My classmate & friend Maria and I had the opportunity to attend the National Amputee Coalition Conference in San Antonio, Texas. The Amputee Coalition is “dedicated to enhancing the quality of life for amputees and their families, improving patient care and preventing limb loss.” Of note, almost 2 million Americans have experienced amputations or were born with limb difference, and another 28 million are at risk for amputation. The Amputee Coalition Conference is a wonderful opportunity for both persons with amputees, caregivers and healthcare providers to come together, share knowledge and experience, develop skills and learn about new, innovative technology.
Maria and I began our weekend with the opportunity to shadow researchers from the University of Washington and the University of Miami. Their research is currently related to amputee outcome measures, and it was enlightening to see their procedures and further understand the testing as it relates to K-scores and patient outcomes.
We attended a lecture on Upper Limb Prosthetics by Lisa Smurr Walter OTR/L,MS, CHT, which gave a simple but informative overview of prostheses options for patients/clients to choose from, the pros and cons, and a realistic opinion of them. Since UL prosthetics are relatively rare in comparison it was beneficial to review the patient options and hear first-person what works for patients. The entire conference was unique in this way. Not only were healthcare providers giving information and opinions, patients were there to give their opinions and the facts as it relates to their life. As an SPT I have merely scratched the surface of prosthetics rehabilitation but it’s vehemently apparent that, like all PT, including the patient in the conversation is key to gaining desired outcomes.
In addition to the overview of prosthesis, Smurr Walters included information on the patient-care team, the rehabilitation and advocacy. She reported that patients with upper limb amputations score higher on depression scales, and that partial hand amputees score the highest. As a future therapist, this information is beneficial to understand and be aware of when it comes to including other HC providers on the care team.
Another highlight was the Osseointegration Panel, with 3 internationally known surgeons as well as a physical therapist from Walter Reed National Military Medical Center. It was an amazing opportunity to learn from three surgeons with varying perspectives and techniques.
Dr. Henk Van de Meent, MD – Osseointegration Group of the Netherlands– noted a “key point of [their] treatment program” was the rehabilitation and aftercare aspect. They utilize the Radbound Amputation rehabilitation protocol. Additionally, they utilize a dentistry tool (oral B oxy-jet) to clean the stoma – very similar to a pulse lavage technique – but attainable for patients to do for themselves.
Dr. Munjed Al Muderis, MD – Osseointegration Group of Australia – shared interesting studies of complex patients and highlighted the importance of choosing a physician with good outcomes as opposed to someone who promises quick recovery. He shared various studies on OI patients, including one noting that OI improves patients with bilateral amputation’s quality of life.
Dr. Rickard Branemark, MD, PhD – Integrum – shared the history of osseointegration, from the beginnings of his father’s idea to use OI for dental implants, to the patient who suggested she could use a similar technique in her lower limb. It was a privilege to hear these doctors discuss their techniques, failures and successes, and how the field is everchanging along with the materials and techniques they use.
From a rehabilitation perspective, Dr. Leigh Anne Lechanski, DPT – Department of Defense – shared information on the protocol from Walter Reed. She spoke of an abutment protector for when the patient is not wearing their prosthesis that helps to decrease any pain from accidental bumping of the abutment.
While each of the panel members shared different perspectives, techniques and opinions – the final note was clear: OI is a good option for the right patient, and that decision should be that of the patient and their healthcare team.
At the end of the session, Maria and I had the chance to speak to Dr. Lechanski as well as a person who had received the OI surgery. To gain personal perspective, as mentioned before, was hugely beneficial for me as a clinician and student.
To round out the night, Maria and I toured the exhibit hall and tried out innovative technology, including the COAPT myoelectric pattern-recognizing prosthesis. This prosthetic identifies the users muscular patterns to perform various motions, and then translates it to the movement of the prostheses. For example, the patient is instructed to imagine themselves pointing, closing and opening their hand. The electrodes sense the muscles that activate those “imagined” motions. Then, when wearing the prosthesis, the technology is able to recognize the patterns and perform the point, open and close motions. I admire the innovation of the engineers and wonder what the prosthetics world has in store for the future, from the looks of it – the opportunities are endless.
Day Two:
Before Maria and I went to the gait clinic, we met with our UM grad/Colombia mentor Alicia White, PT DPT who invited us to attend the pediatric walking clinic.
We had two toddler aged patients who were adventurous on their prostheses. Not only were they adorable, articulate children – they played well with us and each other. Making play into therapy is such an interesting concept to me. Something as simple as standing on bilateral limbs to pop a bubble becomes a functional reaching task. We added a blow-up toy beneath the patient’s prosthesis and continued to blow bubbles to challenge her balance while reaching. We also shot foam rockets across the room and had the children walk to get them – creating a perfect “walking task” game. I applaud pediatric therapists for their creativity must be insurmountable.
A few older patients (7-10 years old) came to play: we did the parachute together, made a fort and threw beach balls across the room. We danced, continued to blow bubbles and sat on floaty tubes. Similarly, these things all could be considered therapeutic exercise – and made me realize I should bring bubbles on my next humanitarian trip!
Not only is playing together a vital skill for children, interacting with other children who relate to them is a huge bonus in self-confidence and self-efficacy. One of the patient’s told me she traveled to another state to meet another girl with a similar story to hers. The Amputee Coalition is a perfect opportunity for both children and adults to form relationships with one another.
Gait & Running Clinic with Dr. Gailey, PhD, PT
The double doors swung open, and in front of me were 60+ patients surrounded by therapists, student physical therapists and prosthetists, and CPOs. Each person donned a gait belt and their prosthesis, as Dr. Gailey walked them and their therapist through the next step (literally!). At times, patients appeared frustrated - -but were reassured that they were receiving (at least) four weeks of physical therapy condensed into two hours. These changes cannot all be achieved in one day, but are tips to make gait easier, conserve energy and overall improve quality of life.
Some of the participants were less than a year out from their initial amputation, others were coming back after years of gait clinics with Dr. Gailey to learn something new. As a human being, it can sometimes feel like you are alone in your situation – rightfully so, as each is unique to the person – however, being around persons that can relate to you, level with you, help you and push you is a huge benefit in therapy. The lines of people standing side-by-side quickly became a network of support and friendship.
While, of course, not everyone leaves the clinic with supermodel gait (you probably want a wider base of support anyway) they leave having been pushed to activate muscles they may have forgotten about and unlearn any bad habits they might fall back into.
What has really struck me between my past two experiences in amputee rehabilitation, as well as my time in the UMiami Pro-bono clinic, is the expression of gratitude from both sides. It fills me with pride and joy, as a future therapist, to hear therapists thanking their patient for the opportunity to work and learn together. As patients/clients/participants and therapists we share a symbiotic relationship of personal and educational development. It’s been imperative for me to express this gratitude toward the people I’ve worked with and the reciprocal thankfulness is worth more than anything. This is to say, all the hugs at the end of the morning really warmed my mushy heart!
The running clinic began in the afternoon, and the real fun began! The entire convention hall was cleared out and the patient’s and volunteers formed lines for drills. Piece by piece, Dr. Gailey taught fundamental aspects of running. The patients, he noted, need not don any “tesla-level” prostetic…anyone can run in their every-day prosthesis. I had the opportunity to work with one of the pediatric patients from the morning and though she was challenged at various points, she smiled and cheered for her line of participants. She never gave up on herself, and made her way through the karaoke/braid, despite a few bumps along the way.
As the participants began to get a feel for the run, the smiles grew and the cheering began. Each person in their own personal phase of achievement seemed to be literally making strides of improvement.
And finally, it was time for the relay race. My friend and I were team one, and although team one didn’t win – I would consider the whole day…won. Caregivers, friends and family lined the obstacle course, we cheered, clapped and yelled as each participant made their way through race! The room was electric!
Prior to dinner, Maria and I stopped to say goodbye to a few of the participants before they went to the gala and we went to explore. One had a good question that I will continue to ponder throughout my career: when the patient’s visits are up, how can therapists better encourage their patients/clients to maintain the learned strategies? While the answer is absolutely multifactorial, it lies within the symbiosis I spoke to earlier. As we learn together, we must encourage one another to be better! I would encourage any patient to give me ways to be a more effective teacher for life-long changes.
I had the opportunity to meet so many participants and get to know their stories: how many kids they have, what sports they play, what their current life is like and how they’re always changing. I feel very fortunate to have developed such quick friendships and conquered the day with them.
Maria and I also had time to explore both the Riverwalk & the Pearl District. We also got to catch up with Jenn, another SPT we worked with in Colombia. Though she was unable to attend the clinic, she is currently doing her clinical in San Antonio. It was such a cool coincidence to bring the three of us back together under these circumstances!! And to reminisce on what seems like a lifetime ago, but what we realized was just TWO months prior.
What an amazing, immersive summer it’s been!
If you’re interested in learning more about the Amputee Coalition and how you can get involved next year click me!
As always, if you have any questions regarding this post – you can contact me at Kayleevd@gmail.com or on twitter at @SPTKlee.
Special thank you to Dr. Gailey, Pili Bruce and the University of Miami for their support in making this possible!