For New Patients

Making the Most of Your Visit to our Office

Many people are unsure on how to prepare for their visit to see their prosthetist or orthotist. Here are
some suggestions that will make your visit more efficient.

• Be on time for your appointment, or 10-15 minutes early if you need to fill out registration papers
• On your first visit, bring your prescription from the referring physician
• Bring all of your current insurance, Medicare, Medicaid cards
• Let us know if your insurance, address, or phone number has changed
• Be prepared to discuss your personal health history and current conditions
• Be prepared to discuss your personal goals and activities
• Bring a family member or friend. It is easy to forget much of what was discussed during an office visit
• Don’t be embarrassed to ask your prosthetist/orthotist to explain medical words in simple terms until you are sure you understand Bring a pair of shorts if we are measuring or fitting a device to your leg
• Bring a pair of lace up or Velcro shoes Please turn off your cell phone
• Before your appointment, make a list of any questions that you want to ask your prosthetist/orthotist If you are coming for an adjustment, make sure you can describe where you are experiencing the problem or irritation
• Make sure you understand what you are supposed to do at home after being fit with a device: gradually increasing the wear schedule, checking your skin for signs of irritation, how to remove the device, etc.

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Information for New Amputees

Clothing

It is very helpful for initial evaluation and subsequent fitting appointments for your prosthesis (artificial limb) if you wear (or bring with you) clothing that will allow full access to your residual limb. This might mean comfortable shorts if you are a below the knee (BK) amputee or perhaps loosely fitting shorts, a bathing suit, or leotards if you are an above the knee (AK) amputee. We are concerned with your feelings and will make every effort to assure your privacy and comfort.

 

It is important that you bring with you, at the time of measurement or first fitting, a pair of shoes that fit you properly and have a reasonable heel height. The shoes are the foundation for the prosthesis and are your “connection” to the ground. Your shoes should be in good repair (that is, the heels should not be badly worn down), well constructed, and reasonably light weight. We will do all that we can to ensure that your prosthesis is as lightweight as possible. This effort can be easily lost with the use of heavy shoes. For the most part, the foot and ankle of a prosthesis cannot accommodate a wide range of heel heights. Remember, your sound ankle can automatically compensate for higher or lower heels. The prosthesis cannot do this without major modifications. Popular athletic shoes such as running shoes (New Balance, Reebok, or others) work very nicely, as they are fairly lightweight and soft. This type of footwear helps to cushion the step of the prosthesis and lessen the shock to your limb. If you have questions about appropriate footwear, discuss it with your prosthetist.

Limb Wrapping

Swelling is normal and to be expected for new amputees. It is very important that the residual limb be kept under moderate compression. This can be in the form of shrinker socks that you may already be wearing or will be fitted with, Ace wraps, or a Removable Rigid Dressing (RRD). Please keep the wrap on, even on the day you are coming in for measurement and fitting. We would prefer that we remove the compression just prior to measurement so that we will not take a cast of a swollen limb. The compression wrap or RRD should be worn 24 hours per day except for the time you are cleaning or dressing the amputation site.

Appointments

We take great effort to assure that your scheduled appointments are made in a timely manner. We will attempt to work around your schedule as much as possible. Please be on time for your appointments. Please do not come in more than 5 or 10 minutes early, as we will rarely be able to see you before your appointed time. Please do not be late and if you must cancel, call us as early as possible so that we can schedule someone else for that time period. We do not overbook and will do all that we can to see you at your appointed time. There will occasionally be instances beyond our control that may require you to wait. We try very hard to minimize this, but due to emergency hospital work and clinical schedules, there may be instances that you have to wait. If this occurs we will do all that we can to make you comfortable and will try to minimize your inconvenience.

Financial Policy

Our knowledgeable and helpful staff will do all that we can to assist you with the financial requirements for your prosthesis. It is our policy to accept assignment from most third party payers. If you do not have Medicare supplemental insurance, you will be responsible for any co-pays (usually 20% after deductibles). You may also be responsible for co-pays and deductibles from private insurance, depending on your policy.

We are approved by most major carriers, including Ohio BWC, Medicaid, BCMH, and the Veteran’s Administration. As each individual contract varies, your specific coverage will be verified and explained to you upon completion of initial evaluation and once your prosthetic needs have been determined.

We will as members of your rehabilitation team, in consultation with your physicians and physical therapists, do all that we can to provide the most appropriate prosthetic care for your individual condition. If you have special needs, please discuss them with your practitioner.

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FAQs about amputation

Driving FAQ

 

1.  Will I need to have my car modified to be able to drive it?
After a limb amputation, a person is sometimes unable to drive a vehicle in the normal manner. There are several types of adaptive devices that will allow an individual with an amputation to safely resume driving.
Usually, modifying a vehicle involves compensating for the inability to reach and operate the various driving controls. The type of modification will depend on the level of amputation. Most, but not all, vehicles can be modified with adaptive equipment.
We recommend that new amputees go through a driver’s evaluation through OSU Medical Center’s Rehabilitation Driving Program which helps restore mobility and increase independence for individuals with a wide range of disabilities. You will learn how to safely operate an automobile through driver simulation and on-road training. They can provide recommendations on car or van adaptive equipment.

Rehabilitation Driving Program
2050 Kenny Road
(OSU Martha Morehouse Medical Plaza)
Columbus, OH 43221
(614) 293-3833

2.  I am a lower limb amputee. Can I drive a car?
It may be possible for you to drive either with or without modifications to your car. In general, if you are a left leg amputee and your car has automatic transmission, you won’t need modifications and can continue driving as normal with your right leg.
The usual modifications/ suggestions made for a lower limb amputee are:

Right leg amputation:

• Left foot accelerator pedal
• Automatic transmission
• Power brake

Bilateral amputation:

• Hand controls for brake and accelerator spinner knob
• Automatic transmission
• Emergency brake extension

3.  I am an upper limb amputee. Can I still drive a car?
It will still be possible for you to drive, either with or without modifications to your car. In general, if you can reach and operate all your car’s controls either with your “good” hand or with the help of your prosthesis, or with your “good” hand and residual limb, you will not need modifications. Indeed, many people with bilateral below-elbow amputations can drive as easily without prostheses or modifications as the rest of us can with both hands. However, those with bilateral above-elbow amputations generally need vehicle modifications.

The usual modifications made for an upper limb amputee are:

• Automatic transmission
• Steering device
• Reduced effort steering (power steering)
• Modified gear shifter and secondary driving controls (turn signals, windshield wipers). How do I get a handicap placard for my car?

Fill out Ohio Bureau of Motor Vehicles application for disability placards. Obtain a prescription from your physician as proof of the disability. Return completed from to any local Deputy Registrar or mail to the Ohio Bureau of Motor Vehicles.

Limb Loss FAQ’s

1.  How can I reduce the risk of amputation?

• Practice good foot hygiene and care, especially if you are diabetic
• Stop smoking
• Practice good safety habits when operating machinery (lawnmowers, etc.)
• Reduce the risk of limb deficiencies in your unborn child by taking medications only when absolutely necessary and under your doctor’s supervision

2.  After losing a limb, are there increased risks for other health problems?
Amputation is more often the result of, rather than the cause of other health problems. Since the loss of a limb can result in decreased activity, the risk of health problems associated with a sedentary lifestyle may be increased. Residual limb and phantom pain, as well as skin problems associated with prosthetic use are also common.

3.  Is it common to have feeling in a limb even though it is no longer there?
Yes. This is called phantom limb sensation and is common among many amputees. If it is uncomfortable, it is called phantom pain. For many amputees the sensations cease shortly after amputation. Others experience them for a number of years. Some treatments that have worked are certain medications, exercise, heat or cold applications, acupuncture, and biofeedback. Consult your doctor for the treatment that is best for you.

4.  What is phantom limb sensation?
Phantom limb sensation is the term given to any sensory phenomenon (except pain) which is felt in an absent limb. Approximately 80% of amputees experience phantom sensations at some time of their lives. There are various types of sensations that may be felt:

• Sensations related to the phantom limb’s position, length and volume. Some amputees will experience a sensation called telescoping. This is the feeling that the phantom limb is gradually shortening over time.
• Sensations of movement - feeling that the foot is moving
• Sensations of touch, temperature, pressure and itchiness.

5.  What is phantom limb pain?

Phantom limb pain is the feeling of pain in the absent limb. Some describe the feelings as burning, cramping, slicing, squeezing pain. The pain sensation varies from individual to individual. Phantom limb pain can start anytime after the amputation. It has been said that it usually starts within the first 2 weeks post amputation.

6.  When does phantom limb pain start to disappear?
This varies for different individuals. Some may experience phantom limb pain longer than others. Some unfortunate individuals can even experience phantom limb pain forever although the frequency and the intensity of the pain may decrease.

7.  What are the factors that may reduce phantom limb pain?
Various methods have been used to help reduce phantom limb pain. Often simple methods like light massage, electrical stimulation, hot and cold therapy, rest and elevation of the residual limb can be used with variable results. Doctors may also prescribe medications to reduce the pain. A well fitting prosthesis is also important in making phantom limb pain more bearable.

8.  What can cause residual limb pain?
There are many causes of residual limb pain that occurs in the amputated limb. Internal causes include:

• Bone related- bony overgrowth or sharp bony fragment
• Vascular- intermittent claudication or ischaemic pain due to lack of blood circulation
• Nerve – hypersensitive nerve endings or neuroma (excessive growth of the nerve ends)
• Skin- open amputation site or infected wound

External causes of residual limb pain include:

• The residual limb bandage being too tight.
• Inadequate socket fit.

Prosthetic General FAQ’s

1.  What is a prosthesis and what is it used for?
A prosthesis, also known as an artificial limb, is an externally applied device designed to replace a missing part of the body or to make a part of the body work better. Missing arms, hands, and legs are commonly replaced by prosthetic devices.

A prosthetic device is used to replace an amputee’s missing limb so that they may perform regular daily tasks more easily, helping them gain more independence and confidence as they carry on with everyday life.

2.  How do I get a prosthesis?
Before being cast and fit for a prosthesis, you will need to be adequately healed and your doctor will decide when you are ready to precede with getting a prosthesis. A prescription is also needed from your physician to begin working towards your prosthesis. Once our office receives the prescription you will be scheduled for an evaluation appointment.

You will see a prosthetist, who is a professional trained and licensed to fit, adjust, and modify prosthetic devices. The first visit will include an evaluation to better determine the type of prosthesis that will match your needs. A plaster mold is taken and used to develop a model of your residual limb. Several visits to the prosthetist will be required to assure proper fit and function of the prosthesis. Initially, you will be fit with a clear ‘test’ socket to evaluate the fit of the socket. A second test socket maybe necessary to assure the best fit possible. You will then be fit with your final prosthesis.

After taking your prosthesis home you will return to our office for follow-up appointments and may consider going to several visits with a physical therapist. A physical therapist will help train you how to use your prosthesis in different situations including stairs and ramps.

3.  How long will it take to make my artificial leg?
Once you have been cast for a prosthesis, you will be scheduled for your first fitting appointment in 7-10 days. A permanent prosthesis normally requires one or two fittings appointments in a ‘test’ socket before the permanent prosthesis can be fabricated for you to take home. The whole process usually takes from three to four weeks. The timeline may differ depending on an individual’s needs. Our goal is to fit you with the best fitting prosthesis possible.

4.  What should be considered when choosing a prosthesis?
Your prosthesis will be made to match your functional levels. There are several important factors that will be considered when choosing your prosthesis including:

• Your amputation level
• Activities you would like to return to (sports, hobbies)
• Your occupation (office job vs. manual labor)

The prosthesis should not be the limiting factor to your functional level. You may have to perform tasks differently, but you should be able to perform most tasks you did before the amputation.

5.  Will my prosthesis be covered by insurance?
American Orthopedics works with most insurance companies and most insurances will cover a portion of the total costs of your prosthesis. The cost of your prosthesis varies depending on the components used. The type of your prosthesis and your insurance policy will determine reimbursement and out- of-pocket expenses. After your evaluation we will be able to provide you with estimated costs.

Rehabilitation FAQ’s

1.  Who are the core members involved in amputee rehabilitation?
There are many professionals involved in the rehabilitation process including the physician, prosthetist, physical therapist, occupational therapist, and most importantly the amputee.

2.  What happens pre-amputation?
When possible, an amputee will be provided with psychological support, counseling and information on prosthetics and living as an amputee. This is not always possible for traumatic amputations, where the emphasis is on saving life and speed is essential.

3.  What process does an amputee go through during rehabilitation?
During the healing stage you should start physical therapy with the goals of maintaining range of motion, preventing muscle shortening, and maintaining muscle strength. It is also important to massage tissues at the end of your residual limb to prevent adhesions and reduce hypersensitivity. Once you have received your prosthesis you may continue physical therapy to help with gait training and activities of daily living.

4.  What happens after the prosthesis is finished and is taken home?
You will continue to see your prosthetist for follow-up appointments and adjustments. As your residual limb changes, adjustments can be made to the socket to maintain a proper fit.

5.  Can I wear different shoes?
You can wear different shoes with your prosthesis. However, it is important to wear shoes with the same heel heights. Your prosthetic foot has been aligned for a certain height shoe and the function of the prosthesis can be changed if you are wearing a shoe with a different heel height.

6 . Will my residual limb change size?
Yes. Over time, your residual limb will lose volume and become smaller. Following surgery the shape of your residual limb will be bulbous, but it should gradually shrink down.

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