Week 3: The Business Side & Upcoming Weeks

After my first few weeks on site, I have learned much about the insurance side as well as the business side of the prosthetic/orthotic industry. I will be outlining both sides in this blog post.

Firstly the insurance side of both orthotics and prosthetics. The biggest problems for McCleve occur from the insurance side of this industry. As a small privately owned business, a large portion on the payment comes from the insurance like any medical facility. Every prosthetic and orthotic device provided to patients must go through a process to be confirmed by the insurance company. Often times the corporation does not want to pay out and will attempt to find loopholes and/or push for a very clearly written reasoning of why the device is necessary. Lacking a limb is not considered enough of a reason for an insurance company to pay for a prosthetic leg. One must show dedication and drive to walk again and clearly state why they need their lost limb. Because some patients are more active and require a different type of prosthetic device to allow for such high activity levels, insurance companies must be convinced that the individual will continue at such a level and will try to prevent paying the higher cost of the better prosthetic.

The biggest proportion of business comes not from walk-in appointments but from doctor referrals. To show doctors the newest devices and update them on different prosthetic and orthotic technology, companies will often have in-service presentations. Providing lunch and an informative presentation both improves ties with the people who will be sending them business and educates them of different devices that can be prescribed. While having a fully booked day, the clinicians must also be prepared to fit in patients who come in needing bracing.

I am also excited to announce that in the upcoming weeks I will be working with the clinicians to implement a new type of 3D imaging device that will be able to capture 3D images of the stumps of patients to provide a more precise cast (3D printed) to make the socket off of. Like any other industry, technology is currently advancing and changing the way things are done in the field. Implementation of such technology successfully will cut down the time it takes to create a cast as well as increasing the precision of the cast. I hope to show an example of this software and how it works in the near future.

Thank you for reading this week’s edition! I will see you next week! 

Week 2: My First Interaction with iLimb!

Hello once again!

After my second week on site, I have been lucky enough to see two rare iLimb devices. The prosthetic industry is dominated by lower extremity prosthetics because of the prevalence of diabetic amputations to lower limbs. Amputations are most commonly a last case scenario after diabetic sores develop then become infected with gangrene and the only option at that point is to remove the infected portion of the limb. Many patients even start with a below the knee amputation and must have further amputation (above the knee) because of more infection. Upper extremity devices make up a very small percentage of the prosthetic field.

On Tuesday of this week I was fortunate in that a Touch Bionics Sales Representative stopped by the office to show off the latest and greatest new devices. The newest prosthetic is called the iLimb Quantum. The difference between this form and the previous model is the newly added gyroscope feature which allows for more options for movement. The device works with the myoelectric signals that come from the muscles. For an above the elbow amputation specifically, the user is able to flex the bicep to perform the movement and flex the tricep muscle to release the movement. With a held flex, the digit will make a small twitch which tells the user that they are able to switch between the four hand functions which are picked up by the gyroscope. For movement in up, down, left, and right directions, a different hand function can be set using the phone application. It is astounding the quick response and movement that the new prosthetic hand offers. Even the hold strength has been quadrupled allowing the hand to bear a weight of approximately 200 pounds. 

Above is a representation of what the iLimb device looks like and the variability of the hand based upon your other hand's size. 

Although just a demo hand, I was able to see the functionality of the iLimb device and see the effectiveness of such a device. My second encounter came in the form of an arm which had been completely taken apart to add a design on the exterior of the socket. Unfortunately in doing so the user accidentally lost parts and needed the limb fixed. As a company that creates custom made prosthetics, one option for patients is to add a graphic. From sports teams to TV shows, people have a huge variability in what they want upon their prosthetic. A press is used to copy the printed image onto a t-shirt and from the t-shirt it is able to be used to make the image upon the device itself. 

That’s all for now, I’ll see you next week! 

My First Week!

Hello again!

On my first day of the internship, I was welcomed by the employees of McCleve Orthotics and Prosthetics and was immediately whisked off to the first patient consult this week. My first real experience with prosthetics came in the form of an above the knee amputation. I quickly learned the complexity that goes into each prosthetic device as they are custom made on site in the fabrication room (also known as the fab). This leg in particular had made use of the LimbLogic device, which allows for elevated vacuum of the stump, providing a more secure and comfortable prosthetic. The prosthetic itself is made up several parts: the foot, the pylon, the knee, and the socket. Such devices must be frequently adjusted as the size of the stump constantly shifts with the amount of swelling in the leg. To combat this, wearers are provided with variable socks to fill in the extra room while still maintaining the suction.

When working with prosthetics and orthotics, each patient is different and the specific needs of the patient must be met. As a company that creates both, the clientele is extremely varied. From sports injuries to amputations, the clinicians find ways to improve patient’s mobility.

I was astounded upon entrance of the fab to find the immense time and effort that goes into every device created. A simple shoe insert to provide more support can take over an hour of work! In prosthetics, the devices take a huge amount of time to create as they are a multi-step process. First the initial mold must be created from plaster much like that used on a cast. Then from here they fill this casting with a hard plaster to make a replica of the stump. The replica is then covered with a heated plastic (taken straight from the ovens) to provide a molding of the socket. This isn’t even the actual socket! The final socket is fabricated from carbon fiber filaments coated in resin upon the hard plastic covering!

One difference that makes McCleve special is the way that they cater to their patient’s needs. Often times, prosthetic patients find it difficult to reach the office, whether it be because transportation from home or admittance into hospital. Today was my first time leaving the office and visiting a patient in the hospital. It was an interesting change, suiting up in gown and gloves (to prevent infection), and meeting with a patient so soon after surgery.

My first week on site has been an amazing experience! In the next upcoming week, I will further my research and provide a more detailed discussion of the prosthetic devices themselves.

See you next week!

Sebastien 

Image Retrieved from McCleveop.com