From family setback to career inspiration

Isaac Yoder

You never know what – or who – will inspire a kid’s career choice.

At age 14, Isaac Yoder learned that his mother, Robin, would need a leg amputated due to cancer.

“Honestly, I don’t remember much about the day itself,” he recalls. “I was going into the first year of varsity football so my mind was in a lot of other places. At 14 I was trying to grasp life changes you can’t prepare for.”

Robin adds: “It was either give up your leg or you will not survive cancer,. He told me, ‘Mom, amputate your leg so you can have the best chance to see me grow up.’”

Thanks to the inspiration of his mother and the team at Powell, Yoder, now 23, is on track to become an orthotist or prosthetist so he can help others improve their lives.

Yoder studied exercise science at Lenoir-Rhyne University and is about to begin the Master of
Science program in prosthetics and orthotics at the University of Pittsburgh’s School of Health
and Rehabilitation Sciences.

It’s a journey that started with an office visit to Powell with his mother, an athletic and goal-
minded social worker who participated in triathlons and running races.

“We were in Joe (Sullivan’s) office and with Scotty (Poindexter),” Robin says. “We spent two
and a half hours at the office and they showed him prosthetics and talked to him and explained
the journey to get mom back to functioning. It planted the seeds of giving us hope.”

For Isaac, it also inspired a career.

An early influence

Six weeks after the first visit, the family was back at Powell for Robin’s first prosthetic. Isaac was
present to see the process and how Robin’s new leg was made.

“That early influence started by being comforted by a team of people,” Robin recalls. “Isaac saw
me getting on track with the best possible team who knew how to work with me. He began to
get influenced when Scotty took his own prosthetic leg off and put it in Isaac’s arms. He said,
‘This is will be what it’s like.’” It set a different tone. Joe and Scotty had a positive, hopeful
attitude and made us part of it and put us at ease.”

After initial interest in physical therapy, Isaac realized he enjoyed making and fixing things and
working with his hands. The combination of his desire to help others and build something
turned his focus to orthotics and prosthetics. An internship in North Carolina, where he worked with a patient to get a prosthetic casted and molded in one day, as well as ongoing visits to
Powell, including recently being involved in a casting process to create a new socket for his
mother, sealed the deal.

“What led him down the path was Joe and the clinic and it opened his mind to be helpful to
people,” Robin says. “Isaac took it all in. He will be an earth angel to someone who needs the
help.”

Isaac now is preparing to start graduate school. He’s looking forward to bringing a positive
attitude to those in need and making a difference.

“I could take my personal experience as a family member and apply that to people,” he says. “I
can now talk to kids and tell them, ‘I was in your shoes.’”

Isaac prefers working in a setting similar to Powell thanks to Sullivan’s encouragement: “He
didn’t have to do it for me but he’s making me a better practitioner.”

Curvy Girls Provide Group Support for Scoliosis

Marissa

As if puberty isn’t awkward enough, each year about 3 million new cases of scoliosis are diagnosed in the United States. 

Scoliosis, the sideways curvature of the spine, shows up most often during growth spurts, usually when kids are between 10 and 15 years old. While the same number of boys and girls are diagnosed with minor idiopathic scoliosis, curves in girls are 10 times more likely to get worse and may need to be treated with braces. 

Coming at a time when pre-teen girls are self-conscious about body image, the idea of wearing bulky braces can be especially daunting for a kid who just wants to be normal.

Enter Curvy Girls, a support group for girls with scoliosis.

Led by girls who share the same challenges and concerns, Curvy Girl members meet regularly in Richmond to talk about anything they’d like.

“It offers girls a comfortable and supportive environment to help each other carry on daily life with a brace,” says Jaime Gates, whose 12-year-old daughter, Ella, one of the group’s co-leaders. “Things like what do you wear under your clothing? How do you tie a shoe? They truly lead the meeting and Curvy Girls International (the parent organization) gives them the tools.”

Ella

Ella and co-leader Marissa, also 12, met at a Curvy Girls meeting in Norfolk and are patients at Powell Orthotics and Prosthetics, where orthotist Beth Martin customized their braces.

“The parents are in a separate room during Curvy Girl meetings, giving the girls a chance to talk freely,” explains Marissa’s mother, Shannon Wood. “That way the parents can talk about issues, bounce some ideas off each other and learn about new ways we can help.”

Signs of scoliosis

While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown.

If you look at someone’s back, you’ll see that the spine runs straight down the middle. When a person has scoliosis, the backbone curves to the side. Anything that measures more than 10 degrees is considered scoliosis.

The most effective treatment is with a customized brace. There are a number of different rigid-back braces available that vary in how pressure is applied to the spine and ribs to prevent a scoliosis curve from progressing. Some braces require full-time wear, typically 16 or more hours a day, while others are worn at night while sleeping.

Given the impact of a brace on daily living, it’s helpful to have a support network for girls 8-18, Gates says. 

“It’s a journey and every girl’s journey is different,” Gates says. “Everyone in the group is there to give advice, comfort and listen on that journey.”

“It’s a lot of responsibility for young children,” adds Wood. “When my daughter was first diagnosed, it was a tough period and very painful. She was the only kid in her school with a brace. We were searching for help. Through Curvy Girls she got to meet peers in a brace. It’s made a world of difference.”

Gates has two daughters with scoliosis. “They were on this little island together and no one to understand what they were going through,” she says. “And you truly don’t get it – how uncomfortable a brace can be, the pain, having to sleep in it and yet figure out how to let them be a kid. Just to have these girls together and able to talk privately about wearing braces is so wonderful.”

Gates and Wood also credit the support of Martin and the team at Powell. “They care about their people and they want them to have every opportunity,” Gates says.

They encourage parents to have their children checked out during regular pediatric visits. A simple bend-over test can catch a problem early, especially if scoliosis runs in the family.

“The sooner the better – in elementary school before growth spurts,” Wood says.

Curvy Girls meet monthly at different locations. To learn more, please send an email to Richmond@CurvyGirlsScoliosis.com.

Discover Your Possible

New one-day event offers resources and skills for amputees and caregivers

Not every amputee is on the same path to recovery.

For Robin Yoder, an athletic and goal-minded social worker, losing her right leg to cancer could
have been a devastating setback. For someone who participated in triathlons and running
races, though, it was just another challenge to overcome.

But she quickly realized not everyone heals the same.

“Looking back I was naïve,” says Robin, an eight-year amputee. “I was a success. An athlete my
whole life. I had big goals with David Lawrence, physical therapist and owner of Lawrence
Rehabilitation, The Gait Center, and Joe Sullivan, prosthetist and co-owner of Powell Orthotics
and Prosthetics. I walked and ran quickly and did a triathlon that first year. I was in my own,
isolated world getting those skills back. I assumed everyone else was recovering at the same
pace.

“I assumed in my own naiveite that even though I was going through a struggle physically and
emotionally, I learned about frustration and perseverance through athleticism. I was assuming
everyone else was progressing like as me but they weren’t showing up at races.”

When she realized other amputees needed more resources and encouragement, her fix-it
instinct as a social worker kicked in: She created “Discover Your Possible,” a one-day, affordable
skills/education and activity clinic in Richmond for individuals living with lower-limb
amputations regardless of their activity level.

She does not have the physical therapy background to lead such a workshop but she is
connected to the people who are. Robin pitched her vision and idea to Lawrence, founder of
Mission Gait, and his team. Mission Gait accepted the lead role in this unique first-time event.

“This event is a result of a vision to help people have the opportunity to discover what they are
capable of,” Robin says. Discover Your Possible is open to all skill levels of lower-limb amputees,
their caregivers and families to learn new skills and explore activities such as running, fly-
fishing, kayaking, wheelchair sports and much more.

“This is an event designed to improve capabilities and confidence,” Robin says. “We’ll have
experts available from the physical therapy/prosthetic specialties along with community
partners from the adaptive and therapeutic recreational areas helping those attending from
basic skills to a high level of activity.”

The first Discover Your Possible will be held from 8:30 a.m.-4:30 p.m. on Saturday, April 27 at
Mission Gait, 8191 Staples Mill Road. The $20 registration includes lunch. Caregivers, families
and students are welcome to attend for $10.

Powell is proud to be a sponsor for the event.

Filling a community need

Robin says the event is part of an effort to show amputees that life doesn’t have to be
stationary.

“Learning to live with limb loss is hard and leaning to use your prosthesis is harder,” she says.

“It requires determination and motivation, along with good a support team. You need a highly
skilled and compassionate prosthetist and a physical therapist with prosthetic specific training
who can educate you about the unique challenges you will face and the resources available to
you. If just one of these is missing or weak, progress and success may take longer or not
happen at all. The goal is for you to be the best that you can be.”

Participating in support groups, Robin said she wanted to provide motivation to give fellow
amputees something more to be hopeful about. Through her position as a board member with
Mission Gait – a non-profit organization that empowers the physical rehabilitation community,
through education and research, to help patients with complex gait disabilities learn to move
again with confidence – her idea for a hands-on clinic took hold.

“This is a wonderful way for amputees in the Richmond area to get together, learn new skills,
network, and learn about the resources available to them in a supportive environment,” she
says. “We want this to say – there is an active and fun life for you beyond therapy.”

The event includes education, drills, equipment demonstrations, a panel discussion and three
breakout sessions to try new activities, including running, wheelchair tennis, golf, hand-cycling,
circuit training and more.

The guest speaker is Cosi Belloso, a physical therapist dedicated to working with amputees. The
owner of Palanca Physical Therapy, a prosthetic training specialty clinic in Tampa, is the host of
Cosi Talks, a Facebook page teaching amputees, clinicians and supporters about topics that
impact their daily lives.

Powell’s Joe Sullivan will be among those participating on Belloso’s panel discussion.
“I’ve been blessed to have the right people in my world and the motivation,” Robin says. “I
can’t teach it but I’m connected to the people who are. Let’s showcase this day that brings

people together in a united front who care for and live with lower-limb amputations to move
beyond therapy to enjoy what is possible.”

For more information and to register, please visit www.missiongait.org/events.

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.

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 45^th 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.

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.