What is the difference between prosthetics and orthotics? Why would someone need an amputation?

How long after amputation can I be fit with a prosthesis? How long will I have to remain in hospital? What is your fitting protocol? What outcome should I expect?

What is enhanced vacuum? How does that system differ from a conventional prosthesis? Why is this important? How do I know if the system I am wearing has enhanced vacuum?

How soon will I be walking after being fit with a prosthesis? How long will my prosthesis last?

Who will pay for my prosthesis and what is required from the client who presents at a prosthetic facility?

What are "orthotics"?

Does a prosthetist make foot supports? What kinds do you make?

What is CBC?

  What is the difference between prosthetics and orthotics? Why would someone need an amputation?

Prosthetics is the branch of medicine pertaining to replacing what is missing, and orthotics involves bracing an existing part of the body. Amputations occur as a result of diabetes, necrotizing fasciitis and other bacterial infection, circulatory disease, and trauma. Some people may be born with non-functioning limbs (congenital birth defects) that can be made useful by reconstructive surgical techniques. Amputation is not a medical failure - it can save lives and ease chronic pain. It is an opportunity for the surgeon to fashion the most appropriate residual limb for prosthetic usage. It is a good idea to meet with your prosthetist prior to surgery if circumstances permit. Your prosthetist will want to look at the physical aspects of your limb, discuss with you possible fitting techniques, and assure you that, following amputation, you are a full human being who will get better and carry on with your life. With a multi-disciplinary rehabilitation team consisting of the patient, physician, prosthetist, and physical therapist as the core members, the goal of optimum patient outcome can be achieved. Each member of the team has specific duties; and cooperation, respect and understanding must exist among the members of the team.

  How long after amputation can I be fit with a prosthesis? How long will I have to remain in hospital? What is your fitting protocol? What outcome should I expect?

Immediately following surgery, you will likely be fit with a shrinker sock, which acts to minimize edema in the residuum. Following amputation, once your surgeon has discharged you from hospital, an amputee can often recover more quickly at home, encouraged and surrounded by loved ones, using out-patient services with careful monitoring to ensure that the wound is clean and compression is properly applied.

As your prosthetist, upon receiving a prescription from your medical doctor, Stan begins the fitting protocol with a polyurethane liner which, in conjunction with a barrier cream:  (1) protects the limb from infection, (2) limits the amount of swelling, (3) begins to shape the residuum, (4) conditions the skin, and (5) provides the best physiologic environment for healing to occur. Once the sutures are removed and slight weight-bearing can be tolerated, the actual fitting can begin.

The style of prosthesis is important to your rehabilitation. In Stan's experience, a total surface bearing system, with enhanced vacuum, is the optimum choice. You will first be cast for a temporary socket. A well-fitting socket is the key to a properly fit prosthesis. Often several temporary check sockets are required to monitor whether total surface contact is being achieved and to capture the shape and volume changes which the residuum will experience. Then together we select a system that will work with your lifestyle. Once fit with the prosthesis, you will begin to feather your weight onto the prosthesis using a walking aid initially, and gradually transferring your weight to the prosthetic side as in normal gait.

Your prosthetist should be willing to spend considerable time with you, and you with your prosthetist. It is therefore important, when selecting your prosthetist, that you are able to establish good communication. Ideally, you will want to interview several prosthetists prior to commencing your first fitting. Use the Yellow Pages of the telephone book ("artificial limbs") or the internet, or obtain a list of facilities in the province from the Alberta Association of Orthotists & Prosthetists (c/o Debbie Moe, Secretary, 11024 - 127 Street, Edmonton, AB T5M 0T2 (780) 452-9513). Find out about the prosthetist's credentials, level of education and experience, as well as his or her fitting protocol. Ask about the facility's location (parking, access to public transportation) and cleanliness. You and your prosthetist will have an ongoing relationship for the rest of your life. You will need to be educated concerning the proper care of your skin, maintenance of the prosthesis and what danger signs to watch for. You should not experience blistering, abrasion, soreness, irritation or discomfort. Return to your prosthetist immediately should you experience any of the above.

  What is enhanced vacuum? How does that system differ from a conventional prosthesis? Why is this important? How do I know if the system I am wearing has enhanced vacuum?

Stan Wlodarczyk is an Adjunct Instructor certified in the TEC^R and VASS^TM systems. In the summer of 2001, he introduced into Canada the Vacuum Assisted Socket System (VASS^TM) that was created by TEC Interface Systems of Waite Park, Minnesota (later bought by Otto Bock Health Care). This technology is believed to be the greatest breakthrough in prosthetics since polymers. The merits of VASS^TM are continuing to be reported. The VASS^TM system was developed to manage daily volume fluctuations in the residual limb of lower-extremity amputees. It uses the Harmony^TM pump and employs a reverse pressure concept. The total weight bearing socket creates the optimum suspension socket environment. The VASS^TM system creates an elevated vacuum between the liner and the socket wall. It will manage volume fluctuation and control perspiration, reduce shearing to the residual limb and liner, and increase suspension and proprioception. Perspiration, edema, and other fluid movement can result in size changes in the residual limb of as much as 6-12% throughout the day. This forces the wearer of a conventional prosthesis to insert materials, such as wedges or extra stump socks, to retain a proper fit. Proprioceptors are sensory nerve endings that give information concerning movement and position of the body; they occur chiefly in muscles and tendons and provide feedback to the brain. When properly fit by the prosthetist, the enhanced vacuum system allows many amputees to wear a very comfortable, controlled prosthesis. The majority of Stan's lower extremity clients have been fit with the enhanced vacuum and total surface bearing combination. Amputees are always impressed by the way the prosthesis adheres to the residual limb. It enables the amputee to know where the heel will strike, thus allowing amazing trust and control.

  How soon will I be walking after being fit with a prosthesis? How long will my prosthesis last?

With enhanced vacuum and total surface bearing systems, you will be walking immediately after fit and alignment are established. Most people will leave the facility with a working prosthesis after two or three visits.

Many factors influence how long a prosthesis lasts. Once the limb has matured into its preferred shape and size, with regular maintenance a prosthesis may last three to five years on average. Components will need to be replaced occasionally due to wear or upgrade. Also, weight gain or loss or revision surgery may require that a new socket be made.

  Who will pay for my prosthesis and what is required from the client who presents at a prosthetic facility?

                     Alberta Aids to Daily Living (AADL)

                     Workers' Compensation Board

                     Alberta Blue Cross

                     Veterans Affairs

                     CHAMPS

                     War Amps

                     Private insurance

A new amputee requires a prescription first time from an orthopaedic or vascular surgeon or physiatrist and thereafter from a medical doctor. You will also be asked for the following:

Alberta Health Care, Alberta Blue Cross identification numbers

Private insurance identification number, insurer's name and address, signed insurance claim forms (once work has been provided and provider is ready to make a claim)

Specific paying agent information:

AADL (Alberta Seniors and Community Supports) currently covers Alberta residents and their dependents. For amounts claimed by the provider, AADL requires a signed Client Declaration Form (acknowledging that client will pay 25% of cost, to a maximum of $500 each fiscal year and will properly care for the device. Note: An application can be made for full benefit assistance for those who are not able to pay the $500 deductible. A prescription (valid for six months) is required for certain items contained in the fee schedule (check with your prosthetist). Quantity limit: one per affected limb each two-year period if deemed irreparable, unless otherwise indicated on the fee schedule, i.e., one liner each year, six sleeves, twelve sheaths, twelve socks per affected side. Payment is made directly to the provider.

Workers' Compensation Board covers work-related claims for prosthetics. It requires pre-authorization from a case worker if the item is over $750 or replacement is required prior to eligibility. A prescription may be required. Client must sign the provider's invoice to indicate that the work has been completed. WCB asks that the client complete a satisfaction survey. Payment is made directly to the provider.

Alberta Blue Cross offers supplementary coverage to the AADL program and administers "Coverage for Seniors" on behalf of AADL. ABC almost always requires a prescription for seniors (valid for six months). Client must sign a Health Services Claim form and a Health Services Assignment form. This enables the provider to invoice ABC directly on client's behalf; otherwise, client must pay provider and obtain reimbursement from ABC.

Veterans Affairs - Veteran identification required. For a first-time claim, client must have a prescription from an orthopaedic surgeon or physiatrist. Work must be pre-authorized. Certain items require further prescription. Client will have to sign the claim form upon completion. Payment is made directly to the provider.

War Amps - effective January 1, 2008, provides up to 7% of the cost of one new conventional prosthesis applied towards a preparatory or definitive prosthesis, once every three years to a maximum of $700.

CHAMPS is the children's prosthetics program of The War Amps. The program is for children under 18 years of age. Pre-enrolment is required, and pre-authorization is essential prior to work commencing. Components may be eligible for replacement on a more frequent basis than once every three years due to growth. Payment is made directly to the provider.

Private and/or union insurance - Often an employer or a union will provide additional coverage, or an individual may have an enhanced insurance program (e.g., Alberta Blue Cross). Clients should check with their employer or union concerning coverage, eligibility and requirements for prescriptions, claim forms, etc. If possible, the provider should be paid directly, as the amount that would be required for the client to pay may be considerable.

Please note: Several of the above agencies will assist with financial aid for orthoses as well, according to contractual fee schedules; however, many do not cover foot supports.

  What are "orthotics" ?

Commonly, people will refer to "orthotics" as foot supports. In actuality, "orthoses" are the devices that a person would use or wear to enhance function or reduce or eliminate pain. "Orthotics" is the practice of using applied knowledge in the assessment and fitting of such devices.

  Does a prosthetist make foot supports? What kinds do you make?

We have been making foot supports for many years. The types we make rely on the physical aspects of the problem presented. Not all foot problems can be solved with one type of foot orthosis. Some require shear control and accommodation, such as in the neuropathic foot of the diabetic, while others require firmer control of foot motion, such as in the pronating or "flat" foot. Some are for mechanical pain control, as in plantar fasciitis, while others are for shock absorption, such as in the cavus or "high arched" foot. We use materials like silicone, urethane, closed cell foams, cork, plastics, carbon fibre, and leather. The type of material used is critical to the motions we want to allow and to accentuate and the motions we would like to control. The methods used for obtaining an impression of the person's foot are many. We mostly utilize the "foam in box" method. We have done tracings of the foot and plaster casting, in some cases. All available methods are but tools to use in getting a desired result. The outcome of the intervention will only be as good as the skill with the "tools." We hand-make all of the supports on premises. Tendon ruptures, plantar fasciitis, joint degeneration, flat feet, arthritis and ankle instability are but a few of the problems that can be addressed by foot orthotics. The solutions are many, but comfort and control are always the goal.

  What is CBC?

In 1966, the Canadian Board for Certification in Orthotics and Prosthetics (CBC) was founded to encourage and promote high standards and to develop competence and professionalism.

Practitioners whose education and experience meet CBC requirements are eligible to take the examination. Those individuals who pass, receive certificates in their discipline. These certificates must be renewed each year to maintain good standing.

Practioners must keep their skills and education up to date (mandatory continuing education credits) through publications and continuing education courses offered by these organizations.

A certified practitioner can be identified by the credentials C.O., C.P., or C.P.O. Certification may be in either orthotics (C.O.), prosthetics (C.P.) or both (C.P.O.). The designation is usually followed by the country in which certified, for example Canada (c) and America (a).

In Alberta, in addition to being members of the Alberta Association of Orthotists and Prosthetists (AAOP), many practitioners belong to national and international organizations such as the Canadian Association of Prosthetists and Orthotists (CAPO). Stan is a member of the American Board for Certification in Orthotics and Prosthetics (ABC), as well as the American Association of Orthotists and Prosthetists. He is the first Canadian ever to receive his Fellowship with the American Association of Orthotists and Prosthetists (FAAOP). This designation is the highest achievement in continuing education offered by the Academy. It represents the years Stan has dedicated to the discipline of prosthetics and his continuing acquisition of knowledge.