Monday, April 30, 2007

New limbs for new lives

QUESTION: How are prosthetic limbs made?

ANSWER: First, a prosthetist fits the amputee’s limb with a compression garment to reduce the swelling that occurs after surgery. Next, the prosthetist takes an impression of the limb with plaster of Paris, fiberglass or, most commonly, a 3D digital scanner. Using the positive impression of the limb, the prosthetist designs a clear test socket and asks the patient to walk on it to test the fit. After making any adjustments, the prosthetist makes the prosthesis from a carbon graphite composite material. Depending on the patient’s needs and desires, the prosthetist may then cover the prosthesis with foam in the shape of the patient’s leg and lastly, a silicone covering that matches the patient’s skin tone. Most people need to replace their prosthetic limbs every two to five years because of wear and tear and changes in body shape.

Q: How much do prosthetic limbs cost?

A: The cost varies greatly, depending on the patient’s needs. A below-knee prosthesis can cost anywhere from $8,000 to $20,000, largely depending on the design of the foot. An above-knee prosthesis can cost $15,000-$20,000. A prosthetic leg built with a computerized knee can cost $40,000-$65,000. Designed for active patients, computerized legs anticipate what the wearer is doing and accommodate every change by using microprocessors to control the knee’s hydraulic function 50 times a second.

Q: Does insurance cover the cost of prosthetic devices?

A: Medicare usually covers 80 percent of the cost of a prosthetic device. Coverage by insurance companies varies; many place limits on their coverage. Several states have passed or are considering prosthetic parity laws that would require insurers to provide better coverage for people who need prosthetic devices. The Ohio Orthotics and Prosthetics Association plans to introduce such a bill in the Ohio state legislature this year, and the Amputee Coalition of America is working with a small set of activists to introduce a prosthetic coverage bill in Kentucky.

Sources: Pat Flaherty and Steve Roller, certified licensed prosthetists at the Brace Shop in Mount Auburn; Enquirer research

Going mobile / City Councilman hopes high-tech limb can get him up to the ‘M'

Missoula City Councilmember Jon Wilkins walks up a small knoll with his new prosthetic foot on Thursday as prosthetists Cara Negri and Doug Turner follow. Wilkins' new Proprio Foot, one of the first 100 on the market, enabled him to walk up the incline, which he couldn't do with his old prosthetic. “Normally I wouldn't even attempt this,” Wilkins said.
Photo by TOM BAUER/Missoulian

Jon Wilkins hasn't been able to climb Mount Sentinel for more than 20 years. In 1990, a boulder crushed his foot while he was laying pipe and the accident led to a partial leg amputation.

Wilkins, a member of the Missoula City Council, has walked with a prosthetic ever since, and it tires and hurts him. The rigid, artificial limb requires a lot of energy to move. In fact, people with such injuries use 35 percent more energy to move than do folks using their own limbs.

Climbing stairs often sends a bolt of pain down Wilkins' back, and he hasn't been able to walk far without sitting and resting. He definitely couldn't walk straight up a hill - until Thursday.

On Thursday morning at Western Montana Orthotics & Prosthetics on Reserve Street, a team of prosthetists fit Wilkins with the first Proprio Foot to hit Montana and one of the first 100 on the market. The new foot and ankle look to be improving not only his body, but his entire being.

With “the world's first motor-powered and intelligent prosthetic foot” secured to his left leg, a beaming Wilkins marched straight up a knoll without even a wobble.

“I've never been able to do that,” Wilkins said. And setting his sights even higher, Wilkins decided to climb to the “M” on Mount Sentinel.

“That's my goal. I haven't been up to the ‘M' in 20 years,” he said.

Developed by an Iceland-based company called Ossur, Proprio was released just nine months ago and received an award for excellence in medical design earlier this month.

Wilkins was paging through an issue of Popular Science when he learned about the foot and ankle. A computer in the foot records the wearer's typical gait. It senses angles and then flexes like a real foot.

His old artificial limbs don't have computers and can't bend at the ankle, either. That means Wilkins has to walk sideways to go up and down inclines. Stairs are hard, too, because he has to swing his leg around and over every step. If he doesn't, his toe catches.

Since the construction accident along Highway 200, he's worn out four prosthetics, though they're not completely out of commission. Wilkins sets them out as decorations on Halloween.

When he read about the computerized foot, he called his prosthetist, Doug Turner, to learn more. They decided to give it a shot, and it helped that workers' compensation approved the expense. At $35,000, it costs some three times more than a traditional artificial limb, though to Wilkins the benefits appeared to be vast, too.

Two representatives from Ossur's California office were in Missoula helping Wilkins learn to use his Proprio. In the office, Wilkins joked about his disability: “You ever seen a one-legged man swim?” he asked. You haven't, he said, because he only swims in circles.

He joked and tested out the foot as Cara Negri, an Ossur prosthetist, adjusted it to fit.

In a brand-new pair of hiking shoes and fresh socks, Wilkins stood, walked and sat back down. When he sat, he even let his foot relax and bend. That action allowed his upper leg to relax, too, which he hasn't been able to do without removing his prosthetic.

Ossur's Nicholas Antonucci explained that Wilkins' body had learned to walk a different way to compensate for not being able to rely on that foot, and his body would readjust.

“He's going to walk a lot better and feel a lot better,” said Antonucci, an Ossur manager.

In fact, Wilkins felt better within a couple hours. He climbed a small hill head on - “That's just unbelievable,” he said, as the team looked on.

“That is really impressive,” Turner said.

Wilkins didn't need to sit and rest after the climb, nor did he feel the stab of pain.

“It saves so much energy. It's just absolutely phenomenal,” said Turner, who also wears a prosthetic.

Over time, people who wear prosthetics put more pressure on their spines, hips and knees, he said. They also are acutely aware of the paths on which they travel by foot. They know which side of the street the good sidewalks are on. They see even the smallest divots in the grass and avoid them.

“I think about every step I take,” Turner said.

They pay attention to where they are in space, and they can't take that for granted - “If you do, you fall on your butt,” said Wilkins, and he meant it literally. An ice patch once threw him to the ground.

The Proprio Foot will help, and he wants other people to know it's available.

“I felt it was a fluke that I found it,” he said.

Wilkins, a combat veteran, said he especially wants other veterans to know about the opportunity.

He believes his endurance level will go up as he uses his new leg. He plans to hook a fish again, too.

Since he hasn't been able to walk up and down riverbanks with his old prosthetic, he's been relegated to fishing from a boat on a lake.

He hasn't caught a thing. So he's going to head to the Blackfoot River, and he plans to take that hike up Sentinel, too.

“I think I can get to the ‘M,' ” he said. “I'll wait a week, but I think I'll try it.”

Young Gaza amputee takes steps in Oakland

By Angela Hill, STAFF WRITER
Article Last Updated: 04/29/2007 02:50:57 AM PDT

OAKLAND — He was early for his appointment, of course. Seven-year-old Abdallah al-Athamna, who has been staying with Fatima and Adli Rasheed and their children in San Ramon for the past month, could barely sleep the night before. He talked nonstop Thursday morning while Adli Rasheed drove him to the specialist's office in Oakland, as if somehow the rush of words would make the car go faster.
After all, this very day was the reason for Abdallah's visit to the United States. This was the day he would get his new leg.

The bright-eyed little boy lost his lower right leg, just above the ankle, last Nov. 8 when Israeli shells fell on his family's house in the Palestinian city of Beit Hanoun, on the northeast edge of the Gaza Strip.

His mother was killed, as were his two little sisters — 3-year-old Maram and 9-month-old Maysaa — and 15 other members of his extended family. At least two other people died, and 40 more were injured. It was an incident that sparked a worldwide reaction, and changed life forever for Abdallah, his father and the remnants of their once-large, once-prosperous clan.

Abdallah spent several weeks in various hospitals, first in Gaza City, then in Egypt. A healthy and resilient child, he recovered fairly quickly, but stillneeded a prosthesis.

So with help from the Palestine Children's Relief Fund — an American humanitarian organization that provides free medical services in the U.S. for sick and injured children — Abdallah and another boy, who is staying with a host family in San Francisco, were flown here March 25 to receive donated services from Bay Area specialists. Abdallah will go home to his father in a few weeks.
Robert Smith, a prosthetist in Oakland, agreed to donate his time and a custom prosthetic device — which ordinarily would run about $5,000.

"I see somebody's excited," Smith said to smiling and fidgeting Abdallah in an examination room of the CIRS Prosthetics & Orthotics offices on 40th Street on Thursday. "I saw you through the window. You came nearly running in on your crutches, didn't you?"

Abdallah, who speaks only a few words of English, smiled shyly. Smith held out the carbon fiber-sleeved device with a flexible-keel foot.

"Wanna see?" he asked.

Abdallah's black eyes opened wide, as if being presented with a coveted toy. Smith fitted the device to Abdallah's limb, secured it with Velcro straps, and the boy instantly stood and walked out of the exam room and into the lobby. A little wobbly at first, but quickly sure footed.

"It's always amazing with kids," Smith said. "No crutches, no parallel bars. No fear of falling. They catch on right away."

Abdallah said a soft "Thank you" in English, and wobbled over to hug Smith. Adli Rasheed snapped a photo for Abdallah's father.

"His dad called on the way here, and wants to express his gratitude also," Adli Rasheed told Smith.

The day before this final fitting, Abdallah had happily hopped on his good leg through the kitchen of the Rasheeds' home — his preferred method of travel rather than on his crutches.

Well-mannered, Abdallah shook hands with visitors and smiled. He had been upstairs playing a video game with one of the Rasheeds' children, and has already become familiar with some American ways. He's been to the Oakland Zoo, and likes In-N-Out burgers — plain, with no cheese or spread. And he had been watching Heather Mills, who has a prosthetic leg, with great interest as she performed on the TV show "Dancing with the Stars."

Back home in Beit Hanoun, Abdallah was a very good student, Fatima Rasheed said.

"There, instead of A's and B's, they do it by numbers — the best student in class is number 1, then 2, then 3 and so on," she said. "He would always take the second in his class. So he is very bright."

One of his favorite things to do is ride his bike.

"He was telling me that he used to race everybody on his bike and nobody could beat him," Adli Rasheed said. "He hopes to do that again."

Abdallah, climbing up on Adli Rasheed's lap as he sat on the couch, showed visitors a photograph of his family — a collage of old photos that his father put together for him after his mother and sisters died. Each face is superimposed on a heart shape.

"This is my sister, and this is my sister," he explained, pointing at the girls, as Adli Rasheed translated.

Abdallah is a happy child, but he has his moments, Fatima Rasheed said. Especially after his daily phone calls with his father back home.

"He feels homesick," she said.

"And he's been traveling a lot, so he hasn't really spent much time at his home," Adli Rasheed said, smoothing Abdallah's hair after another rambunctious hug on the couch. "He understands very well what happened, but I don't think it has really hit him, to see what's left."

It was just one day after Israel Defense Forces had pulled out from the northern Gaza Strip in a weeklong operation to deter rocket attacks fired by Palestinian militants. Because of the withdrawal, residents in Beit Hanoun felt somewhat secure and went about their daily routines, said Dina Aburous, a volunteer for PCRF's Bay Area chapter.

The al-Athamna family was one of the largest and most respected middle-class families in town, a well-educated group of doctors, engineers, merchants, farmers and, like Abdallah's father, taxi drivers. They all lived together in four floors of one building — similar to a four-plex, with Abdallah's immediate family on the second level. Some were still asleep. Some had risen at about 5:30 in the morning for the dawn prayer. They heard an explosion outside. Close.

Word soon came that Abdallah's uncle was injured, Aburous said. Abdallah's father drove the uncle to the hospital in his taxi. But the shelling continued for about 15 minutes more.

"In moments, six shells fell on their house, and other houses nearby," Aburous said. "Abdallah's father and others shuttled people back and forth to the hospital. While on one of these trips in the hospital, two hours later, he sees Abdallah there," she said.

"Later, he went to the morgue and identified his wife, his

9-month-old daughter and his

3-year-old daughter," she said.

This was said to be the highest Palestinian civilian death toll in a single incident since the current Israeli-Palestinian conflict erupted in 2000. According to news reports, IDF officials later said its artillery guidance system malfunctioned. The intended target was a missile-launching spot nearby, but civilian homes were hit instead. Israeli Prime Minister Ehud Olmert called the shelling a "mistake."

"Abdallah's father told us, 'We used to be a big family, all of us living together,'" Aburous said. "He said, 'Now we're only a handful.'"

At the Oakland prosthetics office Thursday, Abdallah continued to practice walking, back and forth, again and again. He would sit briefly to rest, then be back at it some more.

As he grows, the device will need to be refitted every couple of years, so he may need to come back to the U.S. occasionally. The leg may take some getting used to, but Smith said Abdallah should be able to ride his bike, and play soccer at school again.

Next stop, shoe shopping.

"We're going to buy him some Nike Airs today," Adli Rasheed said.

"This is wonderful for him to have this device. But because of his age, I believe he thinks the prosthetic leg will solve everything, that this is going to be the answer," Adli Rasheed said. "There is much that will still be difficult for him when he goes back home."

Friday, April 27, 2007

Prosthetics Socks And Linear

About the Author:

Jack E. Uellendahl, CPO, has over 25 years of experience in prosthetics. He is currently a clinical specialist in prosthetics for Hanger Prosthetics & Orthotics, Inc.


If I were to ask a room full of amputees what the most important feature of their prosthesis is, I am certain that comfort would be high on the list of responses. Without comfort, the most technologically sophisticated components become useless. At the most basic level, comfort within a prosthetic socket is achieved by good pressure distribution and the management of friction (shear) forces. Prosthetic socks and liners are the interface materials in contact with the residual limb and are integral to the comfort of the prosthesis.

Please check link for the whole story.......

Thursday, April 26, 2007

Amputee athlete aims for Olympics

By Orla Guerin
BBC Africa correspondent

Three years ago Oscar Pistorius had never stepped onto a track, let alone run a race.

Today he is an athletics sensation - holder of world records in the 100m, 200m and 400m events.

His coach, Ampie Louw, says Oscar is "a natural champion - born that way".

The 20-year-old South African is one of a handful of runners around the globe who could make the Olympic qualifying time. He is less than a second away.

But Oscar's Olympic bid is like no other - he is a double amputee.

'Blade runner'

At birth he was missing bones below the knee.

After his legs were removed, at the age of one, he learnt to walk on prosthetics, and he believes this pushed him to excel.
He has done everything from quad biking to water skiing. He took up athletics as rehabilitation for a rugby injury.

On the track, they call him "blade runner" - thanks to his carbon fibre prosthetics, custom-made in Iceland.

He and his blades, called Cheetahs, have run into sporting history, and into controversy.

He has been dogged by claims that the blades give him an extra long stride - something he denies.

The manufacturers, Ossur, say the blades are "passive devices", which lag way behind what biological legs can do.

They insist the Cheetahs are not performance-enhancing, but simply give amputee athletes a fighting chance.

Winning ingredient

Oscar says he is the winning ingredient, not the blades.

He is outrunning single amputees using the Cheetahs.

"I train harder than any of the other guys do," he says.

"I put in more hours. I eat better. I sleep better. I rest better and, overall, I am more diligent."

He has just shown what he can do against able-bodied athletes.

In South Africa's National Championships in Durban last month, he came in second.

"I don't see myself as disabled, and I think it's the guy that wants to win the hardest that's gets it," he explains.

Oscar's next challenge is the Visa Paralympic World Cup in Manchester next month, but he is looking ahead to Beijing in 2008.

Olympic hopes

One of Britain's sporting heroes, former world record holder Colin Jackson, says he should be given the chance.
"I think it's a great idea, if he makes it as the first paralympian," he told BBC News.

"He's one of these guys who is a genuine athlete. And he's young enough to not only make 2008, but to compete also in 2012, which would be really sensational."

But the world body governing athletics, the International Association of Athletics Federations (IAAF), has already moved to block him from the Olympics, with a new ruling banning "technical aids".

Senior officials have "suspicions" about his performance on the Cheetahs.

Oscar says his critics are only looking at the advantages of the blades - "if there are any" - and not the disadvantages.

"There's never been a disabled athlete running in the Olympics," he says.

"There's a fear of change."

Oscar believes some people just do not like the competition, but he says he will keep chasing his dream.

Wednesday, April 25, 2007

Professors have hand in shaping new generation of prosthetics

About 1.8 million Americans live without one or more of their limbs, according to the National Limb Loss Information Center. Until recently, amputees could expect no more than a plastic mold of their arm or leg that requires manual control.

Today, the face of prosthetics is changing. Researchers are moving beyond the standard plastic mold to lifelike limbs that operate like an actual part of the body by responding to brain signals.
Steve Helms Tillery, an assistant professor in the Ira A. Fulton School of Engineering's Harrington Department of Bioengineering, and Marco Santello, an associate professor in the Department of Kinesiology in the College of Liberal Arts and Sciences, have been working together for several years on understanding the control of arm and hand movements.

Five years ago, Helms Tillery teamed with ASU researchers Andy Schwartz (who now is a professor of neurobiology at the University of Pittsburgh) and Dawn Taylor (who now is an assistant professor of bioengineering at Case Western Reserve University), to demonstrate that monkeys could operate a robotic arm to feed themselves using their brain signals.

Helms Tillery and Santello are part of an interdisciplinary team trying to build a state-of-the-art prosthetic hand controlled entirely by brain signals.

Their work is part of a National Institutes of Health Bioengineering Partnership project, “Cortical Control of a Dexterous Prosthetic Hand,” funded by a recent grant of more than $5 million shared by researchers at the University of Pittsburgh, the University of Washington, Carnegie Mellon University, the University of Minnesota and Columbia University.

The ASU team will focus on the neurological component of the research by analyzing the types of brain signals used in the operation of a prosthetic device, as well as the sensory signals that a real hand sends back to the brain.

Posted by Mr.Blogger at 8:54 PM

Caps on insurance coverage for prosthetics are targeted

A mandate included in a bill before the House could increase premiums, critics say.
April 23, 2007

Brent Soderstrum found out about 1 1/2 years ago that his insurance would pay only half of what it would cost to fit him with an artificial leg.The insurer, like many others across the nation, had placed an annual limit on payments for prosthetics.Soderstrum, who lost his right leg in a car accident about seven years ago, spent almost $5,000 for the prosthetic leg that fits just above his knee. His insurance company paid $2,500. He was lucky - some prosthetics cost $30,000 or more.Soderstrum, an attorney for a Des Moines law firm, said the issue isn't about his personal costs. He's fighting for other Iowans. "This bill is about what insurance should cover," he said.Now, Soderstrum and others, including representatives from American Prosthetics & Orthotics Inc., are pushing Iowa lawmakers to pass a bill that bars such insurance caps.The proposal, Senate File 508, has already passed the Senate and is on a list of unfinished bills in the House.Opponents say the mandated coverage could increase insurance premiums."They create added costs to the policies that small businesses have to buy," said John Gilliland, a lobbyist for the Iowa Association of Business and Industry.The caps for artificial limbs became widespread in insurance agreements about four years ago. Since then, Colorado, California, Maine, New Hampshire, Rhode Island and Massachusetts have passed legislation that requires companies to cover prosthetic care to the same extent that Medicare does, according to information from the Iowa prosthetic company.Rep. Linda Upmeyer, a Republican from Garner, has offered a revision to the proposal that calls for a yearlong study to see whether the mandate is needed. In the meantime, the state would pick up the cost for people who don't have coverage."One of the things that worries me a little bit, the people really pushing this bill forward are the people who are making prosthetics," Upmeyer said. "Do we really have an issue here, or are we trying to sell more prosthetics?Advocates say the increases in insurance costs would be minimal. Colorado lawmakers, for example, estimated their law would increase premiums by 12 cents per person per month for residents with health insurance."This is coverage Iowans used to have in their health coverage, and that coverage has been taken away," said Rod Cheney, president of the Iowa Prosthetic, Orthotic and Pedorthic Association.Large businesses are often self-insured, which means they would be exempt from the mandate. Small businesses would be most directly affected, said Paula Dierenfeld, executive director of the Federation of Iowa Insurers. Small businesses currently can choose the level of coverage they desire."What I can tell you is all mandates increase premium costs. It almost goes without saying," Dierenfeld said. "By imposing the mandate, you would take choice away from businesses."Reporter Jason Clayworth can be reached at (515) 699-7058 or

Tuesday, April 24, 2007

Doctors help amputees in the Caribbean to walk again

April 10, 2007
Getting more than 30 artificial legs to long-waiting amputees in the Dominican Republic took a lot of planning and hard work.
After weeks of pre-trip logistical complications, unexpected expenses and fears that the trip might fall through -- as one to Mexico had a year before -- five prosthetics experts made their journey to the Caribbean nation.
They got what they expected, more hard work, and then some on the March 1-11 trip that they called Operation Compassion.
"In my whole life, this is probably the best thing I've ever seen," Dr. Saul Morris of Warren said of the trip.
Morris coordinated the trip and is founder of M-STAR (Michigan Society to Advance Rehabilitation), an organization that serves amputees.
"We got 30 people walking, and in a short time. We had children who had never walked. We had people who hadn't walked in 20 years," Morris said.
M-STAR collected many of the artificial legs that would go to people in the Dominican Republic, and it located the would-be recipients who often wait years to get prosthetic limbs.
The legs, which range in price from $2,000 to $8,000, were donated to M-STAR.
The organization accepts artificial arms and legs that cannot, by law, be reused or resold in the United States. The donations then go to patients in other countries. Before they could be donated, many of the prosthetics had to be repaired and others were made from parts of other prosthetics.
The mission to the Dominican Republic was the epitome of what Morris hoped to accomplish when he formed M-STAR in 2002.
Morris made the trip with Dr. Robert Maniere, who lives in St. Clair Shores and is president and co-owner of Comfort Prosthetics and Orthotics in Clinton Township. Maniere is certified in prosthetics and orthotics.
Both use prosthetic legs. Morris' leg was amputated in 2000 because of a condition called peripheral vascular disease. Maniere lost a leg as a teenager after he attempted to jump onto a moving train.
Also making the trip was Jim Williamson, a registered prosthetics and orthotics assistant from Clinton Township, David Ballantyne, a certified prosthetist from Harper Woods, and Dr. John Sealey, vice chief of staff and a vascular surgeon at St. John Detroit Riverview Hospital.
Maniere, Ballantyne and Williamson did weeks worth of work, much of it on their own time, getting the legs ready for re-use and packed for shipping. In the Dominican Republic, they did more hard work but also encountered many appreciative patients.
"One man was so excited, he went off and left his wheelchair," Morris said. He came back for it later "with a big smile on his face."
Comfort Prosthetics and Orthotics provided about $15,000 to pay for the trip.
The team worked in a prosthetics clinic at a rehabilitation hospital in Santo Domingo. Sealey was on hand in case surgeries were needed to correct vascular problems common in amputees. No surgeries were necessary, Morris said.
In addition to custom-fitting patients for legs, the team showed their local counterparts how to do the work so that they can do more for their patients.
Planning for the next mission has already begun.
"We would like to make this an annual thing," Morris said. "I'm still 10 feet tall. It touched my heart so much. It touched all of us so much."

Medicare Announces Competitive Acquisition Program For Certain Durable Medical Equipment, Prosthetics, Orthotics, And Supplies - USA

The Centers for Medicare & Medicaid Services (CMS) today issued a final rule that will reduce beneficiary out-of-pocket costs, improve the accuracy of Medicare's payments for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), help combat supplier fraud, and ensure beneficiary access to high quality DMEPOS items and services through a new competitive bidding program. In 2008, the competitive bidding program will operate in competitive bidding areas (CBAs) within 10 of the largest Metropolitan Statistical Areas (MSAs), excluding the New York, Los Angeles, and Chicago MSAs and will apply to 10 of the top DMEPOS product categories based on criteria outlined in the final rule. The program will be expanded into 70 additional MSAs in 2009. After 2009, CMS will expand the program to additional areas and items. "The final rule we are announcing today is focused on improving both service delivery and the quality of care, while getting savings for beneficiaries and taxpayers." said CMS Acting Administrator Leslie V. Norwalk, Esq. "Given the need to tackle the continued and unsustainable growth in health care costs, this new program represents yet another way to use the competitive marketplace to bring the best possible and most efficient care to Medicare beneficiaries. And when combined with the accreditation and quality standards initiatives that are already underway, this program will provide assurance that high quality service and items are available to those who need medical equipment for home use." The new competitive bidding program, which is required by the Medicare Prescription Drug, Improvement & Modernization Act of 2003 ("Medicare Modernization Act" or "MMA"), will replace the current payment amounts, for the items being bid, under Medicare's DMEPOS fee schedule with payment rates derived from the bidding process. Suppliers that wish to furnish competitively bid items in a CBA will be required to submit bids to furnish those items. Contracts will be awarded to a sufficient number of winning bidders in each CBA to ensure access and service to high quality DMEPOS items. The winning bids will be used to establish a single Medicare payment amount for each item. For beneficiaries in the selected CBAs, this program will reduce out-of-pocket expenses while ensuring that they receive high quality items and services. This is because the rule requires all contracting suppliers to be accredited by an approved accreditation organization as meeting CMS' quality standards. CMS has designated 10 entities as qualified to accredit DME suppliers, based on quality standards that were posted on the CMS website in August 2006. The single payment amounts established through competitive bidding will be lower than the current fee schedule amounts for the items. In addition, contract suppliers must accept the single payment amount established through competitive bidding as payment in full. The beneficiary's liability is limited to 20 percent of the payment amount and any unmet Part B deductible. For taxpayers, the competitive bidding program means potentially significant savings for Medicare. When fully implemented in 2010, it is projected that these savings will amount to $1 billion annually. "For DME items and services, beneficiary coinsurance is 20 percent of the total Medicare payment amount," said Norwalk. "The savings this program will generate will directly translate to lower coinsurance for Medicare beneficiaries, thus significantly reducing their out-of-pocket costs for health care." CMS is creating a limited exception to the competitive bidding requirement that will allow certain treating professionals to furnish items on the competitive bidding list to their own patients without having to participate in bidding and without becoming a contract supplier. This exception would apply to certain specified items furnished by physicians, physician assistants, clinical nurse specialists, nurse practitioners, occupational therapists in private practice, and physical therapists in private practice. In addition, the item must be furnished as part of their professional services. CMS believes that allowing this type of arrangement to continue will promote the efficient and uninterrupted delivery of care to beneficiaries. The rule also adopts some special protections for beneficiaries in the CBAs who are already renting certain DMEPOS items when the program becomes effective. For example, the final rule includes a grandfathering provision that may enable these beneficiaries to continue renting these items from their existing suppliers if the supplier chooses to continue renting the item under grandfathering rule (called "noncontract suppliers"), rather than having to switch to a contract supplier. If the beneficiary continues to need the item that they are renting from a non-contract supplier and switches to a contract supplier, access to items and services will be ensured because the contract supplier that assumes responsibility for serving the beneficiary will be able to take advantage of special payment provisions. For suppliers of oxygen equipment, the final rule provides for a minimum of 10 months of payment to a contract supplier who assumes the responsibility for providing oxygen to a beneficiary who had been receiving services from a non-contract supplier. Similarly, if a beneficiary who is renting capped rental equipment switches from a noncontract supplier to one that has been awarded a contract under the competitive bidding program, the new contract supplier will receive 13 months of rental payments. These payment provisions apply without regard to the number of months of payments Medicare previously made to the noncontract supplier; however, payment can only be made if medical necessity for the equipment continues. The final rule allows beneficiaries who own an item of DMEPOS that is part of the competitive bidding program to obtain maintenance and servicing from any Medicare supplier that has a valid billing number, and is not limited to seeking repairs from contract suppliers. However, if the standards for obtaining a total replacement of an owned item that is part of the competitive bidding program are met, the beneficiary will have to obtain the replacement item from a contract supplier, and payment will be made for the item at the single payment amount. After reviewing comments on the proposed rule, CMS has included in the final rule a number of provisions that will modify the rule's impact on small suppliers, which are defined for purposes of this program as those suppliers having gross revenue of $3.5 million or less in annual receipts. CMS worked closely with the Small Business Administration to establish a new definition of small suppliers that is reflective of this area of the health care industry. The use of this new definition, in conjunction with policies established in the final regulation, will enhance the ability of small suppliers to participate in the competitive bidding program. As they did when CMS published the proposed competitive bidding rule, small suppliers account for approximately 85 percent of DMEPOS suppliers enrolled in the Medicare program. The final rule provides for a 30 percent target number for small supplier participation. If CMS determines after the initial evaluation of bids that there are not enough small suppliers with winning bids to meet the target goal of 30 percent in each product category, then contracts will be offered to small suppliers that submitted bids higher than bug close to the winning bids. The small suppliers will have the option to accept the single payment amounts based on the winning bids until the 30 percent goal is met or there are no additional small suppliers. The final rule also allows small suppliers to form networks in order to participate in the bidding process, provided that these networks comply with all federal and state laws including the federal antitrust laws. In addition, small suppliers will not be required to submit bids for all product categories. As a result, small suppliers will have the flexibility of deciding for which product categories to submit bids. The Medicare law requires that CMS first implement the DMEPOS competitive bidding program in 10 of the largest MSAs. In selecting the specific MSAs for the program, CMS took into account allowed DMEPOS charges per beneficiary, the number of suppliers per beneficiary, the total population of the MSA, and the MSA's geographic location. CMS has the discretion to exempt from DMEPOS competitive bidding, rural areas and areas with low population density within urban areas that are not competitive unless there is a significant national market through mail order for a particular item or service. The Medicare law gives CMS the discretion to phase in the types of DMEPOS items to be subject to competitive bidding. In evaluating an item's savings potential and selecting the items to be subject to bidding, CMS considered the amount of allowed charges, the growth in expenditures, the number of suppliers of the item, savings realized in the DMEPOS competitive bidding demonstration projects, and reports and studies by entities such as the Health and Human Services Office of Inspector General and the Government Accountability Office. In order to qualify for a contract under the competitive bidding program, a supplier must generally meet certain criteria, including: -- Be in good standing with the Medicare program and not under any current sanctions by Medicare or any governmental agency or accreditation or licensing organization. -- Have an active National Supplier Clearinghouse (NSC) number. -- Meet any local or state licensure requirements for the item being bid; -- Submit a bid as a prerequisite to becoming a winning supplier. -- Be accredited or have an application for accreditation pending in order to participate in bidding. -- Provide capacity estimates of the number of units for each item included in the product category that the supplier would be capable of furnishing under the program. -- Agree to service the entire CBA regardless of where the beneficiary is located, although the supplier will not be required to be capable of servicing 100 percent of the beneficiaries in that geographic area. If a supplier has multiple locations in a competitive bidding area, then it must submit a single bid for all of its locations and if the supplier is selected as a contract supplier, than all of its locations within the CBA would be considered to be contract suppliers. This will help ensure geographic distribution of suppliers. In developing the DMEPOS competitive bidding program, CMS built on experiences gained during DMEPOS competitive bidding demonstrations conducted in Polk County, Florida and San Antonio, Texas from 1999 through 2002. The two demonstration sites proved successful in terms of generating substantial program savings, maintaining consumer access and satisfaction, upholding the quality of items, preserving competition and administrative feasibility. Additional information on the DMEPOS competitive bidding program, including the CBAs and competitive bidding items for the first round of competitive bidding, is available

Bomb Victim Gets Legs

April 2, 2007STOCKTON — The war in the former Yugoslavia took family and friends of an eleven year old boy and a bomb he found took his legs. But now with the generosity of others he's getting a new start.Chuck Stockert with Hanger Prosthetics and Orthotics said, "His life just beginning, we've just opened his life back up again."19-year old Daniel Ivic was just fitted for two prosthetic legs. The people at Hanger Prosthetics and Orthotics in Stockton say it will take him a while to get used to them. Ivic lost his legs eight years ago when he came upon an un-detonated cluster bomb in his war town country of Kosovo. He found part of a cluster bomb he picked it up and suddenly the bomb just exploded, it took his legs and eye.That was in 1999 during the time the United States and NATO were bombing the former Yugoslavia trying to bring to an end to Slobodan Milosovic and his ethnic cleansing that the U.S. claimed took two to three hundred thousand lives.Ivic, who also lost his right eye and 50 percent of his vision in his left got two prosthesis legs after the accident, but outgrew them five years ago. And now through the generosity of Hanger Prosthesis and the organization Save Serbian Children the prognosis for Ivic is good.Stockert said, "He's fortunate he's strong, he has an awesome attitude and what we hope to see is he goes back and he's the teacher he's the ambassador he's the one that shows not just what we do but what people can do with good hearts as well as minds."Daniel just got his customized limbs Saturday and tomorrow he's back on a plane headed to Serbia to start a new life.
Copyright © 2007, KTXL

John Lee finds strength to move on after illness takes his arms and legs

FLINT -- John Lee looks down at his prosthetic legs and gathers strength.
The time has come to take the first step back to independence. To reclaim his legs, his future, his life.
He leans forward in his wheelchair and pushes up with all his might -- brow sweating and muscles trembling -- to stand on his own for the first time in five months.
It's a task most take for granted. But standing -- if only for four minutes -- is a monumental accomplishment for John, 47, who fell victim to a fast-moving, vicious septic infection in October that claimed all four of his limbs and left him near death.
John eases back into his wheelchair with the help of his physical therapist, hangs his head and chokes up.
The fact that John is not only alive, but full of determination, is a testament to his extraordinary courage in the face of an illness that doctors say could have -- should have, by most accounts -- killed him.
"I almost lost my life," said John, of Imlay City, about 40 miles west of Port Huron. "I want my life back. I'm giving 110 percent. I'm going to do this. All I can do is thank God that I'm alive today."
The road hasn't been easy.
John -- who was laid off from his truck driving job before illness struck -- is likely facing bankruptcy and foreclosure on his home as he and his wife, Sherry, struggle with medical and related costs not covered by Medicaid.
And the physical journey is far from over. In fact, it's just beginning as John faces the unimaginable challenge of relearning life's simplest activities -- such as eating, walking and bathing -- with four prosthetic devices.
The man before the illness
John is strong, independent and, some would say, a little rough around the edges.
He's a man's man who loves cracking dirty jokes, cruising the back roads near Fostoria on his beloved 1993 Harley-Davidson Heritage Softtail and drinking Jack Daniels and Coke with his buddies.
A U.S. Army veteran who never finished high school, he enjoys the outdoors, hunting for deer in the Thumb and riding along the Port Huron shoreline on his Harley, stopping at A&W for chili dogs and root beer floats with Sherry. He rarely misses a motorcycle swap meet or the Renaissance Festival in Holly every year.
But he's also a proud family man who likes to grill steak and watch movies like the Wayans brothers' comedy "White Chicks" at home with Sherry, 36, his wife of nearly three years, and three stepdaughters, Amanda Earl, 18, Kaley Earl, 16, and Jamie Earl, 12.
Remembering those times has helped John endure the nearly six months he's been lying in a hospital bed at Hurley Medical Center in Flint. They have helped him brave his new life as a quadruple amputee.
"I've done a lot of thinking," John said. "I've got a good life. And I've got a good wife, and I've got good family and friends. That's what kept me going.
"I had so much to fight for."
But as much as John pushes himself to return to normalcy, he knows life won't be the same.
He's accepted the harsh reality that after 25 years, he'll never sit behind the steering wheel of an 18-wheel big rig to support his family.He's also realized he'll never again ride a two-wheel motorcycle with the Tribesmen, a close-knit motorcycle club from Fostoria that he joined a decade ago.
That chapter of his life, however, isn't completely closed.John said his goal is to ride again -- by next year -- on a three-wheel motorbike or one with a sidecar built by his club brothers."I've learned you live your life to the fullest," John said. "Today, you could click your fingers and it could change tomorrow, you're laying in a bed like this. You've just got to be strong."
The life John knew changed instantly
In the time it took Sherry to dash downstairs for a load of laundry on Oct. 15, John's life changed.
Arms loaded with clothes to fold, she walked by John resting on the couch and couldn't believe what she saw -- his nose and ears were nearly black.
"I knew that something was wrong. I didn't want to scare him, either," said Sherry, a nursing student at Mott Community College in Flint. "I said to John, 'To be honest, not to scare you, I've only seen this with dead patients. I need to get you to the hospital.' "
John had been feeling ill the night before, and by the next morning his symptoms had worsened.
What they didn't know was that toxins from a common urinary tract infection -- complicated by a kidney stone -- had begun circulating through his body, crippling multiple organ systems, said Dr. Bernard Danan, a trauma and critical care surgeon at Hurley.
The last thing John remembers after Sherry loaded him into their run-down 1997 Chevrolet work van was worrying about the long emergency room wait at Lapeer Regional Hospital. That wasn't an issue.
By the time doctors removed his clothes a few minutes later, the blackish color on his nose and ears had spread down his body. Sherry said she never expected him to make it out of the emergency room alive, let alone survive the ambulance transfer to McClaren Regional Medical Center.
There, doctors diagnosed John with severe sepsis -- a bacterial infection in the bloodstream -- and gave him a 1 percent chance to live. He was immediately put on dialysis and, for more than two weeks, stayed in intensive care while in a coma.
Essentially, the kidney stone backed up the infected urine, which seeped into his bloodstream and quickly spread the bacteria through his body, Danan said. As a result, John went into septic shock.
His kidneys shut down, his blood pressure dropped, and he was placed on a ventilator. The infection also spread to a valve in his heart, Danan said.
His body went into survival mode -- it clamped down on the vessels that deliver blood to his arms and legs and redirected it back to his heart to keep him alive. Within a few weeks, his limbs had evidence of gangrene -- and literally died -- from lack of blood.
Danan said such extreme cases of sepsis are rare.
More than 750,000 cases of severe sepsis occur annually nationwide, according to the Des Plaines, Ill.-based Society of Critical Care Medicine. It kills about 215,000 people a year, according to Eli Lilly & Co.'s, a reference provided by the National Center for Infectious Disease.
"From the beginning, with all the complications, I didn't think he was going to survive," Danan said. "He's a fighter."
"Who the heck is this guy?"
When John awoke from his coma more than two weeks later, he didn't recognize the man staring back at him.
His face was swollen, and his hands and legs looked like they were badly burned.
After a few moments, John realized the man wasn't a stranger. He was looking at his reflection in the window on the hospital room door.
"I was somebody I didn't even know," he said. "I looked down at my hands and everything and saw what had happened. I knew I was going to lose my legs and my hands.
"That's when I knew the only way I'm going to get out of this is to get off my ass and do what I've got to do and be strong."
It wasn't easy. John had multiple setbacks -- wounds on his back and buttocks, a heart attack, pneumonia and poor blood flow to bones in his shoulder -- that threatened his recovery and positive attitude.
He was transferred to Hurley's burn unit on Oct. 27 because the facility was better equipped to handle his blackened limbs. There, doctors broke the news about amputation.
John's legs were amputated at the calf on Nov. 14. Doctors amputated above the knees and below the elbows on Nov. 27.
Shortly after his surgeries, John became agitated when some staff members pushed him to begin working out his muscles in his hospital bed.
"I said 'Give me some time,' " John said. "You go through a lot of pain and agony. It was rough for me for a couple of days. At a little point there, you just felt like you didn't give a s--- no more."
Hurley had him talk to a clinical psychologist, whom he met with regularly to discuss his emotional issues: fear of the future, finances, regaining his independence.
Those are common fears, said Kirk Stucky, the psychologist who worked with John.
"A lot of folks get so overwhelmed about what the future holds that they don't do their rehab. (John) remains a pretty motivated guy," he said. "The goal is to try to help the person focus on what they can control and stay as much on the present as possible."
It's unclear how many quadruple amputees there are nationwide, but John's prosthetic specialist Bob Maniere believes the number probably doesn't exceed 200, because most don't survive such trauma.
Through it all, Danan said he's never had a patient who dealt with the loss better than John.
"There were bad days that he was pretty angry and justifiably so. After that initial anger and disappointment, he'd bounce right back."
A journey marked with hurdles
Despite the mood swings that marked those early weeks at Hurley, John understood the key to recovery was getting physically and emotionally ready to be fitted with prosthetic arms and legs.
He began that lengthy process about a month after his amputations, with Maniere, president of the Clinton Township-based Comfort Prosthetics & Orthotics.
At that time, John started wearing shrinkers, or fabric compression bandages, over his residual limbs -- stumps -- to reduce the swelling. Once the swelling subsided, Maniere took measurements and impressions of his limbs with a fast-drying plaster wrap.
In the meantime, the frustration was overwhelming. John had to set aside his pride and rely on others to help him with even the simplest tasks -- from scratching an itch to brushing his teeth.
Eventually, however, there were milestones.
On Feb. 20, John fed himself for the first time. A fork was attached to the ends of his "check sockets," clear plastic sockets used to evaluate fit before the prosthetic limbs are made.
John had to rest between bites of a pre-cut peanut butter and jelly sandwich because his arm was tired. A few pieces fell off his unsteady fork. Eventually, he finished his sandwich.
"I'm like an 80-year-old guy almost. I do this, and I need to stop (and rest)," John said. "I'm moving along and that makes me happy."
John's arm coordination and strength improved the more he wore his check sockets. And by April 3, he used his new arms and legs together for the first time. Maniere said it will take time and patience before John is comfortable with the prosthetics.
"Skill matters," he said. "It's going to be a long process. It takes a baby nine months to learn to walk. John is in the same shoes."
John will eventually be able to walk short distances -- from the car to the doctor's office -- on his own. For longer distances, he'll always rely on an electronic cart or wheelchair because he'll wear out quickly.
His prosthetic arms will allow him to do simple activities, like eat, open doors and brush his teeth. He won't be able to tie his shoes, and it will be a challenge to use the bathroom by himself.
The burdens are heavy
When John lost his independence, the weight of responsibility landed on Sherry's shoulders.
She sat beside him nearly every day, writing thank-you notes to those who donated to his rehab fund.
She began preparations to put their home up for sale, since they can't afford the $1,400 monthly house payment, and found a wheelchair-accessible apartment in Lapeer.
And she's tackled the daunting task of filling out paperwork so he could get Medicaid to help offset medical bills nearing $1 million. John didn't have health insurance before his illness because it was too expensive to pay out of pocket once he was laid off.
Her work hasn't come without a price.
"I'm tired," said Sherry, who was recently diagnosed with thyroid problems.And, "coming home by myself is very lonely. The times that I break are usually when I'm by myself. I do that often, like when I'm bagging the garbage.
"It reminds me that John used to do that."
With John unable to work and Sherry juggling school and caregiving duties, the couple faces foreclosure on their Imlay City home. The bank has afforded them a year to sell, but Sherry is skeptical because the market is unstable.
And bills continue to climb. Sherry begins each day with a cup of coffee as she looks over the utility shut-off notices and tries to pay the bare minimum from their dwindling savings account.
John's disability qualified him for Supplemental Security Income, which will pay him $671 a month. It's just enough to cover their $590 a month rent at the new apartment, she said.
"It's stressful, but I can't sit there and dwell on it," Sherry said. "I've got so many things to concentrate on."
John remains focused on his long-term goal: riding again.
"It's very important for me. I love bikes. We've got a long road," he said. But, "it is possible."
You can reach Christina Stolarz at (586) 468-0343 or

The sweetest step

By Sara Cardine
Record Staff Writer
April 03, 2007 6:00 AM
Wars end, but their potential for human destruction endures.
Consider Daniel Ivic. One afternoon in May 1999, the 11-year-old was running through a field in his hometown in the Kosovo region of Serbia when an object caught his attention. It was part of a deadly cluster bomb and, when it exploded, it obliterated his legs, right eye and embedded shrapnel in his back.
Ivic would remain wheelchair bound, his family unable to afford quality medical care. His outlook was bleak until last year, when two Stockton groups helped him walk again.The 18-year-old took his first steps in years Monday on legs designed and donated by Stockton's Hanger Prosthetics and Orthotics. Ivic's visit was sponsored by Save Serbian Children, a nonprofit organization founded by local resident Milos Supica. He has spent the past 16 years providing aid and medical care to people in need, not only in Serbia but around the world.
"I'm more than excited and honored to help these people," Supica said. "They need this now, just as much as when (Serbia) was in the news."
Ivic has been overwhelmed by the thoughtfulness of Americans, particularly the Stocktonians who have helped him.
"Something I never expected was (to learn) how very thoughtful and nice people are here in the U.S." Ivic said with Supica translating. "I'd heard a different story, so that's something new to me."
Save Serbian Children partners with local hospitals to provide care for young people and their families. When Supica learns of someone in need, he goes to work.
He heard about Ivic from a relative who was visiting the town of Smederevo, where Ivic was living with his parents. Supica worked closely with prosthetic expert Chuck Stockert of Hanger to fit Ivic with two prostheses, a below-the-knee piece for his right leg and a fully-jointed prosthetic for his left leg.
Stockert chose low-maintenance pieces that would not give Ivic too much trouble. Taking stock of what patients need and want in a prosthesis is an important part of making them whole again, he said.
"The big challenge is not making plastic or metal legs," Stockert said. "It's rebuilding the whole person."
But Ivic, whose limited English was derived from dubbed Hollywood films, had a much simpler take on his experience these past few weeks.
"It's great," he said, gripping his crutches and muffling a smile.
Contact reporter Sara Cardine at (209) 546-8269 or

Govt boosts funds for landmine victims

The federal government has boosted funding for the physical rehabilitation of landmine victims in Vietnam.
The $1.5 million dollar contribution over three years will help support amputees and provide prostheses for newly identified victims.
Parliamentary Secretary to the Minister for Foreign Affairs Greg Hunt said the program had already helped thousands of survivors who might otherwise have been left destitute.
"Since 1995, the fund has assisted more than 15,000 amputees in Vietnam, or almost one-fifth of amputees in the country," he said in a statement.
"In 2006 alone, about 3,000 newly identified amputees were fitted with new prostheses and were supported through rehabilitation offered by the fund."
Mr Hunt said the poor were particularly vulnerable to being injured by landmines.
"They are more likely to be handling mines and unexploded ordnance as a source of scrap metal from which to earn a living," he said.
"Landmines and unexploded ordnance continue to pose a serious threat to development in Vietnam, particularly in rural areas where they are most prevalent."
The funding will also help the Vietnam government provide training to enable the production of high quality prosthetics and orthotics.
The boost is part of the federal government's $75 million commitment for mine action globally from 2005-2010.
© 2007 AAP

Ossur's Proprio Foot Walks Away With 2007 Medical Design Excellence Award - Ossur's Bionic Technology Breaks New Ground For Amputees

Ossur, a trusted and global developer of more scientifically advanced prosthetic innovations than any other company in the field, is pleased to announce that its PROPRIO FOOT(TM) is the winner of a 2007 Medical Design Excellence Award. The PROPRIO FOOT, the latest in Ossur's Bionic Technology platform, is the world's first motor-powered and intelligent prosthetic foot, a seamless fusion of electronics, mechanics, and human physiology that reduces the energy patients spend in reacting consciously to the environment. The foot replaces muscle function that was lost due to an amputation, enabling amputees to perform normal, functional activites by:* Sensing. Knowing where their foot is in space is a huge safety issue for amputees. Sophisticated sensor technology mimics the body's own neural receptors that are sensitive to mechanical change, providing artificial proprioception (that sense of where the limb is in space). Hence the name PROPRIO FOOT.* Thinking. Patented artificial intelligence (AI) processes information from the sensors and activates the most appropriate response for the next step.* Acting. The AI transmits a constant stream of signals which instruct high-precision actuator technology to act and deliver optimal function. Expertise in real-time motion analysis for the foot was provided by Canadian company, Dynastream.The Medical Design Excellence Awards competition is organized and presented by Canon Communications LLC (Los Angeles) and is the only awards program that exclusively recognizes contributions and advances in the design of medical products. Entries are evaluated on the basis of their design and engineering features, including innovative use of materials, user-related functions that improve healthcare delivery and change traditional medical attitudes or practices, features that provide enhanced benefits to the patient, and the ability of the product development team to overcome design and engineering challenges so that the product meets its clinical objectives.A comprehensive review of the entries was performed by an impartial, multidisciplinary panel of third-party jurors with expertise in biomedical engineering, human factors, industrial design, medicine, and diagnostics."We are delighted that the PROPRIO FOOT and Ossur's research and development have been acknowledged by this prestigious award," said Hilmar Janusson, global vice president of R&D. "The foot was launched in September, 2006, and the U.S. Department of Defense and the VA are both actively using it to benefit servicemen returning from the Iraq and Afghanistan conflicts, as well as veterans of past wars. It is also quickly becoming the foot of choice for diabetic amputees all over the world."Read More
Posted by Mr.Blogger at 11:47 AM

Injured dolphin may get a new tail

CLEARWATER -- The tale of Winter the dolphin may be headed for a happy ending.
Today, the Clearwater Marine Aquarium will unveil a prototype of a prosthetic tail fluke that could help the 18-month-old dolphin swim normally for the first time since she was a baby.
Winter lost her own tail flukes after she got entangled in a rope tied to a crab trap off Cape Canaveral in 2005. When she arrived at the Clearwater aquarium, she could barely swim.
The injury damaged not only her flukes but part of the peduncle, or tail shaft. Without her flukes, she lacks her main propulsion. She can compensate, but over time veterinarians expect problems to develop with her spinal cord.
So the aquarium is turning to Kevin Carroll, vice president of prosthetics for Hanger Prosthetics and Orthotics, a division of Hanger Orthopedic Group, based in Bethesda, Md.
Amazing as it sounds, Carroll has done this sort of thing before. He has fitted dogs for artificial legs -- and an ostrich, too. He even fitted a duck for a fake beak.
"That was fun," he said.
But this is the first time he's worked with a dolphin.
Some people say "it's crazy to do this," Carroll said. "But if you have an animal and it's injured, why not nurse it back to health?"
- - -
For Winter, Clearwater Marine Aquarium CEO David Yates said he expects the device to consist of three parts: a sleeve made of silicone that will slip over Winter's stump, a joint made of titanium and a tail made of rubber.
And what will it look like?
That's top secret until a news conference today, when Carroll will show a prototype.
Even then, it will almost certainly change as Carroll adjusts it for Winter's needs.
For her initial fitting, Winter will be lifted out of her tank and will undergo a digital scan of her stump. Once the prosthetic tail is ready, there will be no surgery to bolt the device onto Winter. Carroll will use high-tech suction technology to hold it in place.
She will wear it for a few hours each day.
"Dolphins have very sensitive skin," Yates said. If she wore it for 24 hours a day, it would cause irritation.
Hanger Prosthetics and Orthotics is donating the entire cost of the project, which could exceed six figures. The process could take a year or longer.
Winter, an Atlantic bottlenose dolphin, is lucky. Only a few other dolphins have ever received artificial fins.
Several years ago, Bridgestone Corp. engineers fashioned a partial prosthetic for a 34-year-old Japanese dolphin named Fuji who had lost part of her tail to disease.
Yates said both Bridgestone and the Okinawa Churaumi Aquarium, where Fuji lives, have discussed the project with him.
- - -
Carroll typically works with humans who have lost limbs because of disease or accidents.
On Thursday, he fitted a 3-year-old girl with a new artificial leg with a working knee. The girl lost her leg at age 1 when boiling water spilled on her, burning her to the bone.
At first, Carroll said, "she would not have anything to do with it."
But when he let her feel it and handle the prosthetic, she finally accepted it. It took a kind heart and a lot of patience.
He said working with a young child is similar to working with Winter, whom he met more than a year ago.
"Winter is like a kid," Carroll said. "She's inquisitive. She wants to know what's going on."
He knows that if he tries to force an artificial device on a child or an animal, he or she will reject it -- and hate him on top of it.
To introduce the device to Winter, Carroll and the Clearwater aquarium trainers thought about tossing it into her tank and letting her play with it. But they decided they don't want her to think of it as a toy.
He will let Winter's trainers decide how best to get her used to her new tail. Once the dolphin realizes the prosthetic is not anything to be afraid of, she will probably accept it.
"She has a great personality," Carroll said. "I get the feeling she knows we're here to help."
Carroll, 48, was born and raised in Ireland. He has a bachelor's degree in gerontology and a master's in psychology. He lives in Orlando but has traveled the country for the past 30 years fitting humans and animals with artificial limbs.
"I see a lot of people come to see me in wheelchairs and then walk out the door," Carroll said. "That's very rewarding. When I go to work, it's not work. It's just another joyful day."
Eileen Schulte can be reached at (727) 445-4153 or

Monday, April 23, 2007

InnerView: A long journey from Vietnam -- Tim Woodville's career is no typical story

By STEVE BROWN - Staff Writer
Article Launched: 04/17/2007 12:13:44 AM PDT

It sounds like a straightforward enough story: a soldier who had his legs blown off in the Vietnam War goes on to have a meaningful career making artificial limbs.
This is what happened to Tim Woodville, but it wasn't that simple. "I never thought, I'm an amputee, so I might as well go into prosthetics."
The first thing he had to do was survive the night in February 1971 when he lost his legs. "I laid on top of a charge that went off. It was night, so I didn't see it. It took my left leg off right then. At the same time, I had a hand grenade thrown at me. It went off. I don't know if it or the charge took off my right leg or even if it was gone right away." Woodville figures that being right on top of the charge helped keep him alive. "If I'd been just 3 feet away I would have been killed."
He said the scenes in John Wayne war movies about injured soldiers falling asleep and never waking up again seem to be accurate. "Your mind stays 'stop,' but your body says 'keep going.' My job that night was to stay alive. But you felt like you could just close your eyes, go to sleep and slip away."
The next thing he had to do was figure out what to do with the rest of his life. "I was going to make the military my career," but the loss of his legs forced him to change his plans.
When he returned to civilian life, there was a long adjustment period. "Obviously, my legs were gone. I was proud of what I had done in Vietnam, but there was no way I could say that at the time and be accepted by my peers."
He said he spent the next few years as "a semi-hermit. I didn't want to socialize with a lot of people." But after he decided to go to college, "I discovered that I could immerse myself in my studies."
At that time, he was not studying prosthetics. He earned a degree in biological sciences from UC Davis, got a teaching credential and taught science for a couple of years in Elk Grove. He then entered a master's degree program in biological sciences at Chico State University. He went into that field because he wanted to become a researcher, but decided against it when he discovered it could be a cutthroat profession.
During this time, he met his wife. "She's been my rock forever. I can't express how much she means to me."
About 20 years ago, he started having anxiety symptoms. "I went to the VA. They told me I had post-traumatic stress syndrome. At first I didn't believe them. I felt I had to suck it up, be a man." But he said over time he came to understand that being in a war is stressful, and you can't always acknowledge it at the time it is happening.
For a while he stayed at home and took care of his two sons while his wife went to school to become a cosmetologist. "I started going a little stir-crazy." That's when he decided to become a technician at a prosthetics business in Redding where he had gone to have his legs worked on. He liked the job so much that he went to UCLA to become a certified prosthetist.
He opened his Chico business, Tim Woodville's Orthotics and Prosthetics, about 15 years ago. What convinced him that this could be his life's work was that it allowed him to work with people — his clients — and his hands. He builds artificial limbs and orthotics braces in a lab at the back of his business. "One of the biggest rewards for me is seeing how clients, their spouses and their offspring realize how life can go on after amputation. I enjoy helping people get back to what they were doing before they lost a limb."
Woodville said he has a few regrets about having lost his legs. "I wish I could have played football with my boys when they were growing up. I like to walk on the beach with my wife. I can do it, but it's hard. I wish I could compete in a triathlon. I can swim and ride a bike, but I can't run."
Despite having lost his legs in the Vietnam War, Woodville still supports the military. "It gave me a sense of accomplishment, a sense of belonging to something bigger than myself. It's an honorable profession. And it's physical. I liked that part of it."
Staff writer Steve Brown can be reached at 896-7755 or
In a nutshell
Name: Tim Woodville
Age: 56
Job: owner of Tim Woodville's Orthotics and Prosthetics
Hometown: Born in Alameda, raised in Healdsburg
Family: Wife, Cheryl; sons, Brad, 25, and Doug, 21
Hobbies: Fishing, swimming, weightlifting. "When you have prosthetic limbs, you try to keep your weight stable. It makes a big, big difference."
Words to live by: "When you commit to something, you have to follow through."

Walking made easier

Cynthia T. Pegram
April 20, 2007
Give your opinion on this story

Keith Richmond’s souvenir from a motorcycle crash about 14 years ago is the prosthetic right leg that replaced the one that had to be amputated.
Now the Lynchburg man hopes to change to a leg with a microprocessor knee - a technology that will let him walk on uneven surfaces and more naturally navigate stairs and ramps.
And that means hunting and fishing again.
“I had to quit all those activities,” said Richmond, 51, after the motorcycle accident, which caused the loss of his right leg and injuries to the other, as well as damage to his back.
He tried out the $30,000 Otto Bock C-Leg in Lynchburg this week.
“I like it,” said Richmond. “It’s going to take getting used to.”
Richmond and Wilbert Green of Ruther Glenn near Fredericksburg each got to use the C-Leg Wednesday at Excel Orthotics and Prosthetics on Langhorne Road. The C-Legs were brought to Lynchburg by manufacturer Otto Bock’s traveling team.
The two clients seemed intrigued and pleased in the results they were getting from the hydraulic technology controlled by a microprocessor.
Fifty times a second the hydraulics are fine-tuned so that the knee can react to subtle changes encountered by the attached foot.
It feels different, too.
“It has some resistance I’m not accustomed to on my other leg,” said Richmond, as he learned to adapt to the new mechanism’s style.
“The knee knows when to bend,” Douglas Walters explained in an interview. Walters is an orthotist and owner of the Roanoke-based Excel.
People have to learn to trust the knee - to step forward and have the knee move forward, lift up and extend.
“It kind of walks for you a little bit,” said Walters.
“Because the motion of walking is more normal, it’s also less wearing on the natural leg,” said Walters.
Currently, two or three companies manufacture microprocessor-control systems, said Joe McTernan of the Alexandria-based American Orthotic and Prosthetic Association, a nonprofit trade association.
McTernan, in a telephone interview, said the essential design of a hydraulic knee is a cylinder filled with fluid. A piston in the cylinder mimics the natural movement of the knee joint. The tension can be adjusted to allow the leg to swing with “more or less resistance.”
The microprocessor feature, said McTernan, makes thousands of readings, “and based on the readings, adjusts the fluid in the cylinder and automatically changes the rate at which the knee swings.”
The feedback is based on the person’s walking pattern, “so every time the patient swings the leg forward it is swinging at the most appropriate rate for the conditions at that moment in time.”
The technology is becoming more widely available, he said, and more insurance companies are willing to consider it an advancement in technology “as opposed to experimental technology.”
Fitting the devices takes extra training because the knee must be programmed using a computer, he said. Prescriptions for the legs come from the physician.
He noted that the average fluid-based prosthetic knee costs around $2,700. “The microprocessor is significantly more expensive,” he said.
McTernan doesn’t see microprocessor legs becoming the norm in the near future, however. The legs provide more stability, which is important for patients who fall a lot, he said.
Not everyone needs microprocessor technology. A person with an above-the-knee amputation that only transfers from the bed to a wheelchair doesn’t need it.
“We try to provide the patient what’s needed for his use level,” said Walters of Excel.
Keith Richmond is an active person.
Amy Richmond said that because her husband’s present prosthetic leg needs so much effort by his good leg in walking and standing, “he’s wearing that knee out,” she said. “This is going to save his left leg.”
The couple recently purchased a farm in Kentucky, where the new way of walking on uneven grounds - and hunting game - could be a great help.
On Wednesday, Wilbert Green of Ruther Glenn also seemed truly pleased with his trial run with the C-Leg.
The Vietnam-era veteran didn’t expect to get the chance. But, he’d done so well since last June after his amputation due to diabetes that his therapist suggested he consider a computerized leg.
“I’m like, ‘Yeah, right,’” said Green. “I don’t think the VA is going to give me a $30,000 leg.”
However, through some private funding, with Veteran’s Affairs supplementing a little, it looks like it might happen.
“I’m excited about it,” said Green, who tried out the leg in walking, sitting and stair situations. “With the old leg, I’d have to drag it.”
Although it’s less than a year since he’s used prosthesis, he’ll still have to re-learn his old way of walking.
The C-Leg can return some of that natural grace.
“With this, it’s designed not to think about it, just to walk,” said Green.
His wife Gwen said that his ability to walk so much earlier than expected after his surgery is because “he’s a very determined person.”
“He ran track for many years. That has a lot to do with that type of mind-set,” she said.
And she said, “It’s all about his faith in God, and what he believes God has in store for him.”
Jeff Honma, a certified prosthetist/orthotist, is based in Los Angeles and works with the Otto Bock company. He was doing the computer programming for the legs being tried out in Lynchburg.
The hardest part most people have in using the C-Leg, said Honma, is “not thinking about how the knee works, and not thinking about the walking.”
Then, after awhile, “Timing becomes second nature.”
Scott Moltzan, also with Otto Bock, has an above-the-knee amputation and has worn the C-Leg for seven years.
He doesn’t have to look down at the ground anymore, said Moltzan, as he walked down the sloping grassy area outside the Langhorne road office, head up. “I can look right at you.”

Tuesday, April 17, 2007

Vietnam landmine victims to get more Aussie aid

Peace Journalism Posted April 13th, 2007 by Tarique

Melbourne, April 13 (NNN-BERNAMA) Landmine victims in Vietnam will receive extra funding from the Australian Government for their physical rehabilitation.
The A$1.5 million contribution over three years will help support amputees and provide prostheses for newly identified victims.
Greg Hunt, Parliamentary Secretary to the Australian Minister for Foreign Affairs, said the programme had already helped thousands of survivors who might otherwise have been left destitute.
"Since 1995, the fund has assisted more than 15,000 amputees in Vietnam, or almost one-fifth of amputees in the country," he said in a statement.
"In 2006 alone, about 3,000 newly identified amputees were fitted with new prostheses and were supported through rehabilitation offered by the fund."
Hunt said the poor were particularly vulnerable to being injured by landmines.
"They are more likely to be handling mines and unexploded ordnance as a source of scrap metal from which to earn a living," he said.
"Landmines and unexploded ordnance continue to pose a serious threat to development in Vietnam , particularly in rural areas where they are most prevalent."
The funding will also help the Vietnam Government provide training to enable the production of high quality prosthetics and orthotics.
The boost is part of Australia ’s A$75 million commitment for mine action globally from 2005-2010.