Get Up And Go
By Becky Kesner
Imagine a Paralympic athlete skimming
across the finish line, impossibly toned figure outstretched, achieving feats
most able-bodied people only dream about.
Now, picture this more common experience: Having just lost a limb, possibly even due to a sedentary lifestyle, an amputee struggles with what were once simple daily tasks such as walking down steps or opening a cabinet door.
As every practitioner knows, an active lifestyle can help amputees gain limb strength and flexibility. And being more active as soon as possible will battle the weight gain difficulties most amputees face at one point or another. Add the numerous psychological and physical benefits that exercising provides, and you’ve got a strong motivation to get your patients up out of their seats.
But how do you motivate your previously sedentary patients? And, if you have a patient who already wants to be active, how do you help?
Now, picture this more common experience: Having just lost a limb, possibly even due to a sedentary lifestyle, an amputee struggles with what were once simple daily tasks such as walking down steps or opening a cabinet door.
As every practitioner knows, an active lifestyle can help amputees gain limb strength and flexibility. And being more active as soon as possible will battle the weight gain difficulties most amputees face at one point or another. Add the numerous psychological and physical benefits that exercising provides, and you’ve got a strong motivation to get your patients up out of their seats.
But how do you motivate your previously sedentary patients? And, if you have a patient who already wants to be active, how do you help?
One step at a time
Many patients may think that they need specialized equipment, new running feet, or a different socket to start being more active. The opposite is true. Getting active simply means getting up and getting out the door.
One of the first benefits that exercise will give your patients will be gait training beyond what you, as a prosthetist, can provide in a lab. Michael Davidson, CPO at Loma Linda in California and prosthetist for amputee athlete Rudy Garcia-Tolson, points out, “We teach them to walk, but they’re walking across a level floor inside a lab. And the real world isn’t like that. It’s got sticks and bumps and holes in the ground.”
Go to an amputee-specific event
An often-heard estimate is that it takes 20 percent more energy for an amputee to complete a task than an able-bodied person. So, amputees may be discouraged by how difficult it is to do tasks they were used to performing effortlessly before.
For these amputees, becoming engaged in everyday sports activities may seem distant and improbable. To help, point them to the many different resources for amputees looking to improve mobility and gait in order to enjoy more physical exercise.
The Orthotic Prosthetic Assistance Fund (OPAF) sponsors a host of gait training clinics related to sports. First Swim, for instance, is designed to help amputees learn how to get in and out of the pool, adjust their stroke or just move around in the water comfortably.
Part of the attraction of these events is that amputees can exercise alongside other amputees. The camaraderie and tips other amputees bring can be a tremendous encouragement.
Another way to help amputees be more physically fit is to encourage them to attend an amputee- or disability-specific athletic event. Davidson says, “What we found most helpful in getting patients active is to get them involved in an advocacy group like the Challenged Athletes Foundation.
“That gets them into a big, huge event where they see people with some pretty horrible disabilities accomplishing things, and the patients walk away inspired.”
Prosthetists can benefit from attending these events, too. Because there are few formal resources for helping amputees participate in sports, developing a network of people to ask advice from is the best resource a prosthetist can have for himself and provide to his patient.
“I think the best thing for the prosthetist to do is to find the time to go see the event,” says Davidson. “There’s no shortage of new ideas running by.”
Join local groups
Amputee-specific events, however, only happen periodically. A local YMCA or gym, while perhaps not as comfortable as a setting, will wind up being your patients’ most reliable resource. Most amputees wanting to stay active will simply need to join a local running group, swim practice, basketball team or other community group.
This takes some initiative on the part of the amputee. Simply because of the size of the amputee population, many coaches may not have worked with an amputee before. But everyone interviewed for the story says they have always found coaches to be welcoming and accommodating if amputees are open about what they need.
Amputee-specific events, however, only happen periodically. A local YMCA or gym, while perhaps not as comfortable as a setting, will wind up being your patients’ most reliable resource. Most amputees wanting to stay active will simply need to join a local running group, swim practice, basketball team or other community group.
This takes some initiative on the part of the amputee. Simply because of the size of the amputee population, many coaches may not have worked with an amputee before. But everyone interviewed for the story says they have always found coaches to be welcoming and accommodating if amputees are open about what they need.
Start competing
For those who show talent or who want to push themselves further, encourage them to begin competing. As before, the first step is for patients simply to join local events, first contacting the race directors to explain what they’d like to do.
Most will work to accommodate patients’ needs. For instance, many amputees competing in triathalons will be allowed to stage the equipment they need for each part of the race—a swim leg or crutches on the beach, for instance. Many competitions also assign handlers to disabled athletes.
The disabled sports associations also know the race directors. Disabled Sports USA, for instance, knows a majority of the race directors for triathalons and can put patients in contact with them.
For those who show talent or who want to push themselves further, encourage them to begin competing. As before, the first step is for patients simply to join local events, first contacting the race directors to explain what they’d like to do.
Most will work to accommodate patients’ needs. For instance, many amputees competing in triathalons will be allowed to stage the equipment they need for each part of the race—a swim leg or crutches on the beach, for instance. Many competitions also assign handlers to disabled athletes.
The disabled sports associations also know the race directors. Disabled Sports USA, for instance, knows a majority of the race directors for triathalons and can put patients in contact with them.
The mechanics
All interviewed for this article immediately point to the patient’s prosthetist as the most important factor determining whether a patient will become successfully active.
“A quality fitting prosthesis is where it has to start,” says Paul Martin, an amputee athlete and coach of other amputees. He suggests athletes have an activity-specific prosthesis, because it will be aligned and contoured to make that particular activity easier. For instance, bikers with BK amputations often ask for a lower trim line in the back.
As an example, he cites runner Amy Winters, who did well in her first races running on a walking leg but then started breaking records once she got a properly fit running leg.
Because it’s crucial to have a properly fit and suspended leg, a prosthetist must excel at analyzing the stresses of the specific activity, the weight of the patient, and adjust the leg accordingly.
Martin, in fact, feels prosthetists need to do this more.
“With most prosthetists, 90 percent of their population is geriatric. They just build the legs they’re used to using” and then get frustrated when they don’t work, he says.
A prosthetist’s active involvement—to the point of even doing the events with the patient—is key. Davidson suggests prosthetists be actively involved in the patient’s events in order to adjust the prosthesis accordingly.
“It’s hard to envision how something will affect a patient until you get out there and see,” he says. “You’ve almost got to get out there [and do the event] with the patient, instead of hearing about it a day later.”
All interviewed for this article immediately point to the patient’s prosthetist as the most important factor determining whether a patient will become successfully active.
“A quality fitting prosthesis is where it has to start,” says Paul Martin, an amputee athlete and coach of other amputees. He suggests athletes have an activity-specific prosthesis, because it will be aligned and contoured to make that particular activity easier. For instance, bikers with BK amputations often ask for a lower trim line in the back.
As an example, he cites runner Amy Winters, who did well in her first races running on a walking leg but then started breaking records once she got a properly fit running leg.
Because it’s crucial to have a properly fit and suspended leg, a prosthetist must excel at analyzing the stresses of the specific activity, the weight of the patient, and adjust the leg accordingly.
Martin, in fact, feels prosthetists need to do this more.
“With most prosthetists, 90 percent of their population is geriatric. They just build the legs they’re used to using” and then get frustrated when they don’t work, he says.
A prosthetist’s active involvement—to the point of even doing the events with the patient—is key. Davidson suggests prosthetists be actively involved in the patient’s events in order to adjust the prosthesis accordingly.
“It’s hard to envision how something will affect a patient until you get out there and see,” he says. “You’ve almost got to get out there [and do the event] with the patient, instead of hearing about it a day later.”
Potential problems
“Skin breakdown is the real devil,” says Martin. He stresses that folliculitis (ingrown hairs) can be a common problem for anyone with a high activity level.
For patients, keeping their prosthesis clean and inspecting their residual limb for skin breakdown will always be important, but in Davidson’s experience, the increase in activity doesn’t seem to put his patients at greater risk. “It’s almost as if with higher activity, people become healthier, not more prone to injury.”
He tells the story of running 13 miles with a patient and then examining the limb. Davidson expected to see developing sores and edema, but “his skin was perfect.”
Martin also emphasizes that proper training and focusing on keeping good form can prevent injury from overcompensation. When he runs, he consciously puts effort into using his prosthetic limb. He would also do exercises—such as climbing two stairs with his prosthetic side to each one with his sound side—to make sure his prosthetic side was strong enough.
“Make sure you’re not using [the prosthesis] as a temporary crutch to get over to the other side,” he advises amputees. “When you’re standing around, don’t stand on one side. When you take the stairs, don’t just use one leg.”
Davidson encourages his patients to see their physicians once a year. He feels this not only keeps their insurance accounts active, but it also makes it easier for patients to get in to see their doctor if there is a training problem.
“Skin breakdown is the real devil,” says Martin. He stresses that folliculitis (ingrown hairs) can be a common problem for anyone with a high activity level.
For patients, keeping their prosthesis clean and inspecting their residual limb for skin breakdown will always be important, but in Davidson’s experience, the increase in activity doesn’t seem to put his patients at greater risk. “It’s almost as if with higher activity, people become healthier, not more prone to injury.”
He tells the story of running 13 miles with a patient and then examining the limb. Davidson expected to see developing sores and edema, but “his skin was perfect.”
Martin also emphasizes that proper training and focusing on keeping good form can prevent injury from overcompensation. When he runs, he consciously puts effort into using his prosthetic limb. He would also do exercises—such as climbing two stairs with his prosthetic side to each one with his sound side—to make sure his prosthetic side was strong enough.
“Make sure you’re not using [the prosthesis] as a temporary crutch to get over to the other side,” he advises amputees. “When you’re standing around, don’t stand on one side. When you take the stairs, don’t just use one leg.”
Davidson encourages his patients to see their physicians once a year. He feels this not only keeps their insurance accounts active, but it also makes it easier for patients to get in to see their doctor if there is a training problem.
The mindset
For amputees who work at becoming active, the possibilities are great.
“I play ice hockey,” says Martin. “Plenty of guys can beat me, but you wouldn’t know I’m playing with a prosthesis.”
Many involved in the world of amputee athletics feel that the biggest barrier to realizing these possiblities is the mindset of not only the patients, but also the prosthetists.
Davidson says, “As a society, we put people with disabilities into the category of ‘You can no longer do this.’ And I think it starts with the health care profession.
“We make a big deal out of simple things, like getting people to stand or to tie their shoes. With the focus so much on everyday activities, doors of opportunity start to close in patients’ minds.
“We need to stop thinking about how to get a patient to walk, and let the patient set the goals.”
For amputees who work at becoming active, the possibilities are great.
“I play ice hockey,” says Martin. “Plenty of guys can beat me, but you wouldn’t know I’m playing with a prosthesis.”
Many involved in the world of amputee athletics feel that the biggest barrier to realizing these possiblities is the mindset of not only the patients, but also the prosthetists.
Davidson says, “As a society, we put people with disabilities into the category of ‘You can no longer do this.’ And I think it starts with the health care profession.
“We make a big deal out of simple things, like getting people to stand or to tie their shoes. With the focus so much on everyday activities, doors of opportunity start to close in patients’ minds.
“We need to stop thinking about how to get a patient to walk, and let the patient set the goals.”
Becky Kesner is managing editor of the
O&P Almanac.
