of your limb. Every amputee’s needs are unique, so discuss your inspection needs with your provider.

If you encounter a skin problem that you are unable to resolve or that will not heal, then the ﬁrst step is to see your prosthetist. The prosthetist can then determine if the problem can be resolved pros- thetically or through other conservative means. If not, the prosthetist may refer you to your primary care physician or a Photo Diagnosis History [Signs/Symptoms] Physical Exam Findings Acute Management Long-Term Management (Name) Figure 1 Pressure sores Pain and/or redness over bony prominences Erythema (redness) or ulceration over x Stop using prosthesis x Prosthetic adjustment (Decubitus ulcers) bony prominences x Antibiotic ointment (e.g., Polysporin*) x New socket Figure 2 Allergic Contact x First exposure causes no reaction (type IV x Acutely, may have well-demarcated x Moisturizer Allergen avoidance Dermatitis delayed hypersensitivity reaction) erythema, weeping or blisters x Topical steroids (e.g., hydrocortisone) (substitute allergen for x Itching and redness appears 1-5 days after x Subacutely, erythema, less well-demar- materials that do not aggravate second exposure and affects everywhere the cated, maybe scaly skin symptoms) allergen contacts the skin x Chronically, erythema and dry, thick, x May extend beyond allergen contact areas scaly skin if severe Figure 3 Irritant Contact x Itching and redness typically appear immedi- Same as allergic contact dermatitis x Barrier cream [zinc oxide] Avoid or minimize irritant Dermatitis ately after contact (even with first exposure) x Moisturizer exposure (e.g., perspiration from x Severity related to duration & amount of x Topical steroids heat or friction) exposure x Never extends beyond contact area Figure 4 Negative Pressure x Negative pressure socket, pain and erythema Well-demarcated erythema that is exqui- x Stop using prosthesis x Correct underlying problems: Hyperemia under prosthesis in a well-circumscribed sitely tender to palpation x Moisturizer x Curb weight gain (diet/ pattern exercise) x Usually a history of limb volume change (i.e., x Treat edema weight gain/loss, edema) x New socket? Figure 5 Folliculitis Itching, possibly pain, “pimple” (properly termed x Direct visualization of folliculocentric x Decrease heat and friction (remove Avoid shaving area (increases pustule) pustule prosthesis if possible) incidence) x Typically with erythema x Topical or systemic antibiotics Figure 6 Abscess Inflammation with erythema and severe pain Visualization of erythematous nodule that Incision and drainage absolutely x Keep area clean is exquisitely painful necessary by physician, may also need x Avoid shaving affected area systemic antibiotics Figure 7 Xerosis Dry skin, may have erythema and/or itching Dry scaly or flaky skin, may have excoria- Moisturizers (over-the-counter) x Keep area clean tions or erythema x Maintain hydration (systemi- cally and locally) * Polysporin® is recommended over Neosporin® due to a high incidence of allergic contact dermatitis. Consult your dermatologist for more information.

42 inMotion Volume 21, Issue 1 January/February 2011 PARTICIPANTS NEEDED FOR RESEARCH STUDY OF ELECTRICAL NERVE BLOCK FOR CHRONIC Figure 4. Negative pressure hyperemia in an above-knee limb POST-AMPUTATION PAIN

We are looking for volunteers to take part in a study of an electric nerve block application for patients suffering from chronic post-amputation pain. Your participation would involve 7 office visit sessions, each of which is approximately 30 minutes for the purpose of interviews and completion of questionnaires. Figure 5. Folliculitis In appreciation for your time, you will receive $50 per office visit for a total reimbursement of $350. There will be no cost to you for taking part in this research study. The clinic visits, tests and surgical procedures that are done as part of the research study will be free. For more information about this study, or to volunteer for this study, please contact:

Figure 6. Infected abscess on a below-knee residual limb Dr. Amol Soin The Ohio Pain Clinic 8934 Kingsridge Dr. Suite 140 Centerville, OH 45458

Phone: 937-434-2226 www.ohiopainclinic.com

This study has been reviewed by, and received ethics clearance through, the Copernicus Group Institutional Figure 7. Xerosis Review Board

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 43 IN OUR OWN WORDS

Wes and Colin Charlton

by Cindy Charlton

As my 8-year-old slid into the back seat of my car, I carefully glanced in the rearview mirror to get a peek at his face, not wanting to be caught trying to get an idea of his mood. Wes had just left his therapist’s ofﬁce after an hour of grief counseling. He had lived through some pretty hard times in his young life, and the effects had been taking a toll on him. Wes was only 4 years old when I contracted a rare form of Strep A bacteria, called necrotizing fasciitis, or what is commonly termed “the ﬂesh-eating bacteria.” As a result of contracting this life-threatening illness, I lost the lower parts of both legs and feet, and my right hand. I was in the hospital for 3 months and in rehabilitation for 9 weeks. Half of Wes's fourth year was spent with me in the hospital. Now, while he was still trying to cope with his feelings surrounding my illness, and subsequent disability, he was faced with his dad’s newly diagnosed cancer. My husband, Michael, was diagnosed with terminal cancer 2 years after my illness rocked our little family. Wes was trying to make sense of it all in his 8-year-old brain.

Survivors His heart had already been beaten and bruised by almost losing me permanently, and now having to deal with a very ill father was almost more than he could bear. Grief counseling seemed like a much-needed part in his troubled life.

44 inMotion Volume 21, Issue 1 January/February 2011 As I looked at his face in the mirror, I could see that he didn’t seem as “rough” as he sometimes did after emerging from his therapist’s office. “Wes,” I began. He looked up at me. “Yeah?” “When we get home, I need you to go over to Johnny’s house and get Colin.” Colin was Wes’s 4-year-old brother. He was playing at a neighborhood friend’s house, while Wes and I were at his appointment. “Why do I have to do everything?” came his mumbled, whiny reply from the back seat. I took a deep breath and gathered my thoughts before I spoke. Dad and the boys “Wes, I know that dad and I expect a lot from you sometimes, and I’m really we are strong! You are the strongest and sorry, but here’s the deal. Your dad is sick most courageous kid I know.” I glanced Do you suffer and in bed, and I can’t get up the steps at again in the rearview mirror, needing to Johnny’s house to ring the doorbell.” see if my words had connected with his from skin rashes, I went on to explain that we were heart. I noticed a small transformation dermatitis, a family, and that families are a team. taking place in my back seat. Wes was “When one of the team members can’t do sitting up straighter, and a smile was or odor and something, the other members come in to beginning at the corners of his mouth. wear a liner? help out,” I said. “That’s what families are “Yeah, I am strong, aren’t I, Mom!” Our Silver Liner Sheath is all about.” “Yes you are, Wes, and that’s what designed to be worn under For the first time since my illness, my being a survivor is all about,” I told him. a liner without compromising son began to speak to me about how he “And, you and I, Wes, we are survivors!” suspension, and can help to felt when I was in the hospital. As we pulled into the driveway, Wes eliminate these problems. “I’m so angry that those doctors took unbuckled his seat belt and loped across your legs!” Wes said. two lawns on his way to retrieve his “I know, honey,” I said, trying to soothe brother. I sat for a moment in the front the pain, “but they had to, to save my seat of my car, amazed at the healing life.” that had just taken place in the confines Call today for a “I was sick too, when you were in the of my car. Both of my boys emerged from complimentary hospital,” he replied. Johnny's front door, in a dead heat, racing sample! “You were?” I asked. for our house. Two beaming little faces “Yeah,” he began in a small, shaking lifted my spirits and warmed my heart. I voice, “my head hurt, and my stomach shook my head slightly, got out of the car The Innovation Leader in Knitted Orthotic and hurt, and my heart hurt.” smiling, and walked to my front door. Prosthetic Products Fighting back my tears, I replied, “But 1-800-822-7500 look at us now, Wes! We’re here, and Photos courtesy of Cindy Charlton [email protected]

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 45 One Prosthetist’s Solution to by Todd Norton, CP, LP, FAAOP

After years of seeing below-knee amputee patients come in wearing their prostheses to Caroline incorrectly, I decided that I needed to do Nielson’s something differently. It became evident study, A to me that the literature I was giving my Survey of Amputees: Functional Level and patients didn’t include what I consider to Life Satisfaction, Information Needs, and instruction, but I have found it to be an be the most important information about the Prosthetist’s Role, “Forty-four percent effective tool to assist in better educat- how to use their prosthesis: donning and of amputees wish they were receiving ing patients. The DVD also stresses to doffing, sock management and hygiene. more instructions with their prosthesis.” patients (no fewer than eight times) to Furthermore, patients didn’t appear to Furthermore, Scott A. Hrnack’s study, Lit- “discontinue use of their prosthesis and be retaining the verbal instructions I was eracy and Patient Information in the Ampu- call their prosthetist” if they are having a giving them. tee Population, addresses the problem of problem. Prosthetists may find it useful One reason why patients have such the medical literacy gap: “The 12 most in their practice, not just for the value of a difficult time grasping seemingly common brochures we give patients are educating their patients but also for edu- simple concepts became obvious: We written on an 11.5 grade level, while the cating therapists, doctors and caregivers. are overwhelming our patients with a average person’s medical literacy level is The DVD can also result in significant lot of information. I was surprised to see only a sixth grade level.” Together, these time savings to both prosthetists and that, for instance, in 5 minutes of sock studies help confirm that there is a need patients alike. management instruction, there are 40 for more appropriate information for On my last day at Northwestern, one sentences that cover what patients need patients. The effect of this problem is that of my instructors offered this parting to know about the subject. That is a lot prosthetists often see their patients wear- advice to the class: “Give back something of information in a short period of time. ing their prostheses improperly. to the field.” I hope, at least in some No one could be expected to remember To solve this problem, I began to small way, this is what the DVD does. most of that information, much less all of search for a way to educate my patients it. And all of it is important! by demonstrating the concepts of proper DVDs are available through Prosthetics In researching the extent of the prosthetic use in a practical way, and in 101, LLC’s Web site: prosthetics101.com. problem, I found some studies that sup- a way that would help them retain the Future DVDs planned by Prosthetics 101 ported my hunch. According to John information. As a prosthetist, I believe are an above-knee version, a Spanish lan- Frederick Jr.’s study, A Survey of Pros- that patients are ultimately responsible guage version and updated versions of each. thetic Sock Ply Management of Transtibial for their success with their prosthesis, Amputees:Patients’ Knowledge of Sock but I wanted to find a way to empower Editor's Note: For videos on introductory Management and the Relationship to Edu- my patients to be successful without amputee care, you may also visit the Ampu- cational Needs of Amputees, “Sixty-seven overwhelming them. tee Coalition's Web site at percent of amputees who come in for an The result was that I created a DVD amputee-coalition.org/video/ adjustment are not wearing the correct called Using a Below Knee Prosthesis. Of introductory_amputee_care.html or call number of plys of socks.” Also, according course, it is not a substitute for prosthetic 888/267-5669.

Photos courtesy of Prosthetics 101

46 inMotion Volume 21, Issue 1 January/February 2011 ost people probably off a deadly infection, and she began to cannot imagine a life- develop gangrene. She was put into a threatening situation medical coma and woke up 2 weeks later happening to them if without her legs or fingers. M they are healthy, and Waheed felt that something had gone most people probably cannot wrong with her medical treatment. She imagine a situation in which their wondered how a healthy person like her healthcare provider makes a life- could have a relatively simple surgery threatening mistake. When Surriya and end up nearly losing her life. Thus Waheed entered the hospital for a stent began the long journey of investigating connecting from her kidney to her blad- her case. She pored over her medical der, she never imagined that it would records and hired an attorney to find out cause her to become a bilateral lower- what really happened. A key factor in limb amputee and lose eight fingers at her case was an untested urine sample, the knuckle. The journey was physically which contained the bacteria that caused and emotionally painful as Waheed came the urosepsis. Her case eventually went to grips with the reality that she would to trial, but the defendant offered a not be the same active, mobile person settlement before the verdict to cover her she had been. The ordeal would have prosthetic and caregiver expenses. been too much for her to handle without With this traumatic journey behind the support of family and friends. her, Waheed is now trying to move on Waheed, born in Pakistan in 1944, with her life. “When I walked into the immigrated to the U.S. in 1971 shortly hospital for the scheduled surgery and after marrying her husband, who had a I came back without my legs, I had no postgraduate medical research appoint- idea what I would do and how I would ment. She was an avid traveler and live my life because I was so sick,” she managed a successful travel company. says. “I made up my mind that I cannot Her medical problems began when she live my life lying down in bed. I have to experienced pain in her right kidney do something for myself.” and difficulty in urinating. She was told Part of this journey of recovery that she needed ureteropelvic junction involved writing and self-publishing (UPJ) surgery due to scar tissue in her a book about her experience, titled kidney. Although English is her second Beyond My Imagination: Living Tragedy language, Waheed asked many questions with Tolerance and Patience. “This was a and was not intimidated by the medi- very cathartic thing for me to do,” she cal specialists. She had experience with acknowledges. “I want others to know medical terminology from dealing with that they can stand up for themselves to her diabetes, and her husband and son doctors who may not always be doing are also doctors. A their best job.” Waheed has spoken to Soon after having the stent inserted, support groups about how to take action Waheed felt sick and had pain urinating. for themselves to ensure they receive She was initially advised that the pain proper medical care. The experience was was normal, but when she later went to journey and still is painful for her to accept, but the hospital, a team of doctors discov- Waheed is determined to make the most ered that she had developed urosepsis, out of her situation and have a good life. blood infection caused by urinary tract through infection. “I call it the ‘mother of all Surriya Waheed formed the Life for Limb infections,’ since it was not responding to Loss Charitable Foundation to support any of the medications the doctors gave darkness people with all kinds of disabilities. For more me,” she says. “I have never felt so sick information, you may contact her at in my life.” Waheed’s body was fighting [email protected].

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 47 The Deﬁnition of Humor hu O PRU h\ǀǀƍ PԥU Q 1. The quality that makes something laughable or amus- ing; funniness.

On Derrick Lewis’ 35th birthday in 2007, his right foot went completely numb. The first he heard about peripheral arterial disease (PAD), the disease that caused this mysterious numbness and eventually took his right leg, was when the doctor removed a nickel-sized blood clot from behind his right knee. Four years later, he is still learning about the disease and realizes that if he knew very little about it, others at risk probably don’t know much about it, either. Since then he’s decided to help inform the public about the ravaging effects of PAD. Not only is Derrick a patient advocate for the prosthetic company New Life Brace and Limb, but he also puts his passion for helping others to use through his humor. Despite a tragic encounter with this quiet, yet insidious disease, Derrick’s perspective is lighthearted. He approaches life – amputation and all – with humor. While in the hospital, he joked with others as a way to connect with them and to heal from the pain of losing his limb. He would frequently laugh with the nurses and physical therapists about being an amputee. They laughed along with him and told him that he should incorporate his funny ideas onto T-shirts for others to enjoy. That was all the coaxing he needed. After Derrick received his first prosthesis and was able to return to some semblance of normal life, he created his own Web site for custom T-shirts for amputees: Ampuwear.com. He currently has four designs, but new T-shirts Derrick Lewis are coming soon. Derrick is also the cofounder of a Web site called t)VNPSJTUt&OUSFQSFOFVSt1BUJFOUBEWPDBUF Ampufreedom.com. With each of his endeavors, he hopes to t$SFBUPSPG"NQVXFBSDPN inspire. He tells other amputees: "Losing a limb doesn’t mean you t$PGPVOEFSPG"NQVGSFFEPNDPN have to stop living." sometimes we just have to pick ourselves up and continue with Do amputees comment on your shirts? our mission in life. Plus, I was always told that laughter is the best I usually get positive responses like, “Hey, man, I love that shirt!" medicine. Or else I can hear them laughing as they pass me by. So far, I haven't come across anyone who was offended by my shirts. I Tell me more about Ampufreedom.com. guess I'm not the only one with a crazy sense of humor! This is a site dedicated to amputees and others with disabilities. The site allows amputees to socialize with others like them. They How do you know when you have a good idea? can communicate through blogging, live chat and uploading I always had a sense of humor even before losing my limb. pictures and videos. I guess that sense of humor went up a notch after my amputa- After my amputation, I searched the Web for information pertain- tion. I usually test out a new idea by printing a shirt and wearing it ing to amputees. I came across numerous amputee social sites and around town when I visit amputee patients at the local hospitals. I I wasn't impressed. So I brainstormed ideas back and forth with also post a picture of the new shirt on my Facebook page and see my father-in-law, and Ampufreedom.com was born. I'm hoping what type of response I get. Ampufreedom.com can provide helpful information and the support needed to overcome their loss. What do you tell new amputees who might be scared or upset and not in the mood for a laugh? Derrick Lewis can be contacted by e-mail at I tell them to keep their heads up; life isn't over because you lost [email protected]. You can also find him on Facebook (Der- a limb. Every day, we are faced with obstacles and setbacks, and rick Lewis) and on Twitter (@ampuwear) (@ampufreedom).

48 inMotion Volume 21, Issue 1 January/February 2011 There are SOME things you simply CAN NOT control.

But there are some really important things you CAN …

… like keeping your family healthy This booklet is for everyone who and safe. The American Diabetes wants to live a long, healthy, happy, Association has a free booklet that active life. Because

!"#$ the American can help you take control. It’s Diabetes Association is concerned about called “Planning the overall health of For a Healthy all Americans – not Life” and it’ll help just people living with you do just that, diabetes. with information

To get your on everything from healthier free copy, call eating choices, 1-800-DIABETES or go to diabetes.org/lifeplanner. choosing a doctor, and managing your ﬁ nances … to planning for a Order yours today. And take control secure retirement. of your life.

1-800-DIABETES diabetes.org/lifeplanner

THE WHOLE CRUTCH CATALOG SINCE 1988

561 Garden Dr. Unit H, Windsor, CO 80550 www.opquorum.com 970-686-2266 [email protected] Fax: 970-686-8823 www.fetterman-crutches.com Toll Free 1-888-582-5544

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inMotion’s new Classified section provides another inMotion 2011 Classified Ads affordable advertising option, perfect for your advertising Rates needs, including: Up to 50 words ...... $100 t&WFOUTNFFUJOHT 51–99 words ...... $150 NOW t*OGPSNBUJPO 100–150 words ...... $200 ACCEPTING t1VCMJDBUJPOT Black & White Photo/Logo ...... $50 PERSONAL t1SPEVDUT ADS! t4FSWJDFT Kim Phillips Call for t*UFNTGPSTBMF Advertising and Marketing Assistant Details t&NQMPZNFOUPQQPSUVOJUJFT 888/267-5669 t$POHSBUVMBUPSZNFTTBHFT [email protected] t1FSTPOBMNFTTBHFT t8IBUFWFSZPVOFFE Classified ad contents are the sole responsibility of the Classified ads are divided into appropriate sections, making advertiser and are not changed/edited in any way by your ad easy to find. Classified advertisers are included in the inMotion staff. All advertising material is subject to Amputee Advertiser Index on the last page of inMotion and are also Coalition approval. The Amputee Coalition reserves the right included on the Amputee Coalition Web site, along with a link to determine the suitability of all ads submitted for publication to your Web site, for the duration of the issue in which the ad and to reject those that do not meet the editorial standards of is placed. our Communications & Public Relations Department.

50 inMotion Volume 21, Issue 1 January/February 2011 TECHNOLOGY SHOWCASE Paid Advertisements Featuring Innovative Products & Services

New SleeveArt® Style

You asked for it, so we got it! Digital Forest Camouflage is the newest addition to our col- lection of more than 70 styles. Available as a prosthetic cover or a laminating sleeve, Digital Forest Camo is a cool design. SleeveArt® prosthetic covers are fabricated from spandex. They stretch to fit over your prosthetic leg or arm. Available in various widths and lengths, there is a right size for anybody. They add a slippery feel to the prosthesis and eliminate the problem of pants clinging. Our laminating sleeves can be used by your prosthetist to create a permanent design on your new leg. President of For more information, please visit our Web site at sleeveart.com. If you don’t have access to a computer, just call Amputee Joanne at 954/646-1026 and she will mail you a flyer. Support Group 'SFET-FHT *ODt%BOJB#FBDI 'MPSJEB Counts on the LegSim for Easy Mobility My name is Mary Petrarca, and The Alpha Select Locking Liner: I am the president of EnMotion, a CNY amputee support group. I have Controlled Pistoning been an avid user of the LegSim for the past 4 years, since my prosthetist The Alpha Select Locking Liner helped me get one. The LegSim has combines many frequently requested literally been a lifesaver. I have had liner traits into one product. Controlled issues with sores and a poorly fitting pistoning is one of the leading liner prosthesis for years and when unable characteristics desired by wearers of to wear my prosthesis, I could always locking liners. count on the LegSim. The LegSim is The one-way stretch fabric used in always a perfect fit. I can go shop- Alpha Select Locking Liners effectively ping, do dishes, laundry, housework, controls pistoning without the use of a cook or even carry my grandchildren traditional rigid distal matrix, which can while using my LegSim. potentially irritate residual limbs. The It is lightweight and so easy to one-way stretch fabric also provides use. I have comfort knowing it stands tissue compression without uncomfort- ready by my bedside in case of any able pressure on the limb. Additionally, the fabric stretches circumferentially, emergency. allowing for easy donning of the liner for a variety of limb shapes. I was up and walking with it in no The Alpha Select Locking Liner features a unique accordion umbrella that time at all. I would highly recommend is sized to each liner to maximize comfort and fit. The shape of the accordion this to everyone who is an amputee umbrella blends into a patient’s anatomy for an almost unnoticeable feeling. to make your life so much easier. For more information, ask your prosthetist or visit Ohio Willow Wood Call 313/735-1659 or visit at www.owwco.com. LegSim.net to see videos.

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 51

2010 INDEX OF inMOTION ARTICLES

Advocacy “Kendra Calhoun, President & CEO of Amputee Coalition of Children & Teens “The 2010 by 2010 Campaign.” May/Jun, p. 58. America, Appointed to Medicare Advisory Committee.” Jul/ “Amputee Coalition of America’s Paddy Rossbach Youth Camp “ACA Holds Successful Meeting With Top Transportation Secu- Aug, p. 9. Hosts 100 Youths.” Sep/Oct, p. 26. rity Administration Officials.” Sep/Oct, p. 14. “Mailbox.” Mar/Apr, p. 9; Jul/Aug, p. 11; Sep/Oct, p. 12. “Fitness for Kids.” Sep/Oct, p. 30. “Amputee Coalition of America 2011 Advocacy Priorities.” Nov/ “Making Limb Loss Information More Accessible.” Nov/Dec, Kajlich, A. “ACA Youth Camp Volunteer Reflects on Camp Experi- Dec, p. 15. pp. 33-34. ence.” Nov/Dec, pp. 18-20. “Getting Involved in 2010.” Jan/Feb, p. 12. “Media Highlights.” Mar/Apr, p. 8. McNutt, S. “Preparing Your Child With Limb Difference for “Legislative Initiatives for 2010.” Mar/Apr, p. 11. “Meet the Board.” Jan/Feb, p. 6. (Jeffrey Lutz); Mar/Apr, p. 6 School.” Jul/Aug, pp. 26-28. “Nation Celebrates 20th Anniversary of the Americans With (Jeff Cain); Jul/Aug, p. 11 (Rick Myers); Nov/Dec, p. 9 (Charlie Disabilities Act.” Jul/Aug, p. 58. Steele). Diabetes Ignaszewski, D. “Legislative Agenda Moving Forward.” May/ “Melanie Staten Hired as Public Affairs Coordinator.” May/ “Broccoli, Cannellini Bean & Cheddar Soup.” Mar/Apr, p. 42. Jun, p. 16. Jun, p. 8. “Diabetic Wound Care.” Jan/Feb, pp. 30-32. Staten, M. “Survey Identifies Air Travel Problems for Ampu- “Mending Limbs Holds Second Annual Benefit Concert.” Jan/ “Study Shows Podiatrist Care Reduces Amputation Risk.” Sep/ tees.” Jul/Aug, p. 12. Feb, p. 9. Oct, p. 25. Young, E. “Becoming Your Own Best Advocate.” Jul/Aug, p. 17. “Mkng Memories @ the ACA 2010 Nat’l Conf.!” Nov/Dec, Kennedy, S. “Choosing the Right Shoe.” Mar/Apr, pp. 27-28. Young, E. “Spotlight on the Disability Rights Legal Center.” Sep/ pp. 12-13. Kennedy, S. “The Vital Importance of Shoes for Diabetics.” Jul/ Oct, pp. 42-43. “New ACA Support Group Manual Now Available.” Nov/Dec, Aug, p. 21. p. 8. McNutt, S. “Can We Prevent Most Amputations?” Jan/Feb, Amputee Coalition Information & News “New Information Packet Now Available.” May/Jun, p. 9. pp. 24-27. “2009 Index of inMotion Articles.” Jan/Feb, pp. 44-45. “Ohio Willow Wood Becomes Amputee Coalition of America McNutt, S. “Don’t Coulda, Woulda, Shoulda Diabetes.” Jan/ “ACA 2010 National Conference Update.” Jan/Feb, pp. 18-19. Bronze National Sponsor.” Nov/Dec, p. 8. Feb, pp. 28-29. “ACA Board Member Tami Stanley Wins AARP Award.” Sep/ “Paddy Rossbach, Former ACA President and CEO, Raises Miles, M. “My Battle With Diabetes.” Mar/Apr, pp. 30-31. Oct, p. 9. $17,000 for Camp.” Sep/Oct, p. 9. “The ACA Hires Controller, Kari Blakney.” Jan/Feb, p. 8. “Print Resources for Members Only.” Mar/Apr, p. 8. Education “ACA President and CEO to Be a Keynote Speaker for Neuro- “Step Out Walk to Fight Diabetes.” Nov/Dec, p. 10. “Making Limb Loss Information More Accessible.” Nov/Dec, prosthetics 2010.” Sep/Oct, p. 8. “Tom Coakley Joins Finance Committee.” May/Jun, p. 9. pp. 33-34. “The ACA’s First Pebbles Party Raises Over $45,000.” Jan/ “Upper Limb Loss Advisory Council Update.” Jan/Feb, p. 8. “Useful Terms for Amputees.” Jul/Aug, pp. 43-44. Feb, p. 11. “Visit the ACA’s New Online 1-Step Products & Services Infor- McNutt, S. “Preparing Your Child With Limb Difference for “The Amputee Coalition 2008 Annual Report Is Now Available mation Center!” Nov/Dec, p. 8. School.” Jul/Aug, pp. 26-28. Online.” Jan/Feb, p. 8. “Visit the Haiti Relief Action Center for Updates.” May/Jun, “The Amputee Coalition 2009 Annual Report Is Now Available p. 9. Employment Online.” Nov/Dec, p. 10. “Watch for ‘The Chairman’s Message’.” Jul/Aug, p. 9. “New Campaign Challenges Public to Improve Disability “Amputee Coalition of America Announces New Board Trea- “Who Is the Amputee Coalition of America?” Jan/Feb, Employment Landscape.” May/Jun, p. 58. surer.” Nov/Dec, p. 9. pp. 14-15. “Amputee Coalition of America Announces Scholarship Recipi- “Youth Camp Sponsor.” Jul/Aug, p. 9. Emergency Preparedness/Response ent.” Jul/Aug, p. 11. Dupes, B. “Message From the Editor.” Jan/Feb, p. 3; Mar/Apr, “Preventing Heat Stroke and Exhaustion.” Sep/Oct, pp. 20-21. “Amputee Coalition of America Hosted Inaugural Limb Loss p. 3; May/Jun, p. 3; Jul/Aug, p. 3; Sep/Oct, p. 3; Nov/Dec, p. 3. Young, E. “The Day the Earth Did Not Stand Still.” Mar/Apr, Task Force Summit.” May/Jun, p. 9. pp. 13-17. “The Amputee Coalition of America Thanks Its 2010 National Arts & Culture Sponsors.” Jul/Aug, p. 8. “A Conversation With Athlete and Author Paul Martin.” Sep/ Emotional Health “The Amputee Coalition of America Thanks Our 2010 National Oct, p. 49. “Cancer Support Community and Genentech Survey Reveals Conference Sponsors.” Sep/Oct, p. 31. “Required Reading.” Mar/Apr, p. 49; Sep/Oct, p. 48. Alarming Levels of Anxiety, Depression and Mental Health “Amputee Resilience Program Launches First Pilot at Adventist “Where Are They Now?” Mar/Apr, p. 32. Problems.” Jul/Aug, p. 59. HealthCare.” Sep/Oct, p. 8. Bokfi, E. “Lessons From the Academy of Life.” Sep/Oct, “How to Find Help Through Seeing a Psychologist.” Jan/Feb, “The Amputee Voice in the ACA.” Jan/Feb, pp. 16-17. pp. 16-18. pp. 40-41. “Announcing the 2010 Amputee Coalition of America Board of McNutt, S. “Renowned Artist Jesse Treviño Shares ‘Mi Vida’.” Charlton, C. “To Finish or Not to Finish.” Mar/Apr, pp. 34-35. Directors.” May/Jun, pp. 12-14. Jan/Feb, pp. 20-23. McNutt, S. “Online Therapy and Social Interaction.” May/Jun, “Call for Physical Therapists.” Mar/Apr, p. 8. Phillips, K. “Guitar Hero.” Mar/Apr, pp. 22-24. pp. 53-54. “Camp Reaches Record Enrollment.” Jul/Aug, p. 9. Young, E. “An Eye for Living.” Jul/Aug, pp. 14-15. Phillips, K. “Support in Numbers.” Mar/Apr, pp. 19-21. “Dan Ignaszewski Promoted to Government Relations Coordi- Young, E. “The Art of Healing.” May/Jun, pp. 18-20. Silver, P. “Finding My Friends.” May/Jun, p. 47. nator.” May/Jun, p. 8. Young, E. “How Peer Visitation Can Help the Journey to Emo- “Dennis Strickland Named Chair of Membership Advisory Com- Assistive Technology tional Recovery.” Mar/Apr, pp. 40-42. mittee." May/Jun, p. 8. Anderson, Madeleine. “An Overview of Crutches.” Mar/Apr, “Derrick Stowell Promoted to Development Coordinator.” May/ pp. 46-48. Financial/Funding Jun, p. 8. McNutt, S. “Adaptive Gardening.” Jul/Aug, pp. 45-47. “Attention, Federal Employees.” Sep/Oct, p. 8. “Did You Know?” Jul/Aug, p. 11. “Seniors Targeted in More Scams.” Sep/Oct, pp. 22-23. “First Step Now Available.” Jan/Feb, p. 8. Caregivers French, J. “Your Shopping Can Change Lives.” Nov/Dec, “Henshaw Promoted to Volunteer and Support Group Coordina- “Two New Videos for Caregivers.” Jul/Aug, p. 58. pp. 48-49. tor.” Nov/Dec, p. 10. McNutt, S. “Challenges and Rewards of Caregiving.” Mar/Apr, Kagan, G. “Myths and Truths About Social Security Income.” “Jamey French Hired as Development Director.” Sep/Oct, p. 9. pp. 36-37. May/Jun, pp. 34-35.

52 inMotion Volume 21, Issue 1 January/February 2011

2010 INDEX OF inMOTION ARTICLES

Health & Fitness “Crown Royal Honors Military Hero.” Mar/Apr, p. 50. Safety “Amputee Resilience Program Launches First Pilot at Adventist Di Leo, A. “Camp Hope: A Retreat for Injured Soldiers.” Nov/ McNutt, S. “Can We Prevent Most Amputations?” Jan/Feb, HealthCare.” Sep/Oct, p. 8. Dec, pp. 40-41. pp. 24-27. “Black Barbershop Health Outreach Program.” Mar/Apr, p. 50. Soza, S. “Bringing Closure to Wounded Veterans.” Jul/Aug, Seaman, J.P. “New Amputee ‘Self-Conduct Pledge’.” Nov/Dec, “Experts Eye ‘Sabotaging Salads’.” May/Jun, p. 48. pp. 37-38. p. 30. “Fitness for Kids.” Sep/Oct, p. 30. “Health Awareness Events.” May/Jun, p. 58. Obituaries Science and Technology “Health Events Calendar.” Sep/Oct, p. 15; Nov/Dec, p. 16. “In Memoriam: Jean Boelter, April 14, 1941 - February 19, “The 2010 da Vinci Awards.” Nov/Dec, p. 50. “November 18, 2010, Marks the 35th Anniversary of the Great 2010.” May/Jun, p. 10. “Transplantation Reality.” Jul/Aug, pp. 49-50. American Smokeout.” Nov/Dec, p. 31. “In Memoriam: Richard Friend, September 9, 1994 - March 15, Dingfelder, S. “Phantom Pain and the Brain.” May/Jun, “PSA: Peripheral Arterial Disease.” Sep/Oct, p. 24. 2010.” May/Jun, p. 10. pp. 36-37. “Resources for Living Longer and Better.” Nov/Dec, pp. 45-47. “In Memoriam: Todd Anderson (1960-2010).” Sep/Oct, p. 10. Malchow, R. “Update in Pain Management for the Amputee.” “Traumatic Neuromas.” Mar/Apr, pp. 44-45. “Jim MacLaren (1963-2010).” Nov/Dec, p. 51. Sep/Oct, pp. 38-40. Graham, R., and Sullivan-Kniestedt, K. “Exercise for Optimum McNutt, S. “Online Therapy and Social Interaction.” May/Jun, Function.” Nov/Dec, pp. 35-37. Peer Support pp. 53-54. McNutt, S. “ Staying Fit With Limb Loss.” Jan/Feb, pp. 37-39. Phillips, K. “Support in Numbers.” Mar/Apr, pp. 19-21. Phillips, K. “Online Friends, Strangers and Stalkers.” May/Jun, Street, A. “Doing It All.” Sep/Oct, pp. 36-37. Tipton, S. “When Opportunity Knocks.” May/Jun, pp. 46-47. pp. 55-56. Whelan, C. “The Peerless Peer Visitor.” May/Jun, p. 45. Young, E. “The Amazing Race.” Nov/Dec, pp. 21-23. Independent Living Young, E. “How Peer Visitation Can Help the Journey to Emo- “HHS, HUD Partner to Support Independent Living for Non- tional Recovery.” Mar/Apr, pp. 40-42. Secondary Conditions Elderly With Disabilities.” May/Jun, p. 58. LaRaia, N. “Ask the Physical Therapist.” Jan/Feb, pp. 33-34. Cosmos, C. “Oh Yes I Can!” Sep/Oct, pp. 32-34. Prevention Seaman, J.P., “New Amputee ‘Self-Conduct Pledge’.” Nov/ “Study Shows Podiatrist Care Reduces Amputation Risk.” Sep/ Sports and Recreation Dec, p. 30. Oct, p. 25. “Amputee Conquers the Heights.” Nov/Dec, p. 51. McNutt, S. “Can We Prevent Most Amputations?” Jan/Feb, “The Definition of Determination.” Jul/Aug, p. 24. Inspirational Stories pp. 24-27. “The Definition of Perseverance.” Sep/Oct, p. 50. “The Definition of Empathy.” Nov/Dec, p. 38. McNutt, S. “Adaptive Gardening.” Jul/Aug, pp. 45-47. “Where Are They Now?” Mar/Apr, p. 32. Prosthetics and Orthotics McNutt, S. “Climber Aims to Inspire ACA Campers.” May/Jun, Anderson, M. “Passing the Torch.” May/Jun, p. 23. Bollenbacher, G. “Learning to Walk at Any Age.” May/Jun, pp. 40-41. Cosmos, C. “Oh Yes I Can!” Sep/Oct, pp. 32-34. pp. 27-28. McNutt, S. “Staying Fit With Limb Loss.” Jan/Feb, pp. 37-39. King, G. “A Life Reimagined.” Sep/Oct, pp. 45-46. Charlton, C. “To Finish or Not to Finish.” Mar/Apr, pp. 34-35. Rosenberg, J. “Staring.” May/Jun, pp. 38-39. McNutt, S. “Renowned Artist Jesse Treviño Shares ‘Mi Vida.’ Clark, D., “Ask the Orthotist.” Jul/Aug, p. 20. St. John, B. “We’ve Come a Long Way.” May/Jun, pp. 24-25. Jan/Feb, pp. 20-23. Kahle, J., and Highsmith, J. “How to Be a Good Patient.” Jul/ Phillips, K. “Guitar Hero.” Mar/Apr, pp. 22-24. Aug, pp. 18-19. Travel Rosenberg, J. “Staring.” May/Jun, pp. 38-39. Kennedy, S. “Choosing the Right Shoe.” Mar/Apr, pp. 27-28. “ACA Holds Successful Meeting With Top Transportation Secu- St. John, B. “We’ve Come a Long Way.” May/Jun, pp. 24-25. LaRaia, N. “What Are Some of the Long-Term Effects of Using rity Administration Officials.” Sep/Oct, p. 14. White, A. “Go. Do.” Jul/Aug, pp. 40-41. or Not Using a Prosthesis?” Nov/Dec, pp. 28-29. Purdy, P. “Saying ‘Yes’ to Travel.” May/Jun, pp. 42-43. Lutz, J. “The Six Questions Patients Ask Over and Over.” Mar/ Staten, M. “Survey Identifies Air Travel Problems for Ampu- Insurance Apr, pp. 25-26. tees.” Jul/Aug, p. 12. “Discussing Healthcare Costs With Your Provider.” Jul/Aug, McHugh, S. “A Case for Body-Powered Hooks.” May/Jun, pp. 35-36. pp. 21-22. Upper Extremity “Marci’s Medicare Answers.” Mar/Apr, p. 51. Rotter, D. “An Overview of Finger and Partial-Hand Prostheses.” “Upper Limb Loss Advisory Council Update.” Jan/Feb, p. 8. Kagan, G. “Social Security and Medicare in 2010.” Jan/Feb, Jul/Aug, pp. 52-56. Doty, R. “‘Do No Harm’: Do Not Destroy Lives to Save Limbs.” p. 53. Valdetero, J., and Haag, J. “Tips and Tricks for Upper- & Lower- May/Jun, pp. 50-51 Kagan, G. “New Healthcare Legislation.” May/Jun, p. 60. Limb Amputees.” Nov/Dec, pp. 24-25. LaRaia, N. “What Are Some of the Long-Term Effects of Using McNutt, S. “Waiting for Assistance.” May/Jun, pp. 32-33. Young, E. “The Amazing Race.” Nov/Dec, pp. 21-23. or Not Using a Prosthesis?” Nov/Dec, pp. 28-29. McHugh, S. “A Case for Body-Powered Hooks.” May/Jun, International Rehabilitation pp. 21-22. Young, E. “The Day the Earth Did Not Stand Still.” Mar/Apr, Bollenbacher, G. “Learning to Walk at Any Age.” May/Jun, Rotter, D. “An Overview of Finger and Partial-Hand Prostheses.” pp. 13-17. pp. 27-28. Jul/Aug, pp. 52-56. “Visit the Haiti Relief Action Center for Updates.” May/Jun, Burylo, M. “Michelle Version 2.0.” Jul/Aug, pp. 33-34. Valdetero, J., and Haag, J. “Tips and Tricks for Upper- & Lower- p. 9. Darnall, B. “Mirror Therapy.” Nov/Dec, pp. 42-44. Limb Amputees.” Nov/Dec, pp. 24-25. Greenfield, M. “Ask the Occupational Therapist.” Jul/Aug, p. 22. Young, E. “The Amazing Race.” Nov/Dec, pp. 21-23. Military/Veterans Holmes, J. “Ask the Physical Therapist.” Jul/Aug, p. 23. “ACA Partners With U.S. Dept. of Veterans Affairs to Provide McNutt, S. “Waiting for Assistance.” May/Jun, pp. 32-33. Peer Support.” Jul/Aug, p. 9. Seaman, J.P., “New Amputee ‘Self-Conduct Pledge’.” Nov/ “ACA Receives Funding for VA Caregiver Support Program Dec, p. 30. From Given Limb Foundation and Department of Veterans Affairs.” Sept/Oct, p. 8.

Contact the Amputee Coalition at 888/267-5669 or amputee-coalition.org 53 Need a new prosthesis? Amputee Coalition Confidentiality Policy A prosthetist?

A funny T-shirt? The Amputee Coalition has a strict policy of conﬁdentiality for If so, visit the Amputee Coalition’s new online all individuals on the Amputee Coalition's database and mail- 1-Step Products & Services Information Center ing lists. As part of our mission to educate our members, the Amputee Coalition works with its partners, sponsors, and other Visit amputee-coalition.org allied health organizations to provide information on the latest and look for the technology, healthcare practices and reimbursement issues 1-Step Products & Services Information Center that affect this community. THE AMPUTEE COALITION DOES at the top of the NOT RENT OR SELL THE MAILING LIST AT ANY TIME. All cor- navigation bar of our respondence sent to our mailing list is through a secure mail home page. house and is never released in any way to any organization or company outside the Amputee Coalition. If you do not wish to receive this information, contact the Amputee Coalition and t -FBSOBCPVUJOOPWBUJWFQSPEVDUTBOE Visit we will activate an opt-out option on your database record. You TFSWJDFTGPSBNQVUFFTBOEUIFJSGBNJMZMJNCMPTT will continue to receive your magazines but will not receive NFNCFSTBOEDBSFHJWFST Today! any healthcare or product updates. If you have any ques- t 3FBEJOGPSNBUJWFBSUJDMFTBCPVU tions regarding the Amputee Coalition’s conﬁdentiality policy, SFMBUFEJTTVFT please contact us at 888/267-5669. t &OUFSGPSDIBODFTUPXJOQSJ[FT t (FUGSFFTUVGG $PBMJUJPOTMJGF t 7JFXPVS$BSUPPOPGUIF8FFL"NQVUFF TQFOEJOHB t 4VQQPSUUIF DIBOHJOHQSPHSBNT XJUIPVU QFOOZ The center is growing daily, so come back often. saving limbs. building lives.

AdvertiserADVERTISER Index INDEX

COMPANIES PAGESPAGESCOMPANIESCOMPANIES PAGES PAGES

A Step Ahead Prosthetics and Orthotics ...... 36 Neuros Medical, Inc...... 43 The American Board for Certiﬁcation in Orthotics, Ohio Willow Wood ...... 51 Prosthetics & Pedorthics ...... 32 Orthotic and Prosthetic Center ...... 33

Amputee Supplies ...... 20 Össur Americas ...... 2 Award Prosthetics ...... 40 Otto Bock HealthCare ...... 28-29 BOC International ...... 7 Quorum Prosthetics ...... 50 College Park ...... 11 Scott Sabolich Prosthetics & Research ...... 55 Comfort O&P ...... 45 Thomas Fetterman, Inc...... 50 Fourroux Prosthetics ...... 15 Fred’s Legs, Inc...... 51 Hanger P&O, Inc...... 4 Hartford Walking Systems ...... 51

54 inMotion Volume 21, Issue 1 January/February 2011

Non-Proﬁt Org US Postage PAID Liberty, MO Permit No 63

Let’s Give This Woman a Hand. After All, She Makes Great Hands.

It takes a skilled, multifaceted practitioner to create the “perfect” arm, leg or orthotic device for today’s limb-impaired patient or amputee. These specialists oversee the process every step of the way—from designing the device, to creating it from raw materials, and ﬁ nally to custom-ﬁ tting each patient for the best possible results. It is a process that takes time, patience and caring. And it’s the most critical step in getting amputees back to living full, productive lives. To these professionals and their patients, arms and legs are not a luxury. For more information go to AOPAnet.org, amputee-coalition.org, or armsandlegsarenotaluxury.com.