i-LIMB Again!

Iraq War amputee's bionic hand moves all five fingers

by Tali Yahalom, USA TODAY

Iraq war veteran Sgt. Juan Arredondo, left, one of the first recipients of a bionic hand with independently moving fingers called the i-Limb, shakes a reporter's hand during an interview in New York.

NEW YORK — Iraq War veteran Juan Arredondo sports a military-colored bracelet on his right hand inscribed with the word "courage." On his left, more shades of green and khaki coat an artificial arm, with a motorized hand at the end.

Arredondo, 27, is one of the first to use the groundbreaking i-Limb, a bionic hand with independently moving fingers.

"My son tells me … I'm half robot, half man," the retired U.S. Army sergeant said Monday at a news event to showcase the device, which he likened to those seen in Star Wars and Terminator.

Five individual motors power the fingers, which Arredondo can position for a desired task, from lifting a 45-pound weight to whitewater rafting.

The i-Limb, which was in development at Touch Bionics in Edinburgh, Scotland, for five years, is marketed by Bethesda, Md.-based Hanger Prosthetics and Orthotics and costs $60,000 to $150,000, depending on the length of the amputation. The U.S. Department of Defense is paying for Arredondo's $65,000 prosthesis...

It contains a tiny computer chip that translates electrical signals made by the arm's nerves into physical movement.

The hand generates a low-pitched sound as it moves and can twist off the arm as smoothly as a lid coming off a jar. The technological nooks and crannies are visible under a clear silicone glove, which enhances the hand's tactile ability. Arredondo can control how tightly he grips an object, and he doesn't tire if it's heavy.

"This is amazing stuff," he says.

Arredondo was on patrol in Iraq on Feb. 28, 2005, when an explosive device blasted through the left side of his vehicle. As he jumped from the driver's seat, he noticed that his left hand was still clutching the steering wheel. He grabbed it before collapsing.

He was sure he would die, and he relayed last words for his wife and two children. But the eight-year Army veteran pulled through and wound up at San Antonio's Brooke Army Medical Center, where he was stabilized enough to have his amputated arm closed up and readied for a prosthesis. He went through two artificial arms until finally receiving the i-Limb.

The i-Limb, now available to the U.S. public, outshines its artificial predecessors by a long shot, says Hanger vice president Troy Farnsworth. It still does not have sensory or waterproof functions, but it empowers the user to use all five fingers. Other bionic hands allow for the use of only the thumb, index and middle fingers. "It works so much like a normal hand that it really bridges the gap" between prosthetic and real hands, he says.

Arredondo now works for the Wounded Warrior Project, a Florida organization that spreads awareness about wounded veterans.

He lives in San Antonio with his wife, Jessica, and their children, Rose, 10, and Diego, 4. The kids get a kick out of their father's prosthetic, particularly when he uses it to get rid of snakes in the backyard.

"He's so excited to be able to use it" and is "very proud to be part of testing it," Jessica says.

And More i-LIMB !

Here are some nice up close photos of the i-LIMB !

And Even More Press On The i-LIMB

Bionic hand grabs our attention
From claw-like device to fully functional digits

Cheryl Chan, The ProvincePublished: Monday, July 30, 2007
John German no longer needs a helping hand.

German, 40, lost his left hand 20 years ago. He was fitted with a bionic hand last May.

"It's making a difference every day. I can hold a child's hand now without crushing it," said the father of two from Altoona, Penn., who was in Vancouver yesterday at a conference of the International Society for Prosthetics and Orthotics.

The i-LIMB costs $18,000 US and is the world's first commercially available bionic hand.
Each finger is powered by an individual motor. The thumb also rotates, giving greater dexterity.
Two electrodes attached to the patient's skin pick up muscle signals that control the hand.

"You think and then you flex, and then the hand picks up on it," said German, whose bionic hand is encased in a flesh-coloured silicone cover that looks much like skin, down to the nails and knuckles.

German says he can now put a key into a door lock, peel a banana, use a can opener, or pick up a Blackberry from a table.

"The world is wide open. I've only seen some of the capabilities," said German, who found out at 20 that he had a neurological condition that affected his arms when a scratch on his hand, made by a puppy, didn't heal and became gangrenous.

He underwent 17 surgeries but doctors were unable to save his left arm, which was amputated at the mid-forearm.

Before the bionic hand, German had a rigid prosthetic that used a thumb and two fingers to produce a simple claw-like grip. "I might be able to grab something but I'd have to bend at my knees, shoulders and elbow to grab it."

Instead of a claw, he now has full use of all digits.

The i-LIMB is manufactured by Edinburgh-based Touch Bionics and runs on batteries that need to be charged overnight. It will be available in Canada this week.

It has been fitted on a Briton and 13 Americans so far.

It comes in only one size but there are plans to produce four sizes to suit female and male hands.

chchan@png.canwest.com

© The Vancouver Province 2007

A Little More On The i-LIMB

Touch Bionics, developer of the world's first commercially available bionic hand, today announced that its i-LIMB Hand and ProDigits partial hand prostheses are now generally available and have been successfully fitted to a significant number of patients across the United States and in Europe.Touch Bionics' i-LIMB Hand looks and acts like a real human hand and is the world's first widely available prosthetic device with five individually powered digits. In another industry first, Touch Bionics' ProDigits product is adapted for patients who have a partial hand, due either to congenitally missing fingers or fingers lost through an accident. Partial hand is an area of prosthetics that has been without suitable powered products in the past.The i-LIMB Hand and ProDigits will be formally unveiled later this month at the 12th World Congress of the International Society for Prosthetics and Orthotics in Vancouver, Canada. But Touch Bionics' technology is already changing the lives of patients with its prosthetic products, working with leading U.S. clinical partners including Advanced Arm Dynamics, Benchmark Orthotics and Prosthetics, Hanger Prosthetics and Orthotics, LIVINGSKIN and Scott Sabolich Prosthetics and Research.Sergeant U.S. Army (ret'd.) Juan Arredondo of Universal City, TX, who lost his hand in Iraq in 2004 after his patrol vehicle was struck by an improvised explosive device, is one patient who today is living a different life after being fitted with the i-LIMB Hand.The technology behind the i-LIMB Hand has come of age after many years of research and development at Touch Bionics.The i-LIMB Hand offers a unique, highly intuitive control system that uses a traditional myoelectric signal input to open and close the hand's life-like fingers. Myoelectric controls utilize the electrical signal generated by muscles in the remaining portion of a patient's limb. This signal is picked up by electrodes that sit on the surface of the skin. Users of existing, basic myoelectric prosthetic hands are able to quickly adapt to the system and can master the device's new functionality within minutes. For new patients, the i-LIMB Hand offers a multi-function prosthetic solution that has never before been available.Touch Bionics has developed a custom cosmesis, or covering, for its products. i-LIMB Skin is a thin layer of semi-transparent material that has been computer-modeled to accurately wrap to every contour of the hand.For those patients who desire a more life-like appearance for the hand, Touch Bionics has partnered with some leading companies in the development of cosmesis for its products. ARTech Laboratories and LIVINGSKIN work at the forefront of high-definition cosmesis -- these companies are collaborating with Touch Bionics to offer patients a life-like solution to compliment the life-like motions and performance of the hand.The i-LIMB Hand and ProDigits products are being shipped today and patients are being fitted at all of the clinics mentioned above in addition to other US clinics, as well as at Touch Bionics' new state-of-the-art facility in Livingston, Scotland.

CollegeRecruiter.com Insights by Admissions Counselors Blog

Are you thinking about a career in the O&P field?
Read this article; it maybe of help.

Orthology and Prosthetology

Orthotics and prosthetics are two exciting careers that combine the challenge of working with cutting-edge technology and the satisfaction of helping people in need.

Patients who need customized artificial limbs or support systems are helped by prosthetists or orthotists. Orthotists work with patients who need extra support for their muscles, spine, or limbs. For example, orthotists design and fit corrective shoes or cutstomized braces.

Prosthetists work with patients who need replacement limbs.

There are two levels of professional work in orthotics and prosthetics: practitioners and technicians.

Practitioners are part of a team of healthcare workers who develop an effective rehabilitation program for the patient. They work with physicians, surgeons, physical and occupational therapists, psychologists, and vocational rehabilitation counselors to understand the patient’s needs. Before designing a prosthesis (artificial limb) or an orthosis (brace or splint), the practitioner examines the patient to determine the best way to make a prosthesis or an orthosis. The practitioner takes measurements and makes a plaster impression; then, he or she designs the device, supervises its construction, and evaluates how well the device fits the patient.

Technicians actually build the orthoses or prostheses—typically from materials such as metals, plastics, leathers, and fabrics—under the supervision of the practitioner.

Becoming a certified prosthetist or orthotist is a five-year process. Certification is optional, but recommended. Prosthetists and orthotists must have a four-year bachelor’s degree. Generally, they have two years of general study followed by two years of professional training, which includes study in science and human anatomy. Following the bachelor’s degree, students must complete a one-year residency. Once the residency is completed, students are eligible to sit for the certification exam.

Becoming a technician is not quite so rigorous. It’s a good choice for students who are interested in craft rather than the clinical aspects of the profession.

Most technician programs are two years and focus on mechanics and materials science.
Career outlook The career outlook for orthotists and prosthetists is good. While only eight institutions nationwide currently offer orthotics and prosthetics education, the demand for provider services is expected to increase by 25% for orthotic care and 47% for prosthetic care by 2020. This practitioner shortage means more demand than ever for graduates of the nation’s orthotics and prosthetics education programs. Changes in technology and science make this career area exciting and challenging. The average wage for full-time registered technicians is $40,454 annually. Most technicians work for practitioners, where they specialize in the types of devices they create. Some work in fabrication centers, where they specialize in the creation of specific kinds of devices.

The average salary for non-certified, licensed orthotists and prosthetists with seven years of experience is $56,040. The average salary for a certified professional with fifteen years of experience is $91,452. Most prosthetists and orthotists work in private practices and hospitals. Some work as researchers in universities and government facilities.

If helping others who are injured or disabled appeals to you—and if you can conceive and create the kinds of devices described above—you should consider orthotics or prosthetics.

If you think you might be interested in a career in orthotics or prosthetics, contact the American Academy of Orthotists and Prosthetists, 526 King Street, Suite 201, Alexandria, VA 22314, 703-836-0788; or visit their website at www.oandp.org or their career website at www.opcareers.org.

Article courtesy of www.careersandcolleges.com

Amputees get a new lease on limb control

July 25, 2007
Edition 1

Sergeant Juan Arredondo's son says his dad is "half robot, half man". The retired Iraq veteran is one of the first recipients of a bionic hand with independently moving fingers, called the i-Limb.
Each finger has an individual motor powering it, enhancing dexterity and allowing patients to do activities they were unable to do with previous prosthetics, such as shaking another person's hand and naturally grasping around round objects such as door handles, fishing rods and a computer mouse.

It contains a computer chip that translates electrical signals made by the arm's nerves into physical movement.

The device - developed at Touch Bionics in Edinburgh, Scotland - costs $60 000 to $150 000, depending on the length of the amputation.

According to USA Today, the i-Limb outshines its predecessors by "a long shot".

Troy Farnsworth, vice-president of Hanger Prosthetics and Orthotics, which markets the device in the US, says although it still does not have sensory or waterproof functions, it does empowers the user to use all five fingers.

Other bionic hands allow for the use of only the thumb, index and middle fingers.
"It works so much like a normal hand that it really bridges the gap" between prosthetic and real hands, he says.

Arredondo lost his hand on patrol in Iraq in February 2005, when an bomb blasted through the side of his vehicle.

As he leaped from the driver's seat, he noticed that his left hand was still clutching the steering wheel.

And this week US researchers unveiled a computerised prosthetic ankle and foot that could change the lives of a growing number of amputees returning from battle in Iraq and Afghanistan.

The prosthesis has a built-in power source and multiple springs to mimic a real human ankle, giving amputees more propulsion when walking, while reducing the limping and back pain commonly associated with existing prosthetic devices.

Garth Stewart, a 24-year-old US soldier who lost his left leg below the knee in a roadside explosion in Iraq in April 2003, demonstrated the device at the Veterans Affairs Medical Centre in Providence, Rhode Island and showed almost no sign of a limp.

"Once you get used to it," he said, "it feels like you have your leg back."

Improvised explosive devices, or IEDs, and other bombs have caused a surge in limb-loss injuries among US troops in Iraq and Afghanistan.

Dr Hugh Herr, a professor at the Massachusetts Institute of Technology who led the research, said the apparatus produced a sensation like that of a moving airport walkway.

"It's a smoother ride, if you will," said Herr, whose legs were amputated below the knee after a mountain climbing accident when he was 17. The ankle-foot prosthetic had been tested on eight amputees so far, he added.

The new device can generate its own momentum, meaning the user can put less effort into the act of walking. The prototype also has sensors and a microprocessor that measures walking speed, terrain and the body's position and adjusts the amount of power supplied accordingly.
It is expected to be made available commercially by iWalk.

John Stephens, vice-president of research and development at iWalk, said the company hoped to have the prosthetic available by next June.

- Daily Telegraph, Reuters

C leg for amputees

7/25/2007 5:00 AM

By: Marcie Fraser

There are 15,000 amputees worldwide wearing a C leg. This computerized leg allows people overcome their disability and return to the life they lived before.

Sparky Gallagher said, "I was 28 and had bone cancer. It's a tumor that starts inside your femur and breaks through and they don't have much choice but to amputate. You go through chemotherapy and fitting up a leg after that."

Before his amputation, Sparky Gallagher was an active young man. Over the years, he's been fitted with several prosthetics, some not so successful and he fell a lot.
He said, "No one knows how to fall unless you are an ice skater or something like that. You have to learn all those things."

Walking with a prosthetic, especially down hills or stairs, takes practice and he fell every day, but not anymore. He's wearing a C leg, a computerized prosthetic knee joint with a microprocessor on board.

Clinical Prosthetics Orthotics Owner David Misener said, "Essentially they all work together for the computer that's on board. It knows when the heel is touching the ground. It knows when the toe is coming off the ground. So the computer is responding to the amputee walking."
The computerized leg reads and controls valves 50 times a second, adjusting to how a person is walking. His gait, flexing and heel-toe load is adjusted using a lap top. This prosthetic is most appropriate for active amputees.

Misener said, "You need to be able to walk at variable cadence. You need to be able to walk at different speeds so the technology on board is actually useful."

It's not uncommon for any of us to trip, stumble, even take a fall, but when a person with a C leg stumbles, there is a computer that senses it, adjusts and goes into a safe mode.
So if Sparky trips, the leg automatically adjusts causing some of the hydraulics to stiffen which gives a person a second to catch their balance.

He said, "It gives you that little bit of time then you got the time to make a hop with your other leg, and if you know you are going to fall it gives you time to get your arm out. Sometimes you've got time to grab a counter or a rail."

Misener said, "You can certainly golf. You can downhill ski. You can run. You can jog. You can bike. You can stand all day. Certainly it gets you back doing what you would like to do throughout the day."

Bionic hand can peel a banana

Touch Bionics, a Scotland-based company, will formally unveil the i-LIMB in Vancouver on July 29

William Lin, CanWest News ServicePublished: Monday, July 23, 2007

OTTAWA -- At an age when many bodies begin to slow down, John German is rediscovering the simple pleasures of using his hands to peel a banana and operate a manual can opener.
After losing part of his left arm two decades ago, he has avoided such simple joys as using his previous prosthetic to grasp the fingers of a baby for fear he could hurt the child.

About a month ago, the 40-year-old clinical technician from Altoona, Penn., switched to the remarkably human-like i-LIMB, a new bionic hand that its company hails as a "generational step" in prosthetics.

Touch Bionics, a Scotland-based company, will formally unveil the bionic hand in Vancouver on July 29 at the World Congress of the International Society for Prosthetics and Orthotics.
"The current products that are in the market only have one grip position, which is effectively the index and middle finger closing down to meet the thumb," said Phil Newman, the company's head of sales and marketing.

The i-LIMB provides patients with new grips that weren't possible for amputees before, allowing them to insert a key into a hole, put on a tie and, in German's case, peel a banana.
The hand uses a rotating thumb and individually powered fingers to form various grips. Also, the skin covering is convincingly life-like, with knuckles and fingernails.
For German, it looks like the real thing.

The hand's movements are not directly generated by brain signals, said Newman, as some science fiction fans might believe.

In each of the fingers, a sensor recognizes the level of resistance on an object and tells them to stop grasping. Each finger also has its own motor.
The five individually powered fingers grips around objects and locks when enough force has been used.

German said his last hand was "no better than a wireless mechanical hook."
"In the past month, I'm rediscovering some tasks," German said, "and really rediscovering what it's like to have a hand that is not just shaped like an original hand, but one that functions like an original."

But the prosthetic hand's functions are still limited.

"There are going to be some functions that you cannot perform like playing the piano," Newman said.

The i-LIMB hand costs $18,000 U.S.

Powered by batteries that last a day located inside the patient's socket, the arm must be recharged overnight.

So far, the bionic hand has been fitted on 14 patients.

© The Vancouver Sun 2007

Prosthetic technology advances to meet wounded troops' needs

Amputees - The new devices eventually will serve a much larger civilian demand
Monday, July 16, 2007
DAVID DISHNEAU The Associated Press
WASHINGTON -- With time and determination, Minnesota National Guard Sgt. Darrell "J.R." Salzman has learned to tie trout flies with his mangled left hand and the shiny metal hook that serves as his right.
But he lacks patience for another prosthetic device -- the Utah Arm -- that the Army gave him after he lost his right limb below the elbow to an enemy bomb in Iraq in December.
The myoelectric Utah Arm, made by Motion Control Inc. of Salt Lake City, has circuitry that reads muscle twitches as electric signals to open and close a hook or hand attachment. But its response time, even at less than a second, is so slow that Salzman prefers an old-fashioned, "body-powered" prosthesis, controlled by a cable and rubber bands.
"I don't like having to wait if I want to grab something," said the 27-year-old from Menomonie, Wis.
The Defense Department has contracted researchers and prosthetics manufacturers to build a thought-controlled arm at a cost of about $30 million.
Dozens of companies have received grants to invent and improve prostheses that will be used first by wounded troops and eventually by civilians.
Because today's approximately 600 war amputees account for a tiny fraction of the 1.9 million Americans living with limb loss, leaders of the nation's $900 million prosthetics industry say the government's investment will be seen less on balance sheets than in the sophistication of new prostheses.
"That is, in my mind, almost like what the space program did," said Thomas Kirk, president of Hanger Orthopedic Group Inc., the nation's largest provider of prosthetic services.
The Pentagon and the Department of Veterans Affairs are buying more prosthetic products and services. For example, the VA said it spent $1.1 million last year on prosthetic devices and services, compared with about $529,000 in 2000.
Wounded soldiers historically have pushed the boundaries of prosthetic technology by demanding more functional, durable, comfortable devices. These days, the military aims to restore functionality to the point that some have returned to battle.
Hanger, with nearly a quarter of the nation's 2,700 prosthetic and orthotic patient care centers, had 2006 sales of $599 million. Its share price hit a nearly three-year high of $12.40 in April. In May, it said sales at patient care centers open more than a year grew at an annual rate of more than 2.5 percent.
The company was founded in 1861 by a Civil War amputee, James Hanger of Virginia, who fashioned an improved artificial leg out of whittled barrel staves, rubber, wood, and metal components and started selling them to other Confederate veterans.
Germany's Otto Bock HealthCare, the world's biggest manufacturer of prostheses, also has wartime roots. It produced devices for World War I veterans. The private firm now has annual sales of about $500 million.
Bock's C-Leg, a microprocessor-controlled knee joint introduced in the late 1990s, is the standard prosthesis issued to U.S. fighters who have lost a leg above the knee, according to the American Orthotics and Prosthetics Association. It costs $30,000 to $40,000 delivered and fitted by a certified prosthetist and equipped with a socket, liner and foot.
Otto Bock is also the commercial partner in the $30 million project at Johns Hopkins University in Baltimore to develop a thought-controlled arm by 2009.

Advances in prosthetics help U.S. soldiers

Hundreds of American soldiers have returned from fighting in Iraq and Afghanistan as amputees, with more than 100 having lost multiple limbs. Fortunately, dramatic improvements in prosthetics are restoring mobility and productivity to these injured heroes.

Some of these innovations include microprocessor knees, the standard for U.S. soldiers in need of a lower-limb prosthesis. They make hundreds of calculations per minute to adapt to a user's gait. Another innovation is targeted muscle reenervation, which reroutes nerve signals in an amputee's residual limb, allowing him or her to "feel" and sense movement in the artificial limb.
"The Departments of Defense and Veterans Affairs have led the way with a huge commitment of resources for research and development to identify superior materials and technologies that have provided a quantum leap in our therapeutic alternatives," said Ted Snell, a certified prosthetist, president of CFI Prosthetics and Orthotics and the 200607 president of the American Orthotic and Prosthetic Association.

In addition to soldiers, civilians reap the benefits of advanced prosthetics and increased funding for research. Heather Mills, a below-knee amputee, was highly praised for her appearance on ABC's "Dancing With the Stars." Oscar Pistorius, a 20-year-old South African double amputee who competed in Athens at the 2004 Paralympics, is now running the 200- and 400-meter sprints fast enough to earn a spot on the official Olympic team.

Although the advances in orthotics (orthopedic braces) and prosthetics are considered good news stories for many, there are still challenges to overcome. Comparing Medicare payments in 2003 against 2005 payments, dollars paid for orthotic and prosthetic devices declined while the number of devices provided increased.


This story is provided by North American Precis Syndicate Inc.

Getting a leg up

Prosthetics companies profit from diabetes rise

The waiting soom in William Yule’s office is full by the time he arrives each morning.
Throughout the day, Yule sees dozens of patients, bouncing between four sparsely decorated examining rooms on such a tight schedule he often has no time for lunch.
But Yule is no doctor. He’s a prosthetist who fits limbs on amputees, and business is booming for one reason: diabetes.
“There’s no such thing as a slow day,” says Yule, of Hanger Prosthetics & Orthotics Inc. in Downey, as he helps a client adjust her new right leg. “It can be hard, because you can’t help thinking a lot of these people don’t need to be here.”
As 1.5 million Americans are diagnosed with diabetes each year, a growing number are confronting one of the most brutal consequences of the disease: amputation of a limb.
The number of amputees in the United States has grown by nearly 1 million over the past decade, according to federal statistics, and roughly 60 percent of amputations are diabetes-related.
Public health experts are ramping up efforts nationwide to reverse the trend, but for now, there is a boom in the long-sleepy prosthetics industry, which experts say hasn’t seen a sales spike like this since its modern inception, on Civil War battlefields.
Sales of prosthetics have jumped from $340 million in 1996 to nearly $600 million last year, according to estimates based on federal data.
The industry’s growing profile has even caught Hollywood’s eye. The Discovery Channel aired a 10-part series on a Fairfax, Va., prosthetics shop, “Rebuilt: The Human Body Shop,” last year, and a prosthetist was prominently featured in the first season of Showtime’s “Dexter.”
Although the industry has begun to consolidate, most manufacturers and sellers remain small to medium-size companies and mom-and-pop shops that are adapting to their growing businesses one step at a time.
Five years ago, Life-Like Prosthetics, a clinic in Torrance that creates artificial limbs, saw two to three patients a day. Now it fits an average of eight patients daily, manager Carlos Sambrano said.
Sambrano, who sold the shop to a larger San Diego company last fall, said up to 70 percent of his clientele was now made up of diabetics, as opposed to one-quarter when he entered the business three decades ago, when most amputations resulted from car accidents or cancer.
The company moved into a 6,000-square-foot warehouse in 2004, doubling its size, and its biggest struggle today is finding qualified employees. “I’ve been looking to fill one of my spots since October,” Sambrano said.
Peter Rosenstein, executive director of the American Academy of Orthotists and Prosthetists, said the industry’s labor shortage worsened in recent years. By some estimates, it will need 100 percent more workers over the next decade.
Since 2003, Congress has given the organization $4 million in grants to heighten awareness of the specialty at high-school and junior-college job fairs and for public-awareness campaigns set to start later this summer.
“We tell kids, ‘you can make a good living doing this,’” Rosenstein said. “A lot of them think it’s cool.”
Diabetes is a metabolic disease in which the body doesn’t produce enough insulin or doesn’t process it well. Because diabetics have reduced circulation in their limbs, an estimated 5 of every 1,000 diabetics eventually requires an amputation, usually of a leg. Up to half of the amputees lose two limbs.
Lilia Portales, a 67-year-old grandmother from San Bernardino, had her left leg amputated below the knee more than a year ago.
The mother of 14 and grandmother of six lost her left leg after a small cut on one of her toes became so infected that doctors had to cut the toe off. When that didn’t help, they removed the other toes and eventually the lower leg.
Portales said that she didn’t leave her house very often at first after the amputation and that she had suffered bouts of depression in recent months.
During a therapy session, Yule, of Hanger Prosthetics, tried to get Portales to walk the length of the room on her new leg with the aid of two assistance bars, enticing her with the possibility that eventually she would be able to dance again.
“Right now, I’ll be happy if I get to the grocery store more often,” she said.
To capitalize on the market boom, manufacturers are introducing an unprecedented number of artificial sockets and limbs, many aimed at older and overweight users rather than the younger patients who traditionally have been the focus for new products.
Some have sensors in the feet that clock how fast a user is moving, how much they weigh and if the foot is on an incline so it can adjust accordingly. Other products, such as the C-Leg and a bionic knee called the Rheo, are so advanced that some amputees use them to run marathons.
Typically patients weighing more than 250 pounds have had a hard time getting prosthetics, but some newer models can accommodate patients up to 350 pounds.
Prices of artificial limbs typically range from $2,500 to $50,000, depending on how advanced they are. Currently, insurers pay for most products, although some have started to balk as the number of reimbursement claims has risen.
In response, three states have passed laws in the past two years requiring insurers to boost coverage. In total, six states now have such laws, and several others are considering similar 
measures.
“We joke that whenever they have a pill to cure diabetes we are all going to be out of business,” said Eric Robinson, president of Fraser, Mich.-based College Park Industries, which recently introduced an advanced foot called the TruStep.

War fuels prosthetics research blitz

By David Dishneau, Associated Press
WASHINGTON — With time and determination, Minnesota National Guard Sgt. Darrell "J.R." Salzman has learned to tie delicate trout flies with his mangled left hand and the shiny metal hook that serves as his right.
But ........

To read story visit USA TODAY at -http://www.usatoday.com/money/industries/health/2007-07-15-prosthetics_N.htm

Amputees make the most of life with a Manchester company's help

By SHAWNE K. WICKHAMNew Hampshire Sunday News Staff Sunday, Jul. 15, 2007

Manchester – Matt Albuquerque calls it the "wall of inspiration," these photos hanging in his company's reception area that depict people scuba diving, dancing, running, golfing, even sky-diving.
And if you didn't know to look, you probably wouldn't notice: All these folks are pursuing their dreams with the help of artificial limbs.
Albuquerque is the founder and vice president of Next Step Orthotics & Prosthetics Inc., a company headquartered in the Manchester Millyard. Here, an on-site lab combines artistry and engineering to create custom fitted devices.
But, Albuquerque explained, "It's really about providing an opportunity for people who don't think they have one."
"We say we're not giving you a leg, we're trying to give you your life back," he said. "I've seen enough miracles, I've seen enough people turn the corner, to know it can happen."
That's what the photos and the scrapbooks scattered around the waiting area are about. It's the first impression that Albuquerque and his partner, Peter Couture, Next Step's clinical director and president, are after.
So even before a client speaks with anyone, Albuquerque said, "This gets rid of a lot of the preconceived notions that people have."
Whatever you did before amputation, you can do again, he'll tell clients, knowing that the biggest hurdles often are not physical but mental.
And if they don't believe it? "That's when we bring people in to talk to them," he said.
People like Jason Lalla, who became a client of Couture after he lost a leg in a motorcycle crash in 1989, just two weeks after his high school graduation. Lalla continued to pursue his dreams and became a Paralympic gold medalist in skiing.
Now he's a certified prosthetist at Next Step -- "To be able to give back," Lalla explained.

Then there's Chris McLaughlin of Gilford, a bio-engineering student at Syracuse University who is job shadowing the folks at Next Step this summer.
He's also a client.
"When I was a kid, I came here, and they accepted me and treated me like family," McLaughlin said. "This is the best place ever."
McLaughlin's left leg was amputated when he was 9 years old, the result of a birth defect, but that didn't stop him from skateboarding and other activities. "Chris was the beta tester for a foot that was supposed to be unbreakable," recalled Albuquerque. "If he didn't break that thing a dozen times..."
The engineers, he grinned, "didn't want to take our calls after a while."
Now 20, the young man with a big smile is a natural with the children who come here for braces or prosthetic limbs. "Ten years ago, that was me," McLaughlin said.
These days, Next Step is seeing more veterans, both from past conflicts and the current wars in Iraq and Afghanistan. And while the mission is the same for all his clients, Albuquerque said, "I have a soft spot in my heart for any veteran."
Next Step is involved with the Wounded Warrior Project's annual ski program for disabled soldiers at Waterville Valley. And Albuquerque has been a key supporter of the Veterans Count initiative at Easter Seals New Hampshire.
His company also is working with its Millyard neighbor, Dean Kamen's DEKA, on a project for the Defense Advanced Research Projects Agency to develop an advanced upper-body prosthesis for amputee soldiers.
Albuquerque said his respect for the military was instilled in him by his late father, a 20-year Navy man. "Everything I have here today I attribute to him, so whatever I can do to help any vet is giving that little bit back."
'Parts is parts'
In 1974, Robert Wilson of Amherst was a flight deck officer on the USS Kitty Hawk. He was directing an aircraft that was landing on the carrier deck and "took three steps back."
"I was in front of one of the cables that catches the plane, and the plane landed," Wilson said. "One-two-three, bang -- gone."
Both legs were severed in the accident, which Wilson doesn't remember. But while it ended his military career, it didn't change his determination to recover -- or his lifelong passion for golf.
Today Wilson is the long-time executive director of the National Amputee Golf Association -- and a client of Next Step, where he serves as an inspiration for others to pursue their dreams, according to Albuquerque.
Here's how Wilson, at 66, sees his disability: "It doesn't mean that life has to stop just because you're missing a part. Parts is parts. And with technology today, the new part might be better than the old part."
One of Next Step's specialties is the custom-molded "socket" that fits over the amputee's body and onto the prosthetic limb. With the lab right here, the staff can fit a client right away, and make any adjustments needed without having to send the device out -- and a person's mobility along with it, Albuquerque noted.
"If you can give us half a day, we can go through two weeks of appointments while you wait," he said.
It's more than a time advantage. "If I'm doing it while you're here," he explained, "I've got your anatomy in my mind."
The client has plenty of choices, from a favorite fabric to cover the socket, to the kind of "cover" that fits over the prosthesis. Albuquerque showed off a remarkably lifelike, high-definition silicon cover that's made in England by fine-art students, the choice of a client who wanted to dance in high heels.
At the other extreme is the futuristic-looking "running leg" that another young woman uses for races.
It's all about the client's wishes, Albuquerque said. For a Vietnam vet, that meant covering a "beach leg" for swimming with a patriotic fabric. For a Harley rider, it was a high-tech prosthesis with no cover "" just small flames to embellish the sleek black metal that matched his bike.
What makes Next Step unique, Wilson said, is "the fact that they take a personal interest in the individual, and they try to make sure that everything is right with the prosthesis before you walk out the door with it."
Indeed, the relationships with clients are as important as the orthotics or prostheses themselves, Albuquerque said. And that's why he doesn't want to grow too large: "We never want to get beyond what our fingertips can touch."
Meanwhile, Albuquerque said he considers himself "one of the luckiest guys in the world."
"Just because of what we get to do: Surround ourselves with true heroes, and make a great impact on people's lives."
YOUR COMMENTS
The voices of UnionLeader.com readers:
Our Daughter Madlyn visits Matt & Scott for her leg brace. what a wonderful team that works in the office. Matt does a great job with our daughter and is also our hero!! Thank you Matt for all you do. Daniel,Laurie & Madlyn Gladysz Manchester NH- Laurie Gladysz, Manchester NH
I have had the opportunity to work with Matt and Scott. What they do is wonderful and they truly are caring individuals. Keep up the good work!!! Kim- Kim Khan, Raleigh, NC
Hello, I am a client of NextStep O+P. I was in a serious motorcycle accident on July 2nd 2002, after dealing with another O+P business for just over a year, I was introduced to Matt Albuquerque. Matt actually came to my Dr.'s office to meet me! He spent a lot of time with me there, he understood, and validated my concerns. NextStep has been there for me every step of the way. I was never suppose to be able to walk again (due to severe nerve damage... I shattered a vertabrae, and injured my spinal cord). However, Matt always reinforced his belief in me, and with the exceptional care that NextStep provides us clients... I do walk today, I am still not able to run, and have other issues to contend with, but thanks to Matt, David, and the whole gang at Nextstep, I do walk!!! There is a great sense of freedom to be out of the wheelchair that was suppose to be my form of mobility for life. Thanks go to Matt and his staff for their undying compassion and care for their clients. I love these people, and I could never thank them enough!!! NextStep O+P is the ONLY place I would ever recommend to anyone needing orthotics/prosthetics. Thank You for the opportunity to live a more confident, comfortable, and satisfying life Matt, I will NEVER forget what you have done for me Matt!!! Ernie Marcoux- ernest marcoux, goffstown

HOMELAND INSECURITY

Al-Qaida infiltrating America as patients

Clinics warn of medical visa scam by foreigners looking to get in U.S.

© 2007 WorldNetDaily.com

Medical clinics across the country have been flooded with requests from foreign nationals from Pakistan and other Muslim countries to help them gain visa entry into the U.S. as patients.

The post-9/11 trend concerns authorities who fear al-Qaida could be using the medical industry to infiltrate terrorist cells into the country.

Some clinics have sponsored foreign patients only to have them fail to show up at their facilities.
The Caster Eye Center in Beverly Hills, Calif., for example, stopped granting such foreign requests after a couple of no-shows.

"In the last few years, we have granted this request only twice. The first was for someone in Uganda, and the other was for someone in Sri Lanka," said Diane Sylvester, surgery coordinator at the Caster Eye Center, one of the leading Lasik eye surgery clinics in Los Angeles. "On both occasions, we issued the letter of invitation, and on both occasions the patient in question never showed up at our facility."

Sylvester told WND the clinic recently has received additional requests for letters from nationals in Pakistan and other al-Qaida hotbeds. Foreign nationals can use the letters to obtain B-2 visitors visas from the State Department to receive medical treatment.

Requests sent to the Caster Eye clinic via e-mail, copies of which were obtained by WND, show nationals have not only requested letters for themselves but for groups as large as a dozen people.

"My concern is that our facility is helping people we cannot personally vouch for to gain entry into the U.S. – or even worse, helping people get visas which are then given or sold into the wrong hands," Sylvester said.

"How many other medical facilities are churning out letters like this under similar circumstances?" she added.

A spokesperson for the State Department, which grants U.S. visas through its embassies abroad, said there are no post-9/11 restrictions on medical facilities issuing invitation letters to foreign nationals. Nor has the department issued any cautions to the health-care industry.
"I'm not sure which I'm more alarmed by – people scamming for visas, or the casual attitude of those overseeing the granting of visas," Sylvester said.

The department added, however, that a letter of invitation from a medical facility does not necessarily guarantee approval of a foreign patient's visa.

In the wake of the recent "doctor jihad" in the UK, the FBI and Department of Homeland Security are scrutinizing foreign nationals who have applied to the U.S. for visas to attend medical school or practice medicine here.

Two of the UK physicians who plotted to car-bomb London's entertainment district had applied for permission to work in the U.S. One made contact with the Philadelphia-based Educational Commission for Foreign Medical Graduates.

Terrorists posing as patients also are a growing concern, federal authorities say.
FBI case agents contacted by WND confirm al-Qaida in the past has tried to infiltrate operatives into the U.S. by claiming they need medical treatment.

Take the case of Tawfiq bin Attash, also known as "Khallad" or "Salah Mohammad."
The dangerous al-Qaida operative and one-time bodyguard for Osama bin Laden – who helped plan both the 2000 bombing of the USS Cole in Yemen and the earlier bombings of the U.S. embassies in Africa – tried to enter the U.S. from Yemen before 9/11 to participate in the attacks.

In 1999, FBI sources say, he assigned a suspected U.S.-based facilitator for al-Qaida to solicit a Seattle-area medical clinic to vouch for him as a patient so he could receive a U.S. visa.
The facility, called NovaCare Orthotics & Prosthetics, issued a letter to the suspected al-Qaida facilitator confirming the appointment he made for his "friend" bin Attash – who unbeknown to the clinic, was one of the world's most dangerous terrorists.

Despite the letter of invitation, bin Attash's visa requests fortunately were denied by the U.S. government. He was arrested in Karachi, Pakistan, in 2003, and is now in U.S. custody.
In 2004, a Pakistani national from Bahawalpur – another known hotbed for terrorist recruits – demanded the Caster Eye Center in Los Angeles issue him a letter of invitation he could present to the U.S. consulate to obtain a visa.

"I want a free visa for sergury [sic]," Nabeel Ahmed Bhatti wrote in an e-mail, a copy of which was obtained by WND. He claimed to have what he described in his limited English as a "short problem" with his left eye.

Pakistanis posing as disabled travelers

Additionally, the FBI and Homeland Security have warned consular officers in Pakistan, as well as law enforcement in the U.S., to be on the alert for al-Qaida terrorists posing as medical aides to disabled persons.

In November 2003, for example, WND has learned U.S. intelligence intercepted information about a plot by al-Qaida to employ the scam to obtain U.S. visas for terrorist operatives at the U.S. embassy in Islamabad.

Here is the text of the warning issued in a closely held intelligence-driven action bulletin by Homeland Security at the time:

"As of mid-November 2003, Islamic extremists were supposedly planning to send operatives to the United States and United Kingdom to conduct attacks. The attacks will allegedly take place in April 2004. The operatives will be Pakistani individuals who would obtain U.S. visas in Islamabad, Pakistan. The operatives will accompany a disabled person and act as the disabled person's assistants when obtaining the visa."

The two-page DHS intelligence bulletin, marked "SENSITIVE LAW ENFORCEMENT INFORMATION" and obtained by WND, added that operatives could conceal weapons, explosive materials or other contraband inside prosthetic limbs or in wheelchairs on board inbound flights to the U.S.

"This method fits with current al-Qaida methodology," the bulletin said, "as al-Qaida has been trying to recruit individuals who would draw less scrutiny from U.S. law enforcement entities."

The 2007 ESPY Awards

Jessica Long is a nominee for Best Female Athlete with a Disability. Vote for her at:ESPN.com

Here is Jessica's Story!

I was born in Russia-- Irkutsk, Siberia actually-- without proper bone structure in my lower legs. I didn't have fibulas, ankles, heels or most of the other bones in my feet. I lived in an orphanage until my parents adopted me and brought me to the U.S. When I was 18 months old, both of my legs were amputated below the knees. I was fitted with prosthetic legs and my parents tell me I learned to walk within a few weeks.

I always liked swimming, but for six years, I did gymnastics. I really didn’t want to use prosthetics to compete, but my parents were afraid I’d injure my knees without them. I looked into other sports and decided on swimming because I didn’t have to wear prosthetics to compete.

When I began swimming competitively, I was the only disabled swimmer on the team, but I really didn’t care what anyone thought. Most people didn’t even notice my legs were missing until I got out of the pool.

Swimming was really hard at first, but now I’m used to it. When I first started breaking records, I thought, “Wow, I’m good.” Now I hold 21 American Records, eight Pan-American Records, two Paralympic Records and two World Records. I’ve earned seven national gold medals and one national silver medal.

I competed at the Paralympic Games in Athens, Greece in 2004. The Paralympics is for disabled athletes at the highest level. Over 4,000 athletes from over 140 countries participated. At age 12, I was the youngest member of the U.S. team and the youngest Paralympian to win gold-- two individual gold medals and one gold as part of a relay. I was really happy to win the gold. I knew I was representing my country, but then to get on the podium . . . that was my flag, that was my anthem. It was amazing. My whole family was there and Jonas Seeberg, my prosthetist at Real Life Prosthetics, even went to cheer me on.

I feel very thankful to have come all the way to America from a Russian orphanage. God has given me many opportunities and I know He still has more planned for me in the future. I hope those plans include me going to Beijing in 2008 for the paralympics. I want to compete in six events and bring home six more gold medals. For now, Jonas has made specially designed running legs for me, so I can play basketball and compete in triathlons.

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Outsource Marketing Solutions blog

Stop by and visit this very nice blog which is filled with many wonderful resources!

This blog is all about orthotic and prosthetic marketing, business and practice development, public relations, branding, Web sites, e-marketing, brochures, newsletters, direct mail, announcements, press releases, relationship building, cross-selling, networking, conferences, and referrals.

Running Across America For Jesus

Maryland amputee, Eugene Starks Roberts, Sr. started his run across America on July 2, 2007.

Visit Eugene's web site to track his journey across America.

www.raafj.com

The Disabilitynation Podcast

Stop by and listen to The Disabilitynation Podcast, A Podcast by and for People with Disabilities!

New prosthetic device helps grant second chance at “normal life”

Dr. Rick Psonak, right, assistant professor of orthopedic surgery and rehabilitation, adjusts Anthony McCool's high-speed myoelectric prosthesis called the "Dynamic Arm."


With the birth of his second son and the holidays around the corner, Anthony McCool was working all the overtime he could manage at a plant in Yazoo City.

At 10 p.m. on what would have been just a normal October night at work, the 25-year-old took a misstep that would forever change his life.

McCool fell off an observation platform. His arm got caught in a conveyer belt, and he was pulled approximately 300 feet before being hung in midair for an hour. While in the most excruciating pain of his life, he wondered if he would even survive to see his family again.

That night, McCool lost three quarts of blood. He eventually made it to the University of Mississippi Medical Center, but his arm could not be saved.

“They had to take my arm, my shoulder joint, everything,” he said. “I never dreamed anything like this would ever happen to me.”

McCool was given a second chance at having a normal life, thanks to Rick Psonak and Richard Boleware, certified prosthetists in the Department of Orthopedic Surgery’s Division of Orthotics and Prosthetics.

McCool became the third civilian ever to receive Otto Bock’s high-speed myoelectric prosthesis called the “Dynamic Arm.”

“Anthony has a very radical amputation,” said Psonak, assistant professor of orthopedic surgery and rehabilitation. “He doesn’t have any of his arm or his shoulder.

“Most upper limb amputations involve the hand and wrist getting caught up in machinery. This type of amputation is extreme and is very difficult to fit with a prosthetic arm.”

Normally an electronically powered arm with batteries can be pretty heavy, so many amputees opt not to wear a prosthesis. However, new, lighter technology is now available, according to Psonak. “This technology has been made available for members of the military who have lost limbs,” he said. “There has been great success fitting microprocessor prostheses because they respond instantaneously.” Most computerized arms are much slower.

This new technology uses an amputee’s own nerves and muscles to activate the prosthetic hand and elbow. This allows McCool to move his prosthetic arm as if it were a real limb – by simply thinking about what he wants the arm to do.

The myoelectric arm is driven using electrical signals from the muscles of the chest, now activated by the user’s own thought-generated nerve impulses. These impulses are sensed, via surface electrodes, from the pectoral muscle and relayed through the microprocessor, causing the arm to function.

The arm, which costs roughly $120,000, is not for everybody. According to Psonak, amputees have to be psychologically and emotionally adjusted to be a candidate for the arm.

“Anthony is a brave guy,” he said. “He is a young, motivated, positive guy who seems to be well adapted to the challenges he has to face each day.”

Before receiving the arm, McCool had to wear a prototype prosthesis to see if he could tolerate the weight.

“We told him we would not fit him with the ‘Dynamic Arm’ unless he could wear the arm at least three hours a day,” Psonak said.

McCool passed several functional tests and was then fitted with the “Dynamic Arm.” They also made sure McCool could easily put the arm on and take the arm off.

The microprocessor technology is developed in Germany. Psonak and Boleware custom design each prosthesis to meet the needs of each individual.

“We want to make sure there is nothing available in the field of prosthetics that we are not familiar with,” Psonak said. “We are on the leading edge of everything we do. It hurts our feelings to think that someone else is getting better treatment than what we are able to provide.

“We make sure we hire the best people and have the best technology.”

Since joining the UMC staff in September 2003, they have had numerous opportunities to help patients suffering the loss of a limb feel “whole” again.

“When we first meet our patients, a lot of them are in the dark about their condition,” Psonak said. “We introduce them to others who have experienced the same things and show them videos of what others have been able to do.”

During this first phase of his prosthetic rehabilitation, Psonak sees McCool at least twice a month, with his visits averaging about three hours. Psonak says he really gets to know his patients because of the time he gets to spend with them.

“We spend a lot of time together and that is the cool thing about this profession,” he said. “I will see him for the rest of his life.”

And now McCool can do the things he has always loved to do, like fishing and hunting. “We went out and watched him cast with a rod and reel and then hook a fish,” Psonak said. “It’s very rewarding. He is an inspiration to us all.”

McCool never realized how difficult things were to do with just one arm. Tasks simple to an average person, like using measuring tape or hanging a picture, can be impossible to do with just one hand. “The arm really helps so much,” McCool said. “I never thought I would deal with things like that, but if it weren’t for this, I would be frustrated. But I know I have an alternative now. If I need it, I’ve got it.” What makes McCool so motivated?

“My family,” he said. “It is lucky I survived. I can see my kids grow up. Things like that flash through your mind when you don’t think you are going to make it.”

Soaring diabetes rates wake prosthetics industry

Soaring diabetes rates wake prosthetics industry
Business is booming largely because of amputations related to the disease. And that has led to advances.
By Daniel Costello, Times Staff WriterJuly 4, 2007

The waiting room in William Yule's office is full by the time he arrives each morning.

Throughout the day, Yule sees dozens of patients, bouncing between four sparsely decorated examining rooms on such a tight schedule that he often has no time for lunch.

But Yule is no doctor. He's a prosthetist who fits limbs on recent amputees, and business is booming for one reason: diabetes.

"There's no such thing as a slow day," says Yule, of Hanger Prosthetics & Orthotics Inc. in Downey, as he helps a client adjust her new right leg. "It can be hard because you can't help thinking a lot of these people don't need to be here."

As more Americans become obese and 1.5 million of them are diagnosed with diabetes each year, a growing number are confronting one of the most brutal consequences of the disease: suffering amputation of a limb or two.

The number of amputees in the U.S. has grown to 1.9 million, up nearly three-quarters of a million people over the last decade, according to federal statistics. About 60% of those are diabetes-related. (By contrast, as of April, the number of soldiers serving in Afghanistan and Iraq who have had a limb, hand or foot amputated is 630.)

While public health experts are ramping up efforts nationwide to reverse the trend, it is leading to a boom in the long-sleepy prosthetics industry, which experts say hasn't seen a sales increase like this since its modern inception on the Civil War battlefields.

Sales of prosthetics have jumped from $340 million in 1996 to nearly $600 million last year, according to estimates based on federal data.

The industry's growing profile has even caught Hollywood's eye. The Discovery Channel aired a 10-part series on a Fairfax, Va., prosthetics shop last year called "Rebuilt: The Human Body Shop," and a prosthetist was prominently featured in the first season of Showtime's "Dexter." (He was a serial killer who — DVD spoiler alert — was killed in the final episode.)

Although the industry has begun to consolidate, most manufacturers and sellers in the field remain small to medium-sized companies and mom-and-pop shops that are adapting to their growing businesses.

Five years ago, Life-Like Prosthetics, a Torrance clinic that creates artificial limbs, saw two or three patients a day but now fits an average of eight patients daily, manager and former owner Carlos Sambrano said.

Sambrano, who sold the shop to a larger San Diego company in the fall, said as many as 70% of his clients had diabetes, versus a quarter when he entered the business three decades ago, when most amputations resulted from car accidents and cancer.

The company moved into a 6,000-square-foot warehouse in 2004, doubling its size, and its biggest struggle today is finding qualified employees. "I've been looking to fill one of my spots since October," Sambrano said.

Peter Rosenstein, executive director of the American Academy of Orthotists and Prosthetists, said the industry's labor shortage had worsened in recent years. By some estimates, it will need 100% more workers over the next decade.

Since 2003, Congress has given the organization $4 million in grants to heighten awareness of the specialty at high school and junior college job fairs and for public awareness campaigns that are set to start this summer on television, radio and the Internet.

"We tell kids, 'You can make a good living doing this,' " Rosenstein said. "A lot of them think it's cool."

Diabetes is a metabolic disease in which the body doesn't produce enough insulin. Because diabetics have reduced circulation in their limbs, an estimated 5 of every 1,000 diabetics eventually suffer an amputation, usually of a leg. As many as half of the amputees lose two limbs.

Lilia Portales, a 67-year-old from San Bernardino, had her left leg amputated below the knee more than a year ago.

The mother of 14 and grandmother of six lost her left leg after a small cut on one of her toes developed an infection that grew so severe that doctors had to cut her toe off. When that didn't help, they removed the other toes, then her leg up to the knee.

Portales says she didn't leave her house very often at first and, tearing up to a reporter's question, acknowledges going through bouts of depression in recent months.

During a therapy session, Yule of Hanger Prosthetics tried to get Portales to walk the length of the room on her new leg with the aid of two assistance bars, promising that she would eventually be able to dance again.

"Right now, I'll be happy if I get to the grocery store more often," she said.

To capitalize on the market boom, manufacturers are introducing an unprecedented number of artificial sockets and limbs, many aimed at older and overweight users rather than the younger patients who have traditionally been the focus for new products.

Some have sensors in the feet that clock how fast a user is moving, how much they weigh and whether the foot is on an incline so it can adjust accordingly. Other products such as the C-Leg and a bionic knee called the Rheo are so advanced that some amputees use them to run marathons.

Other products are now available for obese patients. Typically, patients over 250 pounds have had a hard time getting a prosthetic, but some newer models can accommodate patients weighing as much as 350 pounds.

Prices of artificial limbs cost $2,500 to $50,000 depending on how advanced they are. Insurers pay for most products, although some have started to balk as reimbursement claims have risen.

In response, three states, including California, passed laws in the last two years requiring insurers to boost coverage. In total, six states now have such laws and several others are considering similar measures.

"We joke that whenever they have a pill to cure diabetes we are all going to be out of business," said Eric Robinson, president of Fraser, Mich.-based College Park Industries, which recently introduced an advanced foot called the TruStep.--

daniel.costello@latimes.com

Certification will prevent abuses

July 9, 2007

Re "Federal effort to target medical fraud," July 2It is unacceptable for illegitimate companies to become suppliers allowed to bill for durable medical equipment and prosthetics and orthotics services. This costs us all and especially hurts those who rely on these devices and services to live full and productive lives. The American Academy of Orthotists and Prosthetists supports licensure and education-based certification for individuals and strict accreditation for businesses.It is crucial that the practitioner providing the service and the business billing for it follow high standards to prevent the abuse referred to in this article.

WENDY BEATTIE
PresidentAmerican Academy of Orthotists and Prosthetists
Alexandria, Va.

Healing hands

By Amy DoveNews staff
Jul 06 2007
The child’s hand cupped in Brian Mackie’s palm is both tender and disjointed.
The tiny fist, with five fingers coiled around a Winnie the Pooh soother, fits easily in his own. It’s almost life-like except for the wrist where there is nothing except a hole for an artificial arm to slip into.
Mackie made the hand for an eight-month-old baby born without an arm. The extraordinary task is all in a day’s work for the senior prosthetist and the 23 other staff at the Fisher Building. The facility is part of the Queen Alexandra Centre in Saanich and run under the Vancouver Island Health Authority. Every year, staff tailor orthotics, prosthetics and speciality wheelchairs for about 5,000 people on Vancouver Island. Roughly 1,500 of those are children.
The reasons for coming to Fisher vary from afflictions like cerebral palsy, multiple sclerosis, polio and defects in the feet to sports injuries. The most common reason for adults are complications from diabetes, Mackie said. The majority of amputations they see are a result of the disease.
Despite the number of people served, without a personal connection very few know what happens inside the one-storey building with an ocean front view.
“It’s VIHA’s best kept secret,” Mackie said, before starting a whirlwind tour of the facility.
Walking down the hall at a fast clip, Mackie passes assessment rooms and offices before stopping in a workshop where staff make foot, ankle and knee braces. It starts with a plaster casting of the patient. Technicians then file the pieces down to alleviate pressure in some spots and add it in others, depending on the client’s needs.
The casts destined to become ankle and knee braces move on to the next room where high-grade plastic is softened in an oven, draped over the cast and then vacuum sealed to the cast. Adult braces come in black but the options are endless for kids, Mackie said holding up a collection of animal, sport and other colourful theme braces. The remaining casts become foot orthodics designed to straighten a person’s gait or correct other problems before they escalate.
“In sheer numbers it’s a lot of feet,” he said about the younger clients.
Across the hall, staff make speciality wheelchairs. Each seat must be adjusted to provide the appropriate support for each person. They also fit tricycles and other speciality chairs to help people be more active.
Staff have used the same techniques for decades, but times are changing. The Fisher Building has used a computer and laser scanner for the last five years. The scanner replaces the need to make a cast, while the computer allows technicians to manipulate the brace design. There is another laser device which measures the amount of weight on each foot so staff can adjust a brace for pressure points.
The computer program is great for those that are comfortable with it, Mackie said, but certain types of equipment still benefit from the hands-on technique.
The facility has up to date equipment and a staff of 23, but there are still barriers to getting people the help they need. Youth under the age of 19 are covered for the braces and devices they need to be as mobile as possible either through private insurance or funding from the Queen Alexandra Foundation for Children.
The Fisher Building needs $1.8 million a year to support the children who need the facility. The Queen Alexandra Foundation helps a lot, Mackie said. The foundation raises $240,000 annually for the children’s program, which is spent on staff and equipment costs. This year they are hoping to update the scanning equipment, said foundation vice president Jennifer Jasechko. The foundation is also there to help families who are not covered by insurance.
“Kids do not go without here,” Mackie said. Clients become family as staff watch and help them grow over the years, he added.
It’s a feeling that translates to the parents too. Catherine Trembath and her daughter Charlotte Heine have visited the facility since she was a baby. Now 12, Charlotte has cerebral palsy. Fisher Building staff have fitted her for braces and wheelchairs her entire life.
“They get to know you and they treat you like family,” Trembath said. “The Fisher Building’s clients are very fragile, but emotionally they are very strong. The (staff) realize that and really rise to the occasion to support them.”
Twice, the family has felt the attentive care of staff at home. Charlotte underwent surgery on her hips and later broke her leg. Fisher staff arrived at the front door to make sure her chair was properly fitted for a more comfortable recovery, Trembath said.
As one of two public facilities in B.C., the Fisher Building has more staff onsite then private clinics. To better aid clients from up Island another facility is key, Mackie added.
But getting that space won’t happen anytime soon, said VIHA spokesperson Suzanne Germain.
“We would like to see it move up Island and as part of that program we have expressed interest in getting office space in the proposed new North Island regional hospital,” Germain said.
The hospital, which has been endorsed by VIHA, would serve the communities of Courtney and north.
It could be years before a location and funding are secured for such a site, meaning the program will remain in Saanich for some time, she said, adding there are private clinics currently serving the area.
Despite the itch to expand, staff at the Fisher Building have little to complain about, Mackie said. Frustrations crop up around funding, but the people they help are amazingly resilient. Watching someone walk out of the building when they rolled in that same morning will never lose it’s thrill – especially when that person is a child.
“The kids… they run out.”
Staff at VIHA’s Fisher Building help restore mobility to more than 5,000 people on Vancouver Island

American Association for Homecare Seeks Competitive Bidding Delay

FDAnews Device Daily Bulletin
June 29, 2007 Vol. 4 No. 128

American Association for Homecare Seeks Competitive Bidding Delay
The American Association for Homecare it is seeking to extend the bidding window and registration deadline for the Center for Medicare & Medicaid Services’ (CMS) Competitive Bidding Program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).
Under the Competitive Bidding Program, the CMS will use bids submitted by DMEPOS suppliers to establish single payment amounts for DMEPOS provided under Medicare Part B in certain “competitive bidding areas” (Device Daily Bulletin, April 10). All bids are due by July 13.
The association cited “severe technical problems” with the process and said it is working with lawmakers to request extensions in the program timetable. However, homecare providers subject to the first round of bidding should operate under the assumption that the current deadlines will not change, it said.
The association also expressed concerns about the “late dissemination of critical information” and said numerous questions about the program have not been adequately answered.