Lance Johnston was devastated when he got his first prosthesis.
“You think you can just put it on and go,” he said. “But it’s hard. It’s really hard to learn how to walk.”
Johnston, 54, is a double amputee who uses artificial limbs for his left arm and leg. In 2014, while riding his motorcycle, he ran head-on into a car and medics had to amputate to save his life. He said he’s grateful to be alive every day.
It took Johnston a few months to re-learn how to walk. The process is challenging, he said, and frustrating. While attending an amputee support group, he was approached by Robert Maguire, an instructor at the University of Pittsburgh School of Health and Rehabilitation Sciences Prosthetics and Orthotics program. Maguire asked Johnstone to be a patient model for the department.
“I said ‘heck yeah,’ this helps you transition. You know that you’re helping other people because these students are going to go help people just like me and the more they can learn from me, the better off they’re going to be,” said Johnstone.
He is one of more than 2 million amputees in the United States. But losing a limb doesn’t mean a patient has to lose mobility. The University of Pittsburgh Prosthetics and Orthotics master’s degree is just one of 13 in the country, and has a 98 percent placement rate for graduates. With the help of people like Johnstone and the instructional staff, as well as a modern manufacturing lab, the department can prepare students for what it’s like to work with amputees in a medical setting.
“We’re not just leg-makers or show-makers or brace-makers,” said program director Dr. Sarah Peterson. “Our program offers a whole realm of didactic classroom experiences.”
Instructors cap the program at 24 students out of hundreds of applicants, and those individuals are typically divided into two groups. Each class learns the fundamentals, Peterson said, like what it means to lose a limb and how prosthesis and orthotics function. From there, students are introduced to the lab, where they begin studying how to build artificial limbs.
Second year Jessica Thomas said she’s grateful for how the department is set up because she can perfect her craft without worrying about her mistakes having big consequences. Thomas has a degree in engineering, but wanted to specialize in a hands-on field. For her, this program was a natural fit.
She walks through the labyrinth of labs on the fourth floor of a modern building in Bakery Square in Pittsburgh’s Larimer neighborhood, and points out molds, sanders and plaster wraps. She picks up the cast of an arm she recently formed and it makes a hollow clunk sound in her hand. This is an example of a final product, she said, because it already has a cosmetic print on it. In this case, it’s the Pitt logo.
The first step in crafting an artificial arm or leg is meeting with a client, building a rapport, gleaning important information, and measuring around the residual limb. Then a negative cast of that new limb is fabricated and filled with plaster. When it dries, it’s measured again, modified and eventually thermoformed, or heated up, with plastic. Pitt’s program uses a bubble forming process, which means little air pockets emerge, which have to be removed by vacuums. Plaster is then chipped away from the plastic socket and readjusted to the person’s limb. Patients give feedback based on the fit and the students continue to modify the limb until it fits comfortably.
The way people open and close hands, hooks or other artificial limbs, are considered as well, Thomas said. She described a Figure 8 harness and how its straps tied around someone’s chest was used to open and close a hook attached to a prosthetic terminal device to operate the hand or hook.
“You know when somebody is trying to bust out of their shirt? That’s what this terminal device is like,” Thomas said. The techincal term, she said, is a scapular abduction motion.
The prosthetic limb then goes through two laminations: one to ensure strength of the prosthetic or orthotic, and the other for an outer covering for cosmetic purposes.
“You can either choose to match the person’s skin tone … or you can choose to do a print like I did,” she said, pointing again to the blue and gold Pitt print.
Students like Thomas won’t necessarily be building prosthetics or orthotics in their post-graduate careers, but it’s important for them to know how it all works, said Peterson. That mechanical knowledge is key when students to go to interact with patient models like Lance Johnston. Over their two years with the program, they become more confident about the artificial limbs, as well as making decisions about patient care.
“Our students really have a desire to help people,” Peterson said. “They want to enhance the lives of others.”
Prosthetic manufacturing is constantly evolving and Peterson said instructors do their best to ensure students absorb research and read the latest studies. According to the American Academy of Orthotists and Prosthetists, demand for practitioners is expected to increase as rates of diabetes, heart disease, and obesity rise. With this forecast, Peterson said it’s important to train her students to be advocates and to look out for what’s next in the field, like how limbs can grow older with patients, 3-D printing, and more versatile materials.
WESA receives funding from the University of Pittsburgh.