Back to Class with Orthotic and Prosthetic Devices

This is an encore posting of some Back to Class questions!

We have three questions about returning to school with orthotic and/or prosthetic devices.

QUESTION: 

The start of school is approaching and I am about to start my back to school shopping.   I wear both a prosthesis and an Ankle Foot Orthosis.  Is there anything I should be aware of for my brace or prosthesis?  - Tammy V

ANSWER:

Hi Tammy,

Before going back to school, it is a good idea to do a thorough inspection of your orthosis and prosthesis.  If there are any cracks, creaks or abnormal movements with either device be sure to schedule an appointment with your orthotist or prosthetist to have the devices checked out.   Also, if any of your liners, socks, sleeves, straps or buckles are ready to be replaced, it is better to schedule an appointment before school starts.  This way you won’t miss any classes.

As for your personal shopping, it is important to pay attention to what shoes you purchase for both your prosthesis and orthosis.  Typically, with an AFO we recommend that patients purchase shoes ½ size longer.  It may also be important to purchase a wide shoe in order to fit the device into the shoe.   For both your AFO and prosthesis, it is important that the new shoes also have similar heel heights to the shoes you brought to your most recent appointment with your orthotist or prosthetist.  

QUESTION: 

I want to try out for a school sport this fall.  As a below knee amputee and prosthetic user is there anything specific I should know before trying a sport and are there any restrictions?  - Derek Z

ANSWER:

Hi Derek,

We never want a prosthesis to limit a person’s potential activities.  We have patients who play or have played many of the common fall sports, such as football, soccer, volleyball, cross country and more!  That being said, here are some things to think about when starting a new sport.  1) Before going through a large change in activity levels it is always a good idea to contact your prosthetist.  Different prosthesis setups are intended for different levels of activity.  If your current prosthesis was not built with the expectation of high activity it has a higher chance of malfunctioning or holding you back.   2)  In whichever sport you decide to participate, it is important that you regularly inspect your residual limb for wounds or bruising.  Especially in the beginning, new, unfamiliar movements can change how your limb contacts the prosthesis.  Changes can be made to your prosthetic socket if this becomes an issue.   3) Be ready to sweat!  Prosthetic users almost always deal with the issue of sweating in their socket/liner.  With increased activity, it is very normal and expected.  It may be helpful to remove your prosthesis during breaks in play in order to air out your limb.  Bring extra prosthetic socks to practice and games.   As you sweat the size of your limb may shrink throughout the day, if this is the case, socks can help improve the fit and can assist in preventing unwanted limb movement within the socket.  Also clean your socket and liners daily.  Mild soap a damp cloth and rubbing alcohol can help with personal hygiene, component longevity and odor!  4) Have fun!  

QUESTION:

I am a fairly new above knee amputee.  My limb is very sensitive and I struggle to wear my prosthesis for more than a couple hours at a time.  Any recommendations to help get me through a day of school?  -  Julia D

ANSWER:

Hi Julia,    

Never feel like you have to keep your leg on during an entire school day.  It is common for amputees, especially new amputees, to limit the wear time of their prosthesis.  Schools want to help students who may need accommodations, so rather than struggle, take your time and do what you need to get through the days.  Talk to your prosthetist about writing a schedule down to help you gradually increase your tolerance.  Bring your prosthetist’s recommendations and contact information with you to school. Speak with your school counselor and ask for a meeting with your parents, teachers and the school nurse about your necessity to take breaks with the prosthesis throughout the day.  Your school will help you develop a plan that works for your needs and they can call your prosthetist if they have questions.

We also recommend that you do some work to help desensitize the limb.  First, become aware of issues that create stress for you. Trying to control stress is very important.  Relaxation techniques have been shown to significantly help with residual limb pain.  A second recommendation would be to start desensitizing exercises.  A common exercise is to lightly touch and rub hypersensitive areas of your limb with different textured materials. At first the materials should be extremely smooth and soft, for example silk.  You can do this for about 2-5 minutes, or to your tolerance, several times per day.  Once your limb can handle the silk material you can gradually use more coarse materials.  A common progression in material would be silk, cotton, corduroy, then wool.  If there are any open wounds on your limb do not rub it with any material. Never hesitate to give us a call if you have questions.

Thank you all for your questions!  

Do you have a question you would like to Ask Us? Email us at info@dankmeyer.com.

How often should I follow-up with my practitioner?

QUESTION:

How often should I follow-up with my practitioner?

Nancy W.

ANSWER:

In general, when you have any skin problems (for example, redness that does not go away in 20-30 minutes after using your orthosis or prosthesis) or pain while using your prosthesis or orthosis, you should follow-up with your practitioner. If you notice that your device is not functioning properly (ankle joints not operating well, prosthetic knee is not bending appropriately) we also recommend that you call and follow-up with us.

Prosthetics

If your prosthesis is fitting and working well, it is still a good idea to come in about every 6 months. We can inspect your prosthesis for signs of wear as well as look at your liners, sleeves, and socks to make sure they are in optimal condition for use with your prosthesis. It's a great idea to follow-up with us regularly so we can catch any problems early.  At the beginning of the process, when you first receive your prosthesis, we may see you more regularly for follow-up, as your limb may be changing quickly. However, over time these changes usually slow down and less frequent follow-ups may be more appropriate. We will normally call you to follow-up with you about every 6 months to see how you are doing.

Orthotics

We recommend an annual follow-up for orthoses. This is especially important if you have an orthosis that uses ankle or knee joints that may need maintenance or replacement. We will normally call you once a year to check in and see how you are doing. 

In all cases, if something does not fit or function well, please contact our office at 410-636-8114. We may be able to resolve issues over the phone, and if not we look forward to seeing you in our office!

Thanks for your question! - Nina Bondre, CPO

Do you have a question you would like to Ask Us? Email us at info@dankmeyer.com.

 

What kind of education does my practitioner have?

QUESTION:

What kind of education does my practitioner have?

Kevin B.

ANSWER:

Many people do not know about the education involved with becoming a Certified Prosthetist or Orthotist, as our field is fairly small. This is a common question our patients ask of their practitioners.

The education level for prosthetics and orthotics was raised in 2012 to a master's degree. Prior to 2012, practitioners would complete their bachelor's degree in a major of their choice, and then complete a separate certificate for orthotics and prosthetics. Now, there are no certificate programs available. The only route to become a practitioner is to complete a Master of Orthotics and Prosthetics program.

Once the master's degree is completed, a clinical residency must be completed. Residents can opt to focus on one discipline at a time for 12 months each, or do both orthotics and prosthetics together over the span of 18 months. During residency, residents work under the guidance of the clinical director and clinical mentors to learn patient care, proper documentation, and fabrication techniques. Following the successful completion of the residency, residents then take their board exams.

There are three exams per discipline. One exam per discipline is a clinical exam that takes place in Florida, where candidates are evaluated on their patient care skills and knowledge. After the candidate passes all of the exams, he or she is then bestowed the title of Certified Prosthetist Orthotist (CPO). Practitioners continue to hone their skills after the exams for the rest of their career by completing continuing education through conferences and courses.

Dankmeyer's practitioners have completed education programs all over the country!  You can read about each individual and their education journey on our Clinical Staff page.

Thanks for your question! - Nina Bondre, CPO

Do you have a question you would like to Ask Us? Email us at info@dankmeyer.com.

 

How do I travel with my prosthesis?

QUESTION:

I am a fairly new amputee and plan to take several trips this summer.  What should I know about traveling with a prosthesis?

Melissa C.

ANSWER:

Melissa,

Here are a few tips regarding the most commonly asked questions in terms of summer travel.

Sweat

Many prosthesis wearers find sweat in the summer months to be a frequent concern.  One way to help battle the sweat is to use an antiperspirant on your limb (e.g. Certain Dri has a roll-on version).  With antiperspirants, it is best to apply them at night so they have time to absorb into your skin.  Consistent use of them will also aid in decreasing your sweating over time.  Also, as you sweat, your limb could shrink in size over the day.  It may seem counterintuitive, but putting on extra prosthetic socks could help improve your comfort by tightening up the fit of the prosthesis to reduce pistoning and keep it more tightly secured on your limb.  It is also a good idea to take the prosthesis off a couple of times during the day to let your limb air out, and it would give you a chance to rinse out (using warm water and gentle soap) and towel dry your gel liner, or wipe off your sleeve.

Beach

Taking your prosthesis on the beach?  You may want to consider protecting the components by wrapping any exposed components with clear plastic wrap, or even better – using a waterproof cast sock (such as Xerosox).  If your prosthesis does get wet with salt or chlorinated water, rinse it with fresh water and then dry it completely with a towel.

Airplane 

If you are traveling by air, TSA has some rules for traveling with prostheses and other medical devices. Before you head to the airport, review TSA’s rules so you don't get any surprises at security!  Check here for traveling with prostheses and other medical devices:  https://www.tsa.gov/travel/special-procedures?field_disability_type_value=6%20

You can print out and fill in a TSA disability notification card to have ready to show the security officer, in order to help avoid unwanted delays:  https://www.tsa.gov/sites/default/files/disability_notification_card_508.pdf

Car

For those long car rides, you may be more comfortable taking your prosthesis off completely.  Never store your prosthesis in a hot car.

Prosthesis maintenance

Do a visual inspection of your prosthesis before you leave.  See any crack or tears in the liner or sleeve?  Feel any excessive motion or loose parts?  Or hear any strange sounds?  It is recommended that you schedule a routine maintenance check of your prosthesis before your vacation, to help prevent any problems that may occur while you are away.  If you have any concerns about your prosthesis following your trip, that is also a good time for a check-in with your prosthetist.

Thanks for your question! - Angie Bryl, CPO

Do you have a question you would like to Ask Us? Email us at info@dankmeyer.com.

 

What do I do if my prosthesis locking pin gets jammed?

Question:

What can I do if my locking pin gets jammed by a foreign object, and I am stuck in my prosthesis?   Andy

ANSWER:

If your prosthesis is equipped with a push button mechanism which releases your silicone liner to allow you to take off your prosthesis, this mechanism is called a shuttle lock. 

Over the years we have seen shuttle locks get jammed with foreign objects such as paper clips, craft paper and even a chunk of coal!  Usually it is a frayed sock, and the fabric gets caught, or the sock is donned in haste and not pulled up to expose the pin, resulting in the pin and sock being pulled into the locking hole. 

RULES OF THUMB to avoid the lock becoming jammed: 

1.  Do not allow the shuttle lock to become dirty.  Build-up of dirt may cause the lock to malfunction. You should attempt to keep water, sand and dirt out of the socket.

2.  Your socks were specifically made with holes in the bottom.  This hole will allow the pin, located at the bottom of your liner, to be completely exposed.  

3.  Always pull socks on completely, no wrinkles allowed!  Socks which are not pulled up allow the opportunity for the pin and the sock to become jammed inside the locking mechanism.  

4. The lock should be inspected and cleaned by a prosthetist every year.  

IF THE LOCK JAMS:

Do not panic and try to pull yourself out of the prosthesis.  Water may be used as a release agent.  Here is what you do:

  • Get a glass of cold water. 
  • Pour the water between your skin and the liner. 
  • Work the water around the liner to cover as much surface as possible.
  • Gently work your limb out of the liner.  You may have to add water several times as you gently work your leg out of the liner.

Do not attempt to fix a damaged lock yourself. Call your prosthetist for service. 

- Mark Treasure, CP, BOCO

Do you have a question you would like to Ask Us? Email us at info@dankmeyer.com.