The November-December 2017 Issue of InMotion magazine, published by the Amputee Coalition, features an article on A New Pathway to Function for Bilateral Above-Knee Prosthetics Users, written by Chad Simpson, BS, BOCP, LP and Randy Richardson, ABC-CPA, RPA of Dream Team Prosthetics LLC.
We present the article below for your reference with permission from the Amputee Coalition.
The article can also be accessed online at this link:
by Chad Simpson, BS, BOCP, LP, and Randy Richardson, ABC-CPA, RPA
Once the limbs are healed, it can be difficult to focus on using prostheses after becoming comfortable with using a wheelchair. Unfortunately, due to lack of physical activity, individuals often experience substantial weight gain and develop exion contractures and stiffness in the hip joints, limiting the range of movement of the residual limbs. This general lack of activity and mobility greatly reduces overall strength. All of these factors can have a negative impact on the physical and emotional ability to use bilateral above-knee prostheses.
Individuals with bilateral above-knee limb loss using prostheses have shown a 27-88 percent increase in energy cost during walking compared to individuals without limb loss. The cardiovascular impact is significant and initially can be discouraging. Even the process of donning the prostheses can be physically exhausting. At this stage, many individuals feel overwhelmed and frustrated. Some express their feelings with statements such as, “There is no way that it will be possible for me to use prostheses,” or, “It’s just not a practical option; it takes too long, uses too much energy and it’s easier to use a wheelchair,” or, “I don’t have time to deal with the hassle of learning to walk again.”
Individuals with bilateral above-knee limb loss using prostheses have shown a 27-88 percent increase in energy cost during walking compared to individuals without limb loss. When energy expenditure outweighs functional benefit, bilateral above-knee amputees primarily opt to use a wheelchair and prostheses for special situations.
For example, if a person chooses to use hand control adaptations in a vehicle, this limits them to one adapted vehicle. There are “portable” hand control options, but that requires carrying these devices wherever they go and installing and removing them when switching vehicles.
These bilateral prosthetics users are pushing the perceived limits to regain a higher level of mobility that allows them to go for a walk on the beach, carry their child on their shoulders, play golf, run in marathons, hike mountains and, most importantly, return to work, without using a wheelchair or special adaptations.
Hayden was working as an industrial HVAC repair specialist when he was involved in a single-car accident that claimed both legs above the knees. He suffered many internal injuries and was in a coma for several weeks. When he awoke, Hayden felt the uncertainty and anxiety about his situation and an overwhelming feeling of helplessness. He decided to focus his energy on nding a solution to his limb loss that would allow him to return to the things he loved to do, including working full-time, hunting, fishing, hiking, marrying his sweetheart and eventually starting a family.
Today, Hayden does the same job he was doing before his injury. He regularly goes on service calls in harsh environments, servicing HVAC systems in remote cellular transmission tower electronics buildings, navigating stairs, hills, ramps and ladders, all while carrying tools and equipment. He does not own a wheelchair.
Seth was 16 years old when he lost control of his pickup on a wet road. His vehicle rolled on top of him and crushed both legs. He spent a month in the hospital as the doctors tried to restore the blood flow to his limbs but ultimately, due to gangrene and internal organ failure, he had to make the decision to remove both legs above the knees or die. This was a devastating reality for Seth, who was a high school basketball and baseball superstar.
Seth attended a bilateral above-knee training camp five months post-injury and met numerous full-time bilateral prosthetics users, which inspired him to focus on regaining his own mobility. Today, Seth is married, works full-time, and is pursuing a degree in physical therapy. He participates in numerous running events, half-marathons, 5K, 10K and the 100, 200 and 400 meter events at the annual Endeavor Games. He drives an unmodified vehicle, using his prosthetics to safely go between the gas and brake pedals, allowing him to drive any car, including manual transmission vehicles. He hasn’t used a wheelchair since April 2012.
Kyle was a railroad switchman at a Virginia steel mill. In September 2014, a rail car was sent down the wrong track and before Kyle could react, he was pinned beneath the car, resulting in severing both legs very high above the knees.
While Kyle was recovering in the hospital from his injuries, his first child was born. Kyle was focused on being an active father to his new daughter: “I want to be able to carry her on my shoulders like other dads. I knew using a wheelchair would limit my interaction with my little girl, but my limbs were unbelievably short. I didn’t know if using prosthetics would even be possible. I searched for a prosthetist that had specific expertise with fitting challenging bilateral limbs and spoke with some of his patients.”
The key is selecting the most efficient tool for the specific activity. Kyle attends the annual bilateral training camp to help pay it forward to other uninformed bilateral above-knee amputees and show them what is possible. This year, he successfully completed a three-mile nature hike with the group. Kyle has not used a wheelchair since March 2015.
These individuals have tapped into their own internal passion, strength and determination to not accept the limitations of adaptive equipment, instead opting to adapt themselves to their situation. They have discovered that the more time they commit to using their prostheses, the more function and ability they enjoy in their lives. Mental determination (or stubbornness) to overcome daily challenges is paramount to a successful outcome. Initial full-time use of “stubbie” prosthetics will help build strength, balance and endurance. Keeping a positive attitude is crucial.
(Left to right): Colby Liston, Hayden Bailey, Seth Alexander, Kyle Hannon and Alejandro Chamba
A veteran once remarked that for him, stepping off a curb felt like stepping off a 10-story building. But with training and practice, it can become second nature. The additional programmable mode is used to set up a driving function to prevent the knee from collapsing when going between the gas and brake pedals.
While advanced technology opens up many possibilities, never underestimate the skill, innovation and expertise of your prosthetist. Take the time to interview prosthetists and bilateral prosthetic users so you can make an educated decision for your own personal mobility and function.
Your persistence and due diligence may just change your life!
Safety, Energy Efficiency, and Cost Efficacy of the C-Leg for Transfemoral Amputees: A Review of the Literature. Highsmith, Kahle, Bongiorn, Sutton, Groer, Kaufman. Prosthetics and Orthotics International, December 2010; 34(4): 362–377. ncbi.nlm.nih.gov/pubmed/20969495
Seth Alexander: facebook.com/bilateralathlete
Kyle Hannon: Kyleh204@gmail.com
Hayden Bailey: facebook.com/hayden. bailey.9