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Iowa Governor Chet Culver signed HF Bill 311 into law April 24 guaranteeing access by amputees to comprehensive health insurance coverage for prosthetic care. The new law requires state-regulated health insurance companies to cover medically necessary prosthetics at the same level as Medicare. Before reaching the governor's desk, the House passed HF 311 by a vote of 64-33 on Feb. 18 and the Senate passed the bill unanimously 46-0 on April 1.
Attending the ceremony from APO were Rod Cheney, CPO, Gary Cheney, CPO, Nick Ackerman, CP, and 12-year-old amputee Drew Wall, and his parents Doug and Robin. All had worked with lobbyist Justin Hupfer for the bill's passage.
"Now patients will get appropriate care based on medical need, not a dollar amount," said Nick.
Although Iowa-based insurance companies have large lobbying powers, Nick noted the lawmakers were interested to hear the other side of the story.
"Taking on large companies was tough to do," he said. "We made countless trips to speak with representatives and senators to inform them how the bill would affect amputees and the positive effect it would have.
They (lawmakers) didn't want prosthetic coverage to put anyone out of business. When we talked to them, we educated them about how other states that have already passed this bill were faring. Studies on cost-effectiveness showed it was essentially pennies on the day."
Iowa joins California, Colorado, Indiana, Louisiana, New Hampshire, Maine, Massachusetts, New Jersey, Oregon, Rhode Island, and Vermont in guaranteeing access to prosthetic care.
In addition to the individual state's parity movements, the Amputee Coalition of America launched a federal campaign for prosthetic coverage in 2008 and continues to lobby Congress for parity nationwide.
For more information about the ACA's state parity efforts, contact them at or (202)742-1885. To get involved in the federal initiative, contact them at .
More information can be found on ACA's Web site, www.amputee-coalition.org. Click on the Advocacy Action Center link.
Tom Ham, CO, manager of American Prosthetics & Orthotics' (APO) Iowa City office, received the National Clinical Commitment Award from the American Academy of Orthotists and Prosthetists at the organization's Annual Meeting and Scientific Symposium March 7 in Atlanta. The award recognizes Academy members who have demonstrated a commitment to The Code of Professional Responsibility and to improving the professional image of the orthotic and prosthetic profession to patients, co-workers, and colleagues.
"We congratulate Tom on his award. He is an outstanding orthotist and a caring practitioner to his patients. He also does an excellent job overseeing operations at the Iowa City office," said Ron Cheney, CPO, and president of APO.
Tom joined APO in 1972 and has served as the Iowa City facility manager since 1990.
"Every day Tom brings the best he has to offer the orthotic patients to bear on some of the most difficult one-of-a-kind problems for which often there are no textbook answers," said Don Shurr, CPO, PT.
"Tom has been and remains the person whom all staff and physicians ask for when there is any question about an application or technical issue. He is never too busy to listen and to instruct or take-over any project that needs doing on a short notice," he said.
For many years Tom has made a 75-mile trek every other Tuesday to a long-term care facility for young adults with multiple and very difficult orthopedic problems. During that time, he has earned the respect and affection of every resident of the facility, the staff, and administration.
"Anyone who doesn't understand the meaning of an orthotist or the phrase clinical commitment need only watch Tom in action wherever he works," Don said. "He is the epitome of the word commitment and is a person for whom this clinical commitment award certainly was intended."
Tom received his certificate in orthotics from Northwestern University and is certified by the American Board for Certification in Orthotics, Prosthetics, & Pedorthics. Tom is a member of the American Academy of Orthotists and Prosthetists and the Iowa Prosthetic, Orthotic and Pedorthic Association. He and his wife, Sharon, have four children and two grandchildren.
"The amputation was the right choice. I struggled with it; I didn't just decide one day to have it done," she said. But after so many years of unbearable pain, she knew it was the solution she needed.
Tammy's amputation is related to an accident she had in 1988, which destroyed both of her legs from the ankles down. "There was so much damage," she said. At that time, doctors fused her left ankle, which involved removing the joints and holding the ankles together with metal implants. Her right ankle was fused in 2002. However, the fusion put additional stress on the joints above and below the fused joint. Over time, Tammy's bones became brittle and began to degenerate, causing intense pain and limiting her activities.
After discussions with her orthopedic physician and a consultation with John Kamp, CPO, Tammy opted for an amputation of her left leg, which was causing the most discomfort. Even though she felt she made the right decision, Tammy felt a sense of loss as she walked to the operating room in October of 2008. "I thought, this is the last time I'll be walking on this leg," she said.
Tammy's initial recovery from surgery was good. "My amputation was on Monday, on Tuesday, they got me up on a walker, and on Friday, I went home," she said. While Tammy was anxious to get fully mobile again with a prosthesis, the process took longer than expected because of healing issues around the incision. But she was determined to get moving and went back to her job as a licensed veterinary technician two weeks later – even though she had to use crutches.
After Tammy received her first prosthesis in mid-January, the transformation was instantaneous. "I put the leg on and started walking right away. Basically, I had zero adjustment time. John Kamp was somewhat surprised to see me walking because normally a new amputee transitions to mobility after a time spent on walkers and canes. I walked out of the hospital the same day I got the leg," she said.
"I think because of her compensation with her injuries, she immediately found improvement in function," said John. "Tammy is unusual because she had an elective amputation many years after the original injury, and I think it shows how functional prosthetics can be compared to an impaired limb. She also was otherwise healthy, which helps a lot."
John fitted Tammy with a total surface bearing socket with pink camouflage lamination. A total contact socket offers an intimate fit, but any major changes in the shape of the residual limb means the socket has to be refitted to avoid friction and pressure. As a new amputee, Tammy was still undergoing changes in the residual limb, and received her second socket in April. "She had a lot of volume loss in just a few months. She has been losing body weight and active people tend to lose limb size in a hurry," John said.
John also used an Ossur locking liner for a secure connection between the liner and the prosthesis and an Ossur Flex-Foot®, for strength and flexibility to accommodate Tammy's active lifestyle. Because Tammy's right ankle won't dorsiflex, John put a heel lift in the right shoe to allow easier rollover in gait.
"With my prosthesis, movement is much less painful. I can wear it about 10 or 12 hours without a break. I'm a little tired at night, but then the next day, I'm set to go again," Tammy said. "I'm old school in that I like to push it to the max, otherwise, things won't get accomplished."
In addition to her job at the Newton Animal Clinic, Tammy is back to working out at the gym seven days a week. "It keeps me busy and healthy," she said. "I do weight lifting and elliptical machines because I enjoy strength training. I tried the recumbent bike, but that was uncomfortable; I moved onto a regular bike and it works very well with using just one leg. I can do the treadmill fine on my prosthesis, but because my right ankle also is fused, it is uncomfortable."
Tammy is already preparing herself for the time when her right leg will also be amputated. "I hope it's a couple of years away, but I know it will have to be done."
Then she envisions herself on a treadmill with a goal already in mind. "I plan to run a marathon," she said. While that may be some time away, Tammy has the determination to make it happen. "Attitude is everything," she said. "Life goes on."
American Prosthetics & Orthotics held its Spring Educational Seminar May 9 at the corporate headquarters in Clive. Professionals from our offices gave a variety of presentations. Special guest speaker was John Carpenter from Touch Bionics.
Tom Ham, CO, began the session with an interesting talk about the care of an infant with omphalocele. Tom retraced his steps in the evaluation and treatment of this infant using basic orthotic principles of low force over a long time to encourage the abdominal contents to return to the peritoneal cavity.
John Carpenter reviewed and described the new i-LIMB™ myoelectric hand. John is a particularly gifted speaker. As a transradial amputee, John was able to present a powerful demonstration of this amazing new hand.
Maggie Seibel described her experiences with a bilateral hip disarticulation amputee taking him from casting to independent walking using two hip disarticulation prostheses.
Gary Cheney, CPO, reviewed several Medicare policies and their interpretations. This information is always interesting and useful as the changes keep coming from Medicare.
Mark Scharnweber reviewed the Top 10 solutions to problems or questions practitioners ask when fitting many of the available knee orthoses used in every day practice.
Finally, Don Shurr, CPO, PT, introduced the Bioness FES system and talked about the fitting and indications for this new product. He finished with a review of the role of medial posting in both FOs and AFOs. He paid particular attention to the concept of intrinsic posting to assist in the reduction of valgus positioning of the calcaneus in the adult acquired flatfoot.
The i-LIMB™ hand from Touch Bionics is the first-ever myoelectrically-controlled prosthetic hand that offers the use of five fingers to bend and move, unlike previous myoelectric devices that could only open and close. These new grip options support almost all daily activities including holding a fork, picking up a coin, turning a key in a lock, operating computer keyboards and inserting a disc into a CD or DVD player, to name just a few. The inclusion of a thumb that can, like the human thumb, be rotated into different positions enables grip configurations, many of which have not been available to amputees before.
The i-LIMB hand is controlled by a unique, highly intuitive control system that uses a traditional two-input myoelectric (muscle signal) to open and close the hand's life-like fingers. Myoelectric controls utilize the electrical signal generated by the muscles in the remaining portions of the patient's limb. This signal is picked up by electrodes that sit on the surface of the skin. Existing users of basic myoelectric prosthetic hands are able to quickly adapt to the system and can master the device's new functionality within minutes. For new patients, the i-Limb hand offers a prosthetic solution that has never before been available.
The newly-formed Central Iowa Amputee Support Group, sponsored by American Prosthetics & Orthotics, held its kick-off meeting on May 18, welcoming individuals who have experienced an amputation, as well as their families.
The group aims to provide networking opportunities, education, and advocacy. Meetings are held on the third Monday of each month at the Des Moines Public Library, 5000 Franklin Ave., from 6 p.m. to 8 p.m. The first hour consists of a structured session involving guest speakers and discussion. The second hour is more social in nature, allowing for questions to be asked and connections to be made.
For more information, call (641) 864-2257 or visit www.orgsites.com/ia/ciasg.
Ron Cheney, CPO, president of American Prosthetics & Orthotics announced two administrative changes within the organization.
Don Shurr, CPO, PT, was named Director of Special Projects and Director of Education, reporting directly to Rod Cheney, CPO. Don was the Eastern District Manager in charge of Davenport and Iowa City since the districts were established in the early 1990s. He continues to work with the University of Iowa and the University of Iowa Hospitals as well as working on a number of special projects which have been identified by Ron Cheney.
John Kamp was named as the Eastern District Manager in charge of Iowa City, Davenport, Bettendorf, Galesburg, and Burlington. He has held the position of manager of the Davenport office for the past 12 years. In his new position, John will be based at the University of Iowa office, while managing both the Iowa City and Davenport offices.
Tom Ham, CO, Iowa City Branch Manager, and Andy Besser, CPO, Davenport Branch Manager, report directly to John.
The changes were effective October 1, 2008.
The very first meeting for the group will be held on Monday, May 18, at the Franklin branch of the Des Moines Public Library from 6:00 to 8:00 pm. Speakers include Joe and Mary Shineflew and Austin and Stephanie Meyers.
Joe and Austin have both survived an amputation. Come hear how they and their wives have made the successful adjustment to life without a limb.
For more information, visit www.orgsites.com/ia/ciasg.
A crowd of family, friends, and associates of Ron Cheney, CPO, and president of American Prosthetics & Orthotics, Inc., gathered at the Des Moines Golf and Country Club in June to celebrate Ron's 50th year of work in the profession.
"I'm so honored and thankful to see everyone that showed up tonight," Ron, 68, said in remarks to his guests. "Many of you have helped me along the way somehow and I am so appreciative."
Partygoers recounted anecdotes and observations of Ron's career.
"He's certainly worked hard, but youth slipped out every now and then," said Gary Cheney, CPO, and Ron's brother. "He called in sick one day so we could go golfing. The outing went really well until we ran into Ron's boss on the course."
Attending the party were several former employees who began their careers with Ron including Max McVey and Sam Muehlenthaler. Many former employees that came to honor Ron have gone on to establish and work for other prosthetic companies around the United States.
"The fact that people are still willing to come back to celebrate after they've left the company shows what a good impression he has had on others," said Rod Cheney, son of Ron and executive vice president of APO. "Many of these people are from 20 and 30 years back but still remember their experience with him."
Ron began his career shortly after graduating from high school when he was presented with two job opportunities, both involving creating products from wood. One was in cabinetry, and the other in prosthetics. By choosing prosthetics, Ron would be able to provide a service that would help people improve their quality of life.
"If there is one thing that has motivated me, it's the fact that I believe in my vocation," Ron said. "Everyday, I am rewarded by seeing the measurable help we give to people."
From early on, Ron had commitment to the company and his patients, learning not only savvy business strategies to build APO into a strong company with a top-shelf professional staff, but continuing his own education in the profession. Ron is certified by the American Board for Certification in Prosthetics & Orthotics.
"We are seeing such a revolution in prosthetics today," Ron said. "Many of our composites and computer technology are state-of-the-art. The developments have been amazing to witness and there is only more to come."
Ron started his career at the Winkley Artificial Limb Co. in 1958. In the mid-1960s, the company was spun off by Winkley and renamed American Prosthetics, Inc. Ron and three colleagues purchased American Prosthetics, Inc. in 1972. Ron's full acquisition of the company in 1988 has since resulted in a total of eight offices in Iowa and one in Moline, Ill. It was renamed American Prosthetics & Orthotics in the 1990s to reflect its comprehensive services. In addition to Rod Cheney, Ron's son Brent also is a certified orthotist and is APO's Director of Material Management. Ron's wife, Rikki, is Director of Internal Affairs.
"I believe that if he had taken his job offer at a cabinet store, he'd own his own furniture business," said Rod. "His work ethic and savvy would have propelled him to success no matter what path he had chosen."
Special thank you to Cole Cheney for contributing to this feature. Cole Cheney is the grandson of Ron Cheney and son of Rod Cheney. A University of Iowa sophomore, Cole currently double majors in finance and journalism, reports for various Iowa City newspapers and dabbles in ping-pong.
By Don Shurr, CPO, PT
In a nicely authored paper, authors Neville and Houck wrote an article on the science behind the use of orthoses in posterior tibial tendon dysfunction; a paper that should have been written by a certified orthotist, preferably one who teaches in one of our schools.
The authors begin by writing a clear description of the four stages of PTTD. They then qualify the description with the important clinical features of the disease and provide context as to the clinical meaning and relevance of these features. They go on to describe the natural history of the disease and how these changes are relevant to the findings and important considerations for the proposed treatment.
Since some authors link the loss of the long arch to the course of the disease, these authors discuss the connection between the loss of arch and the hypertrophy of the flexor digitorium longus. Eventually the spring ligament fails and the foot collapses creating the adult acquired flatfoot.
The authors then review the relevant literature no matter the level of controls. There are a number of relevant papers on the subject using reliable and valid indices and outcome measures. These papers speak to the positive results involving the use of orthoses and AFOs, which seem to relieve the symptoms related to the disease.
Later in the paper the authors reference a paper by Arai et al. This Mayo biomechanics lab research hypothesizes that increased friction may play a role in the process known as PTTD. They go on to describe the mechanical advantages to the disease that maintaining the medial longitudinal arch and minimizing transverse rotation play in this disease. They propose a mathematical model that compares the friction increase on the posterior tibial tendon when the foot collapses or externally rotates during stance phase. Both of these positions increase the load on the tendon. They also propose that a well made anatomically neutral insert or AFO will hold the foot and ankle in the more normal position, thus reducing the friction on the tendon.
There is also presented on page 129 an algorithm for the treatment for the condition known as PTTD. This may offer the novice some reference and guidance until enough cases have been managed successfully.
This is a must read for any practitioner involved in the care of the PTTD patient. If interested in obtaining a copy, contact me: .
A scientific symposium on the various clinical uses of the Van Ness surgical procedure was hosted by American Prosthetics & Orthotics in Iowa City in late fall.
The Van Ness surgical procedure is performed on foreshortened proximal femurs where the goal is to surgically align the short ankle near the sound side knee joint. The ankle is also rotated 180 degrees, thus the name "turn-around" procedure. A prosthesis is then fitted to the shortened limb so that the involved ankle becomes the "knee" and the weight is borne on the foot with the prosthesis making up for the leg length discrepancy.
Dr. Todd McKinley, an orthopedic trauma surgeon at the University of Iowa Hospitals, spoke of a unique case where this was done as an effort to allow a patient the opportunity to walk where otherwise only wheelchair ambulation would have been possible. Dr. McKinley discussed in detail the process he and his team went through to prepare the patient for this unique use of the Van Ness surgical procedure.
Nick Ackerman, CP, followed Dr. McKinley with a complete and detailed description of the design and materials used in the fitting of this patient. He also spoke of the unique difference between this application and the usual applications for the Van Ness, in the treatment of congenital deficiencies usually seen and treated with Van Ness. He detailed the classification system for the four major types of proximal femoral focal deficiency (PFFD), the congenital condition usually treated with this procedure.
Custom Inserts for Flatfoot
Don Shurr, CPO, PT, then spoke of the posting of the custom insert used to treat the flatfoot. He discussed the biomechanics of the post, and the result in the neutralization of the hindfoot while slightly supinating the forefoot.
John Kamp, CPO, led a discussion about orthotic solutions for spinal problems from the cervical to the lumbar spine using a new design of brace. Fitting criteria were presented for all systems as well as fitting tips for the more difficult devices and problems seen in many clinical settings.
In the final segment of the meeting, Jeff Palmer, CPO, discussed the material science involved in the foregoing system designs and John Kamp reviewed the correct designs for this patient group. Jessica Schaefer, CPO-OT/L, described the similarities and differences while dealing with the upper limb and the patients with spasticity.
Nick E. Ackerman, CP, has been named the director of prosthetics at American Prosthetics & Orthotics. Nick has been a practitioner at APO's Davenport office since 2005.
In the newly created position of director reporting to Executive Vice President Rod Cheney, Nick will develop and execute marketing plans and programs, and plan advertising and promotional activities. He will develop a uniform prosthetic protocol and establish standards for fabrication, turn-around time, and patient clinics.
Among other duties, Nick also will educate prosthetic staff on new components and techniques, and assist the resident director by supervising prosthetic residents and developing a prosthetic curriculum. He will also plan and conduct meetings with company prosthetists, evaluate appropriate prosthetic billing codes to maximize reimbursement, and provide companywide pre- and post-operative consultation as needed.
Nick, who loves to spend leisure time hunting and fishing, originally planned on a career as a park ranger. He earned his bachelor's degree in Environmental Biology. However, after speaking with amputees and prosthetic professionals, Nick realized the impact he could make in working with prosthetic patients.
A native of Colfax, Iowa, Nick lives with his wife, Rachel, in Davenport. They were married in May.
For stroke patients, regaining lost mobility and achieving greater independence to improve quality of life are among their most important goals. Working with Bioness Inc., a world leader in medical technology, APO is one of just a few facilities in the country to offer this breakthrough technology and user-friendly therapy service to stroke and other neurological patients with foot drop.
The device, called the NESS L300™ neuro-rehabilitation system, is a revolution in Functional Electrical Stimulation (FES) technology, designed to help patients "normalize" walking and gait. The system uses wireless communication to "talk" to its components, eliminates cumbersome wires, and allows the clinician to fine tune settings while the patient is actually walking. The L300 is appropriate for a broad range of conditions, including stroke, traumatic brain injury, multiple sclerosis, cerebral palsy and incomplete spinal cord injury. According to Don Shurr, CPO, PT, the NESS L300™ accelerates and complements traditional therapy.
Studies indicate that the Bioness, when used on patients with recommended conditions, increased their walking speed and walk with a more symmetrical gait. In a more acute methodology, the results indicated that the stroke patients' composite spasticity score was reduced, with an increase in ankle dorsiflexion torque. Finally, these patients (84.6%) could be returned to their homes.
Due to the Bioness systems' unique design, the sensing resistor allows for modification using wireless controls. This feature allows the practitioner or therapist to adjust the length of the stimulation and automatically adjust to non-forward progression activities such as stair climbing, side walking, and inconsistent speeds or cadences.
Bioness, Inc. was formed in California in 2004 by the Alfred E. Mann Foundation for Scientific Research, and NESS Ltd., a company headquartered in Israel that develops and manufactures innovative devices, neuroprosthetic and rehabilitation systems.
American Prosthetics & Orthotics (APO) has added Matt Kasten, orthotic resident, to the staff of its Iowa City Hospital office.
Matt joined the APO staff in July 2007 as an intern and is currently completing his residency requirements. He is enrolled in the prosthetic blended learning program from Chicago's Northwestern University Prosthetic-Orthotic Center. Matt received his bachelor of science degree in biomedical engineering from the University of Iowa in 2007.
In his spare time, Matt is a competitive wakeboarder and participates in the University of Iowa's Ski and Snowboard Club. A native of Waterloo, he currently lives in Iowa City.
The 18th Annual Iowa Amputee Golf Tournament will be held at Willow Creek Golf Course in West Des Moines July 10-12.
A scramble format tournament is open to the general public on Friday, July 10, preceding regular competition July 11 and 12.
As in past years, major sponsorship of the tournament is provided by American Prosthetics & Orthotics.
Golf is one of the most adaptable sports available. Almost everyone, regardless of disability, can participate and enjoy the benefits it has to offer: increased flexibility, improved balance, fresh-air exercise, and camaraderie.
For more information on the Iowa Amputee Golf Association, or to register, contact Mary Stark, (515) 771-3459 or e-mail: .
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