Form and Function – Advances in Prosthetics Help Amputees Return to a Full Life

In the early 20th century, the Wason Manufacturing Co. on Main Street in Springfield built streetcars so people could get around town. Today, in one of Wason’s former buildings, James Haas builds different kinds of devices, for a similar reason.

Specifically, Haas, co-owner of Orthotics & Prosthetics Labs, and his staff manufacture prosthetic limbs for amputees and orthotic devices, including braces and splints, to provide support to various parts of the body.

According to the Amputee Coalition, nearly 2 million people living in the U.S. have lost a limb. Most amputations result from vascular disease — in particular, peripheral arterial disease (PAD), which is commonly caused by diabetes. Of the 185,000 amputations performed every year, most are below the knee, where vascular disease prevents muscles in the lower extremities from effectively circulating blood back up the leg.

Haas said the world of prosthetics is far more customer-focused now than in the past. He spoke of a time when a prosthetist would meet patients in a small office where measurements and a plaster cast of a patient’s limb would be taken. Once the device was built, the patient would return for a test fitting that involved little more than taking a few steps down the hall.

“After going home, the patient would start to experience all kinds of challenges they didn’t know to ask about at the office, such as how to manage the three steps that lead into their house,” he explained.

In February 2018, Orthotics & Prosthetic Labs opened a prosthetic center in the former Wason complex. Resembling a gym, the center recreates situations prosthetic patients are likely to encounter in their daily lives, such as an incline ramp and a set of stairs. In the middle of the room, a harness device called a Solo-Step helps prosthetic patients improve their walking and balance without the risk of falling. “Today, we’re not just providing a prosthetic,” Haas said, “we’re actually providing care.” 

Societal perceptions about prosthetics have changed for the better as well, he noted. “It used to be that, if you became an amputee, your life was considered over. Now, it’s just a stumbling block.”

Take Rushel Rhiney, for example. Born with a congenital limb deficiency, Rhiney lost her right leg above the knee at age 9 and was fitted with her first prosthetic at Shriners Hospitals for Children in Springfield. Now in her junior year at UMass Amherst, Rhiney said she is comfortable wearing a prosthetic and sharing her story. “For me, it’s much more than a prosthetic — it’s my leg.”

For this issue, HCN spoke with prosthetic and orthotic professionals and patients — two of them fall into both categories — about the challenges of adapting to life as an amputee, and the advances in both technology and rehabilitation that are making that transition smoother than ever.

Impending Loss

Christian Rogers, co-owner of Prosthetic & Orthotic Solutions in West Springfield, said many people are introduced to his company because they need diabetic shoes, orthotic footwear designed to lessen skin breakdowns and irritations in the feet. Without proper foot care, infections can develop, and when combined with a diabetic’s vascular issues, the risk of losing a foot greatly increases.

“I can never stress enough for diabetics to manage their symptoms and take care of their feet,” Rogers said. When an amputation is necessary and the patient begins using a prosthetic, keeping the sound leg healthy remains a top priority.

“My whole career is about preventing people from needing amputations,” said Dr. S. Lowell Kahn, president of New England Endovascular Center in West Springfield. He observed that the Greater Springfield area has a large population of diabetic patients, who along with smokers have the greatest risk of developing high levels of plaque in their arteries. Because diabetes tends to affect small blood vessels, the knees, feet, and toes are more vulnerable to vascular disease than the body’s core, where blood vessels are larger.

Early symptoms of vascular disease include fatigue and cramping in the legs. As the disease progresses, walking becomes more difficult. A minor cut can develop into an ulcer, which could lead to gangrene and eventually require an amputation. Kahn said results can be greatly improved with early intervention.

“We can reduce amputations by 50% when we screen early for PAD,” he explained. Using fluoroscopy — a live-action X-ray — he can locate the worst blockages and clear the plaque from the arteries, an outpatient treatment that is minimally invasive and allows for quick healing. When patients manage their diabetic symptoms and practice other healthy habits, they can also lower the risk of further damage to their arteries.

Kahn said he works with primary-care doctors, wound-care centers, prosthetic and orthotic professionals, and others with one goal in mind. “We all want to help the person save their limb. I fix the plumbing, but that’s just one small piece of the whole picture.”

Blaine Drysdale, a certified prosthetist and co-owner of Orthotics and Prosthetics Labs, said he came to the business initially as a consumer. At age 19, he lost his left leg due to a motorcycle accident and shortly after was fitted with his first prosthetic. He changed his career ambitions from photography to physical therapy, where he earned a master’s degree, then eventually a second degree in orthotics and prosthetics.

Drysdale said he has seen patients hold on to an infected limb for years, and when they finally have it removed for a prosthesis, their spirit and health improves. “They tell us how much easier it is to get around and how their body feels better because they’re not fighting infections.”

Larry Younce describes himself as an independent guy who can’t sit around. Two years ago, he developed diabetes and didn’t know he had it. One day, a water blister on his right foot burst, which began a degenerative process that led to an amputation of his right leg. As his diabetes became worse, Younce lost his left leg in November 2018.

While acknowledging that he faces a long road to recovery, Younce remains positive. “I’ve worked in the medical field, so I made sure to take care of my wound and was diligent on staying on top of all my self-care.”

He added that an occupational therapist cleared him to do “normal stuff” at home, so he goes out with friends every Saturday for food shopping and takes advantage of living close to Szot Park in Chicopee to get fresh air.

A New Normal

For patients struggling to face the reality of losing a limb, Drysdale recommends developing a mindset that it’s going to be a new normal. “I don’t sugarcoat it; it’s a lot of work to get back to what you want to do.”

As part of finding the new normal, Drysdale encourages new amputees to avoid setting limits on themselves. Patients often say they just want to walk again. Drysdale credits peer-support groups for their role in helping amputees understand that they can usually do more than just walk.

In fact, he said prosthetics are tools that are built to undergo heavy use, and the only time a prosthetic should be nice and shiny is when it’s new. “If patients don’t come back with a bunch of bumps, scratches, and dings on their prosthetic, it makes us sad. We feel like we didn’t do our job.”

But physical recovery is only part of the rehab process. When Rhiney is not in class at UMass, she is a certified peer counselor at the Hanger Clinic in Springfield.

She made the decision to become a peer counselor after a hospital stay where she struggled with a fractured femur. “I remember a woman in the hospital at the same time who had just lost her leg. She looked at me as such a strong person and wished she could be as strong.”

Rhiney described it as an “awesome experience” because the woman’s admiration gave both of them the strength to endure. At first, the woman worried about how her friends might react to a prosthetic, but changed her attitude after being inspired by Rhiney. “She called me after she got her prosthetic and wanted me to see her walk. She was so excited about it.”

Peer counseling is just one element of learning to adapt to a new way of life, saod Maggie Baumer, clinic manager at Hanger Clinic’s Springfield location and, like Drysdale, an amputee herself. After losing her left arm below the elbow from an accident in 2012, Baumer said navigating people’s reactions to a missing upper limb was challenging at first. “Overall, I think it was good for me because I learned how to talk about it and be comfortable when my prosthesis arm was on and when it wasn’t.”

The Hanger Clinic is one of the world’s largest prosthetic and orthotic providers, with more than 700 locations in the U.S., and it also runs Ampower, the nation’s largest peer-to-peer amputee support network. Whether in-person at a local clinic or online, Ampower, like other support groups, looks for common ground when matching counselors with new amputees. The online element adds even more specific interests.

“Within the larger online community, there are many smaller groups such as above-knee male amputees, below-elbow female amputees, or amputees who like to ride motorcycles,” Baumer said.

She emphasized that it takes a team effort to successfully adapt to life with a prosthesis. The relationship between a patient and their prosthetist can last many years, so it’s as important as the relationship people have with a primary-care doctor or dentist.

“Prosthetists are sometimes perceived as vendors or someone who supplies an item, but it’s much deeper than that. There’s a trusting relationship that gets formed, so it’s important for patients to feel comfortable talking with their prosthetist.”

Mobile Tech

Rhiney said her growing years were frustrating because every summer meant adjusting to a new prosthetic. “I had just found my comfort with the one I was wearing, and then I’d have to start the whole process over and learn how the new one works and how to find comfort in it.”

Since her first prosthetic leg, though, Rhiney has seen great advances. “I went from having a simple strap on the first leg to my current prosthetic that has a built-in microprocessor to regulate my gait when I walk.”

Fashion is also a fairly new consideration in the world of prosthetics. Rhiney takes great pride in the stylish cover she picked out for her prosthetic leg. “When I wear pants, people might think I just have a limp, but when I wear shorts, people are more friendly. They see my cover and say, ‘hey, I like that,’” she said, adding that compliments like this are motivating for people who wear prosthetics.

The overall method to building a prosthetic has stayed constant for quite some time, Haas said, starting with taking a plaster cast of the patient’s limb and using it to make a plastic socket, which is then modified for a custom fit. He has recently added some disruption to the standard method by adding two 3D printers to make prosthetic and orthotic devices. Using an iPad scanner, he can capture the patient’s exact measurements, make modifications digitally, and not use any physical materials until the final piece is printed. Items he can print include plastic sockets and orthotic arch supports, but he expects this area to grow.

“Right now, we’re testing the waters to see when it makes sense to use the 3D printer and when it doesn’t,” he noted, adding that he predicts 3D-printing technology will dominate his industry within five years.

Meanwhile, as innovations in prosthetics continue to make them more durable on the outside, Haas said real advances have also been made inside with the critical components that make contact with the skin. Where comfort was once limited to socks and neoprene sleeves, now gel liners in different thicknesses make a prosthetic easier to wear.

The field of orthotics has also seen advances in materials and comfort, Rogers said, noting that, when most people hear the word ‘orthotics,’ they usually think of custom inner soles for shoes. But the term also covers dozens of bracing and support products for body parts from head to toe. Examples include remolding helmets for newborns to correct misshapen heads, wristlets to address forearm injuries, and braces for the hip, knee, ankle, and other areas of the body. Because orthotics means so many things, it creates a great deal of confusion.

“Patients will call to say they need an orthotic, then admit they’re confused and don’t really know what they need,” Rogers said. A staff member will take the time to speak with the patient to find out their true needs and how best to help.

For those facing an amputation, those needs are especially significant, which is why patients are gratified by the advances continually being made to support patients — both physically and, of course, emotionally.

Like the peer counseling Rhiney offers to new amputees who have trouble seeing past their amputation and what comes next. “It’s important for them to speak with someone like me who is already beyond that point to give them the self-confidence that they can do it, too.”

Younce, who’s still adapting to that new normal, would agree, advising new amputees is to look for the bright side and just keep going. “Don’t let it stop you,” he said. “I haven’t let it stop me.”