The “Softer Side” of P&O

Last week I sat down with Certified Orthotist Michael Chouinard C.O. (c). Mike has been with us for over 25 years, and has been in the P & O industry for a total of 36 years.  Looking to receive some insight on a more personal level, I figured who better to provide that than somebody who has been specializing in pediatric orthotics for as long as he has.

I started by asking Mike some pretty clear cut questions. I wanted to know what he enjoyed most about the industry and on the opposite side of the spectrum, what provided the most challenges for him as an Orthotist.

Mike cites “seeing the kids walk better, with better positioning and then the parents, the look on their faces and the confidence that comes from the feeling that somebody is helping their child. They are very appreciative and they are just so happy that they are getting the best care”, as the most rewarding part of his job. We spoke in detail regarding the importance of the “team” approach to client care. Mike believes the team at Niagara Prosthetics & Orthotics is well-rounded and provides a positive atmosphere for clients from start to finish “I feel like we have a positive team, so that is like a dream come true”.

As mentioned previously, Mike works predominantly with children- a lot of whom have some form of communication delay that prevents them from being able to fully express their feelings in words.  One of the biggest challenges he faces on a daily basis is when he is casting a child for a new orthotic device. The process of having to use a noisy cast cutter to remove the cast from the child’s leg or arm is one that provides extreme stress for some children, resulting in regular bouts of fearful tears in his clinical room.  Mike relies on clear communication with both the child and the parent to prevent any surprises in the room. “I find that it relaxes everyone in the room when I lay out exactly what is going to happen”

We also discussed Mike’s valuable partnership with the Niagara Children’s Centre. Located directly beside Niagara Prosthetics & Orthotics, he is proud of the quality of care he is able to provide his clients by combining his experience with the expertise of the staff at the Niagara Children’s Centre. “It’s been an amazing experience working with the folks over there”

-Emily McCaffery

Runway of Dreams

At Niagara Prosthetics & Orthotics we are continually amazed by the people, organizations, and causes that have in some way positively changed the lives of those who need it most.

The group that was brought to our attention most recently is called “Runway of Dreams”, a nonprofit organization that is dedicated to developing adaptive clothing designs for “differently abled” individuals.

Too many times we see parents struggle to find a pair of shoes for their children that not only look acceptable, but are also capable of being modified to fit their assistive device, to name just one of the reasons this clothing line will be life changing for so many people.

“Partnering with top brands and retailers, Runway of Dreams works to integrate wearable technology and design modifications into clothing, making it adaptive and wearable for all.”

Runway of Dreams Website

 

Conductive Silicone

Silicone has made a huge impact on the prosthetic community over the last couple of decades. As an interface between the skin of the prosthetic user and the prosthesis, it has proved to be far superior to prosthetic socks in most cases.

For upper extremity myoelectric users, conductive silicone is available for fabrication into a custom silicone liner (the black lines on the liner shown in the picture). The unified structure allows for superior suction suspension and comfort. The conductive silicone allows for the muscle EMG signals to be captured without an electrode having to be placed directly against the users skin.

We have completed two conductive silicone myoelectric arms to date and they have yielded fantastic results and client feedback. It may not be right for everyone, but I would recommend further investigation with your prosthetist for anyone looking to start a new myoelectric arm.

The Financial Side of a New Prosthesis

Is it time for a new prosthesis, or maybe this is your first one. The dreaded question, how am I going to pay for this? Niagara Prosthetics and Orthotics not only manufactures your prosthesis, but assists you through the entire billing process.

I bet you didn’t know there are a wide variety of additional funding sources available within the community for your device. But what options are specific for you? Niagara Prosthetics and Orthotics will provide you with the necessary resources to determine what funding is available for your device and where to begin. Please see below for a quick list of funding sources we have access to.

Available Funding Sources

1. Assistive Devices Program (ADP) – ADP funds 75% up to a maximum of an approved price.

What does that mean? It means you have available funding if you are an Ontario resident and have a valid Ontario Health Card!

But, how often can you receive a new prosthesis through the Assistive Devices Program?  ADP will fund a new prosthesis every 3 years. ADP applications can be found in our office where they are signed, completed and mailed on your behalf.

2. Ontario Disability Support Program/Ontario Works (ODSP/OW) – Are you in receipt of ODSP or OW funding? ODSP can provide financial assistance benefits for medical supplies and equipment such as prostheses. Contact your case manager to find out your eligible benefits!
3. Private Insurance – Do you receive private insurance benefits? Our office works daily with many insurance companies; Sunlife Financial, Manulife Financial, Great West Life, or Green Shield. Our office can submit the necessary paperwork to your insurance company on your behalf.

Community Funding

1. The War Amps – This generous organization provides financial assistance towards the cost of artificial limbs to amputees over the age of 18 residing in Canada. The War Amps can provide funding every 3 years for a new prosthesis. Like to be registered and learn more? Our office can register you for this no cost program! You can also visit waramps.ca for more information.
2. The Niagara Amputee Association (NAA) – NAA is a charitable organization that assists in funding artificial limbs in the Niagara Peninsula. Stop by our office for a NAA Application or more information on eligibility.

Niagara Prosthetics and Orthotics is here for you. Stop by or call our office to speak with a Client Service Coordinator today!

Phantom Limb Pain

Phantom limb pain (PLP) refers to ongoing painful sensations that seem to be coming from the part of the limb that is no longer there. The limb is gone, but the pain is real!  Unlike pain that is caused by trauma directly to a limb, PLP is thought to be caused by mixed signals from your brain or spinal cord.  As with any other kind of pain, you may find that certain activities or conditions will trigger PLP. Some of these triggers might include:

• Touch
• Urination or defecation
• Sexual intercourse
• Angina
• Cigarette smoking
• Changes in barometric pressure
• Herpes zoster
• Exposure to cold.

If you notice any particular thing triggering an episode of PLP for you, let your healthcare provider know so that your treatment plan can be better tailored to meet your needs.  In general, treating PLP effectively takes a multi-faceted approach. Medications in combination with non-medication treatments seem to be most effective. Medication treatments should be discussed with your physician so as to ensure an appropriate choice for our particular situation.  Examples of non-medication treatment include:

• Acupuncture
• Massage of the residual limb
• Use of a shrinker
• Repositioning of the residual limb by propping on a pillow or cushion
• Mirror box therapy
• Biofeedback
• TENS (transcutaneous electrical nerve stimulation)
• Virtual reality therapy
• Imagery

Whatever the degree of pain, type of pain, triggers, or treatment plans there are five essential things to remember about PLP:

1. Phantom limb pain/sensation is common for most people after amputation surgery. Symptoms generally improve over time.
2. Your phantom limb pain/sensation can be managed so that it does not overwhelm your life.
3. The goal of pain management is to reduce pain levels to allow you to get you back to living and enjoying life again.
4. Work closely with your healthcare team to create and maintain the pain management plan that works for you
5. When possible, avoid things that trigger your phantom limb pain/sensation

Our Monday Motivation

We were so excited to read this testimonial from a parent of one of our clients that we had to share! So happy both parent and child had such a positive experience with Niagara Prosthetics & Orthotics. We also LOVE this helmet!

“My experience with Niagara Prosthetics and Orthotics has been so very wonderful. My daughter was referred to the clinic for moderate plagiocephaly (a flat spot on her head). I went to the consultation appointment with an open mind, but I was very nervous to have my instinct confirmed – that she would have to wear a helmet to correct the flat spot. Although it was upsetting to find out that my daughter’s condition would likely not resolve itself naturally, I was quite relieved to finally have some clarity and a solution. Alan very kindly explained how the helmet would be used to encourage her head to grow into the existing flat spot, thus rounding out the shape of her head. He patiently answered all of my questions and even provided an affordable payment plan when our insurance failed to help out.
Her first helmet fitting was an emotional experience. My baby’s sweet fuzzy head was now covered by a large hard shell. Was she going to resent me for making her wear this? What were people going to think when they saw her? Was I making the right decision? Those doubts quickly faded over the next week. Yes, my daughter wasn’t a fan of the helmet at first, but Alan had me put her through a breaking in period, so she quickly got used to it. When I brought her out in public, people didn’t stare but rather cooed and awwed at how sweet she looked. In fact, we had cat ears moulded onto the helmet and then an artist painted Hello Kitty’s face on it. Everyone loves the helmet, including my daughter. Finally, I knew I had made the right decision when we found that the severity of her plagiocephaly had gone down significantly after just one week!
To parents out there who have a child with a less-than-round head, it’s worth getting it checked out by the amazing staff at Niagara Prosthetics and Orthotics.”

To cover, or not to cover…that is the question

At Niagara Prosthetics & Orthotics, we meet women and men of all ages, and all walks of life. Each and every individual we meet has their own story, and their own reason for becoming an amputee. One of the biggest areas of interest to our staff is cosmetic coverings for prosthetics. Some amputees like to be creative with their covers, whereas others will opt for no cover at all. We did some research on the science behind cosmetic covers and some of the options available. Take a look, and please let us know your thoughts.

Prosthetic Coverings (1) (1)

Client Case Study- Knee Instability and Foot Drop

Every now and then we see a client that presents with significant difficulty, whether it be a congenital or acquired condition. The results can be extraordinary when the client is fit with a device that assists in decreasing pain or increasing mobility. We decided to conduct a case study on one of our clients who came to our office with an acquired condition that required a high level of attention to detail, see the outcome below.

This patient was seen in our clinic due to a previous trauma that caused instability of the lateral collateral ligament (LCL) and posterior cruciate ligament (PCL). The trauma at the knee also damaged the nerve responsible for lifting the toes up, resulting in a drop foot.

A hybrid knee ankle foot orthosis (KAFO) was fabricated to mimic the PCL, support the LCL and assist in picking up the foot. The knee section is a custom PCL brace made by Ossur that was altered to allow for a streamlined attachment to the custom AFO. The custom AFO was made at Niagara P&O and is completely made from carbon fiber.

Case Study

Outcome:

The patient displayed significant changes to his gait.  A reduction in plantarflexion allowed for adequate foot clearance through swing.  Reductions in external rotation of the knee,varus of the knee, knee flexion angle at midswing, and lateral trunk lean became less evident when wearing the orthosis. With these changes, we expect the patient’s energy conservation to have improved significantly as well.

3D Printing: As good as it gets?

One of the questions the staff at Niagara Prosthetics & Orthotics face most frequently surrounds the mystery of 3D Printing. Many of our clients wonder why we do not 3D print their prosthetic limbs, given that the media presents this process as being cheap, quick, and effective.  We saw the need for further explanation into this particular topic, and so we conducted research into just how effective and “cheap” 3D printing really is. Take a look at the attached document, with our conclusions. Let us know what you think!

3D Printing

Below Knee Vacuum Casting

Certified Prosthetist Bryn Jones, C.P.O. (c)  talks about the technique of vacuum casting for below knee amputees:

The technique of casting a trans tibial residual limb is not new, but it is something that the prosthetists at NPO have recently started to use with excellent results. The staff at NPO consistently explores new ways of achieving the best fitting sockets that we can produce for our clients. Sometimes we stick to what we are currently doing. Other times we tweak a technique. With vacuum casting it is a much different procedure than the hand casting we have done for years. Utilizing a vacuum pump, we ensure even pressure distribution over the surface of the residual limb, which has been generating more comfortable- fitting sockets for those who have embraced the change so far. We will offer this technique to any client that would like to try it and that is appropriate for it. We will continue to make sure that we are current on all Prosthetic and Orthotic techniques. Next up will be the Otto Bock stance phase control orthotic knee joint course in September.