Week 6:
An Exciting Week

By Sarah Carvo '22

Jon & Jean Reynolds Fellow in Prosthetics & Orthotics

Maughan Prosthetic & Orthotic | Silverdale, Washington

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July 19, 2020

I want to start this week by wrapping up the AFO project with the big lift that I introduced last week. The fabrication went very well and the final brace fit the patient and helped her mobility. She will come in for a follow-up in a couple weeks to address any issues that may have presented while using the brace in her everyday life, but we were very happy with the results of this fabrication.

 

This is the final brace! The two straps keep the brace secured to the patient’s leg, and the black carbon fiber shell provides structure. The heel appears very thick because it houses the lift.

 

A really exciting part of my week was getting to see, and assist with, an upper limb prosthetic. Everything I have worked on at MPO before this week has been for lower limb prosthetics and orthotics so this was a very exciting change in pace. Upper limb prosthetics are more rare than lower limbs, some prosthetists may only see one or two in their career. One reason that upper extremity prosthetics are fairly uncommon is because they are typically more complex, which makes them very expensive. Unfortunately, many insurance companies currently have very poor coverage of these expensive prosthetics, making them unattainable to most patients.

This arm was particularly interesting because it was myoelectric, this means that a computer controls the arm using electrical signals from the patient’s muscles. In the socket there were electrodes that sit against the patient’s skin and forward the muscle signals to the prosthetic arm. This was a Coapt arm, which means that the arm is programmed to learn and improve as it is used. We calibrated the arm to do four basic motions: hand open, hand closed, elbow flexion, and elbow extension. To achieve these motions each is associated with a specific pattern of signals from the muscles. These patterns are given from imitating different motions that activate chest and back muscles. We calibrated the arm so that pulling his shoulders up towards his ear caused elbow flexion, pushing his shoulders towards the floor caused elbow extension, pushing his shoulders forward/closing his chest caused the hand to close, and pushing his shoulders back/pinching his shoulder blades caused the hand to open. To activate the muscles for each of these actions the motions do not need to be big, in fact, the prosthetic arm can be signaled with very little visual movement of the shoulder. As the patient practices with the arm it will learn and adapt so that it becomes easier and easier for the patient to control. Once the patient is confident in those four controls more can be added to get more specific movements in the arm.

I got a lot of hands on work in the lab this week with some new skills and I loved having that opportunity. I made sure to snap some pictures of my work to share with you!

It may not look like much, but this is the most technical skill I have done so far during my time at MPO. This little white circle is a pad that is attached to the inner bootie of an AFO. It will go over the ankle bone and prevent the brace from causing too much pressure on this protruding part of the ankle. I sanded the pad on the grinder. The center is the thickest parts and it gradually thins as you move away from the center until it is paper thin at the edges. I am very proud to have done this successfully on my first try and really appreciate our technician for giving me pad sanding 101!
This is the plaster mold of a patient’s leg. We are fabricating an AFO for this patient that replicated a well known brace called a blue rocker. I was given the opportunity to practice drawing the trim lines for the brace. The trim lines I drew can be seen on the plaster, this particular brace has a lateral strut and an anterior shin plate.
Here I am grinding a carbon fiber BK socket for the first time. I look a little like a mummy, but for good reason! Carbon fiber can be very itchy and the grinder throws carbon fiber dust everywhere, so my coworker made my some nylon sleeves and face covering to protect my exposed skin. The face cover also minimizes the chance of breathing in any carbon fiber dust. I also have safety glasses on to protect me eyes, gloves to protect my hands, and a headset because the grounder and fan are very loud!
This was another new task for me! Foam was added to the distal end of this socket to add the attachment point at the correct alignment. The socket was splinted and the foam is added by pouring it in while it is a liquid, it then hardens. Once hardened the splint is removed and it is ready to be shaped. That is what I am doing here! I am working to blend the foam to the socket seamlessly. A second lamination will cover this and it should appear as one solid piece. One of the residents decided to photo-bomb the shot showing that we love to have fun as we work.
Outside of the office this week I met some of my coworkers livestock! I am learning so much about animals, fishing, and hunting which I did not expect but I find it intriguing. I got to hold a few chickens and in the picture are his two ducks. For those of you I do not know, I LOVE ducks! I was very excited to meet some face to beak. Apparently ducks eat slugs, keeping the garden healthy.

Only two more weeks left here in Washington! These six weeks have flown by and I have loved every moment of it. I am going to do everything I can to make the most out of the last two weeks of my fellowship at MPO.

Sarah Carvo '22

Sarah is a kinesiology and psychology double major from Broomfield, Colorado.