Thinking Outside the Clinical Box—Facility Offers Fitness, Wellness, and Social Space

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Even in a profession noted for dedicated practitioners and quality facilities, Prosthetic & Orthotic Associates of Central Florida (POA), Orlando, and its owner and president, Stan Patterson, CP, stand out. In a tight economy where many healthcare providers are cutting back, Patterson keeps expanding with a business model that focuses on going beyond fitting and prosthetic rehabilitation. Plus, he is noted for treating uninsured patients while operating a large patient care facility in which both patients and staff are treated like family, says Karen Hughes, POA's web and social media director, who also has a transfemoral amputation and is a POA patient.

POA’s multipurpose room contains three sets of 24-foot parallel bars for gait training. A traverse rock climbing wall, seen in the background, adds fun and fitness training. Photographs courtesy of POA.

"In my 40 years of being an amputee, I have never encountered a prosthetic facility anything like this," she says. "Working here has enriched my life in ways that are immeasurable—I feel very blessed to be part of an organization that has helped so many people…. Stan has a simple, humble philosophy: he just does what's right! He hasn't expanded the business for personal wealth, but [rather] because he wants to be able to help more people."

Patterson's history of invention and his dedication to professionalism in the O&P industry have not gone unnoticed by his colleagues either. He was recognized with a 2007 American Academy of Orthotists and Prosthetists (the Academy) Award for Clinical Commitment.

New Facility Helps Address Patient Needs

Last March, POA accomplished another milestone as it opened the doors to its new 22,000-square-foot facility that includes a 5,700-square-foot gait training area, a café-style coffee and lounge area, a fabrication area, and a silicone liner fabrication laboratory. Nine additional O&P practitioners, as well as physical therapists, technicians, and others make up the 23-person staff. Rounding out the team are two "canine counselors"—Patterson's border collies, Simba and Sarabi—whose presence cheer and enliven patients. POA tries to create an enjoyable atmosphere for both patients and employees, Patterson says.

"We encourage our patients to talk and share with each other," Hughes says. "Although we have five dedicated patient rooms, they are rarely occupied as most choose to congregate in the 7,000-square-foot multipurpose room, which contains three sets of 24-foot parallel bars and plenty of room to move about and interact with one another."

Another boon for clients is the massage therapy treatment area where Shelly Diez, LMT, a transtibial amputee and long-time POA patient, offers massages to patients and their families at reduced rates. Diez has a master's degree in engineering and is conducting research on how the musculoskeletal system of individuals who have undergone an amputation adapts during the prosthetic fitting process, as well as how massage therapy and other "body work" can alleviate the stress and strains related to living with an amputation and wearing a prosthesis.

With an eye toward a "whole body approach," the facility also offers a fully equipped sports and wellness fitness center, a 2,000-square-foot golf training center, and a traverse rock climbing wall.

Patient-Specific Fitness Training

Borda watches as a patient works out in POA’s sports and wellness fitness center.

Patterson is a passionate advocate for the benefits of sports and exercise. He stresses the need for people with an amputation to develop core strength, balance, agility, and cardiovascular strength, not only for achieving physical health and goals but also for psychological health and confidence. "Next to having a correct socket fit and learning how to ambulate with the prosthesis, the most important thing is staying in great physical shape," he says. An amputee requires more energy expenditure than a non-amputee. Amputees need a strong cardiovascular system and a strong endoskeletal muscular system for supporting dynamic load while ambulating."

To help his patients work toward that goal, POA has two on-site personal trainers in the fitness center: Jim Borda, certified strength and fitness trainer, and "H" Bufton, a former professional tour golfer, who is available to teach and coach patients. Use of the fitness facilities is free to patients; however, they contract individually with the trainers, often at reduced rates.

Patterson says he saw a need and decided to fulfill it. "It's a gap in the industry. Physical therapists do gait training and help amputees learn how to use their prostheses, but they don't usually do personal training. Plus, insurance only pays for so many physical therapy treatments."

Because most personal trainers might not have even met an amputee, let alone trained one, Patterson and Borda worked together for two years to develop exercises appropriate for each amputation level. Although amputees can do many exercises and activities that able-bodied people do, they often need adaptations to avoid damaging their residual limbs and prostheses, Patterson stresses. Different amputation levels and other factors such as age, activity levels, and comorbidities have to be considered; even across like amputation levels, residual-limb length can make a difference in the appropriate approach to a particular exercise. Similarly, Patterson explains, there is no single approach that fits every person with bilateral amputations since one client may have one leg with a transfemoral-level amputation and the other leg with a transtibial-level amputation, which can cause his or her exercise needs to be different from someone with bilateral transtibial or bilateral transfemoral amputations.

Bufton helps a young amputee hone his golf game in the facility’s golf training center. Bufton also assists patients with fitness techniques that can be applied to golf, other sports, and overall balance and stability.

Hughes offers anecdotal evidence of the healing effect of exercise that Patterson so strongly believes in: One patient, a discouraged Vietnam veteran who suffered from depression began attending weekly training sessions. The emotional healing he experienced from those sessions had an amazing transformational effect on him, Hughes says. "Where he once was barely able to shuffle into the office with a walker, he hardly uses a cane anymore."

Patterson says he plans to post information and videos about exercise and personal training techniques for different levels of amputation on the POA website as well.

The help POA offers its patients is not limited to activities inside the facility walls. POA often helps patients in deciding on and obtaining adaptive sports equipment, Hughes says. "We do whatever we can to help them achieve their sports goals, whether recreational or competitive." And whether the patient-athletes are accomplished athletes, such as Paralympians Scout Bassett, April Holmes, and world-class snowboarder Amy Purdy, or youngsters and teens who have gained confidence and the ability to do more than they ever thought they could, Patterson and his staff celebrate their achievements.

POA's rock climbing wall has served this purpose as well—POA prosthetist Ronnie Dickson, CP, an avid climber with a knee-disarticulation amputation, often trained for the 2012 World Paraclimbing Championships in Paris, France, at POA. Many others have been excited to train on the wall, and Dickson says he is eager to assist them.

Continuing the Spirit of Innovation

While Patterson is passionate about his practice, he is perhaps most noted in clinical circles for his development of the Negative Pressure Suspension (NPS) vacuum socket system. A growing body of evidence shows that sub-atmospheric (elevated vacuum) systems often not only increase prosthetic comfort and control and reduce volume fluctuations in the residual limb compared to traditional systems, but they also promote residual limb tissue health. The innovative NPS system, which features a patented lightweight vacuum chamber laminated into the socket, has proved highly successful for transtibial amputees and for higher levels of amputation: transfemoral, hip disarticulation, and hemipelvectomy (transpelvectomy).

Patterson is also excited about developing new componentry. He is working with an advanced material engineer, Les Kramer, PhD, PE, to develop a new liner along with other innovations. Kramer recently retired from the Lockheed Martin Missiles and Fire Control, Orlando, Florida.

Balancing Growth and Personal Satisfaction in a Business Model

Patterson assists a patient with gait training as other patients relax and socialize in POA’s multipurpose room. Patterson’s two border collies also are on hand to befriend and encourage patients.

Considering the typical business goal of revenue generation and profit from operations while reducing costs, it may give one pause as to why Patterson chooses to offer additional services to his patients without additional charges, and to treat uninsured or under-insured patients, while still growing his business. Although it may seem counterintuitive since it's not focused on maximizing profit, Patterson's holistic business model extends beyond patient care to his own career life—one that balances profit and personal fulfillment. Patterson frankly acknowledges that if he did cut back somewhat in the size of his professional staff or the scope of what his facility offers, "I could probably double my income...but I wouldn't have the satisfaction I have now."

Patterson's belief in offering these extras, however, can reap financial benefits. As marketing guru Andy Sernovitz wrote in his book Word of Mouth Marketing, "You will get more word of mouth from making people happy than anything else you could possibly do."

Patterson concurs. "I think what has grown our business the most by far is when you provide something to someone they can't get anywhere else, and you treat them like you would want to be treated," he says. "Amputees are like a fraternity, and they share their stories. It's as if we have twelve hundred to fifteen hundred ambassadors out there."

Miki Fairley is a freelance writer based in southwest Colorado. She can be contacted via e-mail at

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