Adaptive prosthetics for the lower extremity.

The potential for lifestyle recovery is tremendous for most lower extremity amputees. The amazing and ever-expanding array of adaptive prosthetics can help make the devastating loss of amputation more bearable for patients, their families, and their health care team. The new amputee, in a state of shock and grief, does not know what his or her prosthetic options are. It is crucial that the surgeon is knowledgeable about what the patient can have and what the patient needs to ask for. Dana Bowman stated: Ideally, the new amputee should say to their doctor, "I'd like my leg to be lightweight, flexible, durable, comfortable. I want to do sports or I want to ride bikes with my kids." Whatever it is they like to do. I was told I would never be able to wear two dynamic feet and that my sky diving days were over. I said, "Well how do you know? Can't I try?" It took years to find out what I could have and then to find people to help me get it. The prosthetic prescription the physician writes is the patient's gateway to the kind of prosthetics that will enable him or her to pursue the activities of their life. Often, new amputees end up with the bare minimum prosthesis, which can cause problems with comfort and mobility. A poorly designed or badly fitting prosthesis is as disabling as the actual amputation. When the surgeon can help the amputee and his or her family understand what kind of prosthetic choices are available, it establishes an optimistic outlook that is highly beneficial to the entire recovery process physically and mentally. "When I lost my leg, if someone would have told me that I could at least try to run again, that would have meant a lot," said Brian Frasure. "Getting that positive mental attitude is every bit as important as having good medical and prosthetic care." By asking probing questions about the patient's preamputation lifestyle and postamputation goals, the physician can write a prescription for truly adaptive prosthetics. The surgeon should consider the economic benefits of asking for a waterproof leg for an older adult that he or she can use for more stability in the shower and that can go a long way toward preventing fracture and other injuries. There are economic considerations for a younger amputee, asking for an energy-storing foot or an adjustable ankle so that he or she can be more active and independent and probably avoid the health risks associated with depression, inactivity, or obesity. If all patients received a contoured, flexible, dynamic socket from the beginning, years of medical problems and treatment for injury to the residual limb could be avoided. The initial prosthetic prescription is probably the best opportunity the patient ever will have to get the adaptive prosthetics that can meet his or her needs best. It also establishes a precedent with the payer for quality prosthetic care and begins educating all payers about what prosthetic patients can and should have. Insurance companies may resist the idea of a second prosthesis or of specialized components that increase the cost of the initial prosthesis. Physicians, patients, and the multidisciplinary team can work together, however, to pursue the most complete prosthetic coverage possible. For the prosthetic user, it is the difference between being restored to a full and active life or sitting back and becoming a spectator.