Published on September 5th, 2016 | by David


Are Prosthetics The Best answer For Amputees?

Every few months, there’s exciting news about the latest in prosthetic technology. Most recently, the Department of Defense unveiled a hand with sensors that can feel pressure. Footage of the device is impressive—a patient uses his mind to control a robotic hand that can sense pressure, shake hands, and grasp delicate objects.

Prosthetic technology is certainly advancing rapidly, but there’s a catch. For most people, these state-of-the-art devices are neither attainable, nor well suited for day-to-day life. In fact, for the average person, something far simpler is often in order. Yet what amputees need and what they get can often be quite different—and the question of what makes something “state-of-the-art” can be a confusing one.

One in every 190 Americans currently lives with a lost limb. But the person you generally see in televised breakthroughs is actually the exception when it comes to amputees. Only about 15% of amputees are trauma victims and cancer survivors—the types of patients who most often make good candidates for high-tech prostheses. About 80% of amputations are due to vascular diseases like diabetes. Weight gain, cardiovascular issues and general immobility make it hard for amputees with vascular diseases to get up and walking again at all after an amputation, let alone running around on a myoelectric leg.

Even those who are fit, mobile, and looking to get the most advanced technology then face the question of cost. A myoelectric arm, a design that uses a person’s own muscle contractions in the residual limb to control the device, can cost up to $100,000. The C-Leg, an above-the-knee prosthesis with a microprocessor in the knee, allows users mobility and flexibility, but can cost $70,000. Add a state-of-the-art foot to that and you’re looking at another $5,000.

“We waste a lot of money in getting people into technology before they understand what that technology’s value really is,” says Robert Radocy, an amputee turned prosthetist who founded TRS Inc.

There has never been a scientific study comparing body-powered prostheses with electronic ones. But there may not need to be. Radocy, though a staunch advocate for body-powered devices, doesn’t believe there’s a single solution. He understands that not everyone might want a body-powered prosthesis that looks more like a clamp than a hand. And there isn’t the equivalent of a body-powered prosthetic arm for lower extremity amputations—prosthetic legs with articulated movement have to be electrically powered. What he does argue is that amputees should know what their options are before being wooed by a “state-of-the-art” device—especially in instances where a myoelectric arm may not hold up. “People should be given some choices,” he says.

In some cases, not wearing a device at all, or using a wheel chair instead, is the right choice. Many farmers with upper limb amputations decide not to wear prosthetic devices, even body-powered ones—they find them too hard to manage and even dangerous on the job. Christin Elnistky, a nurse and researcher at the University of North Carolina, organized a panel for women amputees to express their needs. One explained that while she was pregnant, it was using a wheel chair rather than her prosthetic leg that gave her the most ability to move around and stay independent. “Sometimes not wearing, or using another technology like a wheelchair, maximizes their independence,” Elnitsky’s research concludes.

This, perhaps, is the most important aspect of the field—not the gadgetry or the motors or the electrodes or the sensors—but understanding each patient and what makes them the most independent. Elnitksy says that patients aren’t just equal partners in the conversation—they’re more like customers, there to receive a service. “I come to you with a service need, I can tell you what it is I want, you find a way to meet my preferences,” she says. The mark of a great prosthetist is one who can listen to those needs and preferences, figure out which device will work best, and fit that device properly to the person. Sometimes that device is an electric arm or a microprocessor knee. But sometimes it’s not.


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