Surviving War and Wounds: Stan Patterson, CP talks with Dr. Sanjay Gupta on CNN’s Housecall

Prosthetic & Orthotic Associates of Central Florida’s own Stan Patterson, CP speaks with Dr. Sanjay Gupta and Tammy Duckworth, a Black Hawk helicopter pilot who lost both of her legs and her arm. Here’s an excerpt:

STAN PATTERSON, TAMMY’S PROSTHETIST: She’s a unique individual, being a helicopter pilot, being a female, in that role, you knew that she had the charisma and enough umph in her to, you know, do whatever obstacles that she’s faced.

GUPTA: How’s that feel, Tammy?

DUCKWORTH: It feels, you know, it just feels different. It feels – there’s a lot sort of strapped on here compared to my c-leg, which is very streamlined, but it’s doing more of the work. And I’m just mentally telling myself with each step how to walk, and hopefully that becomes second nature the more I walk on it.

GUPTA: So you’re getting used to it actually means doing less.

DUCKWORTH: Right, getting used to it. The first few times I was walking, I was doing way too much.

PATTERSON: Most amputees at that level, they don’t walk. It’s — they just basically succumb to being in a wheelchair. She knew that she wanted to push that envelope.

GUPTA: Now let me show you something here. This is one of the first real-life applications of this bionic leg. It costs about $100,000. The two legs are actually communicating with each other there, sending all the information to this computer screen as well. You can actually measure the gate, check all that, and make alterations so that her walking can be more normal.

PATTERSON: With this, it reads off a sensor on the left side. And so the Bluetooth sensor senses where the foot is on the opposite limb. And so therefore, it propels the leg forward as the amputee walks. So the engines in the knee actually do the workload.

GUPTA: What is the biggest advantage you think this is going to give you, this leg?

DUCKWORTH: Well, I would love to be able to walk without a cane. I mean, I can do, it but I’m not very stable.

GUPTA: What are you going to do to ensure that other veterans are going to get the same kind of care?

DUCKWORTH: I don’t want ten years from now, when the war’s over and people have forgotten about this war, for some veteran to walk in with this $100,000 leg and not be able to get it serviced.

GUPTA: People are going to forget, aren’t they?

DUCKWORTH: It’s what happens. It’s happened after every single war, which is why right now, I’m going to fight as hard as I can to make sure that we set it up so that when we start forgetting about war, and we should, I mean, who wants a country that’s at war all the time? But let’s remember the veterans.

For the full transcript, click here.

Aired May 26, 2007 – 08:30 ET

Editorial: Experiences with Negative-Pressure Socket Design by Stan Patterson, CP

A Practitioner’s Perspective

It is easy to understand how utilizing elevated negative-pressure technology in transfemoral (TF) socket designs can provide numerous benefits to patients. This trend should carry forward into the future as this technique continues to gain momentum as a viable fitting solution. Due to the absence of bony prominences as compared to transtibial patients, and because of the surface area and the average amount of tissue of a transfemoral residual limb that can be placed under vacuum, this design is one I believe will change how we fit and design transfemoral sockets.

As advancements in TF components continue to evolve, it is important to ensure that the most basic—yet critical—necessities for our patients are not overlooked. Those necessities include a properly fitting socket that is suspended so it provides and promotes healthier skin, a more secure fit, increased proprioception, and ultimately increased patient compliance. All of these variables must be realized in order to achieve maximum outcomes. By encompassing elevated negative pressure into TF socket designs, I believe we can meet and/or exceed these expectations.

With the Information Age upon us, we must realize patients are more knowledgeable, involved, and, at times, more demanding in the care they receive. As a result of the “informed” consumer, we as practitioners must not be oblivious to these wants, desires, and even demands our patients are making of us with regard to their socket designs, even if that means acknowledging the shortcomings of our existing sockets.

Figure 1
    Figure 1: Residual limb,
    14 weeks post op.

Elevated vacuum technology was first introduced to the field in the late 1990s by Carl Caspers, CPO, a transtibial (TT) amputee. His research developed a means of securing the limb in a socket utilizing elevated negative pressure while at the same time controlling as many forces as possible. In 2001, once positive results were achieved through the use of this technology in TT sockets, we chose to explore the possibility of achieving those same results with TF sockets. During the initial stages, we understood conceptually the benefits of utilizing elevated negative pressure in a TF socket, but we did not foresee the swiftness with which the patient would experience the benefits and practicality of it.

We asked our TF patients what the major differences were between their past design and the design using elevated negative pressure, and remarkably all of their responses were similar. The patients stated increased proprioception, decrease in volume fluctuations, increased activity level, lower trim lines, greater range of motion, reduced perspiration, lighter weight, and healthier skin. As with all systems, there are some adverse effects, and with elevated negative pressure those include increased donning time, utilization of a lubrication barrier, and rapid permanent volume reduction until the limb maturates, especially when taken out of pin systems. Hopefully, in the near future, these outcomes can be scientifically verified through non-bias studies in order to produce true clinical results. I assume this is a difficult task because of the limited profitability in socket design versus the high profitability of componentry, which is where the majority of research dollars tend to flow. For the purposes of this article, we can only base our findings on practical outcomes experienced in our facility and others currently utilizing this technology.
Improved Proprioception

The first thing that wearers of a vacuum system notice is that their residual limb feels more securely attached. What a prosthetist calls improved proprioception, an amputee perceives as the prosthesis feeling more like a part of them. There is less pistoning, less apparent weight of the prosthesis, and the amputee is better able to control the prosthesis, resulting in increased stability and gait control. Activities that require fine motor skills, like operating the clutch or gas pedal on a car, are accomplished with greater finesse.
Decreased Volume Fluctuation/Increased Activity

Figure 2
    Figure 2: Wound shown prior
    to vacuum socket.

Patients have long complained of volume fluctuation issues with their socket systems. The socket would fit securely in the morning, and by the afternoon it would feel loose and out of control. I feel this is a result of pressure being placed on the tissue and thus forcing the fluid out of the region, which results in volume loss and an ill-fitting socket. I like to explain it to my patients with this scenario: If an ACE® bandage were wrapped around your forearm with moderate tension applied and you took measurements before wrapping and one hour after wrapping, you would expect to see smaller measurements after the elapsed time. We can rule out atrophy as the cause since it is impossible for this to occur in such a short amount of time. I think it is safe to assume that what we are seeing is displacement of the fluid to a different area. The same thing happens when moderate tension levels are placed on the tissue of a residual limb. Over time the volume fluctuates and causes gapping in the socket. Patients are then required to maintain proper fit throughout the day by adding socks to chase the proper fit. When utilizing an elevated vacuum suspension system, you are expanding the tissue versus compressing it in order to maintain suspension and fit; therefore, the reduction does not take place during the day (in a well maturated limb). This allows the system to control the fluctuations rather than the amputee, thus allowing the patient to increase his/her activity level because he/she is no longer inhibited by volume loss.
Lower Trim Lines/Greater ROM

Figure 3
    Figure 3: Wound shown one week
    after wearing vacuum socket.

By utilizing elevated negative pressure around the distal two-thirds of the limb, the socket is no longer overly compressed in the proximal region. The simplest way of explaining the vacuum on the distal two-thirds is to imagine a water balloon wrapped in a sock (to act as a wick) and placed in a sealed container. Then, with a vacuum pump, evacuate the air from the container, and the water balloon would expand to fit the container. As long as vacuum was maintained in the container, the balloon’s shape would not change. As a result of less compression, there is no longer a need for deep undercuts or underbellies in this area, thus allowing lower trim lines on the socket. The surface area being placed under vacuum allows the trim lines in the posterior, anterior, and the majority of the time in the medial portion of the socket to be lowered. In our practice, the average socket is one or more inches below the ischium in the posterior aspect. We have taken long-time wearers of ischial containment (IC) sockets (20 years or more) out of their designs and into elevated vacuum with outstanding results. The amputees are not only benefiting during ambulation but also when they are sedentary. While seated, they are no longer sitting on their sockets but rather on their glutes. Their range of motion is greater because they are no longer being adversely or needlessly contained. One unforeseen benefit has been for the many amputee golfers. With the vacuum systems and lower trim lines, these patients are able to have more freedom in their swing since they are no longer being inhibited in the proximal region by their socket.
Reduced Perspiration

Reduced perspiration is an outcome quite frankly, I don’t completely understand. The majority of our TF patients report reduced perspiration, while our TT patients don’t seem to have as positive an outcome in the reduction of perspiration. There have been some manufacturers that offer speculations about liners, oxygen, and their combined effect on perspiration, and I have read a few studies on perspiration, but they don’t address many of the uncontrolled variables such as socket fit, an individual’s reaction to heat, longevity of the study, and climate. The bottom line is I don’t think there is enough information to form a logical conclusion at this time as to why there seems to be a reduction of perspiration in TF patients, but I can report that from our practice in Orlando, Florida, this seems to be the case.

Although manufacturers have made tremendous progress in the advancement of componentry and continue to push the envelope in this regard, the socket interface that allows these components to function and perform at their peak must be taken into consideration. The best and most expensive componentry means nothing if comfort and proper function is not achieved in the socket. With improved comfort and a more secure fit in the socket, the improved componentry will allow amputees to fully utilize all aspects of the prosthesis and, in turn, reach their full potential and live increasingly active lives. Issues in socket design must continuously be addressed and improved upon, and it is imperative that the knowledge be shared among the clinical community for the betterment of the patient and ultimately the field.

From The Academy Today, June 2007, Vol. 3, No. 3

Scout Bassett: Succeeding in Life, One Step at a Time

Kids often ask Scout Bassett, of Palm Desert, California, if she wishes she had two normal legs. Bassett, 18, answers, “No. I have never known anything different, and it would seem weird to me. Besides, if it weren’t for the missing leg, I wouldn’t have the opportunities I have today!”

What she means is she has learned important lessons about overcoming big challenges to reach your goals. “When you are missing a leg, it teaches you to appreciate little things—like being able to walk and run,” she says.

Scout has faced big challenges. Born in China, she was left at an orphanage before her first birthday suffering from terrible burns. Her right leg was especially damaged, and doctors amputated it above the knee.

She remembers being hungry all the time at the orphanage. As soon as she was old enough to get around, she was put to work mopping floors, feeding babies, and washing dishes.

And she had to do all that with an artificial leg that didn’t work very well. “It was made of things you’d find in your garage,” she recalls. “Belt straps, masking tape, nuts and bolts. It didn’t feel very good, and clanked, and even fell off sometimes.”

Then, when she was seven years old, a family in Michigan adopted her. Everything about her new life in the United States was better, including the improved artificial legs her parents got for her.

First she got a better leg for everyday activities. It was okay for some things, but she still couldn’t play soccer or basketball.

When she was 14, she got a high-tech leg made for sports and put it to the test right away in a race for disabled athletes. “I remember being terrified because this was my first time,” she says. “But my doctor said, ‘You have to start somewhere.'” Read more

Star of the Week: Scout Bassett

 

Palm Desert senior Scout Bassett lives by the motto “The task ahead of you is never greater than the strength within you.” And if the 18-year old’s strength was measured by what she has endured, it would overpower her 4-foot-8, 78 pound frame.

Scout was orphaned at birth and has walked the journey of life on one leg after losing her right limb in a liquid fire when she was only a few months old. Adopted from China at the age of 7, the spunky and courageous girl was named “Scout” after her mother’s favorite literary character in “To Kill a Mockingbird”. Like the book’s character, Scout Bassett has a fierce disposition toward anything that challenges her.

In fact she sees her situation as a physical challenge, not disability. Which is why she teamed up with Running Coach Alan Woodruff to compete in triathlons. Scout says the satisfaction of crossing the finish line is what keeps her going each day, and she hopes that her courage and strength will inspire others to conquer challenges in their lives.

In the race of life, Scout’s next stop is the campus of UCLA in the fall where the 4.0 student has received a full academic scholarship. She plans on studying political science or broadcast journalism.

To watch the video, click here.

By Kate Longworth
CBS2 Sports
Posted: June 20, 2007 09:02 PM