Research Essay: Sara McDermott

Amputee Blade Runners

The Importance of Affordable Prostheses

Many people in the United States face some form of limb loss, due to a birth difference, trauma, or, most commonly, a vascular disease. According to Amputee Coalition, nearly 185,000 amputations occur in the United States each year, and there are currently around 2 million people in the United States who live with a limb difference. Although technology has advanced and awareness surrounding limb loss has increased over the past few decades, amputees across the nation still face difficulty when finding a prosthesis that works for them specifically. Every residual limb is unique due to where it was removed, its muscle and shape, and the individual's age and activity level. However, although the details, quality, and structure of a prosthesis are vital to ensuring the amputee is truly able to obtain full mobility, many amputees struggle to remain active because their prosthesis does not fit them correctly or is not designed in a way that will enable them to do what they want. This dilemma is mainly because, for a variety of reasons, insurance and general healthcare providers give people something that simply works, not necessarily something that fits the patient’s needs. In particular, most young and active lower-body amputees do not have easy or affordable access to prostheses that enable them to stay active such as running blades because such prostheses are expensive and not deemed medically necessary. The research for this essay specifically focuses on lower-body amputees and aims to address the importance of a prosthesis that allows an individual to have an active lifestyle by fitting well and suiting their specific needs The essay also explores why insurance companies do not cover running blades and how organizations like Amputee Blade Runners can give people access to high-tech running blades at an affordable rate.

It is very important that a prosthesis fit an individual as close to perfectly as possible because the long-term implications of an ill-fitting prosthesis are worse than the extra cost to ensure a prosthesis properly fits Research shows that many lower-body amputees continue to face medical issues even after their amputation. A majority of amputations (about 54%) are due to some form of vascular disease, such as diabetes or a cardiac condition (Amputee Coalition). Post-amputation, the activity level in most individuals decreases, which not only worsens the original condition that led to the amputation, but also results in issues such as obesity, hypertension, and clogged arteries in their heart (Amputee Coalition). Thus, individuals must maintain an active lifestyle to prevent the previous condition from returning or worsening while also preventing future conditions from arising. Particularly for children and young adults who face amputations for these vascular disease-related problems, if they are not given the opportunity to remain active, they will only face more and more health issues for the rest of their lives. Technology such as running blades can help lower health risks due to decreased levels of activity because they do not just enable, but encourage individuals to exercise and live life as they did pre-amputation. It has also been shown that an ill-fitting prosthesis causes a variety of issues that may lead to a decrease in the quality of the residual limb and thus the individual’s overall health. Issues such as excessive sweating, blistering, and bruising can all result from the liners and design of a prosthesis, as do problems with posture, muscle imbalance, and an unequal gait (Amputee Coalition). Prostheses cannot fix everything, but issues such as these can be prevented, or at least minimized, with a prosthesis that fits the person better, whether that means a specific material for the liner or a different vacuum or locking device to keep the socket in place. However, since many insurance companies do not cater perfectly to each amputee, many amputees face this issue of low-tech problems because the limb does not have proper ventilation, or their limb shape changes and the prosthesis is slightly off. If these problems are not addressed, they can result in long-term issues that continue to hinder the person ’ s recovery process. Furthermore, research shows that rehabilitation post-amputation with a prosthesis not only improves the individual’s mobility and quality of life, but a quality experience can actually reduce some of the amputee’s future health costs (Hanger Clinic). Nonetheless, since making prostheses is an expensive and time-consuming process, insurance companies do not emphasize a perfect fit, only that the prosthesis works. While this necessity for perfection may not seem vital, as people recover from their amputation and their body heals, their residual limb will change shape, just slightly or more noticeably, and even the smallest shift in a person ’ s body weight or alignment can throw off their entire prosthesis as a bone or muscle that was not once as prominent may suddenly prevent the artificial limb from fitting correctly. These scenarios are what result in the rubbing and bruising mentioned above, and yet prostheses are generally made to simply be good enough to get the job done. Since the majority of amputees are over the age of 65, these basic prostheses may be enough for them to obtain basic motor skills, but younger amputees like children and athletes need prostheses that will grow with them and cater to their more active lifestyles. While the invention of running blades has led to a new kind of technology made specifically to help these individuals remain active, a properly fitted prosthesis is equally important to ensure the individual can safely and comfortably use the artificial limb to its full capability as they exercise. Access to running blades would not only assist in an amputee’s long-term health both physically and mentally, but it would also help reduce some of the overall costs related to prostheses. Furthermore, it is equally important that these prostheses, running blades or otherwise, fit the individual properly such that they are comfortable and confident in all aspects of their lives.

While the fit of a prosthesis is very important, it is also essential that each individual uses the right prosthesis for what they are doing. Walking prostheses, which are the most common kind of prosthesis, are good for what they are designed to do: enable someone to walk However, younger amputees require something like a running blade to stay active. Running blades essentially function as springs, allowing the user to push off the blade and propel themself forward, similar to how a human leg works to generate force and momentum allowing people to run. These running blades can come in a variety of forms and have become a key way for athletes, children, and generally active individuals to exercise daily and maintain an active lifestyle. Nonetheless, unlike a standard walking prosthesis, running blades are not considered medically necessary and Medicare will not cover the cost of such a prosthesis (Standup Wireless). Joshua Southards, the Executive Director of Amputee Blade Runners where I volunteered, explained that “Medicare establishes the baseline for lots of payment/coverage decisions.” This means that insurance companies look to see whether Medicare would pay for something and follow their lead, so in the case of running blades, as Medicare does not cover them, nor will most insurance companies. Mr. Southards went on to explain, “The big mobility goal [for Medicare-eligible amputees] is usually something like pivoting from bed to wheelchair or wheelchair to toilet Others might want to walk from the bedroom to the living room, or maybe in a parking lot at Walmart before getting on a motorized scooter.” All of this means that there is no reason for Medicare to cover something like a running blade when a simple walking prosthesis is more than enough for the majority of their patients. However, this causes a negative impact on younger amputees since they cannot easily access running prosthesis because insurance companies base their policies on what Medicare covers, even if their patient demographic is on the younger and more active end of the spectrum. Since more active individuals with limb differences, such as athletes and children, still exercise daily, they wear their prostheses more often and for longer time periods than the majority of the amputee population Although a walking prosthesis is useful in many situations, kids who want to play sports or games at recess along with adults who want to exercise and stay healthy cannot depend on a walking prosthesis to get them through the day. However, although these blades are extremely beneficial to amputees both physically and mentally, individuals have to find a way to pay for these high-tech, expensive prostheses themselves as their insurance company typically will not cover the cost While this is an option for some people, many cannot afford a high-quality running blade, even if it would vastly improve their lifestyle, as so much money already has to go to doctor’s appointments, physical therapy, and other forms of strength and rehabilitation for those with limb differences. However, there are organizations such as Amputee Blade Runners that work specifically to make running blades that are both high-quality and affordable for amputees, regardless of what their insurance company outlines. Organizations like Amputee Blade Runners, which is the nonprofit I worked with for my service project, aim to approach prostheses from a different direction than insurance companies; they provide lower-body amputees with custom prostheses to help them pursue more active lifestyles at no cost As a non-profit, Amputee Blade Runners relies on donations and fundraisers to provide their athletes with scholarships and grants. These scholarships enable the athletes to access high-tech, top-of-the-line prostheses that cater to their needs and allow them to enjoy full mobility, range of motion, and activity levels. In addition to using the best materials available, Amputee Blade Runners ensures every prosthesis fits each patient as close to perfectly as possible, occasionally going as far as remaking the whole thing to ensure a perfect fit. Furthermore, Amputee Blade Runners does not just provide one-time services, they stay with athletes throughout their whole lives. This means that, especially for children, as the individual grows, gains muscles, and their residual limb changes, ABR continues to redesign and rebuild their prostheses to ensure an optimal fit Since Amputee Blade Runners keeps track of every leg mold they make, their athletes, once fitted, can request a new limb that is nearly exactly the same as one ABR made for them previously. However, if the athlete’s limb shape has changed over time, which is especially common during the first year or two post-amputation and for children and growing teenagers, Amputee Blade Runners will recast, shape, and build a prosthesis for the patient, even implementing a new design like a suction or vacuum to not only adapt to the new limb shape but take the patient’s feedback on what previously worked and what needs improvement. Another unique element of Amputee Blade Runners is that they provide their amputees with both running and walking prostheses, with the running blades specifically designed to ensure the amputee can be as active as possible, whether that means playing school sports, training for and running marathons, or even competing in the Olympics. Although this is an expensive process, especially since insurance companies do not cover any of these costs, Amputee Blade Runners has found a way to help children and individuals stay active in spite of their limb differences. Unfortunately, Amputee Blade Runners is one of very few organizations that functions in this way, despite the growing awareness surrounding limb loss in the United States. While organizations like Amputee Blade Runners are a great start to helping amputees across the country gain access to high-quality prostheses that will improve their lives, there still remain questions of how to encourage insurance companies to understand the health benefits of prostheses such as running blades and how to make such high-quality prostheses a viable option to an even broader range of amputees.

Works Cited

“About Amputee Blade Runners – Who We Are.” Amputee Blade Runners, 2023. Web. 1 Feb. 2023.

https://amputeebladerunners.com/about/amputee-blade-runners/ Horton. “How Much of My Prosthetic Will Insurance Cover?” Horton’s Orthotics and Prosthetics, 2 Feb 2021. Web. 1 Feb. 2023. https://www.hortonsoandp.com/how-much-of-my-prosthetic-will-insurance-cover/ Lewandowski, Kerri. “Hanger Clinic Blog: Limb Loss and Limb Difference: Facts, Statistics, & Resources.” Hanger Clinic, 1 Apr. 2022. Web. 1 Feb. 2023 https://hangerclinic.com/blog/prosthetics/limb-loss-and-limb-difference-facts-statistics-resources/#:~:text =Limb%20loss%20is%20more%20common,arm%20or%20leg%E2%80%94by%202050. https://www.amputee-coalition.org/resources/limb-loss-statistics/ “Will Medicaid Cover Prosthetics.” Stand Up Wireless, 24 June 2022. Web. 1 Feb. 2023. https://standupwireless.com/blog-will-medicaid-cover-prosthetics/ Southards, Joshua. Personal interview. 24 January 2023.

“Limb Loss Statistics.” Amputee Coalition, 2023. Web. 1 Feb. 2023.