Prosthetic care takes comprehensive support and perseverance

Adjusting to life after amputation can be challenging – both physically and mentally. Amputees need a lot of endurance and discipline before a prosthesis can fully replace a missing body part. Find out at REHACARE.com what is important when it comes to prosthesis fitting and discover where amputees can turn to for support.

Right now, all eyes are on Tokyo where the 2020 Paralympic Games opened after a one-year delay. As we watch competitors vie for the coveted Olympic medals, it’s easy to forget how much work and effort went into making this pivotal moment in their career possible. Behind every successful athlete is a team of coaches, therapists, and often even sports nutritionists. However, the undeterrable will to succeed belongs to the athlete along with the discipline to defy the body’s limits each and every day during training. All of it serves the goal to be successful although athletic talent alone is not enough to achieve a triumphant career.

The same concepts can be applied to prosthesis wearers. Great prosthetic care requires an effective network of specialists, physiotherapists, caregivers, and orthopedic technicians. They all do their part to successfully ease the patient back into everyday life. That being said, the amputees face the biggest challenge. Not only do they have to learn to “accept” the loss of a body part, but they must also be highly self-motivated and muster the courage to persist despite many setbacks. And while the prosthesis wearers must travel their own journey at their own pace, they are not alone in this endeavor.

According to recent estimates, there are nearly 250,000 amputees in Germany. Each has his/her own story to tell. Take Kim Cremer. He lost his left lower leg in a motorcycle accident. On his blog, the 34-year-old details his journey from the hospital to his current prosthetic limb.

The athletic family man knows from personal experience that the way to a prosthetic limb with the best fit is not a sprint. "The sprint metaphor is quite fitting because sprinting is more than just running very fast. It challenges both your body and mind. You need patience and have to repeat the same steps over and over,” he explains. Cremer has found “his” perfect prosthetic device at Össur.

But before he did, Cremer needed a lot of patience and perseverance. He went through countless prosthetic sockets and repeatedly had to take breaks because his body slowed him down. "Unfortunately, even the most advanced prosthetic device doesn’t walk on its own and requires active body-muscle interaction. That is not a feel you develop overnight. Your wounds are still fresh, and your body must first get used to managing unfamiliar pressure. Everything is new and different," says Cremer. Setbacks are just a part of the process. You also need courage to put weight on a prosthetic device. You can only get a feel for your artificial limb with lots of training and practice. To stay with the previous metaphor: just because you are a successful 100-meter sprinter doesn’t automatically mean you will be successful running the 400-meter track. To do so takes patience and a willingness to listen to your body when it signals you to take a break. Until you get a prosthetic device with the perfect fit, this is the hard reality: "You track your pressure points, and find out whether the socket is too loose or too tight – it’s something you need to learn and deconstruct on your own."

But that’s not all. You must also learn to communicate if something doesn’t fit right. Tobias Werner, a certified orthopedic technician at apt Prothesen points out that "teamwork between the user and the technician is essential for providing quality prosthetic care." And adds, "the more information technicians get, the more they can utilize their skill and expertise to achieve the best result for the individual wearer."

Innovative technologies ensure the increased comfort and better fit of prosthetic devices. Says Werner: "When it comes to making custom adjustments, 3D printing, and scanning technology are growing in use and popularity as they increasingly become more affordable." And so the workshop goes digital. Peter Fröhlingsdorf, CEO of Mercuris and a certified orthopedic technician himself knows that new technology will never replace the human specialists and their expertise in this field. "Even if scanners, software, milling, and 3D printing can make my work easier, I still need to achieve the perfect fit of the prosthesis." After all, that is still the key responsibility of his profession. It is also important to know how the production technology works. "If we want to use the latest technology, we must first spend some time to put it to the test. At the end of the day, I also need to make sure that my company gets paid for this effort since profitability is another key aspect."

The COVID-19 pandemic has given this topic a boost. After all, modern scanning technologies can eliminate the need for close customer contact and – thanks to a laptop- technicians always have access to the digital workshop at home or on-the-go. Some specialists used the mandatory break to learn about new production options.

While that’s great, it still does not solve the financing issue because great care in this setting involves getting a great prosthetic device. And the latter is not only getting more advanced but is also getting more expensive. Read our article titled "The Future of Prosthetics is Here Thanks to Artificial Intelligence and Bionic Feedback" to learn about exciting advances in the field of prosthetics and discover the latest medical and technical research.

But sometimes, the hands of technicians at modern medical supply stores are tied. "We have to go by the coverage and services the health insurance companies provide. And they state that care must be appropriate. And that means it doesn't always have to be the high-end product," explains Felix Raab. Depending on the patient’s mobility and everyday requirements, the standard model may also be adequate.

Having said that, it’s a tedious struggle to get health insurance companies to cover the right prosthetic device as a paid benefit – not just for the wearer. Fröhlingsdorf puts the quandary in a nutshell: "As an orthopedic technician, I don't want to get into a situation where a patient asks me, 'Back when you fit my prosthesis, there were more innovative options available that would have made this or that aspect better in my life. Why didn't you give me the best prosthetic device at the time?'" The authorization process must be revised, Kim Cremer agrees. "Getting the right care takes too long in some cases and people put up with pain from their prosthesis just to get back to normal life. But that can have disastrous consequences for prosthetic wearers."

Apart from a faster and easier authorization process, Cremer admits he was initially desperate to get in touch with other amputees to learn about their experiences. Enter the German project "Peers im Krankenhaus" (PiK, English: Hospital Peers) at the Unfallkrankenhaus Berlin (ukb). After his accident, Cremer scoured the internet to find information. He wished someone would have told him that it is perfectly normal to experience pain in the early stages of amputation, that it takes time for the user and technician to find their groove and build rapport and that you shouldn't expect too much all at once. That is why Cremer believes a good network includes people who have undergone an amputation and are there to take your hand and walk the first unfamiliar steps with you. "That was hands down the best connection I made!"

By now, the 34-year-old has created these meaningful connections and found the right prosthesis. A well-fitting prosthetic socket was important to him, and he considers it the nuts and bolts of the prosthesis. "In fact, if the prosthetic socket doesn’t fit correctly, there is no point in using the other components because the pain forces me to assume a different posture to avoid discomfort." He dreams of a socket that adapts autonomously. "I keep having volume-related problems with my residual limb. Sometimes I can adjust, but often I am forced to take breaks. It would be so exciting if the socket could adapt to my situation. If it were adjustable, I could put more pressure on it for sport activities and reduce the pressure when I have to sit for a long time."

Cremer uses the Pro-Flex® XC Torsion. "I like to move with this system because it provides natural feedback and is lightweight," he says. He also uses the Flex-Run™ and the Cheetah^® Xplore, both prosthetic devices that allow users to engage in various sports and activities. But for Cremer, every prosthesis is a piece of sports equipment. "I have always viewed the prosthesis as a piece of sports equipment that I must learn how to use to achieve the best results and reach my full athletic potential," he explains. He thinks it would help all users to try sports prosthetics to then "get the technician and/or the health insurance company involved to decide whether the device might benefit them."

At first, an amputation tears you away from the life you knew. But as Marcel Michitsch points outs: "Hey, I only lost a leg, not my life." The right mindset and a dash of courage help you make the long journey to finding the prosthetic device that fits you perfectly. Along the way, you get support from people who are experts in this area – including physicians, technicians, or fellow amputees. The idea is to assemble the right team and make sure the individual parts join and work as one. Excellent prosthetic care hinges on effective communication and the persistence of everyone involved. The determination to not let a prosthetic device limit or define you can move mountains. Orthopedic technician Tobias Werner is glad that users are better informed than ever before. "They insist on improved quality of life and more individuality from us technicians and are prepared to fight with their healthcare payers to get their needs met." But all this takes patience and perseverance.

And it applies to both people with disabilities and athletes. For the most part, it’s not about speed, it’s about endurance. Even sprinters don’t start out setting records running the 100-meter dash. They first have to work hard to get there. It requires hard training, and discipline. But once they stand on the podium with a gold medal around their neck (like in Tokyo), all the hard work will have paid off and all the struggles and hardships along the way will be forgotten.

Sometimes Kim Cremer doesn't even want to take off his prosthetic device. Marcel Michitsch is also more mobile with his prosthesis than he was before his amputation. The engineer likes to compare life with his hobby – Enduro Racing: "And honestly, wouldn't life be boring without hurdles? Obstacles are part of it and can even be fun."