Pre-Amputation Questions (1)

Contact our office at (856) 810-7900 for a pre-surgical consultation at no charge.


New Amputee (12)

There are different methods of suspension of the prosthesis.

They are: anatomical, suction, elevated vacuum, shuttle-lock (pin type) systems and lanyard systems.

  • Anatomical suspension utilizes the contour of the bony prominences of the residual limb to hold onto.
  • Suction system area used with either a cushion liner, with or without sealing bands, or direct skin contact of the residual lib. The socket has a a one way valve to expel the air out of the socket, which creates negative pressure in the socket to attain suspension.
  • The elevated vacuum system utilizes an external pump to draw the air out of the socket and obtain negative pressure inside of the socket to achieve suspension.
  • The shuttle lock system consist of a pin that is threaded to the distal end (bottom) of the liner, which then engages to the locking mechanism attached to the distal end of the socket to achieve suspension.
  • The lanyard system often used with transfemoral (above knee) prosthesis. It consists of wearing a liner, attached at the distal end of the liner is a Velcro strap or braided string. Then is is fed through the locking mechanism and pulled out of the bottom of the socket to obtain suspension.
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A socket that is fit properly, will be more comfortable to wear for prolonged duration. A proper fitting socket melds together, proper weight bearing areas, relief of bony prominences, and have total contact on the residual limb.

 

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Phantom sensation ( or limb) is the feeling that an amputated limb is still attached and is moving appropriately with other body parts. Phantom sensations ( or Limb) usually will disappear or decrease over time.

Phantom pain is pain that feels like it is coming for a body part that is no longer there. This is a real sensation that originates in the spinal cord and brain. For many people, phantom pain dissipates over time with prosthetic utilization, but for others managing phantom pain can be challenging. You and your doctor can work together to treat phantom pain with medication or with other therapies.

 

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The right physical therapist will have extensive experience serving other amputees and is willing to work with you to achieve your short term and long term goals. The ideal therapist is one who has specific amputee gait training and has knowledge of how your prosthetic componentry works. The therapist is a part of your rehabilitative team and should feel comfortable working with your prosthetist to achieve the best outcomes for you. The relationship between the therapist and your prosthetist will have a significant impact on your outcome.


Unique to the individual and cause of amputation. Your surgeon will provide clearance for a prosthesis when the limb is healed from surgery. About 2 to 4 weeks after clearance you will be able to take your first steps with the prosthesis. (See fitting process)


The process of fitting a new prosthesis involves a number of steps. Shortly post- amputation as your limb is healing, a cloth shrinker will be provided and applied to your limb to help control swelling. An evaluation is performed where the practitioner learns about your abilities, goals, and activities. This information is used to determine an appropriate design of the prosthesis. Upon receiving clearance from your surgeon for a prosthesis, your limb will be cast with a plaster wrap to capture the shape. Before delivery of the final prosthesis there will be a number of fittings in a diagnostic test socket (DTS). A DTS is a transparent plastic utilized to confirm a proper fitting socket by your prosthetist. You will walk in the DTS aligned on your definitive componetry (knee/ foot). In this stage the fit of the socket and the alignment will be fine tuned and then transferred to make the definitive prosthesis. Upon receipt of the prosthesis you will work with a PT to learn to walk using the prosthesis.


Your surgeon will provide clearance for a prosthesis when the limb is healed from surgery. About 2 to 4 weeks after clearance you will be able to take your first steps with the prosthesis. (See fitting process).


A prosthesis could be worn throughout the course of the day. A new prosthetic wearer or a new prosthesis, would require a wearing schedule to acquaint the residual limb to the prosthesis. Proper volume management of the residual limb throughout the wearing time, would also determine the length of time the amputee could wear the prosthesis.

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A well fit lower extremity prosthesis should be used daily for up to 16 hours and for a lifetime. It benefits those who have multiple co-morbidities. Often there is improvement in mobility compared to pre-amputation for those who were managed for limb salvage.


You will be working with your prosthetist more closely than any other health care provider therefore you should ask questions before committing to a prosthetist.

  • How many patients with your level of amputation has this prosthetist worked with?
  • Ask about their success rate.
  • Is the prosthetist you’re considering licensed and certified?
  • Do you like the prosthetist?

The best way to find out about the cost of your prosthetic care is to call our office and talk with a financial counselor. They will talk to you about your insurance coverage and copays. If you don’t have insurance, they will help you find a paysource.


Contact us for information about local support groups. The Amputee Coalition of America also has a listing of support groups nationwide – www.amputee-coalition.org.


General Questions (16)

Most prosthetic services require between one to three weeks to be completed. We also offer a run-through process where you can leave the same day with a temporary prosthesis.

 


A referral is not necessary, however, a doctor’s prescription is required for us to provide a prosthetic device.


There are 3 possibilities:

  • On site. Optimal ability for the practitioner to interact with the technician throughout the process.
  • Internal C-Fabrication. Some interaction between practitioner and technician. May be modified by the practitioner, may not ask. Who is modifying model.
  • External C-Fabrication. Likely providing the information model measurements to the technician. They have limited contact with practitioner, limited knowledge of the patient. Your model may be modified by the technician instead of your practitioner.

Hand casting is a wrapped impression of your limb and volume. It usually results with a superior fit of the residual limb. Highly customized to each individual. One off! CAD CAM/measurements can be done with measurements or digital scan, and utilizes a pre-determined template socket/shape that can work for the average of the patients. This does not give the clinician as much ability to modify the model or template as you would with an actual “positive” model. They can be effective but often are not detailed to the level of hand cast impressions. If measured only, not likely to result in a superior fit. The practitioner depends on the model template to create a generic model. Be cautious of measurements only to make a socket. Digital scans can be more effective than measurements, but also require a template of the average shape, and cannot accommodate uniqueness of individual amputation.


Your overall comfort, control, confidence and ability to reach your goals are being met.


Your family is also dealing with your limb loss. They want what is best for you. Your family will have similar feeling to what your are feeling (sadness, frustration, fear of not knowing what life will be like with a prosthesis). Our goal here at POSI is to try to help you regain your independence and eventually return to your pre-amputation activities. You may do this a little differently, but with the right fitting prosthesis and proper training we will do our best to help you achieve the best outcomes.


There are several ways you can get in contact with another amputee. You can reach out to the Amputee Coalition to have them contact a mentor for you. The Amputee Coalition is a wonderful resource to gain early knowledge on how the process works obtaining your prosthesis and getting you back to your pre-amputation status. Your mentor can help you to see what life is like with an amputation. Your mentor can give you valuable advice on how to navigate what steps are next in your journey toward independence.

Local Amputee support groups are another valuable resource that can help with the emotional support you will need during your rehabilitation. At these groups, you and your family members will get to meet and ask questions to fellow amputees about your prosthesis, your therapy and how to achieve your rehabilitative goals.

  • Amputee Coalition
  • Marlton Rehabilitation Hospital (Limbs in Motion)
  • Voorhees Amputee and Stroke Organization
  • Magee Rehabilitation
  • Good Shepard/ Penn Partners
  • Deleware support group
  • Lehigh Valley Support GroupLimbs in Motion

  1. Pre-amputation lifestyle – the most important indicator of potential utilization after amputation
  • Hobbies
  • Vocation
  • Terrain
  • Previous activities
  1. Objective testing – series of objective measurements that predict your potential mobility
  • Amp Pro
  • Timed Up and Go
  1. Participatory Interview – a review of the prosthetic options that are available for your individual management
  • Education of systems
  • Options
  • Pros/cons of each component

Below knee designs can range from 2 ½ lbs. up to 5 lbs. depending on componentry utilized. Above knee designs weigh between 5 lbs. and 9 lbs., also depending on componentry utilized.


Socket and componetry are expected to last 3-5 years. Either can be replaced before this time due to damage or physical change of the residual limb. (See socket fit)


The socket will fit appropriately until your body undergoes a physical change. Adjustments will be made to maintain fit for small changes. As a new amputee, your residual limb will change rapidly through the maturation process. Sockets may be replaced more frequently as your limb begins to mature. Weight changes of about 10 lbs or more will also affect socket fit. Even if there hasn’t been any significant change the active user can expect the socket to be changed on average 18-24 months.


Your first steps using the prosthesis will be taken in the office during the fitting process. Upon receipt of the prosthesis you will participate in a PT gait training program to learn to walk. It would be beneficial to supplement PT by participation in an OT program where you will learn proper donning techniques and how to use the prosthesis in the house and community.


Majority of the prosthesis components are water resistant. It could get wet in the rain and shallow puddles without damaging the device. Most of the current microprocessor controlled knees and feet/ankle complex are now water resistant, weatherproof, or waterproof.

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The safest and most hygienic way to shower, is to use a shower chair. It would allow you to cleanse your residual limb at the same time you are washing your whole body. However, there are prosthesis that are specifically designed for showering for amputees that prefer, and are capable to stand, while taking a shower.


No. If we are contracted with your insurance company, we can only bill the contracted rate. If we are not contracted, we make every effort to keep costs at a minimum and to negotiate rates with your insurance company.


Insurance Questions (5)

The warranty period for a custom prostheses is three months for workmanship and materials.  The componentry part of the prosthesis has a warranty under the vendors guidelines that can be from 1-3 years.


On your initial visit, please bring your physician prescription, your insurance cards, identification and any other related billing information.  For your convenience you can complete the patient information sheet and bring along with you.


Medicare, Workman’s Compensation, Auto and most other insurances.  Please contact us directly to determine if we accept your insurance.


Yes through part B coverage.


Most health insurance policies cover prosthetic services.  There are many plans that have specific prosthetic coverage.  Please contact your insurance carrier or POSI for this information.