Say that you need to wear your prosthesis at work. It’s integral to being able to fulfill the functions of your job. But wearing it for a full workday is too tough on your residual limb. Maybe you don’t even want to put your prosthetic device on in the morning because the fit is so uncomfortable. After wearing your device for even short periods of time, your residual limb aches, the skin is irritated and the muscles just want a break. What can you do to get more wear time out of your prosthesis each day?
There are several ways to do this, but we’ll take a look at three today: fit, silicone and the BOA system.
From Limbs 4 Life: “A poorly fitting socket in upper limb amputees can cause skin breakdowns and irritations and impact your ability to successfully use the prosthesis.” If you are seeing a prosthetist who is not one of ours, they may tell you that having irritation from your device is normal. We spoke to Jason Koger, a bilateral amputee, about this issue. “The first prosthetist I saw, I was visiting him every week — I would tell him, ‘this doesn’t feel right, I’m getting sore spots on my arms.’ And my prosthetist was just like, ‘Hey, listen, this is something new. It’s a foreign object on your limb that your limb doesn’t like.' And well, I just took it for granted that he was the expert and that was the way it was supposed to be."
But the process of getting used to a prosthetic device shouldn't take weeks on end. “Yes, there is a period of time to acclimate to the prosthesis, get used to the pressure it puts on your residual limb.” says Mac Lang, Arm Dynamics’ prosthetist in Portland, Oregon. “But you should be able to generate tolerance for the pressure in a week to two weeks, if the fit is right.”
The difference between how we fit our patients and how other prosthetic companies fit their patients comes down to three factors: expertise, time, and weight. During your initial fitting, our prosthetists (every one of them an expert in socket design) spend the majority of their time working on the interface between your prosthetic device and your residual limb. “Good enough” doesn’t cut it. They work to ensure that the fit is optimal. As far as weight goes, we’ve noticed that a lot of other prosthetists will “over-build” an upper limb prosthesis because that’s what is typically done with a lower limb prosthesis, and that is what they are used to building. Lower limbs need to withstand the impact force of weight-bearing, walking, and running. Since upper limbs generally do not need to be weight-bearing, they simply need to be structurally sound — and ideally as light as possible. Our years of experience working exclusively with upper limb prosthetics allow us to make lightweight and well-fit devices for each patient we see.
“Before I visited the Arm Dynamics center in Dallas, I had never worn a prosthetic more than three or four hours at a time before I needed to take it off for a break,” Koger told us. “And the very first time I was fitted by Rob, my Arm Dynamics' prosthetist — when I flew home from Texas, that first day, I think I wore my arm for twelve hours or more.” Koger continued, "Even if you really like your prosthetist, and you get along with them, what they really need is experience. How many arms do they fit in a year?" This is why we tell people that they may have to travel to find excellent upper limb prosthetic care.
Silicone is “flexible, but also elastic — meaning that we can customize it to cushion your device and make your socket fit better,” says Lang. “With silicone, we can fit the device tighter to the patient, but still have it be comfortable.” When your device is tighter, it’s more stable, meaning you can wear it for longer periods of time without it making your residual limb as tired. “There’s less surface shear with silicone, and it’s forgiving, so it’s better on skin. The skin is less likely to become raw or abraded with silicone.” This is because we can add areas to the silicone that offer more cushion to alleviate discomfort on sensitive areas, such as bones and scar tissue. We could go on and on about the benefits of silicone sockets — and we have!
You can see our patient Max Okun wearing the BOA system in the photo above, with his prosthetist Julian Wells. The BOA system is a patented system often used in sports shoes that allows the wearer to tighten or loosen the shoe, while wearing it. Stainless steel wires are connected to the turning knob to allow for that tightening. “The BOA system allows for volume fluctuation,” says Lang. Our prosthetists have created ways to integrate the benefits of a BOA system into a prosthesis, allowing us to enhance the comfort and performance of a device. If the wearer needs to tighten or loosen the suspension of the socket, that is possible, at any point, while still wearing their prosthetic device. “Say that the patient wants to visit the gym, and needs that suspension to be aggressive,” says Lang, “with the BOA, they can tighten it without going through the whole donning process. And later, if they’re, say, sitting at a desk, and they don’t need their device to be quite so tight, they can give it some slack.” We will have an upcoming article explaining more about the BOA system soon — be sure to sign up for our blog updates by using the box to the right. You can check out the video below with Okun to see the BOA system in action.
Have we piqued your interest yet? Would you like to come in for yourself and find out why our patients are able to wear their prostheses comfortably for longer? Contact us! And if you’d like to tell your fellow prosthetic users about the best ways you’ve found to increase your wear time, please comment below.
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