Today is my last day of O&P school.  I took my final final this morning and will graduate in a few short hours this afternoon from the Prosthetics program.  I can’t believe how fast this year has gone and how much I’ve learned…and how much I still need to learn.  Looking back, so much has happened these past eleven months.  By my best guess, we’ve sat through 3000+ PowerPoint slides, seen approximately 40 patient models, used 2000+ pounds of plaster, and countless sheets of polypro, LDPE, vivak, surlyn, and lamination supplies.  On the student side, to make it through the year, numerous $1 tacos, free hotdogs, 2-for-1 burgers and $2 beers were consumed. 

Murphy’s Law never applied to us during Orthotics or Prosthetic project fittings…until critique started.  That was when mysterious “rocks” appeared in AFOs, or a forearm section of a myoelectric prosthesis just “fell off.” Our teachers were always supportive and great, even on the days when they basically told us that we had produced an “epic failure.”  However, it was not a failure unless we didn’t learn anything from our mistakes or misfortunes. Critique even showered us with miracles somedays, too, but those didn’t come as often.

I’ve also met some of the greatest people in the world.  I am proud to call my fellow classmates my friends and future colleagues.  We stood by each other on the days filled with laughter, stress, boredom and enlightenment.  We ate lunch in the grass, followed by handstands, cartwheels and Frisbee dodgeball.  We enjoyed beach bonfires, movie nights, game nights, and ladies night out. All these memories bring a smile to my face.

So what happens now after graduation?  My residency.  The future is looking good…I can’t wait! 

Fall 2009 Orthotics Graduating Class

Spring 2010 Prosthetics Graduating Class

There are only two weeks of school left, and the cool stuff just keeps coming!  Today we learned about myoelectric controlled prostheses.  We had already made sockets for our patients, but hadn’t designated a location on the socket for the electrodes.  Before the patients came to school, however, we got to play with the Otto Bock myoelectric ‘toys’ ourselves.

We had to find the perfect electrode sites on the extensor and flexor muscle bellies of our forearms (some were easier than others), then the real fun began.  There are simulators on the Otto Bock software to test the user on their functional ability.  One of the simulators asks the user to flex/extend their forearm to move a car through a maze of walls.  Sounds easy, but it’s not.  Especially if ones forearm muscles aren’t accustomed to flexing repeated for three continuous minutes!

After playing with the games, we connected the electrodes to a prosthetic hand.  We programmed the hands to different settings and learned what muscle motions opened and closed the hands.  Now we were ready for our patients.

The patient model we worked with had a very short transradial amputation.  She also doesn’t usually wear a prosthesis.  Finding electrode sites that produced the right signal was a challenge, then trying to train the patient how to flex her muscles was a bigger challenge!  We had her use her sound side as a reference and try to mimic it with her limb deficient side.  We also attached the prosthetic hand to the electrodes so our patient model could get a better visual of what we wanted the hand to do. It was much easier for her to look at the hand than the signal data crawling across a computer screen.  After awhile, she got the hang of it, however we were still fishing around for the perfect electrode sites!

We finally determined that only one site was going to work, but it was going to work great.  We taped a forearm frame to her socket, attached the electrodes and crossed our fingers that everything would still work when she put the prosthesis back on.  Sure enough, it did! Our patient model was excited; my partners and I were excited; everyone was excited!  What we thought was going to be a very long and complicated day actually turned out pretty fun. Yeah for upper extremity prosthetics! 

Three weeks until graduation…we’re on the final unit of the semester: Upper Extremity Prosthetics!  We’ve learned a lot these first few days.  In order to understand how to don and use a harness, we got to put one on each other.  The terminal device (a Hosmer Hook) was attached to the bottom of a metal bar-stock “mock prosthesis.”

Once we got the straps untangled and properly connected, we figured out the shoulder and elbow motions that opened the terminal device.  We picked up objects, tried to put on jackets, and some classmates tried to play a game of catch with the ‘prostheses,’ too. 

Our first patient day was really interesting.  The patient I got to work with had a biceps cineplasty.  She showed us how she put her prosthesis on and then inserted the post into her bicep.  Then she flexed her bicep to open the terminal device.  My partners and I were in awe.  We were extra careful during casting so as not to accidently get plaster in the biceps insertion. 

It was quite a shock to go from a huge transfemoral cast, to a miniature transradial cast.  I felt like I needed tiny, little rasps and tools in order to modify properly!  The fabrication process is going quickly, though.  We’ll see the patients early this week for a fitting and critique.  But first, we get to play with foam! 

We had our last transfemoral critique yesterday.  It was a lot more fun than the previous ones, for sure.  This last project was an independent project.  We could cast the patient any way we wanted, we could fabricate any style of socket, and use any type of suspension.  Essentially, the teachers told us “no hand-holding.”  It was our turn to show how much we understood the biomechanics of transfemoral “socketology.” Since our previous projects had been skin suction suspension, many of my classmates and I opted for a seal-in suction suspension. 

My partner and I worked with an amazing patient model this time.  It was the first time she had come in as a patient model this year.  Jenny (not her real name) was 30-something, athletic, and funny.  She was born with bilateral limb deficiencies above her knees.  She had always used skin suction suspension, but was game to try whatever style socket we thought could work for her.

I ended up fabricating a socket with an Evolution Origin liner and the Aura Sealing Sheath for my patient model.  I had asked my instructors where extra silicone liners were located and they opened the door to the Aura idea.  My instructors hadn’t used the sheaths just yet, so it was an educational trial and error in fabrication.  (Note: don’t modify cast like a traditional seal-in liner…tends to make socket a little tight).  

Critique was short and sweet.  We each told of fabrication and alignment snags we had run into and the problem we solved without too much instructor intervention.  The patients seemed a lot happier than the first critique, too.  Not too many grimaces from pain!  Jenny was pleased with her sockets and was able to walk outside of the parallel bars in both my partner’s and my sockets.

Looking back, we have come a long way since the first project.  Our sponge-like brains absorbed a ton of information in these past weeks.  However we can’t turn them off just yet. Graduation is right around the corner…after we complete our final unit: Upper Extremitry Prosthetics! 

A couple of weeks ago, our preceptor day was spent in San Diego at the Balboa Navy Medical Center.  Navy Medical is one of three hospitals that soldiers wounded in battle are flown to for care.  Walter Reed Army Medical Center in Washington, DC and Brooke Army Medical Center in Texas are the other two hospitals. 

The prosthetic facility is located in an area called C5: Comprehensive Combat and Complex Casualty Care.  It integrates prosthetic care with physical and occupational therapy.  The facility runs snowboarding, surfing and even rock climbing clinics for their patients.  The patient care area is a big, relaxed room with cushy chairs, parallel bars, and a TV tuned to ESPN.

Each patient we saw was upbeat, motivated and really active.  There was a runner, a scuba diver and a surfer among the group.  My classmate and I made small talk with each soldier as their prosthesis was being adjusted.  We told jokes, talked about the weather, and some even opened up about their amputation.  One patient’s story really stuck with me.  Danny (not his real name), a bilateral transfemoral amputee, had walked in to the prosthetic office with fanfare.  He’d high-fived everyone, hugged one of the patient’s in the office and immediately hooked up his Ipod to the stereo for an upbeat atmosphere.  He introduced himself to my classmate and I, and then plopped down in a chair like it was his own.  While the practitioners were looking for some components, Danny told us that he had been in a humvee that hit a roadside bomb.  One leg was injured in the explosion while the other was crushed and pinned down in the vehicle.  Danny watched a fellow soldier amputate the pinned leg.  Danny had then passed out and his heart stopped.  Someone (wasn’t told if it was a medic or fellow soldier) cut open Danny’s chest and started pumping his heart with his hands.  Nearly two years later, here he was shooting the breeze with us, laughing his infectious laugh, loving every minute of life. 

While driving home, my classmate and I couldn’t stop talking about the facility and the amazing people we’d met that day.  It’s great that there is a place like C5 for our soldiers wounded in battle.  They deserve nothing but the best.  Even a few weeks later, I still think about those soldiers.  I know Memorial Day is reserved for honoring the fallen soldiers. However this Memorial Day, I’ll also honor those that are still serving in the military.

Update on last weekend’s surf clinic:  The founder of AmpSurf was nominated as a CNN Hero.  Click here forvthe link to the video and story. 

The AmpSurf Clinic inspired a few of my classmates and I to learn to surf.  Last weekend we decided it was time we learned.  With our wetsuits in hand, we headed off to the beach.  We met with a few of my friends from last semester: two Southern California natives, one of which is a lifeguard.  (Can it get any safer with a personal lifeguard?)

We had a quick safety lesson on land then headed out to surf in the biggest waves I have ever seen.  These waves looked like the “black diamond” waves.  I kept searching the beach for the “bunny hill” waves, but none were found.  Apparently the giant waves were surf-able because the entire horizon was filled with surfers.  So I headed out into the ocean to be a surfer extraordinaire like the surfers from the previous weekend. 

The first wave I came upon while paddling out knocked me clean off the surfboard.  Surfer extraordinaire no more.  Wipeouts were pretty much the trend of the day.  Oh well.  I got lots of practice paddling in the water and creating stylish wipeouts.  I also learned a few valuable lessons.

1. Surfers get up early on a Saturday.  (Parking lot was full before 7:30am).
2. Swimming dolphins=no sharks.
3. Wetsuits are one of the greatest inventions.
4. Balance is important while paddling.  Very important.
5. Just because one goes to the gym does not mean said person is already in shape to surf.
6. There are fins on the bottom of surfboards.  They are called ‘skegs.’
7. Skegs hurt.
8. Every surfer falls off their board…at least once.

I can’t wait to get back out there and try again.  Maybe this time I’ll be able to stay on the board “through the wash” and get to the “outside” without wiping out.  In the meantime, I’ll work on my upper body strength with the transfemoral ischial containment modifications!

This past weekend, the Association of Amputee Surfers in Southern California hosted their monthly surf clinic in San Clemente, CA.  A few classmates and myself signed up as volunteers, while a few others signed up to participate.  It was one of the coolest things I have ever been a part of.  

The participants included persons with transtibial, transfemoral and hemipelvectomy amputations.  There were also persons with traumatic brain injuries, and spinal cord injuries at the clinic.  People at the clinic came from all over: Northern California, Washington and even South Africa. 

The organization wanted at least a 4 to 1 ratio of volunteers to participants.  There appeared to be about 6 to 1 the day of the event.  The volunteers were surf trainers, in-water assistants, and beach assistants.  The trainers taught each participant the onland and water skills for surfing.  The water assistants helped the participant onto the surfboard, helped grab the surfboard when the participant wiped-out, and added a bit of moral support.  The beach assistants helped the participants into the water if needed, provided extra eyes to watch the safety of the participants, and helped with the moral support.  Since I don’t know how to surf (just yet) I was assigned as a beach assistant. 

Everyone was excited when the surfing began.  The waves were plentiful and perfect.  One of the participants with a hemipelvectomy amputation caught one of the first waves.  She rode the wave in a tripod formation, then gained her stability and balanced on one leg the rest of the way.  Everyone on shore cheered for her.  We cheered for everyone that we saw catch a wave that day.  A few of my classmates had some awesome rides, and even better wipeouts.  (Imagine the surfer ‘cartwheeling’ left while the surfboard ‘cartwheeled’ right…). 

Awards for the participants were handed out at the end of the clinic: Best Wave, Best Smile, Most Stoked, etc…It was a great end to a great day. A few of my friends that participated in the clinic want to start surfing on a regular basis.  I volunteered to be a surf partner.  We are now on a mission to find some beginner surfboards.

Next weekend is the Western Surfing Association’s West Coast Championships in San Onofre, CA.  A few of the trainers are going to be in the challenged athletes division.  A few of us are hoping to get down there to watch and maybe get a surf lesson or two.  I’ve got my wetsuit and sunscreen packed and ready to go!

For more information: www.ampsurf.org

Click here for more images

There was a “Tango on the Street” Festival yesterday in Santa Monica.  No, I didn’t go to tango (although the music was quite infectious).  I went to watch and support one of our transfemoral patient models as she made her dancing debut.  Brenda was dressed in a bright red, sequined dress with a white silk ‘robe.’  She looked radiant.  She joked that she was the only dancer that brought her own pit crew:  Her husband was in charge of adjusting her foot after she put on her tango shoes, one of her friends was in charge of the camera, and another was in charge of her cane while she was dancing.  And she had a cheering section, too.

Brenda got a little quiet and nervous when her tango instructor told her and her partner that it was time to line up (she’s usually chatty with a smile). Her cheering section got a little giddy in anticipation.  Before Brenda went onstage, her instructor said a few words.  Brenda was part of the Embrace Project, whose mission states:  “Sharing the joy of Argentine Tango dancing with the amputee community by connecting through the tango embrace.”  Then the music started.

I love watching Tango dancers because it makes me want to dance just like them. I wish I knew tango terms to be able to describe all the great dancing that I saw.  Brenda danced backwards and forwards.  She pivoted on her left toe; she pivoted on her right toe.  She swirled and kicked her foot.  Her microprocessor knee performed beautifully as well.  My description really doesn’t do the dance justice.  When the dance was over, Brenda and her partner were greeted with monstrous applause and a standing ovation.  Brenda walked over to the microphone and started telling the audience how she lost her leg a few years ago.  Up until a few months ago, she was using a walker.  She had no idea that she would be tango-ing on the streets of Santa Monica one day.  And she thanked her instructor for the opportunity to do so.  A few audience members were crying, along with a few of her friends.  It was an amazing moment.  I don’t think my smile could have been any bigger. Brenda is truly an inspiration to all of us around her.  I can’t wait to give her another big hug the next time she comes into school.

I could not have been luckier this week with the way that class work tied into preceptor hours.  Cal State builds 6 preceptor days into the already busy schedule.  It allows us to see different types of O&P offices and patients.  My classmates and I are partnered up each week and sent off to various locations in Southern California. 

During our first week of transfemoral, we had an in depth lecture about the different prosthetic knees: outside hinge, single axis, stance control, polycentric, manual locking, and even hybrids!  Then we had a lecture on TF gait, deviations, and possible solutions to the deviation.  Our poor little heads were swimming after that day of lectures!  The following day was a preceptor rotation.

My partner and I didn’t know what to expect.  Our instructors told us to be ready for anything.  Be it casting, fabricating and everything in between.  When we walked into the office, the practitioners told us we’d be testing out different knees on a new TF patient that hadn’t walked yet.  Coincidence?  

The patient was fit with an Otto Bock 3R60, 3R80 and an Ossur Mauch that they had in the office.  Like many people, this patient didn’t expect walking to be so difficult.  The practitioners gave out a few gait pointers, many similar to transtibial.  Rocking back and forth to get a feel for the foot and knee, hand placement on the parallel bars…The patient took a few laps, alignment was adjusted, and a few more laps were completed.  We worked on steps, riding the knee and equal stride length.  Just as the patient was getting used to the knee he was in, it was swapped out.  He immediately felt the differences. 

By the end of the appointment, the patient’s gait was still shaky, but his stride was equal and he was having fun.  I was excited that the practitioners let my partner and I set up bench alignment for the knees and let us get our hands dirty during dynamic alignment.

The whole day was an amazing experience.  I may not have learned all the nuances of TF gait, but I learned quite a few in that appointment.  Can’t wait to see what’s in store for the next preceptor rotation! 

We had our final transtibial patient fitting and critique early in the week. At the final critique, I had one of those moments that reaffirms why I chose this profession.  The patient model my partner and I worked with for Total Surface Bearing sockets hadn’t walked since his amputation about 6 months prior.  He was in the process of having his first prosthesis fabricated at his local office while we were working with him.  Our patient was a challenging fit, but my partner and I finally succeeded on the second round of check sockets we fabricated.  (My partner and I each made two check sockets). During the initial dynamic alignment, one of our instructors gave our patient gait pointers, such as rock back and forth on the prosthetic foot; take a longer step with his sound limb…
 

Finally, it was time for critique.  Our model was a little unsteady the first few steps, but then gained speed with each step after.  He did a few laps in the parallel bars with one prosthesis from our group, and then switched to the other.  I watched as our model adapted to the different prosthetic feet used between my partner and I, and then take off walking again.  I couldn’t help but smile.  He was walking!
 

Our patient asked to say a few words once he sat down and caught his breath.  He told the class that it’s amazing what standing up on two legs and actually walking can do to improve a person’s spirits.  After critique, our patient took my partner and I aside and thanked us for getting him up and walking again.  It was a heartfelt moment that left me momentarily speechless (quite unusual for me to be speechless!).  I don’t think I’ll ever get tired of moments like this.  I’m excited to hear how our patient gets along with his new prosthesis in the next few weeks. 
 

Transtibial studies are now a thing of the past.  We said goodbye to our patient models until graduation, and survived the final exam.  It’s now on to transfemoral prosthetics…the easy stuff, right?