Prostheses: An Expert’s Perspective

DON CUMMINGS became interested in the field of prosthetics in 1978 when, as a freshman in college, he lost both legs below the knees to bacterial meningitis. In 1981, he received a Bachelor of Science degree in generic special education from the University of Texas at Dallas, and in 1984, he earned a Bachelor of Science in prosthetics and orthotics from the University of Texas Southwestern Medical Center. He is an Association of Boards of Certification-certified and Texas-licensed prosthetist.

BSTQ: Tell us about your work in the field of prosthetics.

Don: I work in a pediatric orthopedic nonprofit hospital in its prosthetics department. We attend interdisciplinary clinics with the surgeons, personal trainers, occupational therapists, nurses and psychologists, and we hold three prosthetic clinics a month during which we see about 20 to 25 children per clinic. Our patients range from infants to 18 years, with about 70 percent having a congenital limb difference, and the remaining 30 percent losing limbs either to cancer, disease or trauma. We are part of a full orthotics and prosthetics department, so we have a mix of practitioners who either work exclusively in prosthetics or who are certified in both orthotics and prosthetics.

BSTQ: What does your work entail?

Don: Our staff sees patients in clinic, and based on a prescription generated in that setting, we cast, design, fit, align, fabricate, deliver and provide all adjustments and follow-up on site. We have a full lab to fabricate prostheses, including carbon laminations and thermoplastic. My work involves seeing patients, attending clinics, fitting, aligning, trouble-shooting, making growth adjustments, and really getting to know my patients and their families because I spend a lot of time with them. I also document and submit insurance codes for billing, and work with insurance companies. Also, I have some administrative responsibilities, including submitting an annual budget and attending a lot of meetings. However, it is the patient care I most enjoy.

BSTQ: What surprises you the most about how the field has evolved?

Don: The introduction of 3D printing and its gradual advancement as a possible means of fabricating structurally strong prostheses with lots of unique artistic esthetics has been interesting to follow. It’s not there yet for routine rapid fabrication of highly durable prostheses, but I think it will be in a few years. Developments in technology have evolved quickly since wounded warriors began returning home with amputations and more federal and private research has become available. Recently, microprocessor knees and myoelectric hands have advanced quite a bit with more options than ever before. In general, the greatest advancements have been in socket technology, lots of different material options, and carbon fiber or fiberglass composites used in feet, pylons, knees, etc., which have provided patients with more dynamic feet, running blades and all sorts of components to match their needs.

BSTQ: What’s your opinion about recent developments such as prosthetics with nerve detectors and consciously controlled limbs?

Don: It’s exciting to watch research and development in this area. But, it takes a while for this research to filter down to the pediatric level. We would love to see true sensation easily integrated in a noninvasive way for upper-limb prostheses. I think the function would be much better, and acceptance of upper-limb prostheses for children born with absent hands might improve greatly if they had true sensory feedback. Myoelectric arms using surface electrodes that pick up EMG signals from muscles to control a hand or elbow have advanced quite a bit in recent years, but again, mostly in adult-sized hands. All the advancements are fun to watch and to get excited about, but the biggest challenge will be keeping them affordable so the technology is practical and available to as many people who need it. It can be very frustrating as a patient to find your insurance company considers an emerging technology that you would benefit from experimental or not medically necessary.

BSTQ: What do you find most rewarding about working with younger patients?

Don: Kids are generally on the upswing physically and so a prosthesis is a positive thing in most cases that enables them to be active and pursue their goals and dreams as they grow up. Pediatric and adolescent patients challenge us to find creative ways to enable them to participate in a wide array of activities. We make a lot of activity-specific prostheses such as for riding a bicycle, playing a guitar or other instrument and, of course, for running track or participating in sports. Also, I love that kids are honest and straightforward and generally tell it like it is, but are also very adept at telling whether we’re being honest. So it’s good to be able to shoot straight when we’re communicating. Kids see the world with fresh eyes, and that’s enjoyable. And, in general, they are enthusiastic and moving forward, so our practice is a positive upbeat place.