|Ben Stewart: |
A Quick Wit and Quick on Skates
The first one-handed player in the NHL or a stunt man: these are the answers you'll get when you ask 10-year old Ben Stewart what he wants to be when he grows up. Yes, Ben, a quick witted and energetic young man who plays hockey for the Cincinnati Swords traveling hockey team, is not your typical kid.
Having lost his right arm below the elbow due to amniotic band syndrome, Ben plays hockey one-handed because he says wearing his prosthesis would slow him down. He was initially reluctant to wearing a prosthesis at six months old. Every year Ben and his parents would follow up with the orthopedic surgeon about a prosthesis, and every year Ben's answer would be "no."
However, one day Ben came to parents saying he wanted to try the prosthetic so he could do "new things" like tying his shoes and writing with his right hand. Ben first received his prosthesis back in May and was in recently for adjustments so he could wear it to school.
Ben isn't shy about his arm, and uses his wit and sense of humor when talking about it. Whenever other kids ask Ben what happened to his arm he says, "This is what happens when you don't eat your veggies!"
When talking about advice he'd give to other kids with limb difference, Ben said, "Keep trying and have a sense of humor."
His mother, Tammy, offered up this advice: "Let them be themselves and go at their own pace. And don't offer too much help. Kids often want to do things on their own, and you have to let them figure out how to do that."
We have no doubt that with his endless energy and positive attitude Ben will achieve much in his life. If all goes to plan, we'll be seeing him in a couple of years on the ice or in Hollywood movies!
|Organization Spotlight: Amputees in Motion|
When people hear the phrase "support group" they may conjure up images popularized by Hollywood of people sitting in a circle of aluminum chairs in a small, empty room. This stereotype doesn't apply to Amputees in Motion (AIM), a support group for amputees here in Ohio.
The group, started by Optimus patient Linda Lyon, works to "keep people in motion" by sharing their stories, struggles and triumphs. You won't hear members complain or say, "Why me?" Instead, the group tries to keep a positive and uplifting attitude toward their lives and the obstacles they face.
Linda knows a great deal about these struggles. On July 7, 2007, she and husband Jerry were riding their motorcycle less than a mile from home. A car came over a hill and sideswiped the motorcycle, causing Linda and Jerry to slide off into the ditch. Linda's leg was twisted up behind her, but she had the presence of mind to tie her jacket around her leg to stop the bleeding. After being airlifted to Miami Valley Hospital, the decision was made to amputee Linda's leg above the knee. Jerry suffered a broken metatarsal in his foot and a nearly severed finger that was able to be saved.
Linda's road to recovery and founding AIM was influenced by Optimus patient Tim Buehl and another local amputee, Molly Null. Linda met Tim when she was having a particularly bad day in therapy. Tim, who himself was also in a motorcycle accident three months earlier, was also in therapy that day and was already walking around with a cane. Linda said that after seeing Tim, she knew she could make it through therapy.
Linda heard about Molly after Molly lost both her legs and two fingers to strep throat and a staph infection. Linda sent Molly cards offering her support and encouragement, and after Molly left the hospital she called Linda and the two became friends. They met another area amputee, Terry Lutz, and began meeting together to plan meetings.
There is great power in being a part of a support group, Linda said.
"When someone who has gone through what we have - to be around other people who have gone through the same thing, gives you a comfort, you know you're not alone," she said. "We try to find answers - financially, emotionally, whatever support our members need."
Amputees in Motion welcomes everyone willing to come and share their story. They meet the second Monday of every month in the basement conference room of the Darke County Health Department, 300 Garst Ave., Greenville, Ohio 45331.
More information can be found by calling (937) 548-8139 or by going to www.amputeesinmotion.com or the AIM Facebook group page.
|The Importance of Residual Limb Extension and How to Get it Right|
|Jim Scharf, PTA|
The goal of "Jim's Corner" is to provide helpful information and be a resource for those helping patients fitted with prosthetics learn to use them correctly in order to enjoy a better quality of life as an amputee.
In the past I have touched on the importance of residual limb extension and this month I would like to devote more time on the importance of this topic. Residual limb hip extension is required:
- For proper prosthetic stance control, providing a pressure or a backward force on the back wall of the socket so the patient does not experience any unwanted prosthetic knee collapse.
- For guarding against a premature stance disengagement, or when the prosthetic knee buckles and can result in a fall.
- To aid the patient in achieving terminal stance, to "load the toe" that is required for proper stance disengagement for a proper prosthetic swing and toe clearance during gait.
- For power of movement from point A to point B.
- 10°-15° of hip extension is required for normal gait and a proper opposite limb step length.
I have found that patients generally have a very poor understanding of how to extend their residual limb at the hip (although they may verbalize it well). All it takes is 1 or 2 times for that prosthetic knee to buckle and the patient will have great difficulty with trusting their prosthesis, which can lead to:
* Not shifting their weight onto the prosthesis.
* Not bearing the needed weight on their prosthesis that is required for proper prosthetic stance and sound limb swing.
* Poor balance on the prosthesis.
The result is a very poor foundation for prosthetic gait, and in my opinion we will set them up for a gait that is very inefficient, lacking in safety and that limits their full potential and freedom.
A generalized and simple set of rules to remember are:
|Left: stance engagement, with weight over heel and a backward push on back wall of socket (hip extension), knee stays. Right: stance disengagement, with weight over toe and forward push on front wall of socket (hip flex), knee gives.|
A great cue that I have used is to tell the patient "Imagine that I have put some eggshells in the back of your socket (tapping the posterior wall of the socket). I want you to smash the eggshells." I really want the patient to use their hip extensors, to push into the back wall of the socket with their femur via hip extension. I have found that sometimes patients will mistake hip extension with just tightening their hamstrings leading to cramping, spasms or complaints of pain in the hamstring area. When this happens you have a very good clue that they are not using their extensors.
Standing Residual Limb Extension
If the patient is having difficulty with proper residual limb/hip extension, one way to teach them proper extension is to have them stand in the parallel bars or with a stable walker with their prosthesis off. The patient is to stand on the sound limb with a good posture keeping the pelvis level. They will usually compensate as in the photo below. To teach, I start by manually moving the residual limb into hip flexion, and then manually move it into hip extension, extending their residual limb at the hip and trying to keep their pelvis stable to learn proper residual limb/hip extension. Once the patient understands this concept then the patient is to actively extend their residual limb at the hip. Next we can add resistance; resistance can be manual or with a resistance band/sport cord. For manual resistance I will generally place my hand on their posterior thigh.
Again we want to try to get them to use their hip and not over recruit their back & hamstrings.
I then have them stand in the parallel bars with their prosthesis on and manually move their prosthetic leg into the various positions of stance disengagement (prosthetic knee flexion) and the patient is to move into stance engagement (prosthetic knee extension) as follows:
I really want the patient to use their hip extensors, to push into the back wall of the socket with their femur via hip extension. It is important to be aware that the shorter the residual limb is, the more muscle force is required due to a shorter lever arm. Also, keep in mind functional anatomy (what is missing & what remains) combined with gravity, ground reaction forces, movement, and how what is remaining must compensate for what is lost.
Jim Scharf, PTA, Prosthetic Assistant/Gait Specialist
Jim has been a Licensed Physical Therapist Assistant since 1988. Jim has worked with lower extremity amputee patients throughout his career. He serves as a Gait Specialist and Liaison when prosthetic patients are meeting with their therapists. Feel free to contact Jim if he can assist you in any way at: firstname.lastname@example.org.
D = Dayton Area
C = Columbus Area
Completing Course #1 - "Amputation & Prosthetic Overview"
D - Thursday, Oct. 3
Good Samaritan - 12:00
C - Wednesday, Oct. 9
Tuscany Gardens- 12:00
C - Tuesday, Oct. 29
Mt. Carmel West Inpatient Rehab - 12:00
Completing Course #2 - "Lower-Limb Prosthetics: Transtibial"
D - Friday, Oct. 18
Arbors of Dayton - 12:00
C - Friday, Oct. 18
Rehabilitation & Health Center of Gahanna - 12:00
D - Wednesday, Oct. 23
Miami Valley Hospital - 12:30
C - Thursday, Oct. 24
Select Specialty Hospital - 12:00
Completing Course #3 - "Lower-Limb Prosthetics: Transfemoral"
C - Tuesday, Oct. 8
Columbus Colony Elderly Care - 12:00
D - Wednesday, Oct. 16
Wilmington Nursing & Rehab - 12:00
C - Wednesday, Oct. 16
Franklin Woods - 12:00
C - Thursday, Oct. 17
Laurels of Norworth - 12:00
D - Thursday, Oct. 31
Koester Pavilion - 12:00
Course #4 - "Lower Extremity Amputee/Prosthetic Evaluation & Outcomes Measures"
D - Tuesday, Oct. 8
Xcel Sports Medicine - 12:00
D - Wednesday, Oct. 9
Kettering Neuro Rehab and Balance - 12:00
Course #5 - "Lower-Limb Prosthetic Gait Training"
C - Monday, Oct. 21
St. Ann's Hospital - 12:00
D - Thursday, Oct. 24
Kettering Neuro Rehab and Balance - 12:00
D - Friday, Oct. 25
Springfield Masonic Nursing and Rehab- 11:00
D - Wednesday, Oct. 30
Kingston of Miamisburg - 12:15
Course #6 - "Lower-Limb Prosthetic Gait Deviations"
D - Friday, Oct. 4
Shiloh Springs - 12:00
D - Wednesday, Oct. 16
Wayne Hospital - 12:00
D - Thursday, Oct. 17
New Lebanon Rehab - 12:00
D - Tuesday, Oct. 22
Four Seasons - 12:00
Course #7 - "Upper-Limb Prosthetics"
D - Thursday, Oct. 10
Sanctuary at Wilmington Place - 12:00
D - Friday, Oct. 25
Fidelity Home Health Care - 8 a.m.
Course #8 - Prosthetic Advances
D - Monday, Oct. 7
Friendship Village - 12:00
D - Friday, Oct. 25
Fidelity Home Health Care - 9 a.m.
Course #9 - "Partial Foot, Ankle/Knee/Hip Disarticulation, & Transpelvic Prosthetics"
Optimus Prosthetics, Dayton
8517 North Dixie Drive, Suite 100/300
Dayton, Ohio 45414
Optimus Prosthetics, Columbus
3132 Olentangy River Road
Columbus, Ohio 43202
(614) 263-LIMB (5462)
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