research

Ask (interviews):

Michael

He is the co-founder of Prosthetic Laboratories in Rochester, MN. He has had more than 38 years of experience in the field of prosthetics. He specializes in soft tissue supplements, hemipelvectomy, and rotationplasty prostheses. He got his undergrad from the U of and his degree in prosthetics from Century College in Whitebear Lake, MN and Northwestern University in Chicago. He is certified in C-Leg, Myoelectric Arm, Harmony Vacuum Technology, Helix 3D Hip System, MAS Socket and NPS Socket. I thought he would be a very suitable person to interview as he is very experienced and knowledgeable in the field of prosthetics.

Michael was a fun person to interview. Being a co-founder of the company, he was very knowledgeable about his facility and how they do things. He is clearly very proud of his facility and his team and what they are able to accomplish. He told me about the prostheses he specializes in which are soft tissue supplements, hemipelvectomy prostheses and rotationplasty prostheses. Realizing these words mostly went over my head, he explained them in more detail. The rotationplasty procedure is quite interesting, I learned. It’s when they remove an infected section near the knee and then reattach the lower part of the leg but rotate it that it’s now backward and the ankle joint then can act as a stand in knee joint. There are clearly some creative thinkers in this field. Prosthetic Laboratories is definitely a stand out facility. They partner with the Mayo Clinic in Rochester, which brings them unique patients every day. They also have their own fabrication center, which not all facilities have. This way they can oversee the entire process from start to finish and ensure a quality prosthesis for their patient. As he tells me about the process that one must go through to obtain a prosthesis, he talks about the tests and everything, but really emphasizes that they want to know about the patient and what they want to achieve. He really pushes a personal aspect about it. When discussing insurance and costs, it’s clear to see that he doesn’t think it’s fair when a potential patient gets turned away solely for the lack of funds. I asked if there are common problems patients have with their prostheses that are still in need of an answer and he tells me that they get new problems every day that they don’t know how to solve, but they usually have to do with the specific patient and would be hard to resolve on a wide scale. I asked him about phantom pain and if there’s any sort of product that specifically helps patients get over this, but he tells me that no one fully understands why phantom pain occurs so it would be hard to nail down a helpful product. His company partners with other businesses in Rochester that provide the additional products patients may need like fitted shoes or walking canes. When I ask if he ever gets frustrated with his patients, his answer is truly heart-warming. He says that the main time he gets frustrated with a patient is when they give up on themselves when he knows he can help them. At one point, he brings up a point about children outgrowing their prostheses and constantly needing new ones, which I imagine gets to be very costly. When I asked if he could tell me about a success story they’ve had, he tells the most inspiring story of Randy who has an amputated leg, but still accomplished his dream of hiking down the Grand Canyon. It’s clear to see that Michael genuinely cares about all of his patients and their wellbeing. It would be a great experience to create something that could help him do this.

“I would say to help someone enjoy life again is the goal of prosthetics, taking people so discouraged from their loss and showing them that life moves on and they’re still along for the ride.”

“From the first meeting with a patient to their finished prosthesis, we are able to control the whole process right here and oversee everything to make sure our patients are cared for in the best way possible which is always our highest concern.”

“They like to say a lot of things aren’t necessary, which as a prosthetist and a human being, it’s easy to see that they are.”

Sara

She has been with Prosthetic Laboratories for over 14 years. She got her Bachelor of Science degree in Kinesiology from University of Wisconsin Eau Claire. Afterwards, she got her degree in prosthetics from Century College in Whitebear Lake, MN. I chose to interview Sara, because she is a happy medium between the most experienced and the newest of the field. Not to say she isn’t well experienced after 14 years, but I hope this combination of people will give me the best outlook.

Sara is clearly also very passionate about her career. She tells me that she didn’t know what she wanted to do at first, but her parents always nudged her in the medical direction. When she job shadowed at an orthotics and prosthetics clinic, she said it felt like the perfect fit and knew what she wanted to do from then on. She feels very blessed to have worked at Prosthetic Laboratories for the past 14 years. She explains that the prosthetic magic all starts with an initial visit where you are set up with a practitioner that will be with you every step of the way. They do some evaluations to determine the patient’s K level which basically means their activity lifestyle. The scale ranges from 0 to 4 and helps determine what prosthesis would be right for them. Apparently for whatever K level the patient is there are hundreds of options that would be suitable and that’s only one component of it, not even talking about a knee or socket or liner. To me, it seems overwhelming to have all of these options and be in charge of picking out the exact right one, but she assures me that’s all part of the fun of job. I asked her if they often look for potentially more suitable material options and I was told that yes, they always try but adaptation with what they do takes a long time to integrate fully. I wasn’t quite sure if all prostheses were custom-made for individual patients or if that was just a specialty thing, but I learned indeed they are and they have to be actually. It’s a worldwide standard in the field of prosthetics. I was interested in learning more about the additional products patients may need and what they do for them. There are many items that patients use to make their life easier with a prosthesis, from rubbing alcohol to clean the socket to walkers or canes to socks and sleeves and such. She also pushed that even though they’re not products, having a supportive family and understanding job that works with them are extremely helpful when transitioning into a new lifestyle like this. I asked her if she ever gets frustrated with the patients and she told me a story where she was showing a patient and their dad the new device and how it worked and all of a sudden the dad got unexplainably angry about the whole process, saying things like this isn’t what it looked like at all and wanting to talk to her out in the hallway. She said it’s frustrating when things like that happen, especially when it’s not even the main patient, but she says it’s just part of the job, the less fun part. She knows the people she’s treating are stressed out and most likely dealing with something like this for the first time so she doesn’t blame them. On a happy note, she told me about companies like Gillette and Shriner’s where they take over the responsibility of children’s costs until they turn 21 which is very generous and inspiring. Sara was able to inform me in a lot of ways and I enjoyed talking with her.

“Every person you see walking on a prosthetic leg, that prosthetic leg was made for them.”

“In order to adapt something, we have to prove it works and repetitions of making sure that this works, and it’s put up against something we know how to do and know how to do well so it takes a while.”

“Every time they take a step or master a new task with their prosthesis, it just makes you smile.”

Josh

He is currently an Orthotics Prosthetics Resident at Prosthetic Laboratories. He got his undergraduate degree in Kinesiology-Exercise Movement Science with a practicum in Adaptive Fitness. His father was a Certified Orthotist before him, which gave him the opportunity to spend many months volunteering and working in an O&P facility where he fell in love with the field. He chose to Prosthetic Laboratories’ Residency Program, because of the team, the history, and the location. I thought it would be a good idea to get the perspective of a resident to show all areas of the field.

Josh is only a resident at this time, but he actually informed me the most about the specifics of everything, including the steps the patients must go through before they can receive even their first prosthesis, let alone their finished prosthesis. He says that he really enjoys the opportunities he gets at Prosthetic Laboratories, stating that since they’re attached to the Mayo hospital that they get to see things that people may only ever see once in a lifetime 10 times a year. After we went through what all happens in the process, I asked him if he was satisfied with it or if there were things that could be improved. He told me that in his position right now, he has been satisfied with the process, but in this field you’re always learning. He informed me that costs and insurance are big factors that affect who can receive prosthetics. Apparently, prostheses can range anywhere from $10,000 to hundreds of thousands of dollars and that insurance generally only covers 80% of the costs, if they even deem the device medically necessary. It is clear that there is a constant battle between them and insurance companies, fighting to get the best care they can for their patients. When I asked him about common problems with the prostheses, he says that the main problem they see is patients having fluctuating volume on their residual limb, meaning that their weight changes causing the prosthesis to no longer fit right. Another problem is that some patients need to wear prosthetic socks to make sure everything fits fairly nicely and if they mismanage this it could lead to bigger problems in the long run. He says this is a recurrent problem they have to deal with and it’s mostly because of patient error. He mentions a patient that complained about a noise his prosthesis made when he walked and they could hear it too, but they could not locate it. It drives him mad when he can’t figure small things like that out. Another thing he mentioned is that sometimes the difficult part is understanding what the patient wants. Going off of the person’s description of their experience trying to make a mechanical change on a physical object is not an easy task. When we discussed phantom pain, he told me of a method that involves a mirror that reflects the sound limb and somehow the brain clicks and realizes that there is no other limb there anymore. Phantom pain is an incredibly interesting topic, but also so confusing. You never know what will work and what won’t. There are certain surgeries that would fix this, but most patients avoid surgeries as much as they can. I asked him if 3D printing is being utilized in the prosthetics field at all and he told me he actually did his college dissertation on that exact subject. He says that while it’s being worked on, it has not currently reached a level where patients would get it. He thinks it will be a big thing of the future, but as for now the strength of the plastic is not where it needs to be. I think Josh offered up a lot of useful information and am glad I got to interview him.

“The main thing I get from my patients is being thankful for my life and how easy it is, even when I think it’s not.”

“That’s what we strive to do here with every patient, make every story a success story.”

Observation

For my observation, I went to one of the businesses that partner with Prosthetic Laboratories, Lair’s Shoes.

My observations:

• arrived at 10:30 am
• good array of orthotics products such as socks and gel pads on display
• 3 customers during my visit, one seemed to need specific products, other two unsure if just looking for comfy footwear
• located in subway connecting downtown areas and medical buildings
• not only orthotic products but other footwear
• did not see prosthetic-specific products, must be more in other partner stores
• offers custom fitting and molding for shoes of your choice
• staff helpful and knowledgeable
• not much traffic, may depend on time of day
• would be a very useful shop if orthotics were needed

Unpacking:

Unpacking really helped me put all my thoughts out there where I can see them and make connections between them even if they came from different interviews or the observations.

What I got out of this is that are so many different things that go into a career in prosthetics, like how to understand and then meet your patients’ needs, how to choose the right fit for them, how to deal with problems as they arise, and how to be thankful for life in general.

There are a lot of ways that the field of prosthetics could use help as they experience new problems every day. From children constantly outgrowing their prostheses to people not even being able to afford their first prosthesis. From fighting battles everyday with insurance companies to patients not following directions and making more work for the prosthetists ever adjusting to everything that changes.

Even if they think their process is satisfactory, I’m sure there is a way to improve it to be more efficient or more helpful. As we know, the customer doesn’t know what they want until you show it to them.

The people I interviewed were truly very passionate about their work and took above and beyond to new levels with patient care.

Every story should be a success, but how do we help make this into a reality?

What technologies are out there that we can put to use? Are there some not ready yet, but could be in the works for the future?

How do we make people happy? How do we perceive what people want before they want it?

Do we focus on children or adults or elderly or everyone?

Major Insights:

1. There is innovation and creativity working in every field in every place. (in reference to the rotationplasty procedure in interview with Michael)

2. Prosthetics is effortlessly a more personal medical field. (in reference to every prosthesis being custom made for an individual patient in Sara’s interview)

3. Adaptation to new technology is not always an easy fix. (in reference to adapting new technology taking a long time while going up against something well known and integrated already in Sara’s interview)

4. Taking care of patients’ needs calls for endless patience. (in reference to prosthetists not always knowing what their clients are wanting or having to readjust and make changes over and over in Josh’s interview)

5. Treating phantom pain is blind guess-and-check work. (in reference to no one fully understanding phantom pain, why it occurs or what makes it go away in Michael’s interview)

6. Not everyone who needs prosthetics can get them. (in reference to people not being able to afford what insurance doesn’t cover in Josh’s interview)

7. Doctors are not always right. (in reference to Michael’s favorite part of the job to be proving doctors wrong when they tell a patient they can’t do something in his interview)

8. A physical product is not always the answer. (in reference to having a supportive family and understanding job being key factors to helping with the transition in Sara’s interview)

9. Having insurance does not always mean you are covered. ( in reference to insurance companies only paying part of the costs if they even deem the device medically necessary in Josh’s interview)

10. Children prostheses could be considerably cheaper or more expensive than adult prostheses depending. (in reference to children outgrowing their prostheses and needing new ones more often, but also companies like Shriner’s that funds children’s medical expenses in Josh’s interview)

Problem Statements:

1. People need a way to receive prosthetics care regardless of their income, because people in need are being turned away.

2. Prosthetists need a way to better understand what their patient needs, because some patients are not able to communicate this effectively.

3. Technology needs to find a way to produce stronger plastics, because this would make for a less costly, more efficient process.

Market Survey:

1. “Now: innovation in India, where there’s a new effort under way to bring mobility and prosthetic limbs to some of the world’s poorest people.”

2. A way to read the thoughts of the patient and be able to understand what they are trying to communicate to you.

3. 3D printing while not at the capabilities it needs to be at the moment will soon shape the future of the prosthetics field by being a resourceful, cheaper route to help the people who need it.