Steven Few, Certified Prosthetist / Orthotist, and Area Clinic Manager for Hanger Clinic, talks about the advance in the technology of fitting amputees with prosthetics, specifically an advanced type of knee prosthetic with a microprocessor designed to adjust specifically to the patient’s movements.
Interview conducted by Ivanhoe Broadcast News in October 2019.
What does it mean to be a prosthetist?
Few: Well, it’s an opportunity for us to help patients come in and provide them with the equipment and education that they need to be able to increase mobility, is really what it comes down to.
So most of the patients you see, Steven, are amputees?
Few: For me, they are, yes. We see both prosthetics and orthotics here, but I typically see mostly prosthetics.
It would definitely seem to me that every one of these patients who come in have their own journey, their own experience. In other words, they wound up here for a number of reasons, it could be anything?
Few: It could be cancer, it could be a traumatic [injury], it could be diabetic-related issues, infection, a whole host of reasons.
When you fit someone for a prosthesis, what are you looking for to help them?
Few: Mostly we’re looking at what they could do before and we have to assess what their goals are. We’re trying to get them as close to functional after amputation as they were before amputation. We tend to assess what comorbidities they have. What’s their limb shape look like? Try to match the technology for them to what their lifestyle is.
And when we talk about technology, there is advanced technology in these type of prosthetics. The ones especially that Jeremy uses and Robert and Ms. Lee. What is it specifically and how does it work?
Few: So all three of the patients that you mentioned have microprocessor knees. They all have a processing unit with multiple sensors and it monitors the position of the knee space. So as the knee begins to bend, it’s reading those sensors very rapidly and it’s adjusting hydraulic pressure inside the knee to either allow the knee to bend or to create it to be stiffer. When they’re out in public or just walking in any kind of environment, the knee has to adapt. Prior to microprocessor technology, you know, you had knees that were either swinging or they were not, where the microprocessor allows it to adapt to what’s going on for them.
I know Jeremy says when he makes his adjustments, he does it by an app on his phone. You can adjust it to climb the ladder or climb stairs, running or walking.How? This can adjust to specifically what you’re going to do?
Few: When we see [patients], we do the evaluation and we kind of set the knee up for where they’re at. And then as they go through the rehab process, that may change; those settings may change some. So we’ll continue to help them adjust to that. What the phone app does is it allows them [to control]a percentage of change in between [modes]. So if we have them set to do a locked [knee]mode, so if they want to climb that ladder, you know, they can lock it in and be safe doing so, they can do that with their phone. Even if they’re going down, they need to be where the knee is a little bit more dynamic for them. They can free that up some within a set parameter. We don’t give them complete adjustment of [the knee]because there are a lot of other factors that go into our process that can become unsafe for them.
Right. They are very educated on what the knee can do and how it works. I imagine they are happy with this microprocessor knee? Do they ever have any issues with it or troubles?
Few: Sure. Any amputee is going to have troubles as they go along, as their limb changes. It’s not a static environment. As you continue to wear the socket, their limb is going to continue to shrink and atrophy over a period of time. As a result, most of the time that change that they have can cause them some issues. That’s when they come back and see us and we make adjustments to that. Also when they are first learning to walk and learning how to use their muscles again, they’re getting their rehab, so it’s different. I have to come in and adjust some of the settings. Sometimes you have to even adjust the position of the knee under the socket a little bit to either make it more stable or less stable.
What are you looking for when it comes to your patients, we mentioned Jeremy, what are you looking for as far as a patient be able to walk in a normal fashion and feel good with the process?
Few: It’s really a whole host of things. They’ve got to have the strength to be able to do it. They’ve got to have a range of motion in the residual limb to be able to properly walk efficiently. And in [prosthetic]systems for folks that don’t have as much strength and don’t have as much range of motion, we’re really trying to match it to what their ability is and what their potential can be, which is the trickier part, always figuring out where the potential is going to go. But we have tests and exams that can help us predict, if you will, a percentage of accuracy that they’ll be able to move on into a normal gait pattern and getting physical therapy is a huge portion of that. We work pretty hand-in-hand with the local therapist here. We’ll get their prostheses, and they go back and get some rehab ideally, and they begin to develop a gait pattern, they begin to walk more efficiently. As they become stronger and become more confident, then we make some adjustments to the alignment to make it a little easier for them.
And how did Robert do since he first came here?
Few: Robert’s doing great; he has got a tremendously wonderful attitude. He’s kind of one of those guys who nobody’s gonna slow him down. But if he puts his mind to it, he’s gonna do it no matter what. He has had some shrinkage in a socket, we’ve been working through that and he has a hip disarticulation. So he’s not only got the knee joint that’s gone, he’s got the hip joint that’s gone; he’s got three [prosthetic]joints that he’s working with having to try to figure out how to control or rotate with his pelvis. And it’s difficult, but he’s adapting really well.
He’s doing really well. And what about Ms. Lee?
Few: She is so funny; she’s just a very bubbly personality. She’s also doing really well. She had an apartment when we first met her and she had three flights of steps that she had to go down. With the microprocessor [knee]she was able to do that and go down those. And it was the first time she had actually been able to carry her son, which she couldn’t do before, because without a prosthesis and on her feet, she was using a crutch on one side. She’s really adapted quite well too. She’s back in school and doing some additional studies now.
It must make you feel really good, Steven. It’s got to be a very rewarding field to be in to see these people who come to you in need of guidance and to help them and see them be able to do that, be with their child, carry their child down a flight of stairs and be OK.
Few: It is. It’s really rewarding to see them succeed and for us to help them along their journey and just for them to come in and share those stories, you know? It’s just a really good feeling, really.
Absolutely. It should be. You guys are doing a lot of good work here. So where can people find out more about the microprocessor [knee], is it available? Is it widely available or is it available around the country?
Few: It is. There are several different types of microprocessors available. Each one’s tailored to a specific set of needs so not everybody’s a candidate for it. You need to see a qualified prosthetist to run through the evaluation to make sure you’re qualified for that, but they are widely available in the U.S.
And is this covered by insurance or is it something they have to pay out of pocket?
Few: It just depends on their situation. A lot of times insurance does cover it. So we work with the patient, and we work with their insurance company to facilitate that as best as possible.
That’s great. And Hanger Clinic is nationwide?
Few: We are you know, we have over 750 clinics right now.
So if someone is out there, they hear this or see this, they can contact maybe a clinic near them, talk to them about what’s available.
Few: Yeah. Get an evaluation and see if they’re a candidate or not. You can schedule an appointment or find out more at: www.hangerclinic.com.
END OF INTERVIEW
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