Changes

During the past few weeks we have been making some changes. Our website has been moved to www.opc1.com. Although the website looks similar, we are confident that you will find it to be a valuable resource. The NEWS section will be updated regularly to keep you abreast of pertinent information and programs at OPC. We invite you to bookmark the new page and check back often.

OPC has entered the world of social networking. In addition to our Facebook page, we are also Tweeting (opc_news). We are now able to conduct some visits using Skype in order to save our patients the drive to the office. Ask about this option if you feel that your concerns can be addressed without a "hands on" appointment.

We have been busy securing prizes and incentives for our New Year, New You, New Foot (or Hand) challenge. The grand prize for the individual with the greatest percentage of weight loss is a new foot or hand. Elliot will discuss the component options with the winner in order to determine what foot (or hand) is the best option for them.

If winning a free foot or hand isn't enticing enough, we have secured a number of other prize incentives. We are excited to announce that Nutrisystem has joined forces with OPC to support this endeavor. The individual with the greatest weight loss after four weeks will win their meal delivery program. No cooking or grocery shopping for a month- talk about motivation!

Gift cards for local services as well as Internet merchants have been pledged. We are aiming to make losing weight and becoming healthy as fun and rewarding as possible. If you haven't already registered, the application is available on this blog. Remember, you don't have to be a patient at OPC in order to participate in the challenge. What's stopping you? Sign up today.

The Blade Runner Controvery Dissected

With the Summer Olympic games slated for next summer, the controversy around Oscar Pistorius, aka "The Blade Runner," has been heating up again. Initially denied eligibility to compete in Beijing in 2008 due to the "unfair advantage" provided by his carbon fiber prostheses, he was eventually granted permission through a lengthy appeal process. Unfortunately, the lengthy appeal process reportedly took him away from training and resulted in his failure to qualify for the team.


Pistorius has been a double below knee amputee for most of his life. Born without the fibula in his legs, his parents opted to amputate both limbs when he was only 11 months old. Always active in sports growing up, he considered rugby to be his sport of choice. He sustained a rugby injury during a game and began running as rehabilitation. He has been running ever since.

Since sprinting onto the international racing scene since 2004, Pistorius has been breaking records and leaving spectators amazed. He currently uses two cheetah legs. Upon beating his sound limb counterparts, controversy started to brew about the design of his carbon fiber feet providing him with an advantage over his non-amputated competitors.


An Olympic scientific committee was convened to examine the issue with the findings of the study confirming the "prosthetic advantage." According to researchers, Pistorius cheetah legs provided him with an astounding 90% energy return, considerably higher than the purported 60% by the intact human foot. Immediately the controversy of whether or not carbon fiber prostheses sparked an unfair advantage hit a furious speed.


Researchers involved with the initial study failed to cite the energy return of the human foot with an intact calf muscle (which, in the case of Pistorious is obviously missing). Some researchers have estimated the human foot, with an intact calf muscle, to have an energy return of 254%. All seem to agree that a prostheses cannot provide more than 90% return due to energy lost due to components.


Disagreement not only exists concerning the amount of energy return by the human foot, but also on the best method to obtain that measurement. The controversy was laid to rest in 2008 not because Pistorius was deemed to have no unfair advantage, but simply because he failed to qualify and his eligibility was a moot point.


With Pistorius expected to qualify for the South African Olympic Team for 2012, the debate is expected to heat up. When asked about the controversy, Pistorius responded by saying, "If you think having carbon-fiber legs will make you a faster sprinter, have the operation and we’ll see you at the track." I think amputees world wide would agree with that assessment!

Now Making (cyber) Housecalls!

Choosing a prosthetist can be a difficult decision. Traveling out of the immediate area to receive prosthetic care can be daunting. The risk of not developing a rapport with the practitioner, worrying about communicating goals, and confusion about the fitting process serve to compound the uneasiness. At OPC, we strive to make the process of exploring our facility a positive experience.

We are pleased to offer complimentary Skype consultations for prospective patients. If you are interested in our services, simply call and ask for a Skype appointment. With a computer and a webcam, you can meet our prosthetists and learn what we can offer. Don't have Skype? It's free and easy to install.

Go to www.skype.com to establish your account. After providing your demographic information, you will be asked to provide a "Skype name" and password. The user name becomes the identifier when making and receiving calls. A prompt will then appear to walk you through the installation process.


With Skype, you have the ability to speak directly with our prosthetists and have your questions answered. Because of the video component, evaluating your current prosthetic components and demonstrating other options become easy. By offering complimentary Skype consultations, we are hoping to alleviate much of the anxiety that often accompanies switching prosthetic facilities. We appreciate the value of your time and want to make getting to know OPC as convenient as possible.

If you are an existing patient, we consider Skype to be another communication tool. If you have a concern about your existing device or have a few questions for your prosthetist, feel free to request a Skype appointment. We are striving to minimize the amount of time that our patients invest when traveling to and from our facility for appointments.

Acupuncture... Know the Facts!

Phantom limb pain is an issue that nearly 80% of all amputees have experienced. The pain is often described as stabbing, burning, stinging or cramping, and the onset typically occurs within the first three years following the amputation. For some, phantom pain can be an inconvenience that occasionally flares up. For others, it becomes a debilitating and chronic condition.

Modern medicine has made strides towards understanding the phenomenon. It is believed that the pain originates in the brain, not in the nerve endings surrounding the amputated site as originally believed. Researchers theorize that the brain's efforts to communicate with and to control the missing limb produces phantom sensations. Commands are being sent by the brain through the nervous system but the pathway has been interrupted by the limb loss. The message cannot reach its destination and manifests in painful sensations.

A myriad of treatment options exist for minimizing phantom limb pain. Physicians can prescribe medications ranging from anti-convulsants to narcotics. Unfortunately, many pharmaceutical treatments result in uncomfortable side effects. Mirror Therapy has proved effective for many amputees. We explored Mirror Therapy in this blog several months ago and the post can be read in the archives.

Many amputees who have tried acupuncture for the treatment of phantom limb pain have reported positive results. Acupuncture is an ancient medical practice that has gained popularity for the treatment of a myriad of ailments, primarily pain related. Physicians and researchers are beginning to embrace the treatment as an effective option.

Those unfamiliar with acupuncture often believe that needles are positioned in the tissue of the residual limb. Professional acupuncturists warn that in order to be effective, the residual limb should not be physically manipulated during the procedure. When performed by a qualified professional, needles are never placed into the tissue around the amputated site.

Acupuncture is commonly performed on the scalp or on the earlobes when treating phantom limb sensation. Although researchers do not fully understand how acupuncture works, the scalp and earlobes have long been accepted as the primary treatment path for pain management. Needles are subcutaneously placed strategically on the scalp or earlobes of the amputee. The needles are turned periodically throughout the session and are in place from 10 to 30 minutes.

Many amputees report favorable results within two hours of treatment, and the effects can last for several days to weeks. Depending upon the severity of the pain, most acupuncturists recommend two visits a week until the pain is under control. Each session takes approximately 40 minutes.

A phone survey of three acupuncturists in our region was conducted. All three clinics claim success treating phantom limb pain. After asking about the site utilized for acupuncture treatment, I was put in contact directly with practitioners at two of the clinics. Both acupuncturists reiterated that the procedure should never occur on the residual limb. One acupuncturist cautioned that if the residual limb was proposed as the treatment site, the amputee should seek treatment elsewhere.

Amputees have reported the successful reduction in phantom limb pain using acupuncture. Although researchers don't fully understand how the treatment works, there is little debate that it can be an effective option for many amputees. If you are plagued by phantom limb pain, acupuncture might be worth a try!

New Year, New You, New FOOT

Amputees have the ideal excuse for being overweight. Few people are going to encourage an individual who relies upon a prosthetic leg to walk more. It would be callous to tell the person missing an arm to lift weights. In general, society forgives those with disabilities for being overweight or obese.

In addition to having a socially acceptable excuse for being sedentary, the amputee population is missing role models in popular culture. The Biggest Loser has yet to feature a contestant with a non-obesity related disability. With all of the "diet themed" reality shows, there has yet to be amputee or an individual exercising in a wheelchair .

Statistics show us that approximately 31% of the population is obese. A Senate report from 2007 states that 69% of amputees are either overweight or obese. The obesity rate for those with limb loss is twice the national average.

At OPC, we are committed to the total health and well-being of our patient family. Since role models are not pervasive in the amputee community, we have decided to uncover our own. We are excited to announce The Biggest Loser, OPC Edition.

The contest will officially launch on February 1st, and registration will be open until February 15th. After three months, the amputee with the greatest percentage of weight loss will be crowned the winner. Oh, and did we mention that the grand prize will be a NEW FOOT (or hand)?

We will be providing incentives along the way to encourage you towards achieving a healthier you! We are in the process of working out arrangements with local gyms and online diet resources to help you on your weight loss journey. Stay tuned because more details will be announced soon.

In the meantime you can register for the contest. Simply click on the "Biggest Loser" tab on the main page of this blog to locate the registration form. If popular culture won't provide the amputee community with healthy and attainable role models for weight loss, let's do it ourselves!

Snow and Ice Stability

A winter weather advisory has been issued for the Baltimore, DC and Northern Virginia region. So far this year we have been relatively lucky about avoiding accumulating snow and ice. If the weather forecasters are accurate, our luck is about to end.

Being a lower extremity amputee poses unique obstacles every season. In the summer many amputees complain of excessive sweating within their liners. In the spring and fall, slipping on wet leaves or nut shells poses a risk of falling. In the winter, the threat of snow and ice strikes fear into many lower extremity amputees.

Slipping a prosthetic into winter boots is not always feasible. Some amputees adapt by wearing a treaded boot on the sound foot while keeping their everyday shoe on the prosthetic. In addition to contributing to instability because of the differing heel heights, the lack of winter tread on the prosthetic side can lead to slipping and falling.

A safer option is donning a pair of Yaktrax Walker Traction Cleats. The hand-wound coils on these cleats provide a full 360 degrees of traction on snow and ice. With each step the metal coils "bite" into the ice to provide stability and thwart slipping. The cleats are easy to slip over bottom of shoes and are quickly removed. The prosthetic does not need to be removed in order to don and remove these ice grippers.

As you are stocking up on milk, bread and toilet paper for the impending storm, you might want to consider picking up a pair of Yaktrax Walker cleats. Although they are available through amazon.com and various on-line merchants, they can also be purchased at Wal-Mart, Target and various shoe stores including Payless shoes.

Wii...

One of the most common difficulties encountered by lower extremity amputees is not properly loading the socket. Uneven weight distribution between legs is a primary cause of gait deviation and lower back and hip pain. When standing, many amputees keep upwards of 80% of their weight on their sound side, in essence relying upon their prosthetic for balance.

Weight bearing habits are hard to break, but the benefits are worth the effort. Improper weight distribution can lead to significant medical implications. Osteoarthritis, neuropathy, sore development and osteoporosis commonly develop in the "sound side." Over time the abuse borne by the "good side" causes breakdown and can increase the amputees' level of disability.

The mind naturally wants to avoid relying on the prosthetic; in fact, it feels counter intuitive to fully load the prosthesis. Research has proven that equal weight bearing will not be achieved naturally by the amputee. Rather, he or she must be taught to learn the sensation of fully loading the prosthesis.

Utilizing two scales, the individual can practice putting equal weight into both limbs. Sensors are available that can be placed between the foot shell and the shoe. When the prosthesis is loaded with a predetermined amount of weight, the sensor goes off. If you own a Wii, there is an easier, and more enjoyable, way to learn to load your prosthesis.

The Wii Fit game comes with a balance board which is used in a variety of game applications for the Wii Fit and other exercise themed games. The game and board have proven to be an effective method for amputees to develop equal weight bearing. Military hospitals and rehabilitation centers around the country are beginning to utilize the Wii fit for prosthetic training.

During the initial set up for the Wii Fit game, and during each subsequent log in, the player is subjected to a variety of "tests." One of these activities evaluates whether or not the players weight is being evenly distributed between their feet. Immediate visual feedback on the screen is provided as the individual attempts to equally load both feet.

The balance games, ranging from skiing to jumping penguins, all force the player to shift weight between their feet. The avatar will not react correctly if the weight on the balance board is not correctly shifted. The Wii fit program advances as the player's skills increase. When a balance skill is mastered a new goal is introduced.

The Wii fit has proven to be an effective way for amputees to refine their balance skills. Learning to properly load the socket, and maintaining equal weight bearing throughout the daily activities will help conserve the sound side, staving off possible injury or increased disability.

Prosthetic Parity

Last spring, Maryland and Virginia joined seventeen other states by passing the Prosthetic Parity Act. This important piece of legislation requires insurers to provide realistic and functional coverage for prosthetic devices.

Prior to the passage of this legislation, many insurance companies bypassed providing adequate prosthetic coverage for subscribers through the implementation of lifetime caps. Unrealistic monetary limits for lifetime care, set as low as $10,000, negatively impacted the ability for amputees to receive the prosthetics needed to regain function. With the average prosthetic costing between $7000 for a bk and 12,000 for an ak, many amputees were forced to settle for less function or had to utilize broken down or outdated devices.

Unfortunately the scope of Maryland's and Virginia's Prosthetic Parity Act is limited to insurance companies inside the state's jurisdiction. Self-insured policies are under federal jurisdiction and are currently not bound by the Prosthetic Parity Act.

It is estimated that 59% of all insured are provided coverage through a self-insured policy. The majority of large companies in the United States offer insurance to their employees through this means. Because the Parity Act does not apply to these insurance companies, many Americans are unknowingly carrying inadequate prosthetic coverage. Despite the passage of the state legislation, many amputees are left unaffected and are still under-insured concerning prosthetic care.

The ACA (Amputee Coalition of America) along with over twenty agencies and organizations, successfully lobbied Congress Parity legislation on the Federal level. On May 21, 2009, The Prosthetic & Custom Orthotic Act of 2009 (H.R. 2575) was formally introduced on the House floor. Under this legislation, all insurance companies providing for prosthetic and "custom-fabricated" orthotic devices must provide coverage equivalent to the coverage offered for medical and surgical care.

Passage of this important legislation would create an access to prosthetic devices for a large portion of the amputee community who currently find themselves under-insured. Providing adequate prosthetic insurance coverage for all insured individuals will allow the amputee to return to work, to become more physically active and increased productivity. With the passage of this law, the loop hole that keeps prosthetic care out of reach for so many insured amputees would be closed!

In the coming months Congress will be reviewing the Prosthetic Parity Act. We will keep you informed of the progress of this groundbreaking legislation.