Friday, March 15, 2019

High-tech orthotic braces helping student walk again


Four years ago, Taylor Roberts, then a sophomore at VCU, was driving just a mile from her parents’ house in Powhatan when another vehicle rammed into hers, pushing her into a telephone pole.
She suffered compression fractures in her lower spine – an injury that, for many, could lead to a lifetime in a wheelchair.
But Taylor had other ideas. Upon the start of her out-patient rehab, she began working with Powell’s Beth Martin, a certified orthotist, on what would become an amazing recovery.
“Without Powell, I wouldn’t be where I am today,” Taylor says. “It’s crazy how much a good support system can do not only mentally, but also physically.”
Taylor started her recovery in a back brace following two spinal fusion surgeries. Once cleared of her restrictions, should would take her first steps since the accident in a reciprocating gait orthosis (RGO) brace that Powell made for her.
Providing the necessary stability she needed at her hips, she used this brace for several months before progressing to long leg braces, known as KFOs. Taylor would be using these braces for the long haul.
It wasn’t until she participated in a clinical trial using a powered walking device called the “Indego exoskeleton” that she would progress into the next phase of learning how to walk again. After the trial, Taylor began progressing into ankle braces with the help of physical therapy and the support of Beth and the Powell team.
“Statistically I was not likely to regain the function of walking,” Taylor says. “The prognosis was a wheelchair.”
Now, with the help of technology, she’s about to take a big step.
Enter the C-Brace
New technology is revolutionizing the capabilities of orthotics and prostheses. Taylor is a candidate for the C-Brace, a computer-controlled knee, ankle and foot orthosis manufactured by Ottobock that combines mechatronics (mechanical, electronic, computer, and systems design engineering) with custom orthotics to help people walk.
The C-Brace opens up entirely new possibilities for users with its microprocessor sensor technology. Flexing under load while sitting down, navigating slopes, walking on uneven terrain, or going down stairs step over step, it can open a new level of mobility for those like Taylor.
Small and light, the C-Brace enables the user to wear the orthosis underneath clothing. The unit’s microprocessor sensor makes the entire gait pattern more dynamic and responsive.

“This is going to be a game-changer,” Taylor says. “It will make me independent again by walking and it could change a lot of people’s lives.”
She is working with Ottobock and Powell to become the first person with her type of injury to use the device. “It’s easier to use than you think,” Taylor says. “It’s significantly lighter and will fit snug against my legs.”
With an eye on mobility, Taylor reflects on her injury and the support from family, friends and Powell to keep her spirits up.
“There’s no way to prepare for an injury like this,” she says. “It changes everything. It was difficult to swallow the harsh pill of reality. But Beth was very encouraging and uplifting and will do what she can to help you achieve your goals.”
That includes finishing her degree at VCU. She’s studying journalism with hopes of possibly becoming an advocate for accessibility.
“I spend most of my time in Richmond and, like many cities, it’s just not accessible for wheelchairs,” Taylor says. “The thought of being able to independently get in and out of local businesses would be so liberating for me since I hate to draw attention to myself. Now I have a new outlook.”
And graduation in the near future.

Tuesday, March 5, 2019

Powell resident to present research at national conference


You never know where inspiration will come from.
For Anna Clark Seibert, a first-year resident at Powell, it came from a university classmate, a Marine named Rob Jones, who lost both legs at or above the knee during combat in Afghanistan.
Anna, who was studying pre-med at Virginia Tech at the time, decided to pivot to a career in prosthetics.
“I visited Rob at Walter Reed (National Military Medical Center) and followed his successes to maneuver through life with so much success,” Anna recalls. “It made me fall in love with this profession. Until then I wanted to be in the health care field but didn’t know where my fit was.”
Well, she found it.
Anna is in the first of two years of residency at Powell – one for prosthetics, the other for orthotics. The program enables master’s-degree graduates a chance to work with patients, learn the business and prepare for the rigorous board certification exam.
“I want to be as impactful as I can in the field I love,” she says.

Presenting to national conference
One step to that goal came March 6-9, when she presented an academic paper called “Prosthesis User Experience and Coping Strategies – a Social Media Content Analysis” at the 45th annual meeting of the American Academy of Orthotists & Prosthetists, a national organization.
In the paper, she and co-authors conclude that social media content can help practitioners obtain a more detailed and unfiltered understanding of the interests and concerns that are prevalent within the limb-loss community. Support groups on social media sites such as Reddit and Facebook can be a valuable resource for patients coping with limb loss, albeit it with different information.
The topic came from her own interest in documenting the role of social media to help patients and their families.
“I was mostly curious about prosthetic life hacks but unfortunately I didn’t find a ton of them,” she said. In the process, she and her colleagues collected a year’s worth of data (1,305 posts) and coded the entries to get data points.
Always on the lookout to help patients, Anna hopes to carry out future studies to ensure patients and their families have access to helpful information online at a trying time.
Looking ahead, Anna says she’d love to work with children in part because she can see the same patients more as they grow out of equipment.
“They’re especially resilient and they give it their all,” she said, adding: “Kids also take direction well.”
In the meantime she’ll be greeting patients of any age at Powell.

Tuesday, January 15, 2019

House Bill 2669

2019 SESSION
19104397D

HOUSE BILL NO. 2669 
Offered January 11, 2019 

A BILL to amend the Code of Virginia by adding a section numbered 38.2-3418.15:1 and to repeal § 38.2-3418.15 of the Code of Virginia, relating to coverage for prosthetic devices and components. 
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Patron--Roem (By Request)
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Committee Referral Pending 

Be it enacted by the General Assembly of Virginia: 

1. That the Code of Virginia is amended by adding a section numbered 38.2-3418.15:1 as follows:

§ 38.2-3418.15:1. Coverage for prosthetic devices and components.
 
A. As used in this section:
 
"Component" means the materials and equipment needed to ensure the comfort and functioning of a prosthetic device.
 
''Limb" means an arm, a hand, a leg, afoot, or any portion of an arm, a hand, a leg, or afoot.
 
''Medically necessary prosthetic device" includes any myoelectric, biornechanical, or microprocessor-controlled prosthetic device that has a Medicare code.
 
''Prosthetic device" means an artificial device to replace, in whole or in part, a limb.
 
B. Notwithstanding the provisions of§ 38.2-3419, each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; each corporation providing individual or group accident and sickness subscription contracts; and each health maintenance organization providing a health care plan for health care services shall provide coverage for medically necessary prosthetic devices and their repair, fitting, replacement, and components.
 
C. The coverage required under subsection B shall be subject to the following:
 
1. Coverage for medically necessary prosthetic devices does not include:

a.    The cost of repair and replacement due to enrollee neglect, misuse, or abuse; or

b.    Prosthetic devices designed primarily for an athletic purpose.

2.    An insurer shall not impose any annual or lifetime dollar maximum on coverage for prosthetic devices other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy. The coverage may be made subject to, and no more restrictive than, the provisions of a health insurance policy that apply to other benefits under the policy.
 
3.    An insurer, corporation, or health maintenance organization shall not apply amounts paid for prosthetic devices to any annual or lifetime dollar maximum applicable to other durable medical equipment covered under the policy other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy.
 
4.    An insurer, corporation, or health maintenance organization shall not impose upon any person receiving benefits pursuant to this section any coinsurance in excess of 30 percent of the carrier's allowable charge for such prosthetic device or services when such device or service is provided by an in-network provider.
 
5.    An insurer, corporation, or health maintenance organization may require preauthorization to determine medical necessity and the eligibility of benefits for prosthetic devices and components in the same manner that prior authorization is required for any other covered benefit.

D.    The provisions of this section shall apply to any policy, contract, or plan delivered, issued for delivery, or renewed in the Commonwealth on and after January 1, 2020, or at any time thereafter when any term of the policy, contract, or plan is changed or any premium adjustment is made.
 
E.    The provisions of this section shall not apply to short-term travel, accident-only, or limited or specified disease policies; contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under state or.federal governmental plans; or short-term nonrenewable policies of not more than six months' duration. 

2.    That § 38.2-3418.15 of the Code of Virginia is repealed.

3.    That the provisions of this act shall become effective on January 1, 2020.



Monday, October 1, 2018

Tips for daily living

Losing a limb is a life-changing event. How much of an effect it has on your daily life depends on each individual and situation. For some, it’s just a momentary pause before life gets back to nearly normal, but for others it can be a dramatic change in lifestyle where every activity is somehow different. It’s not only the amputee who has to make changes, often family members, friends and caregivers – even coworkers – must adapt as well. 
If you are an amputee, you’ve likely found ways to adapt your life, whether it’s through a prosthesis or other means or a combination of both. If you’re a recent amputee, we’ve gathered a few items and ideas that will help you in the days and months to come.
  • Thick Leggings: The thick material holds up better against wear. If they do happen to wear, a quick stitch or two fixes the problem.
  • Elastic shoelaces. These little miracles stretch so your foot can slide into the shoe without loosening the laces.
  • Clear pathways. Navigating a cluttered stairway or overflowing garage may not have been such a big deal before, but as an amputee, you’ll want to have a wide, clear path for navigation to prevent tripping and falling hazards.
  • Pant clips can help single-handed people who find it hard to pull up pants and underwear.  Clipped to the front of paints, they can be removed and tucked away for later use.
  • Daily living accessories such as voice-controlled lamps, light switches and phones, doorknob-turners, button aids (picture), dressing sticks (picture), one-handed cutting boards – you would be amazed at the variety of aides available today.
  • Velcro can be used in a variety of ways to assist in daily activities. Many use it on the bottom of their prosthetic foot to keep on any kind of dressy flats, sandals, flip flops or other shoes that don’t tie, in place.
  • Iron on reinforcement patches secured to the inside of pants can help keep the socket from rubbing away at the material.
  • Bra fastening adapters can help those singled handed ladies with the nearly impossible task of fastening a bra.
Life after limb loss is all about finding ways to what you want, in the best ways that work for you. You may not be able to do things the same way, but with some adaptation, you’ll eventually develop systems and habits to function and get the tasks accomplished. Have you discovered your own trick to make life easier? If so, drop us a note and let us know.

Wednesday, May 30, 2018

Curvy Girls Unites Scoliosis Patients



Founded 2006 by Leah Stoltz, Curvy Girls (https://www.curvygirlsscoliosis.com/) is an international scoliosis peer support system. Leah founded the organization “talk to other girls who were going through the same thing--- feeling alone, different, angry about their brace, and worried about having to have surgery.”

Leah’s Story
“Fitting in isn’t easy when you’re a teenager wearing a body brace 23/7. I was finishing my first year in middle school when I was diagnosed with Adolescent Idiopathic Scoliosis and had to wear that “thing” to school. I wore my brace faithfully despite arguments and failed attempts to hide my brace in my locker. Ultimately, I required surgery to correct the two curves growing in my back. On June 27, 2006, I had two titanium rods and 22 screws affixed to my spine. My biggest concern was that I wouldn’t be able to dance for a year.”

Curvy Girls acknowledges that scoliosis affects the patients both physically and mentally. “While the back brace is supporting our bodies, Curvy Girls is our emotional brace. We need to help our girls feel better about themselves from the inside out.”

Patients are able to find local support on the website and local leaders within their own neighborhoods. In the Richmond area, Marissa and Ella are Curvy Girl leaders excited to connect with new friends.

Marissa is 11 years old and excited to be a Curvy Girls' Leader. She was diagnosed with scoliosis in June 2017 and began wearing a Boston Brace in August 2017. She wear it for 16 hours a day, even though she says it is “SO uncomfortable!” She did get used to her brace and now enjoys acting, musical theater, singing, playing piano, dancing, and hanging out with friends and family.

Ella is 11 years old and loves staying active in sports and with her friends. Her favorite sport is gymnastics, but she also plays soccer, dances and is on the swim team.  She was diagnosed with scoliosis in August 2017, the summer before her 5th grade year.  Her curve was at 20 degrees and she was told she needed to wear her back brace 18 hours per day. She has 2 sisters and is in the middle sister.  Both Ella and her younger sister were diagnosed with scoliosis at the same time. Her younger sister is 8 years old and has a 25-degree curve.  Both girls feel blessed to have a sister to share their journey. She is excited to be co-leader with Marissa of the Richmond area Curvy Girls’ group. Her hope is to carry on the positive message and support that she has received for many girls in the area. 

Next meeting is:
June 17th at 1:00pm
July 15th at 3:00pm


Then e-mail Marissa and Ella for location.

Tuesday, May 1, 2018

How To Get Active For Spring



Thank goodness for Spring! Longer days, warmer temperatures, and the opportunity to get back out there and enjoy our favorite spring sports and activities. If you’re a new amputee, or maybe you’re been an amputee for a while, but are ready to be more active – now is a great time of year to get started. Sports are a great opportunity to connect with other amputees and enjoy the camaraderie of taking on challenges together. You might have some questions on what’s right for you, so we have a few tips to get you started.

There are many opportunities for people living with limb loss to get back out in the world and live an active lifestyle. The activities range from golf to running to rock climbing and skiing to much more.  The amount of activities that can be adapted for amputees to participate is nearly endless.

One of the easiest activities to get started in is cardiovascular exercise. Most people still hate it; but its benefits are essential to good health. Cardiovascular exercises strengthen your heart and reduce body fat. Getting your heart beating a little faster also helps to relieve stress, which is also important for a healthy overall well-being.

“There are many forms of cardiovascular exercises that amputees can take part in, with or without a prosthesis,” according to The Amputee Coalition,  “Some are better suited for active amputees, while others are better suited for those who are beginners or who may have medical restrictions.”

There are many options of cardiovascular equipment to choose from. If you don’t have access to cardiovascular equipment, or a gym membership, now is a great time of year to get outside and enjoy nature. The weather is still relatively cool, and perfect for getting some fresh air. On days when the weather is not so great, walking on a treadmill or riding a stationary bike is a good way to get started.
If you’re ready to progress into something different, looking for an organized team, or just more information - we’ve compiled a list of resources for more information about specific sports or organizations.
  • ActiveAmp.org has a large directory of sports and activities for amputees
  • Disabled Sports USA’s mission is to provide national leadership and opportunities for individuals with disabilities to develop independence, confidence, and fitness through participation in community sports, recreation and educational programs.
  • The Amputee Coalition, provides a downloadable fact sheet of sports programs.
  • The National Sports Center for the Disabled (NSCD) is one of the largest therapeutic recreation agencies in the world. The NSCD offers a variety of year-round sports and recreational adventures.
  • The Wheelchair Sports Federation is a national non-profit that provides opportunities for the disabled and wheelchair-bound adults and youth to play sports recreationally and competitively.
  • New England Disabled Sports (NEDS) is a 501 (c) (3) not-for-profit organization, providing adaptive sports instruction to students of all ages and abilities. 
  • The National Amputee Golf Association (NAGA), is supported by the Professional Golf Association (PGA) and the United States Golf Association (USGA). NAGA currently has over 2,000 members in the United States and some 200 players from 17 other countries.
  • The American Amputee Soccer Association (AASA) is the governing body for Amputee Soccer in the United States and is a member of both the World Amputee Football Federation (WAFF) and the United States Soccer Federation (USSF). Their outreach programs help interested players maximize their proficiency, build self confidence, learn the power of teamwork, all while building a strong social network.
  • The Wounded Warrior Amputee Football Team’s (WWAFT) mission is to raise awareness and support for our wounded warriors and their families. The team is made of up service members who have served and are now using a prosthetic device to engage in everyday life activities.  By showcasing our team on the football field, the WWAFT seeks to inspire our fans and highlight the perseverance of our service members (both active and former) who continue to face life’s challenges without excuses.
  • Ski 2 Freedom provides free information so that people with physical disabilities or other special needs and their families to enjoy the physical and affective benefits of mountain activities such as skiing or snowboarding.
  • Sportable. The reason Sportable exists is to transform the lives of people with physical and visual disabilities through sport!
  • Challenged Athletes Foundation. A group that supports those with physical challenges – empowering them to find community, confidence, and conviction. 
  • USA Paralympics. A division of the nonprofit United States Olympic Committee, is dedicated to becoming the world leader in the Paralympic Movement and promoting excellence in the lives of people with Paralympic-eligible impairments, including physical disabilities and visual impairments.
  • Sheltering Arms. An adaptive golf program at Sheltering Arms offers education and opportunities for safe and enjoyable participation in golf.

Monday, April 2, 2018

Knowing the Patient is Key to a Lifelong Partnership

Knowing the Patient is Key to a Lifelong Partnership

Powell Orthotics and Prosthetics has provided freedom for patients since 1932. Years of professional experience, craftsmanship, and technology enable Powell to provide the benefit of mobility and independence to patients.

To provide patients with a superior device, the staff at Powell O&P first wants to get to know you. It’s important to understand your lifestyle and goals. Whether you’re returning to work, walking the dog, cutting the grass, playing with your children, running or just simply getting around. Each device is unique and custom fabricated to fit your needs.

A vast amount of componentry options are available today and Powell’s experienced staff, with your input, is here to ensure you receive the most appropriate device. They take the time to explain each option, helping to fit patients with a device that meets their needs.

 And it all starts with a scan.

We spoke with Michael R. Monteiro, Certified Prosthetist, ABC, and owner of Powell Orthotics and Prosthetics about the process to make a prosthesis for a patient.

Michael took us through the first step in the process, showing us the machine used for scanning the patient. “The scan works just like a satellite system,” Michael said. “It’s all radio waves so they don’t feel anything except for the pressure of me rolling this across their limb. It takes an image of it and puts it onscreen. It’s pressure sensitive so if I press in deep, it will show a deeper presence on screen, so it gives me tissue feedback, kind of like you do when you hand cast.” They run the scanner across the remaining limb, to make the prosthetic limb match the size and shape.

“After that,” continued Michael. “I have an image on screen. I manipulated it to what I need it to do to allow the patient to stand up. There’s areas we want to put pressure on, there’s areas we don’t want to put pressure on. I do all that and I send the file to Scotty, who’s our technician.”

Scotty will then carve out a model and create a clear socket for the patient to stand up on.

        
From standing to walking
This is an example of someone’s limb, after manipulation. Michael showed us his computer rendition of the scan. “This is what our socket will end up looking like when we’re finished,” he said. “We put space in for bones, there’s a small bone at the top of your leg a little nerve runs behind it just like your funny bone only it’s in your leg. So the kneecap sits up in here and the end of the bone we build out, because there’s usually just skin and bone like your shinbone - not much coverage. We try and make it a little between the bones we squeeze, on the medial side of the fibula bones we squeeze. If we make it triangular shape, when you move, the prosthesis moves as well.”

The CAD drawing gives Michael a vision of what everything will look like. He demonstrated how he can rotate the image and look at it from behind and down inside it to make sure he likes what he’s seeing.  He explains that what he sees when he scans someone is “more or less what we see if we have someone sitting on the table.” Michael points to areas on the screen, “All these areas, I create to help him stand up. It disperses weight and pressure, kind of like a bed of nails…if you don’t feel any of them, you won’t have any problems, if you feel one of them, it’s a problem.”

Once Michael is pleased with the scan and manipulations on screen and is sure he’s been able to disburse all the pressure and body weight out, he sends the model to Scotty for carving. Michael starts with the computer, but his partner Joe, prefers the traditional way by hand casting a model first and making the changes and then scanning it in and sending it to Scotty.



Michael then showed us a room full of blank forms and a lathe.  He explained that the lathe has a CNC processer, and carves in 2 planes as it moves. The material they use is harder than Styrofoam because they have to pull plastic over it and they don’t want it to compress. They send the file to the lathe, carve it, and then end up with the model.

Once they have a carved model, all patients receive a diagnostic socket. This diagnostic socket is clear, so the team can stand the patient upright, check to make sure everything’s fitting properly, make sure they have pressure where it’s needed, and make sure they don’t have pressure where they don’t want it. The diagnostic socket is made from a low-temperature plastic, so that if there’s an area causing issue, Michael and team can take it off and heat it up, make a change, cool it down and slide it back on.  “We can modify the diagnostic socket and 90% of the time the patient can walk on this, so they know statically and dynamically how it feels,” said Michael. “Standing may feel good, but walking around may feel different because the body’s doing different things.”

After the carving is complete, a clear plastic pre-form dome goes into the oven, with adapters that go on the end – depending on what they intend to put into the socket.  The oven vacuum forms the plastic based on time and temperature. They then trim the piece out and end up with a plastic socket ready for adapters that they can then attach to a tube system and a foot. “We want them to try it on and stand,” said Michael. “We want them to stand and walk on the feet they’re going to use, because it’s going to feel different with different feet on there. Again, if we need to make changes, we can heat it up, press it out, cool it down and slide it back up on them, to make sure everything’s comfortable before they leave.







The perfect fit

The challenge is finding the right match with the patient’s wants and the patient’s needs. “What they think they want and what they actually need may be different,” said Michael. “There are a series of tests that are pretty predictive of patient’s ability, for newer patients, that’s done during the measurement. If you can walk with a walker or with crutches, vs. some who’s in a wheelchair – that helps determine what kind of feet or knee components we’re going to start with.”

New amputees receive what’s called a preparatory prosthesis, which is designed to get them walking in therapy and limb shrinkage.  The preparatory is designed to get the patient down to a stabilized size, once muscles complete their atrophy and stop losing mass. This process takes about 4-6 months after a patient starts walking. At that point in time, it’s time to start all over again – it’s time for the new leg.

“We use a gel liner, either silicon, urethane or TPE plastic to cushion and protect the skin,” continued Michael. “Almost everybody can benefit from having a gel liner against the skin. It grips the skin, it protects the skin from rubbing blistering and irritations, that’s why it’s so universally used. Some have a pin that goes into a lock, and that acts as suspension, so as they move the prosthesis moves with them.”

Prosthetics have certainly come a long way in appearance thanks to today’s technology. “We can do any color a patient wants,” said Michael. “If patients bring us a shirt, or something special they want on their prosthesis, we can laminate that on there with a clear coat, so whatever the fabric on there can show through.”

We mentioned how important it is to understand the patient’s lifestyle and goals. “We never want the prosthesis to limit someone, but we don’t want to build it so technical that they can’t use it, or can’t generate enough force to use it,” said Michael. “People always say they want ‘the best,’ and they associate the best with the most expensive. I can fit you with a Porsche, I can fit you with a Combine. If you’re a farmer, the Porsche is not going to help you. The cost is about the same. It’s really about finding out what your needs are and fitting you with the best product to fit your needs. Then you’ll get the most out of it.”

“There are dynamic feet, which will give energy in return, and there are energy absorbing feet to give you lots of motion,” Michael says. “If you’re hopping up and down on trucks, you may need something that has a lot of cushion, if you’re walking around a constructions site, you want something that will give you all kinds of side to side motion, because you’re stepping over all kinds of terrain and if you’re sitting in an office all day, you’ll want a smooth foot, if you’re a runner, you’ll want something that allows you to do that.” The process is really about patient matching. Same thing with prosthetic knees, there are a plethora of options depending on patient capabilities and needs.”

In speaking with Michael, it’s clear he and his team have a progressive and honest approach to getting patients back to their daily lives. They have a number of amputees on staff, allowing them to have a unique perspective on their patient’s daily challenges and how to prevail. They know their job is not done when the prosthetic is finished – they have resources for patients, such as support groups and county and state resources to help patients get back to living the life they want.