PROSTHETIC ENHANCE INDEPENDENCE
BY TRACEE SIOUX

Whether it’s enhanced athletic ability or simply being able to reach cookies on the counter, independence makes an enormous impact on quality of life.

Spencer Hawk is an active, bright 10-year-old. If all goes well with an upcoming surgery, he’ll be getting new prostheses from Prosthetic and Orthotic Group in Fort Collins and Loveland in August. Spencer and his family hope new legs will allow him more independence as he matures and his interests broaden.
Spencer was born with Thrombocytopenia-Absent radius (TAR) syndrome, causing, among other health concerns, painful bent legs and very short arms. In 2008, Spencer’s left leg was amputated, and doctors attempted to straighten his right leg with a titanium rod.

“My legs were bent, and since they were bent, all I could do was scoot on my knees, but it would hurt my knees all the time, so I could not stand up,” says Spencer. “I had a knee scoot and I always got wounds on my knees.”

“Double amputees rely solely on their arms, but Spencer’s arms are so short, they really wanted to save the leg,” recalls Jennifer Powell, Spencer’s mother. The concern was with Spencer falling forward without normal-length arms to catch him. A natural leg supplies more balance than a prosthesis.

After a time, complications and excruciating pain rendered his right foot non-functional. Six months of unendurable pain later without achieving a functioning leg, Spencer’s right leg was amputated as well.

Spencer currently has ill-fitting prosthetic legs that he doesn’t like to wear. He’s grown out of them, they are too heavy, and the feet don’t keep his balance as well as he’d like. When he falls, it’s much further and hurts far more than when he falls from his residual limbs.

Without his prostheses, Spencer skateboards, walks, takes karate classes and is on a swim team. With prostheses, Spencer can reach higher things, walk on hard surfaces, and achieve a height more equivalent to his peers.

“When I can’t reach things that are taller than me, I can get in my legs and reach the thing that I need,” he says. “I can walk around in them, like my stumps, but with my stumps alone I can only walk on soft surfaces, while on my legs I can walk on hard surfaces. With stump liners I can walk on soft and hard surfaces, but I’m still going to be shorter.”

“With legs he can look people in the eye and be able to reach things; since he was born with short arms, the height is a big thing,” says Powell.

From Dependence to Independence

As her son’s caregiver, Powell is concerned that as Spencer grows into adolescence and adulthood she, or future caregivers, won’t be able to lift him without new prosthetic legs.

“Especially for caregivers, when he has the legs on it makes it so much easier to transfer him; he’s 84 pounds [now],” Powell says. “I consider [prosthetic legs] a necessity for living an independent life. He may not be completely independent, but he will be able to stand and sit and walk and reach things on his own. My husband is 6’4” and my brother is 6’3”. We know Spencer is going to be a big guy, that’s a lot of torso to lift for the person caring for him as an adult. It’s also much harder to burn calories without legs. Ideally, if he can walk faster, comfortably and safely, he can accomplish being in better shape.”

Children often need new prostheses annually, depending on how quickly they grow. Spencer had to postpone new prostheses when they discovered that his two residual limbs aren’t growing at an equal rate, which could eventually have a negative impact on the alignment of his hips, spine and neck if left untreated. Prosthetic and Orthotic Group in Fort Collins made the discovery when they were fitting Spencer for his new legs. The new prostheses had to be postponed until after his corrective surgery this month.

Spencer’s new legs will be lighter-weight, with better suspension and a vacuum seal to attach the prosthetic legs to his residual legs.

“Spencer’s a special kid and he’s got unique issues,” says Chad O’Connor, certified prosthetist at Prosthetic Orthotic Group. “We look at what he does on a daily basis. And, when you’re dealing with a child, you want them to experience everything in life and not be hindered by anything; we want Spencer to be able to do everything that his friends do. We looked at what kind of device is the best component-wise – what type of knee or foot and how the legs are held on. Because of Spencer’s arms, we have to take into account how much he can do himself. Basically, you want a prosthesis to be as functional as possible and not hinder them at all. It’s a fine line between functionality and becoming too much of a hindrance.

“His new legs will have vacuum suspension, so the legs are held on with a suction effect,” O’Connor continues. “It’s a neat technology that better connects prostheses to limb for overall stability and really good suspension.”

O’Connor will take a cast of Spencer’s residual limb, and from that cast he’ll make a mold out of his limb. He’ll make changes to it to take into account scar tissue, where they don’t want pressure, because it would be painful. From that mold he’ll make the socket. They’ll use a fiberglass cast tape for the mold and then fill that mold with plaster to get a physical representation of the limb. The socket will be made out of fiberglass and carbon.
Spencer can’t imagine it yet because he is uncomfortable in his current prostheses, but O’Connor hopes that Spencer’s new legs will become so intuitively a part of him that he’ll be able to use them in his karate classes and on the swim team – and all the things boys his age love to do.

Prosthesis Enables Paramedic to Help Others
Eric Gundlach, pictured here with wife Courtney at Arches National Park in Moab, is a paramedic who loves cycling and snowboarding. Gundlach requires a prosthesis that can take him over rugged terrain.

About nine years ago, Eric Gundlach lost his leg in a boating accident. The 37-year-old paramedic has a prosthesis on the left leg below the knee. Hanger Prosthetics and Orthotics in Boulder is fitting him for a new socket, which he will wear in July for his belated honeymoon to Italy.

“I work out in western Eagle County; it’s a more rural ambulance service, not every house has a safe approach to it and sometimes we’re in the back country and actually have to walk over or carry people over uneven terrain,” says Gundlach. “I do it, relying on my prosthesis to be steady and able to carry someone else safely. Without some of the technology we have today, I don’t know if I would be able to do it.”

“Eric is a trans-tibial amputee,” explains Angela Montgomery, certified prosthetist and orthotist at Hanger. “Which means he’s missing his leg below the knee. However, like a lot of people who have traumatic accidents, they salvaged his knee, but it’s not a perfect knee. There’s a lot of soft tissue damage that effects the mobility on his leg.”

Prosthetic technology, with vacuum suspension, shocks and lightweight carbon fiber mechanisms, allows Gundlach to safely lift injured people across uneven terrain for his job. Aside from his job, Gundlach leads a very active and rugged lifestyle. He enjoys bike racing, motorcycle riding and hiking. Without access to newer prosthetic technologies, his lifestyle would not be the same.

“The vacuum seal Eric has is like it is suctioned onto your body,” explains Montgomery, “With every micro-move you make it’s right there. He’s fallen in love with this technology and it’s become something he wouldn’t do without. As part of that vacuum pump, there’s a vertical shock and a torsion rod. The torsion rod means that he can plant his foot and twist it side to side. That’s important because he’s a cyclist, snowboarder and paramedic. He’s in all kinds of unpredictable situations. His foot is a dynamic foot that offers energy return so that it springs back and recoils. It also has ground compliance, which means that when you step on a pebble, it will lift on that side versus just staying flat.”

Gundlach is currently wearing a test socket created by Montgomery. Once the mold is created, a person wears a plastic test socket for a week or two to determine if there is rubbing or uncomfortable pressure. If there is discomfort, they make adjustments until the fit is comfortable before they proceed with the carbon fiber permanent socket. Adults need to have the socket remade every few years because the residual limb changes over time and the fit becomes uncomfortable.

“You can’t always tell how the socket will fit without walking around in it,” says Gundlach. “I wouldn’t find problem areas until I had the finished product. Now I can say, ‘This part hurts, it’s rubbing here,’ and she’ll change the shape of it. Once we get the shape right, she’ll make the rigid carbon fiber version.”
“Eric is a great guy,” says Montgomery. “I think it’s really admirable, the work he does as an amputee. We have another client who is a police officer. They have very physically demanding jobs. Eric has to be able to drag people out of the woods. It is pretty amazing.”

New Technologies Driven by Veteran Amputees

Montgomery is excited about the new technology, but notes that the newest, most innovative stuff takes some time to become available to the general population.

“The direction that we’re headed is [to be] more integrative, something that is more connected to the body, instead of just this external tool or attachment that you use,” Montgomery says. “Science and technology are trying to make prostheses more a part of a person. Rather than something that hangs off the body like a hammer, we’re trying to use technology and computers to make it more intuitive.”

Microprocessors with algorithms that react to the external environment are an exciting new advancement. This type of technology isn’t yet rugged enough to endure the type of activity Gundlach needs his prosthesis to perform. Montgomery likens it to taking a very expensive laptop camping or across a stream – you wouldn’t do it because it’s too valuable. Montgomery has no doubt that the new technology will eventually be rugged enough, because the demand is being driven by soldiers returning from Iraq and Afghanistan in need of prostheses.

“I personally believe it’s because of the patient population of the Veteran’s Association (VA). These 20- to 40-year-old guys are demanding more rugged microprocessor technology,” says Montgomery.

Prosthetic devices can be extraordinarily expensive, ranging from a basic rudimentary design for $5,000 to up to $100,000 for the newest microprocessor technology for a single leg.

The VA and Department of Defense innovates many of the new technologies for veterans. Those with workers’ compensation legal settlements and those with disposable income are usually early adopters. Once a technology has proven success for several years, Medicare begins to cover them. Only then do private insurance companies follow suit and the general population gets access to them. The technology, however, doesn’t tend to become more affordable, Montgomery notes.

This month, during the Fourth of July weekend, over 600 people gathered at the bi-annual, International No Barriers Summit in Winter Park to share new discoveries and the latest scientific innovations meant to assist those with disabilities in leading more active lifestyles.

Presenters included the head of MIT Biomechatronics, Hugh Herr, who lost both legs at the age of 17 due to severe frostbite. Determined to keep climbing, he designed and built his own prosthetic legs and feet. His prosthetic device, PowerFoot uses springs and a half-pound lithium ion battery to give the same push off the ground as a human foot, adjust to slopes, walking up and down steps, and hanging casually when one sits.

Current innovations are good news for Spencer and Gundlach. While their new prostheses do not yet have microprocessors, they provide basic independence and even an ability to perform in physically strenuous jobs. As Spencer grows into an adult, the microprocessor technology and prosthetic innovations of the near future will make his adult independence far more likely and, as these innovations and inventions make their way from veterans to the general population, professionals like Gundlach will better be able to perform their jobs and enhance their athletic ability.

Tracee Sioux is a Fort Collins writer. She can be found at www.linkedin.com/in/traceesioux/.