Workplace injuries happen.  Some such accidents involve debilitating injuries that include amputation of a hand, arm, finger, foot, leg or toe.  In fact, according to the United States Bureau of Labor Statistics, as many as 10,000 American workers are victims of amputation injury at work.  These workers represent 6.5 percent of all US amputations in a given year.

Some of these injuries may be due to equipment malfunctions or malfunction or bypass of safety features.  Others result from inattention.  Regardless of the cause, amputation injury is life changing.  The more catastrophic the injury the more expensive to treat and usually the more life changing it becomes.

As a nurse life care planner and case manager, I often work with individuals who have undergone some type of amputation secondary to injury or accident.  Their needs vary greatly depending on the level of the amputation, whether it is an upper limb or lower limb, how much family or social support they have, their pre-morbid health, etc.  In order to truly determine the impact of the amputation, it is imperative to enlist the services of a certified nurse life care planner.

A nurse is a diagnostician.  He or she is responsible for determining the human response to the injury or illness.  We must diagnose the impact.  For example, does the patient suffer from insomnia since the accident?  Does he or she have problems with a child who is unable to accept the parent with the missing limb?  Are there difficulties with activities of daily living?  Then there are the obvious issues to address as well such as pain, mobility, and depression to name a few.

Don’t attempt to determine what an amputee needs simply by asking how many prostheses he or she might need over their lifetime.  It is much bigger than that!

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Cody McCasland, 8 year old from Colleyville, Texas participated in the Ranger Triathlon at the Texas School for the Deaf.  Code is a double above the knee amputee.  He was born with a rare birth defect that caused his legs to form without knees and tibias (large bones of the lower legs).  Cody completed a 100m swim, 2.2 mile bike ride and 800 meter run in under thirty minutes.

Cody uses prostheses to walk around, but removes them for the swim.  He also uses a special push bicycle and racing wheelchair to complete the race.  He received assistance to carry him from each event to the transition area.

Cody is certainly inspiring for this abled body adult!  If you want to read more about Cody and see some other photos from the event, check out Statesman.com.

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Because of my work with amputees, I am always researching and reading about the latest and greatest developments.  Today, I ran across a blog by Peggy, who is both an amputee and a mom to a precious 3 year old little boy.  She hosts a blog titled Amputee Mommy in hopes or providing support to others in her situation.  She chronicles her experiences and ideas and shares her store.

Peggy has an incredibly unusual story that includes having to request that her foot be removed in front of a judge.  Her amputation took place on July 3, 2003.  She explained that her physical recovery was difficult, but it was the emotional recovery that was the most difficult.  “It was not an easy journey,” says Peggy.  “[Luckily] my surgeon recognized my depression and set up counseling sessions with a specialist in the field.”

Peggy goes on to recount how her amputation was affected by her pregnancy.  She sought help, but found very few amputee moms who could provide information about the changes of her body.  An interesting comment about her new reliance on her handicapped accessories was an eye-opener for this life care planner.

If you want to learn more from Peggy, check out her blog at Tales of an Amputee Mommy.  Peggy says it best…”Many times after limb loss, hope is lost.  This is a testament that life continues after an amputation and that the amputee can thrive and achieve goals never imagined.”

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Once again members of the amputee community will be jumping with a group of Wounded Warriors to demonstrate their independence and prove that the sky is the limit following amputation.  There will be live music, games, children’s activities, and WWII era planes will be on display.  It is a Guinness Book of World Record events for Limbs of Love.  The event is scheduled for Saturday, May 1st (a change secondary to inclement weather).  The event will be held at Skydive Spaceland just south of Houston.  For more information about the event, check out Airborne Amputees.

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Lineman, Shawn Spiwak’s was working when he was hit by 7,200 volts of electricity by what was thought to have been a dead wire. His elbow had brushed against the line when electricity ran through his body, sparks flying from his chest.  He fell backwards and was left dangling upside down from his safety harness.  His arm had been burned through and through.  There were entry and exit points left by the electricity.  He was severely burned and eventually lost his right leg at the hip and his right arm and shoulder well into his clavicle.

Electrical injuries often lead to amputation as well as a multitude of other problems which result with the nervous system of the body is short circuited.  The electricity literally burns from the inside out.  What you see on the outside is far worse on the inside.  Treating a patient with electrical burns is very complex and usually have a host of other issues which come up during the treatment.  The body is unable to regulate temperature.  The dead tissue (eschar) has to be cut away daily.  Typically the patient is placed on a ventilator and oftentimes placed into a medical coma.  Feeding tubes are placed to help provide the increased protein needed for wound healing.

These injuries leave an individual with many deficits.  Mr. Spiwak’s walked with a limp secondary to the prosthetic limb.  He is stared out and children often ask about his prosthesis to which he replies, “robot parts”.  Like others with severe injuries, Mr. Spiwak notes it takes more time to do everything.  Simple things like buttoning your clothes, putting on your shoes, opening a bottle, brushing your teeth; all require additional effort and sometimes assistive devices in order to complete the tasks.  Scar management is life long which requires multiple surgeries, compressive devices, and therapy.

Electrical amputation is one of the many topics of an upcoming Nurse Life Care Planning conference scheduled for October 2010.  As a Nurse Life Care Planner and Nurse Case Manager, I am often called on to coordinate care for or develop a life care plan for persons suffering amputation injuries.  If you want to learn more about this devastating injury, please join us in Boston on October 8-110, 2010.

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Commentary on Role of Legal Nurse Consultant and Nurse Life Care Planner in This Case

There were many issues in this posting that struck me both as a Legal Nurse Consultant and in my role as a Nurse Life Care Planner:

-Were the services of a Legal Nurse Consultant used in reviewing this young man’s chart?  How was the standard of care he received specifically evaluated?

The experience a certified Legal Nurse Consultant brings to medical records review and evaluation provides in-depth and detailed analysis due to the fact that nurses, in general, are the professionals most involved in keeping these records.  More to the point, a certified Legal Nurse Consultant is an expert in interpreting medical records, understands and is well versed in parsing out the subtext of these very complicated documents.  In this case, there are 15 physicians, and multiple treatment locations—all with records to be organized and reviewed.

-The post mentions that damages in excess of $25,000 were being sought.  If care was indeed sub-par, I sincerely hope that the services of a Nurse Life Care Planner were also sought.

The expenses associated with a bi-lateral above knee amputee are only beginning with the fitting, fabrication occupational therapy and training on the first set of prostheses.  If the amount mentioned is close to what the family is actually seeking, I trust that his health benefits provider has a very informed case manager advocating for technologically advanced prostheses, provided that he is a candidate for this technology.

In particular, lower extremity amputees require multiple prostheses over the course of a lifetime, due to wear and tear, changes in their weight and other conditions. At the age of 19 and being an athlete, he could potentially benefit from both high technology prostheses, as well as a second set of prostheses for sports activities.  Psychological counseling will probably also come into play as he deals with changes in body image and frustrations in adjusting to his new lifestyle.

Further, the family has already started down the road of adapting their home with ramps, etc.  There will be additional costs as he progresses back into more activities of daily living.

Finally, I would encourage the family, if they haven’t already, to familiarize themselves on the Ohio Prosthetic Parity legislation.  A link to more information about this law can be found at Arms and Legs are Not a Luxury.  This legislation covers such issues as pre-existing conditions when changes in health benefits carriers are made, as well as caps on coverage of prostheses that may be stated in the health care policy.

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The Amputee Coalition of America (ACA) is now accepting applications for the second annual Christina Skoski, M.D., Scholarship until March 15, 2010. The fund will once again award a one-time, $1,000 scholarship to a student with limb loss who has a special desire to learn and exhibits potential for success. The scholarship is only open to undergraduate students who will be entering or who are already attending a 4-year college.

To be eligible for the scholarship, students must be amputees and have a minimum high-school grade-point average (GPA) of 3.5 and a minimum ACT score of 30 or SAT score of 1340. They must also submit a letter of recommendation from a high-school adviser. Additionally, the student or his or her parent/legal guardian must be a current member of the ACA. All majors are welcome.

Applications will only be accepted by online submission through the ACA Web site at amputee-coalition.org/scholarship. The application deadline for fall 2010 consideration is March 15, 2010. The scholarship recipient will be announced no later than May 31, 2010.

If you or a loved one has suffered from amputation, help is just around the corner.  Arkansas is home to the American Amputee Foundation as well as several support groups.  I highly recommend that you become a member of the Amputee Coalition of America too.  If you still cannot find the help and support you need, contact me directly and I will help you find someone to talk to.  In addition to life care planning services, I also provide care management for those with catastrophic injury and illness so I have many contacts within the amputation and prosthetic communities.

Below are several support group locations for amputees and their loved ones:

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In November, there was a story of a young girl, 2 years of age, with major injuries to both of her hands.  She was taken to the local hospital for treatment.  Inadvertently, this young girl had both of her legs amputated, instead of her hands.  This is a headline we have seen too often from hospitals across the United States.  Except, this time, this took place in Africa.   This same story talks of the insensitive approach after the death of a new born baby and the family having to search through baby bodies to find their own child.   See the story here:  http://www.timeslive.co.za/news/article213483.ece

Healthcare has its own challenges regardless of where you may live.  All too often we will raise our voice in detest, complaining about the regulations that we have to follow in our profession and as an industry.  But these very same regulations are in place to prevent wrong site amputations, and prevent a parent from searching for their own dead child.  We could continue to complain about what we do and don’t have in our healthcare system, but it is our system and our responsibility to advocate for own care.  Learn to listen, and listen to question what you do not know or don’t understand.  Get involved in what is happening in the Senate and the House of Representatives.  Pick up the phone, send an email, or write a letter, anything, to become a part of a quickly changing industry that has a direct effect on each and every one of us.  Together, we can make sure that we move forward in our healthcare, and not backwards, like what occurs in other nations.

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A new push in the area of prosthetic technology has certainly provided a variety of new devices to the market place as well as some incredible works in progress.  One such project is the SmartHand.  This prosthetic hand is a complex prosthesis with four motors and 40 sensors which combine to provide realistic motion and even sense to the wearer. It is the first device that sends signals back to the wearer allowing them to actually have sensation again.

The SmartHand is a highly innovative project which combines information technologies with cognitive neuroscience in developing a prosthetic hand which displays all the basic features of a real human hand.  The makers of this Smart Hand stated that electrical stimulation of the nerves has a positive and pain killing effect (think TENS unit for example). They believe that a neural interface with recording and stimulating capabilities could improve the quality of life and relieve phantom pain.

The developers of this artificial hand are from Sweden, Italy, Denmark, Israel, Ireland and even Iceland.  Their expertise ranges from electrical engineering, orthopedic hand surgeons, robotic specialists, cognitive processing specialists, biomechanics, and mechanical engineering.

Phantom limb sensations are the feelings that an amputee still has their missing body part.  The brain remains open to receiving input from the nerves which were severed.  Impulses from the brain still travel down to the missing limb as well.  These scientists are developing electronic sensors to pick up signals and relay them to the mechanical hand.  The goal of the SmartHand is to create a replacement limb that is as near to identical as the lost one.

While this is an exciting project, there is still much work to be done.  The current SmartHand still lacks motion in comparison with a human hand and also lacks strength.  The sensation provided is new and could open another host of opportunity, but is still far from the sensations provided by the millions of nerves in your own God given hand.

The SmartHand is still a project in the works after ten years.  To see a video on the development, check out this YouTube clip.

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