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"Grandma, does this mean we can go places?"
Those words were music to Susan Brown's ears. For the first time in 13 years, Susan, 53, of Moline, Ill., was walking without any assistance after being fitted with an orthotic device to correct her drop foot and unstable knee.
Her 13-year-old grandson was with Susan when her Certified Orthotist, Len Orzechowski, instructed her to take some steps to see how the new orthosis was working. At first, she automatically reached for her cane, but Len instructed her to walk without it, and her grandson echoed the request. "Just walk, Grandma," Susan recalled him saying. And she did, unassisted.
It's been a long journey regaining mobility she once had. An avid biker and hiker and in good health, Susan was only 40 when a slip down a few steps ruptured her carotid artery and caused a cerebral vascular accident (CVA), commonly called stroke. Both her upper and lower extremities were affected.
"Although I have use of my arms, I feel I have two left hands," she said. "It's not strong and I'm uncoordinated with writing."
Medical care delayed
Since Susan's CVA, treatment for stroke victims has advanced and the importance of immediately seeking medical help within the first three hours can improve odds of recovery. But in Susan's case, she didn't seek medical care until several hours later, mainly because she thought she had only pinched a nerve. By the time Susan's daughter took her to the hospital, more damage had occurred. After an MRI, her CVA was confirmed, and Susan was told the episode was over and she should go home until she could meet with a neurologist several days later. She followed orders, but upon waking up after a nap, she was immobile on her right side. After two weeks in the hospital, she was sent home in a wheelchair with a prescription for physical therapy.
Susan's stroke wasn't paralyzing, but left her with extreme weakness on the right side of her body. Her limited mobility necessitated a move to a one-floor apartment from a town house. "If there was a reason for this to happen to me, I still have to figure it out," she said.
Susan noted that a large part of recovery was made possible by her youngest daughter, Erika, who reduced her work hours to part-time and moved back home to help with her mother's care.
"At the time, I wasn't aware of all the services that are available to help someone in my situation," she said. "I would have given up if it wasn't for Erika. My friend, Lynn Baughan, also deserves a special thank you for being there for me."
Susan worked hard on her physical therapy, rigorously doing her at-home exercises following instructional sessions. "I began physical therapy and the therapists were good, but so overworked," Susan said. "I had maybe 10 minutes of one-on-one time with them. But what I learned I took home with me, and continued to do the exercise program."
One year after the stroke, she was walking again, but in a limited manner.
"I walked like Chester with one leg swinging out," she said, referring to the limping character on the old television series, "Gunsmoke." Her right foot was underturned and she had claw toes, a condition caused by hyperextension and hyperflexion that results in the toes curled downward like a claw.
Where there's a will there's a way
"I visited every orthopedic surgeon I could find in the Quad City area and they told me I would just have to live with it," she said. "Then I went to Iowa City to see Dr. Dietz and he was able to help me."
Dr. Frederick Dietz, professor of orthopaedics at the University of Iowa College of Medicine and a staff physician at UI Hospitals and Clinics, performed a tendon reversal and pinned Susan's toes. She also underwent a series of 18 Botox injections in her calf to relieve muscle spasms and jumpy legs. "The pain (after the shots) was excruciating, but worth it," she said.
Following her surgery she was in a cast for nine months before being fitted with her first orthosis - a brace, which ran from her gluteus to her toes. Susan complained that it was too cumbersome, had to be worn outside her clothes, was too hot in summer and too cold in winter, and didn't improve her gait. After a short time, Susan discarded the brace and walked unevenly with the assistance of a cane.
Although several years had gone by since she discarded her first orthosis, Susan still had a strong desire for more function and mobility. That's when she made an appointment at APO's Moline facility to see if Len Orzechowski, a certified orthotist, could help.
"She came to us because she was frustrated that the orthosis she had wasn't any help to her, and she had a strong desire to improve her mobility," Len said.
After evaluation, Len devised a double upright dorsiflexion-assist for the drop foot and to provide more resistance for her unstable knee.
Susan said the orthosis was more comfortable. "Basically it's two rods connected to my shoe," she said. "I can even drive with it."
"The shoe was the key component," Len explained. "I used a New Balance 926 and added an external lateral outflare (clubfoot wedge) to prevent Susan from rolling over the lateral portion of the heel of the shoe, which caused her knee to hyperextend."
Also inside her shoe was a custom molded orthosis to help provide a more even contact with the floor surface.
"Susan was immediately able to walk without her cane, and with very little knee hyperextension," said Len.
Happiness is playing with the grandkids
The new orthosis is providing Susan with possibilities she hadn't thought of for a long time. "When I could walk without my cane, my heart started thumping so hard. As a grandma, it was hurtful not to be able to do things with my grandchildren," she said. "Now, I have enough stability to pitch balls; I even took them bowling. I rolled 107, not bad for the first time."
Although Susan is undergoing a new round of physical therapy to improve her gait, she can now see the possibilities of resuming an active lifestyle. "I used to enjoy playing pool, and I just want to be able to start doing things again," she said.
The 17th annual Iowa Amputee Golf Association (IAGA) tournament was held July 11 - 13 at the Willow Creek Golf Course in West Des Moines. Friday's scramble had a turnout of 68 players. The amputees-only round had 37 golfers playing 18 holes on Saturday and Sunday.
The overall champion was Bill Morrison, a leg amputee, shooting 151. Dale Stogdil was runner-up, shooting 158.
Friday's scramble overall winner, amputees (won by a card off), were team members Bill Morrison, Erin Morrison, Scott Carpenter, and Kate Kanninga.
1st Flight, first place (won by a card off) amputee winning team members were Lonnie Freymiller, Kevin Freymiller, Ernie Wittmaier, and Chuck Kruse. 1st Flight, second place amputee winners were Rick Stockman, Brian Stockman, Cam Stockman, and Dennis Simpson.
2nd Flight, first place amputee winning team members were Bob Mayes, Bob Cochran, Ray McPherson, and Erv Fett, 2nd Flight, second place amputee winning team members were Clint Thompson, Linda Thompson, Larry Devin, and Marie Devin.
Non-amputee winning team members, 1st Flight, were Joe Keitges, John Keitges, Rick Storjohann, and Jason Storjohann. 2nd Flight team winners were Kris Kittleson, Sean Scarbrough, Clayton Godfrey, and B. Hirl.
Howie Kluczinske was the most improved player, cutting 21 strokes off his game from last year.
First place winners in their divisions were: Jim Crossman, Senior Flight; Nick Ackerman, Multiple Flight; Matt Nedved, Arm Flight; Dale Stogdil, Leg Flight; Walt Morris, 1st Flight; John Benway, 2nd Flight; Bill McCafferty, 3rd Flight; and Don Arnold, 4th Flight.
The major sponsor of the event was American Prosthetics & Orthotics. Other sponsors included: Ossur, College Park Industries, Knit-Rite, Ohio Willow Wood, Motion Control, OPGA, and OandP.com.
Kurt Gruben, MSBE, CPO and regional clinical manager for Ossur Americas, was the featured speaker at APO's annual education day in Clive, attended by representatives from all APO offices.
Kurt is a former APO practitioner who worked in the Davenport office. He is now with Ossur doing educational presentations. At the APO session he provided an overview on Ossur's liner products with a focus on the new Transtibial Seal-In liner with multiple seal locations.
Nick Ackerman, CP, a bilateral transtibial amputee, duplicated one of his sockets for the purpose of making a check socket and used that to demonstrate the use of the new liner.
The day's lecture topics included overviews of the RHEO Knee®, the PROPRIO Foot™, the Flex-Foot®, alignment, and setup protocol and techniques.
A patient participant demonstrated the RHEO Knee, walking on level ground, stairs, and ramps with the overall purpose of giving the attendees a glimpse into the features and benefits of the RHEO Knee as well as the specifics of how the knee should be fitted.
Nick demonstrated the PROPRIO foot, walking on challenging terrain around the Clive office parking lot. He also demonstrated his bilateral Flex-Run Feet, as Kurt talked about the use and setup of Flex-Runs.
"This was the best program anyone from Ossur ever presented to our company," said Don Shurr, CPO. "Kurt takes a difficult subject like biomechanics and adds his clinical experience to it to produce a very well-informed and interesting course for our practitioners. Sometimes a day of biomechanics can be a bit dry, but Kurt keeps the group with him by introducing clinical touches and useful information about new products such as the PROPRIO foot/ankle."
When Lynsey Stevenson was born on Sept. 19, 2005, there was no indication she'd have any problems. Within 10 hours of her entering this world, Lynsey was in surgery.
She was born with spina bifida. "We had four ultrasounds and no one had spotted anything," said her mother, Tammy. "So we thought everything was fine, until the doctor said, 'She has an open wound on her back.'"
Lynsey was transferred by ambulance from Davenport to University Hospitals in Iowa City. It was after her first operation that Tammy and Lynsey's father, Matt, were updated by the physician on their first child's condition.
"That was the first time it really hit home, because he said there's a chance she'll never walk, she'll never talk, never breathe on her own, never swallow…all those things. He painted a really grim picture. Basically, we walked out of there and thought our kid was a vegetable," Tammy said, adding that many thought Lynsey wouldn't even survive.
Lynsey became hydrocephalic, which resulted in another operation to place a shunt to reduce the fluid building-up on her brain and to relieve pressure.
"Every day it seemed there was bad news or a set-back," said Tammy.
The Stevensons were at the hospital more than a month with Lynsey. "We went in when it was summer and when I came outside, all the leaves were changing," Tammy said.
But Lynsey made an amazing recovery and none of the gut-wrenching possibilities came true, although her condition will result in continuing medical procedures.
"We got her home and she was like every other kid," Tammy said. "She's a miracle baby."
After seven operations and rehabilitation, the Stevensons were referred to American Prosthetics & Orthotics' Davenport office and practitioner John Kamp, CPO. He recalled how frail Lynsey was when he first saw her. "There was an exceptional amount of laxity; her feet would turn almost 180 degrees," he said.
Ankle-foot orthoses (AFOs) helped. Without them, Lynsey's feet would almost flop up to her shinbone. Torsion cables were also added to straighten her feet.
"If you load the bones in proper position, it provides proper growth," John said. He remembers Lynsey getting mad at him when he would take her orthoses off to adjust them. "She didn't want to give them up," he said.
Lynsey made very good progress at function and mobility. "By the time she was 11-months-old, she was pulling herself up on the couch and standing," Tammy said. "At 17-months-old, she was walking with the aid of a walker. That was the miracle. Once Lynsey began walking, she began talking and developing at a normal rate. The difference APO and the staff has made in her life is incredible."
Lynsey even takes a dance class, and during the past holiday season, she participated in a recital.
"She went on the stage and she was waving, dancing-up a storm and blowing kisses," said Tammy. "As soon as she got off the stage, she jumped into my arms and said, 'Do it again, Mom.'"
Although she still faces some medical challenges, Lynsey is able to keep up with other children and Tammy said there isn't really anything Lynsey can't do. "Other children her age have no idea. They don't even notice her orthoses or that she walks a little bit different," she said.
Matt and Tammy have found John and the APO staff deeply caring about Lynsey. "They are fantastic," said Tammy. "John is just a sweet guy with a grandfatherly attitude. He doesn't just fit her for her orthoses and then send us on our way; he's proud of her."
"Lynsey is a special case," John said. "She reminds me why I got into the profession in the first place."
Donald Shurr, CPO, PT, was presented the Distinguished Practitioner Award from the American Academy of Orthotists and Prosthetists (AAOP) at their Annual Meeting and Scientific Symposium, held Feb. 27-March 1, 2008 in Orlando.
The award, one of the highest AAOP presents, recognizes members of the Academy for their personal dedication and leadership to the advancement of the orthotic and prosthetic profession.
Among Don's many areas of involvement includes mentoring orthotic and prosthetic students. The mentoring relationship provides a supportive environment for the students and encourages them to reach their professional goals, while educating them and holding them to high standards.
In his acceptance speech after receiving his award, Don encouraged the others in attendance to become mentors themselves as a way to help students and to give back to the profession.
Don is the Eastern District Manager of American Prosthetics & Orthotics (APO) and oversees its office at the University of Iowa Hospitals and Clinics. He is an instructor with the University of Iowa Department of Orthopaedics, and an adjunct lecturer in physical therapy education at the University of Iowa. He also is an adjunct lecturer at Northwestern University's Prosthetic-Orthotic Center, Chicago.
The 2007 edition of the Iowa Orthopaedic Journal was dedicated to him in recognition of his teaching of orthotic residents.
Throughout his years of involvement with the University of Iowa Department of Orthopaedics, Don has been active in numerous research studies. He is the author of the text, "Pro sthetics and Orthotics," and has contributed to numerous other books and papers with an emphasis on research and outcomes measurements.
His interest in the physiologic effect of prostheses on amputees led to numerous articles and publications culminating with the Howard R. Thranhardt Lecture Award for his work on "Physiological Gait Parameters during Ambulation in Persons with Above Knee Amputations." His publications in the field of orthotics include finger joint arthroplasty, management of foot and ankle deformity, and diabetic foot care.
Don is former chairman of the National Commission on Orthotic and Prosthetic Education (NCOPE), and he served the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) as former chairman of the standards review committee. He currently serves as a member of the standards review committee and as a member of ABC's facility accreditation committee. He also is a member of the American Orthotic and Prosthetic Association (AOPA), the American Physical Therapy Association, and AAOP.
He is a 1968 graduate of the University of Iowa with a bachelor's degree in Special Physical Education and received his master's degree in Physical Education — Adaptives in 1971, also from the University of Iowa. He graduated from Northwestern University's orthotics program in 1986, and its prosthetic program in 1987.
In his spare time, Don is a history buff, particularly knowledgeable about the Iowa journeys of Lewis & Clark. He is a frequent speaker on the subject to audiences ranging from kindergarteners to retirement home residents.
Don, and his wife, Marilyn, live in North Liberty. They have two daughters, Carrie and Molly, and four grandchildren, Nik, Grace, Jackson, and Sophia.
American Prosthetics & Orthotics extends its warmest congratulations to our own Donald Shurr, CPO, PT, on his selection as "Distinguished Practitioner" of the year by the American Academy of Orthotists and Prosthetists.
This prestigious award is a fine recognition of Don's ability and his contribution to the profession, his dedication, hard work, and service to others. We're very proud that Don is a member of our organization for the past 22 years. We compliment the Academy for the splendid choice they've made.
Ron Cheney, CPO
President
The 17th Annual Iowa Amputee Golf Tournament will be held at Willow Creek Golf Course in West Des Moines July 11-13.
A scramble format tournament is open to the general public on Friday, July 11, preceding regular competition July 12 and 13.
As in past years, major sponsorship of the tournament is provided by American Prosthetics & Orthotics.
The tournament, open to male and female amputees with upper and/or lower extremity limb loss, consists of nine different flights, with first through third place trophies awarded in each division. A Saturday night banquet and a Sunday afternoon awards ceremony are part of the festivities.
Last year's overall winner of the amputees-only event was Jacob Adams of Webster City, shooting 140, or two under par. Dan Cox of Mequon, Wis., was runner-up, shooting 141.
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 for the tournament, contact Mary Stark, (515) 771-3459 or e-mail: .
Nick Ackerman, CP, of APO's Davenport office, received a mention in Challenge Magazine's Fall 2007 issue. The magazine, published by Disabled Sports USA (DS/USA) was commemorating 40 years of disabled sports, and Nick was listed as a notable in wrestling. A graduate of Simpson College (Indianola, Iowa), Nick won the 2001 NCAA Division III Wrestling Championship — the first and only athlete to become a national champion without the use of his legs.
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