March 26, 2021 • 38 mins
In this episode we welcome prosthetist, John Hattingh, of Prosthetic Care of Virginia to the show. With 45 years of experience, John and his team create some of the most technologically advanced prosthetics in the world. From customizing hip and hemi prosthetics, myo and neuroelectronic arms that feel objects and temperatures through sensors, to osseointegration that truly rivals Hollywood cyborgs. Tune into this episode to learn more about Prosthetic Care and what every new amputee should know! See links below for images.
To Connect with Prosthetic Care of Virginia:
Website: https://www.prostheticcarefacility.com/
Facebook: https://www.facebook.com/prostheticcarefacility
Amputee Support Page: https://www.facebook.com/groups/AmputeeHelp
Neuro prosthetic image: https://images.search.yahoo.com/search/images;_ylt=A2KLfSwov1Bg9KEAB3NXNyoA;_ylu=Y29sbwNiZjEEcG9zAzIEdnRpZAMEc2VjA3Nj?p=graphic+of+neuroelectronic+prosthetics&fr=yset_ff_syc_hp#id=4&iurl=http%3A%2F%2Fmedia.ottobock.com%2Fprosthetics%2Farms%2F_general%2Fimages%2Fabove_elbow_tmr_prosthesis_graphic_16_9_teaser_onecolumn.jpg&action=click
Osseointegration image 1: https://images.search.yahoo.com/search/images;_ylt=AwrEze1MvlBgYAEABLFXNyoA;_ylu=Y29sbwNiZjEEcG9zAzIEdnRpZAMEc2VjA3Nj?p=graphic+of+osseointegration+prosthetic+connector&fr=yset_ff_syc_hp#id=16&iurl=https%3A%2F%2Fmedia.springernature.com%2Flw785%2Fspringer-static%2Fimage%2Fart%253A10.1007%252Fs11999-014-3695-6%2FMediaObjects%2F11999_2014_3695_Fig1_HTML.gif&action=click
Osseointegration image 2: https://images.search.yahoo.com/search/images;_ylt=AwrEze1MvlBgYAEABLFXNyoA;_ylu=Y29sbwNiZjEEcG9zAzIEdnRpZAMEc2VjA3Nj?p=graphic+of+osseointegration+prosthetic+connector&fr=yset_ff_syc_hp#id=23&iurl=https%3A%2F%2Fimage.sciencenordic.com%2F1397253.jpg%3FimageId%3D1397253%26width%3D353%26height%3D265&action=click
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Intro (00:03):
Welcome to DisAbility Talks, a podcast produced by
Abilities in Motion.
I'm your host, Shelly Houser.
Join us for real conversationsand no nonsense.
Talk from everyday people withdisabilities, living their most
independent everyday lives.
Tune in for the latest newssurrounding disability,
accessibility and independence,where conversations aren't
(00:25):
dissed and stories that need tobe told aren't missed.
So let's talk.
Shelly (00:28):
Welcome back listeners.
I'm your host Shelly Houser andtoday's guest is prosthetic
genius, John Hattingh, who'soriginally from South Africa.
John and his team now reside inLeesburg, Virginia, where they
create some of the latesttechnologically advanced
prosthetics at Prosthetic Careof Virginia.
Good day, John.
Thanks for being here with us.
John (00:48):
Good morning.
Thanks for having me.
Shelly (00:50):
Absolutely.
Now I need to start with ourlisteners to preface that I
think John is a prostheticgenius because he is my
prosthetist for, I think six,six, seven years?
John (01:10):
Ten years! Yep.
Shelly (01:10):
I forgot how long it was.
Okay.
So I have, I have made friendsthrough this office and we have
a loving community on one oftheir Facebook pages to support
each other as amputees.
John for starters, tell ourlisteners more about yourself
and how you got involved inprosthetics.
John (01:28):
So I'm been in the field for 45 years this year.
I got my Master's inEnvironment, Chemical
Engineering, and one of the,chiefs in charge at the research
center was an amputee.
And that's how I got involvedwith prosthetics.
I did an internship in Germanyand then, w ent back to South
(01:52):
Africa.
I had to go back to school inSouth Africa because in Germany
it's a, it's a technical course.
They call you aOrthopadischemiehankemeister and
in South Africa you had to go toschool.
So al though I had alreadyqualified in my internship, but
when I went back to South Africato go back to school, write the
(02:14):
exams, and we have a medical anddental board in South Africa,
and I ha d t o register withthem before I could ac tually p
ractice clinical prosthetics.
We immigrated in 1990 and ourport of entry was Seattle.
I did research at the Universityof Washington and also, i n
(02:35):
stitution called ProstheticResearch Foundation.
And once that was done, Istarted in as a clinical
prosthetist in a privatefacility.
And we stayed there for 26 yearsbefore Michelle got sick with
rheumatoid and we had to leavethe very cold and wet climate.
(02:58):
So one of the big corporationsbought me and I had a
continental non- compete.
Aft er my non-compete hadexpired, we looked for a climate
that was similar to Cape Town.
And Northern Virginia was asclose as I could get to Cape
Town.
But overall it's not too bad.
Yeah, it's working.
Shelly (03:19):
So Michelle for our listeners is his lovely, very
talented wife who has her ownnon-profit that she started with
her equine therapy, right?
John (03:33):
Correct.
Yeah.
So she rescues horses and thenshe trains them and they become
therapy horses.
And mostly what she does is ifone of my patients is interested
in getting back in the saddle ortrying to get onto the saddle
for the first time, they can goover to the farm and she'll get
(03:57):
them in the saddle and I'lladjust the prosthesis so that it
can accommodate riding and shereally enjoys that.
Shelly (04:05):
I think Michelle rescues every animal that needs to be
rescued.
John (04:09):
No kidding.
Shelly (04:14):
So what are your most unique prosthetics, kind of
prosthetics that you work withis osseointegration.
And I did a little research onthis thing and it seems like
it's new technology for theUnited States, but it's been
developed years ago.
So how long?
John (04:32):
That goes back years in Europe.
I think Invar Brennamar and Ricard Bennamar's father, he did
the first implant.
The first implants were dentalimplants and the dental implant
surgery is huge.
I mean i t, and it w orks sowell.
(04:54):
Dental i mplant surgery has verylittle contra indications
because we've g ot so muchbacteria in our mouth that f
ight any viruses that comealong.
And he did that 50 years ago.
I mean, it's, it's been going onforever.
And then R icard became anorthopedic surgeon and he was g
oing t o work with his dad.
(05:16):
And then, a b ilateralabove-knee amputee from England
wrote him a letter.
And you know, this is about 25years ago.
She wrote a l etter to Ri card and said, Hey, if you guys can do
dental implants, why can't youdo prosthetic implants?
So that's when the pennydropped.
And then Ricard started doingresearch, t hrough his research
(05:40):
company, c alled Integrum.
And she was the first amputeethat they did implant with.
And in fact, she's st illwearing them.
Speaker 1 (05:51):
Okay.
Explain to our listeners whatosseointegration is.
Because I know I have friendsthat have had this done, and I
think you go into the surgerywith the doctor sometimes.
John (06:01):
Sometimes I do.
It's really not that necessary,but it's always just good to see
what they're doing and whatthey're putting in, because then
I have a better clue as to whatI need to do to attach a
prosthesis to the skeletalimplant.
So what they do is there twodifferent thought processes.
(06:24):
The first thought process is theBrennamar procedure, which is a
two-stage procedure.
So what he does is he reams thefemur or the tibia or wherever
they go, they ream, they tap itand then they screw the implant
in with adhesive and then theyclose the surgery back up.
(06:45):
And the patient normally waitsabout three to six months,
depending on the patient'sphysiological c ondition.
And then once the implantsecures into, the long bone.
Then they go back in and theyopen it and they either put the
stoma in or the tapered sleeveor whichever system they use.
(07:07):
And then they bring it throughthe s kin.
And the most important part isthat the soft tissue myodesis
has to be done really well.
So what that means is they isthey have to trim all of the
tissue and fat away from theskin.
They have to anchor the muscleto the end of the bone and they
(07:27):
have to anchor the skin tightlyto the end of the bone.
The first procedure is theBrennamar one, tw o s tage,
normally a t hree to six monthsbefore between stages.
Th e o nce, once th e s tomacomes through the skin, then
they, they have to teach thatbone to do weight loading.
(07:52):
So you don't get the prosthesiscoming out of the gate.
You have to do weight loadingthrough your physical therapy
department.
And they started with 20 pounds.
They increase it by 20 poundsevery week until you can get 50%
of your body weight.
And if you can put 50% of yourbody weight through the bone and
you don't feel pain or discomfort, that's when th e p
(08:14):
rosthesis is attached.
And that's when the prostheticrehabilitation starts.
Shelly (08:18):
How do they attach the weight to the arm or the leg?
Do they hang it off the metalrod that comes out?
John (08:26):
There's a component that we make.
And it's also commerciallyavailable that attaches to the
stoma.
And then we, we make theweight-bearing device with this
scale and then they put pressure, through that pod, into the
implant and they check the scalemeasurement and c ontinue to
(08:48):
stay within the way that theyfeel comfortable.
So, so back up a little bit.
So the other system that isused, that was developed by a
fellow called Munjed inAustralia, and that's the
press-fit system subsequentlyquite a few other companies have
adopted the press-fit system.
The Dutch have adopted it, theGermans have adopted it.
(09:10):
Munjed still everybody flies toAustralia and he does it in
Australia and they fly backhome.
The press-fit system isn't a two s t age s ystem.
They normally do both stageswithin a couple of weeks.
And patients are actuallyambulatory within a couple of
weeks post the second stage.
(09:32):
So those are the two trains ofthought.
They're both efficient, theyboth work well.
It really is just who you preferto have it done with.
The way that you attach itdepends on the implant.
So the Australian system, theDutch system, they have, a
tapered sleeve with a collar.
(09:55):
And there's a, it looks like atube cl amp t hat attaches to
this tapered sleeve.
Shelly (10:02):
Once they're ready for that prosthetic, how does it
physically attach to that rodthat comes out of their stump?
I kind of explained it likeattaching your beaters to your
mixer.
John (10:15):
Very similar.
So this is the press-fit system.
You'll see at the distal end,there's a taper sleeve and then
there's a collar.
And then this is the tube clamp.
It looks like a tube clamp andit just attaches to that collar.
Shelly (10:34):
So that abutments about a two inch steel or titanium
rod.
John (10:38):
Yeah.
And then the Brennamar systemuses what we call an Exor, It's
a breakaway system as well.
So if the patients fell, thisthing can actually breaking in
half and swivel and it doesn'tbend the stoma that goes into
the implant.
And then they have a differentsystem that comes through the
(10:59):
skin and they call it anabutment that comes through the
skin and that Exor actuallyattaches to that abutment.
The advantages of havingOsseointegration is that, you
don't have any socket i ssues.
And we know that that's t he,Alpha and Omega of successful
(11:22):
prosthetics.
If the socket doesn't work, theprosthesis doesn't work.
And patients struggle a ndstruggle And there unfortunately
are prosthetists that just don'thave enough experience to make a
socket that works well.
And therefore, this is a verygood system because you don't
have ever have any s ocketissues.
(11:43):
It connects directly to the, tothe skeletal system and your
skin is always free of anysocket environment.
Shelly (11:53):
And that's good for diabetics.
John (11:55):
It is, but in the same term, it's bad for diabetics
because you always have an openwound.
So you, you always prone toinfections.
And in the majority of failuresof the system is that patients
constantly had chronicinfections and then they would
(12:15):
have the whole thing removed andthey would go back to a socket
system.
Shelly (12:19):
That's a shame.
So let me ask you something.
Sometimes when people gettransplants, they have to be on
medication the rest of theirlife, because their body's
trying to reject it.
Is that the same thing for whenpeople get this kind of surgery
done?
John (12:34):
No, this isn't, this is like your total hip replacement
or your total knee replacement.
Some people are allergic tometal though.
I mean, you've seen so many hipreplacements and knee
replacements that fail wherepatients constantly get
infections because they, theyare allergic to metal.
And certainly there's a smallpercentage of patients that's
(12:56):
just flat out allergic to themetal that protrudes through the
skin.
But in the majority of cases, ifpatients have a sound hygiene
where they wash this in saltwater every day, they, you know,
apply some Vaseline to keep theskin nice and moist and soft.
(13:16):
And, and they watch where theygo.
I mean, you can't go into publicpools.
It's, I mean, it's a bit of aPetri dish, you know, you know,
stuff like that.
I mean, you, you just have to beconscious of your environment.
Then you can keep this thing atBay and sure, some your patients
get infections, but able-bodiedpeople getting infections from
(13:39):
getting a cutting and gettinggerms in it.
So, and wait, they're going on acourse of antibiotics and the
infection is kept at bay.
The biggest issue is when theprosthetist makes the prosthesis
and attaches it to the patient,he has to be sure that there's
always direct vertical loading.
(14:01):
So he c an't get all funny andcreative with the alignment by
putting offset perimits on andmoving the knee out.
And t he, it has to be avertical loading.
If there's an alignment issue,then the patient has to correct
it through muscle t herapy.
So muscle toning and learninghow to walk w here this implant
(14:22):
is really most patients don'thave a problem.
It's just intuitive.
The line of progression of thefemur or the line of progression
of the tibia is normally exactlywhat you need and everything
just falls into place.
The other issue is that patientsc an't be super active because
the stoma or the part that thatcomes through the skin is
(14:46):
sacrificial.
So if patients fall or they, orthey jump off a boulder or t
ruck b ed or something, if theyland o dd, then the stoma will
bend because that's thesacrificial p art and it bends
so that the implant doesn'tfracture the whole femur.
(15:08):
So, so you can't be super activewith osseointegration.
You c an't do the running andjumping that you would have done
had you had a soccer.
But so what?
I mean, you know, that's just,you just have to live with the
limitations of the system.
Shelly (15:24):
Right.
I don't think there's any onetype of prosthesis that does
every single thing you want yourlife to be.
I mean, but it gets us, I think90% of where we want to live our
life.
John (15:38):
True, true.
I mean, if you look at ourParalympic athletes, they have
four or five differentprosthetics that do different
jobs.
If you look at the combatsoldiers at Walter Reed, each
one of them gets four or fivedifferent prosthesis, one for
swimming, one for cycling, onefor running, blah, blah, blah.
But because it's a socketsystem, they can do that.
(16:02):
However, with this system, thereare limitations to the level of
activity and not severelimitations.
You have to comprehend whatyou're going to do next, because
the consequence can be that youend up in ER, and they have to
replace the stoma.
Shelly (16:19):
So somebody with osseointegration, wouldn't be
able to have a cheetah runningblade.
John (16:24):
They can, but they have to understand that it's, it's
purely just a linear loading.
They can't do, they can't do therunning and the jumping.
And the thing that they wouldn'tbe able to do is do a Spartan
race on a blade.
You know, there has to be morestability in the prosthetic
(16:45):
device to be able to do that.
But then it's such a dirtyenvironment that they most
probably wouldn't want to do itbecause they're in mud and they
do low crawls and all kinds ofstuff.
So it's, it's like a toughmutter.
I mean, it's, that's probablynot the best environment for an
open wound.
Shelly (16:59):
It's just asking for trouble I think.
John (17:00):
It really is.
You know?
And I mean, when you choose tohave osseointegration, you have
to understand that those aregoing to be your limitation.
If you want to do that stuff,then you need to stick with a
prosthetic socket.
Shelly (17:16):
Well, with that, I think we're going to take a short
commercial break and we'll beback to talk about
myoelectronics with JohnHattingh.
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Our programs are focused onproviding opportunities for
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(18:10):
www.abilitiesinmotion.org.
Shelly (18:11):
And we're back with John Hattingh, prosthetist from
Prosthetic Care of Virginia.
John, another high-techprosthetic that you work with is
the myoelectronics withelectrical sensors that are
embedded into patient's muscles.
Tell our listeners more abouthow this technology works.
John (18:27):
So previous years we had surface electrodes.
So the mayoelectric systems wereutilized using surface
electrodes.
So we would do a surfaceanatomical and neurological
tests.
We will see where we get thehighest milivolt to contraction
(18:48):
of the muscle underneath theskin.
And then we would coincide thesurface electrode with where
that muscle fires and that gaveus in most cases, it was a two
electrode system.
One electrode was four opening,and one electrode was closing.
And then we, the, the, wedevelop devices that could move
(19:14):
power from one device toanother.
So we called it aco-contraction.
So if the patient's fired boththe muscles and gave both the
electrodes input, then theelectrode would tell the
electronic device to stop thepower from going to the hand and
(19:35):
redirecting that power to thewrist or to the elbow.
But everything worked off twoelectrodes.
So then a guy called Kaican atNorthwestern University
developed a system called TMR,and it was short for Targeted
Muscle Re-innervation.
So when they amputate the limb,the nerves that used to supply
(19:58):
the forearm and the fingers,those nerves are still there.
So what he did is he took thosenerves that were amputated and
he reconnected them into musclelobes into the motor neuron of
the muscle lobe.
And so then you would get aextra nerve input.
And then we could actually go tofour electrodes, but it took a
(20:23):
lot of physical therapy becausethe patient had to learn to
redirect the power from where itused to go to the forearm or the
hand to go to this muscle.
And they had to fire that muscleto be able to run four or even
six electrodes.
So then we would have twoelectrodes for the hand, two
(20:46):
electrodes for the wrist, twoelectrodes for the elbow, and
the patient could actually dosome of the simultanious
function.
So previously he could only doone function at a time.
Now with these four and sixelectrodes, he could operate the
elbow while opening and closingthe wrist or rotating the hand.
So it was a huge improvement.
(21:07):
The problem was this, thephysical therapy to teach the
patient to fire the other musclelobes was really intensive.
And in some cases, patientswould have a wonderful day where
everything works and the nextday they would have it dead day
and they could not make aanything work.
(21:28):
So then a guy, a fellow calledMax Ortiz that worked in
Gothenburg in Sweden, came upwith neural electrodes.
So what they would do is theywould go and find the main
branch of the nerve.
(21:49):
And then what he did, if you cankind of think about it, he would
take an electrode and he wouldroll it up like a piece of
paper.
But what this could do is itcould expand, or it could
retract around the nerve.
So they would, they were goingto do the surgical intervention.
They would open up the nervesheath.
They would put this neuralelectrode over that.
(22:11):
And then the patient couldchoose, thought, have multiple
functions.
But this only work withosseointegration because what
they would do is they is theelectrode would then come
through the middle of the stoma.
And so they would then attachthe arm to the stoma and then
they would attach the neuroconnection to the arm.
(22:36):
And then the patient wouldactually have multiple function
through thought, through realthought.
Because they got in at the, atthe origin of the nerves, as
opposed to at the termination ofthe nerve.
And this was really the start ofneuro electric function.
It's, it's, it's really notmyoelectrics anymore It's neural
(22:58):
electrodes as opposed tomyoelectrics.
So then they started working onmapping and they call it nerve
mapping.
And there's, there's quite a fewcompanies now that have a
software where the software canactually indicate where the
concentration of, of thestimulus is.
(23:21):
And then the whole socket thatattaches to the residual limb
actually has multiple electrodesembedded in the socket.
And then it can pick up a signalfrom anywhere and have multiple
functions.
And now they've actually gotteninto neural attachments in the
brain.
So they go to the absoluteorigin and that gives them the,
(23:45):
to have touch sensation.
So now they can actually feelhot and cold.
They can feel soft and hard.
So this is really the next step.
The problem is that it's soexpensive that unless you become
part of a research program, noinsurance company in America
(24:08):
will pay for this stuff.
Shelly (24:09):
They're not going to touch that.
No.
John (24:12):
No insurance company will pay for this stuff, but Johns
Hopkins has been really on theforefront of this nerve mapping
and they have multiple subjects,you know, that they use to
develop this stuff.
And we're hopeful that as itbecomes more mainstream, that
it'll become easier for patientsto afford.
(24:34):
The terminal devices have becomea lot more intelligent as well.
I mean, you name it.
Everybody has come out with anintelligent hand where we have
multiple finger function.
We have multiple rotation.
You can actually flip the thumband you can now insert a credit
(24:54):
card into a credit card machine,which you couldn't do previously
because you just had thisfunction.
Shelly (24:59):
The pincher function.
John (25:01):
You only had opposition post previously, so you had
multiple finger, but the maingrip was opposition posts.
But now what they've done isthey've allowed you to flip the
thumb this way, and you canactually do this now.
Shelly (25:13):
So when you swipe your debit card.
John (25:15):
Right, you can use a credit cards.
You go into, into a parking areaand insert the ticket.
So this function it's reallyimproved a patient's overall
function, but again, we'retalking of of$150 to$200,000 for
the prosthesis.
And it's still TMR.
It's not even neural connectionsanymore.
(25:37):
The awesome with nerve mappingthat, that falls into that price
category.
So it's a little bit costinhibitive at t his t ime as is
osseointegration.
Now that the FDA has acceptedthat the Integrum system has now
been FDA cleared.
So there i s insurance coverage,but it takes a lot of legwork to
(25:58):
get insurance companies to payfor this.
But then once they pay for theimplant, then they still have to
pay for the prosthesis, which is$50,000.
I mean, y ou k now, it's j ust,it's just huge amounts o f
numbers.
But then, I mean, so is medicinetoday, you know, m edicine in
America is t his i s expensive.
Shelly (26:16):
Are either one of these surgeries done in the United
States yet, or no?
John (26:21):
So the neurosurgery at Johns Hopkins has done quite a
bit of the neural surgery byimplanting the electrodes
neurally and the nerve mappingsoftware is also freely
available in America right now.
Shelly (26:37):
This is not done for lower limb prosthetics.
This is just upper extremity?
John (26:44):
Neural implant.
So again, Kaican, he has doneresearch in doing TMR in thighs
and, and they tried to develop aknee that could in fact and a
knee and a foot, a symbioticsystem.
They ordered a symbionic systembecause they need the foot work
in unison with one another.
(27:05):
And they developed a symbioniclower limb part that was
actually activated throughthought.
So the most important part ofthat research was that patients
could actually walk upstairsbecause if they fired the
extensors, the extensors wouldin fact, almost hoist the
(27:27):
patient to the next step.
So in lower limb, it has beendone, but it's still sort of in
the testing stage.
And I'm sure that that, uh, thesame neural electrodes that they
do for upper extremity, they'llmost probably start thinking of
doing for lower extremitybecause with osseointegration
(27:48):
and the electrode can comethrough the stoma, they can
connect to a prosthetic knee andfoot system as well.
So I'm sure that's coming.
Shelly (27:57):
And we have larger muscles in our limbs, in our
legs.
But the problem is it's moreweight-bearing than arm.
Correct?
John (28:05):
Correct.
Yeah.With, with arms the onlytime it would be weight bearing
i s if the patient did p ush-upsor, you know, did exercise
programs, but in most cases it'sreally dexterity in upper
extremity as opposed to weightbearing and lower extremity.
Shelly (28:23):
I wanted to have you explain to our listeners about K
levels, because I know I'm likea K three or four, but a lot of,
especially new amputees don'tknow what K levels are.
So could you explain what Klevels are and why a certain
amputee that's more active wouldbe more appropriate for these
kinds of myoelectronics than,than somebody else?
John (28:47):
Sure.
So the insurance company andmostly Medicare started
categorizing patients into Klevels.
And the reason for that was totry and save money, because if a
patient wasn't going to activelyuse a prosthesiss, then it
(29:08):
didn't make sense to give them amicroprocessor component.
So they categorize patients in Kzero to K four.
K zero means the patient purelyis in a wheelchair.
There's no ambulatory status.
K one, they can transfer fromthe wheelchair to the toilet but
(29:31):
in most cases they stillwheelchair bound, but they use
the prosthesis as a transfercomponent or a tool to transfer.
K2 the patient can ambulate, butwith an assistive device.
So there's always upperextremity support for the
patient to be able to get frompoint A to point B.
(29:54):
K three, the patient can walkunassisted.
The patient can walk on uneventerrain and the patient can walk
at variable speeds.
K four the patient can run,jump, shoot hoops, do what we
do.
There's no limit to what thepatient can do.
So, and then what the, what theinsurance companies did is they
(30:14):
assigned particular groups ofcomponents to these levels.
So, K one, the patient couldonly get a very unsophisticated
door hinge for a knee, you know,that could lock if they needed
to.
K 2, The patients, you know,would get, a non hydraulic non
(30:39):
anything, but then somemanufacturers started bringing
out, not as sophisticated u nitsfor particular K t wo levels.
And they got it p assed.
Y ou k now, for those that don'tknow, everything that we do in
prosthetics is durable medicalequipment.
We are unfortunately not aprofession in this country.
(31:00):
We fall under durable medicalequipment, which means we fall
under wheelchairs and crutchesand everything else.
It's unfortunate, but it's asystem that we've had for 5 0
years when we get to a pointwhere patients can now really,
they are completelyrehabilitated.
They can use the deviceunassisted, they can do whatever
(31:21):
they did prior to theamputation.
Then we get to the K three and Kf our level amputations, which
means that you qualify for muchmore sophisticated and higher
level dynamic activity in thecomponents.
The system is a little bitbackwards t hough, because they
really should havesophistication underneath them
(31:46):
where there's a microprocessorthat can determine whether this
patient is going to fall and,and can do what we call stumble
recovery or s tance flectionfeatures where they actually
hold the patient so that thepatient can catch themselves
before falling down.
Let me tell you something.
If a patient falls, once theyhave lost complete confidence in
(32:10):
that prosthesis,
Shelly (32:11):
It's over.
It's game over.
John (32:15):
It's totally over.
So if you can stop thatcatastrophic incident from
happening, this will be asuccessful patient and they will
rehabilitate and use theprosthesis to the max that they
can.
But you got to give them yourbest shot coming out of the
gate.
The system is a bit backwards,but it is what it is, you know,
and, and it depends on theprosthetist on how he wants to
treat the patient.
(32:35):
If the patient shows that he isable to get to a K three level,
then it would really be worth itfor you as an individual.
Remember my job, okay.
I have to pick a patient up fromhis lowest point in life or her
lowest point in life.
She or he has lost her limb.
They think their life is overand it's up to me to pick them
(32:57):
up and put them back on theirfeet And the better, the job
that I do, the higher, thesuccess rate on that end.
Granted if there's psychologicalissues and the patient just flat
out says, you know what?
My life is over.
There's not too much that I cando.
But if the patient says, listen,I really want to do this.
I just need the right tool.
Then it's up to me.
Shelly (33:18):
Every new amputee will fall at some point.
John (33:22):
Correct.
Shelly (33:22):
And that's just the way it is.
But once they get through thatfear,
John (33:28):
Right.
Shelly (33:29):
You know, and there's the crossroads of, am I going to
pick myself up and dust myselfoff and keep going and get
better?
Or am I just going to go backinto that chair or that bed or
that, whatever and just give up?
John (33:41):
Absolutely!
Shelly (33:41):
And working with new amputees previously it's I think
sometimes more psychologicalthan it is physical,.
John (33:48):
It is psychological, yes, right?
I mean, you came into my officea couple of weeks ago and you
were on crutches because youwere fearful that your
prosthesis was failing.
And yes, it was one bolt thathas failed, but still, there's
an incredible fear that thisthing will just collapse
underneath me.
And I need to get to John tohave this thing fixed ASAP.
So it doesn't matter how longyou've been an amputee.
(34:11):
Whenever you feel that somethingis odd being below you, you, you
need to have it fixed.
Otherwise you're out of sync.
Shelly (34:17):
It freezes you in your tracks.
And I've been doing this since,since I was born, but I think
you had me up and running in anhour.
So I just had a few loosescrews, right?
John (34:27):
Yep.
Yeah, it is screw loose, but,that's, but that's really the
psychological aspect ofprosthetics.
You know?
I mean, you, you have to havethe confidence that this tool,
cause that's what it is.
It really is a tool that thistool will get you from A to B
safely and successfully.
That's what it needs to do.
Shelly (34:49):
Eventually we have to come to terms that you will
eventually decide to retire.
And maybe get caught up on somesleep!
John (35:02):
While Michelle has horses, I'll work until I die.
Shelly (35:08):
You always have a project at the house or on the
barn or in the field.
So, but Darren will take over,your son, Darren will take over?
Most probably.
Yep.
Most probably.
Lastly, I want you to brieflytell us where on social media,
our listeners can find you.
(35:29):
Because we are in everycontinent of the world at this
point.
So we have a broad range oflisteners.
So where can they find out moreabout Prosthetic Care?
John (35:38):
We have a website, Prosthetic Care of Virginia, and
we have on social media, we haveHattingh Inc.
And I normally post stories onthere.
Good or bad.
I mean, if I struggle, I poststories that I'm struggling and,
and trust me, okay, this is themost humbling profession that
anybody can choose because youcan have 10 successful
(36:02):
treatments.
And number 11 will bring you toyour knees! Because nothing that
you do works and you just haveto go in for a walk, shut it off
and start over, and theneventually find the solution.
Thinking outside the box is keyfor me.
But so we have HattinghIncorporated, which is social
media.
(36:22):
And then Michelle has a page,Amputee Help and Support that
has 10,000 members.
And there everybody asksquestions and everybody helps
one another.
So that really works a lot.
And when, and Jesse is one ofthe moderators, and if a
question comes up that I missed,then he'll actually wake me up
(36:43):
and say, Hey, John, can you justtell this person what to do?
And in some cases, patients loseinsurance and they need stuff.
And you know, we get linersdonated.
We, you know patients haveliners at home and they just
send it to another patient onthe page.
So it's a really supportivepage.
Shelly (37:03):
And it's not about how Hattingh prosthetics, it's more
about that virtual internationalfamily.
And that's one great thing aboutsocial media that I didn't have
that growing up.
John (37:16):
Right.
Exactly.
Shelly (37:17):
So we teach, we learn from each other.
We really do.
So it's extremely helpful.
John (37:22):
It really is.
I mean, social media has reallyhelped a lot of patients just by
being able to speak to somebodyelse about it.
Shelly (37:30):
And no amputee would ever disrespect another human
enough to say, do this or don'tdo this.
John (37:36):
Nope.
Nope.
Shelly (37:38):
Okay.
Well with that, I'm going to letyou go, cause I know you have a
patient coming in, right?
John (37:42):
Yes, absolutely.
An out of state patientfinishing off with her today.
Shelly (37:46):
All right.
Well, that's today's episode ofDisAbility Talks.
Thank you so much to JohnHattingh for educating us on
this amazing technology andprosthetics.
Thank you, John.
John (37:53):
Thank you, all the best! Bye!
Shelly (37:54):
And to our listeners.
Thanks for listening and makesure you hit that Like and
Subscribe button so you nevermiss an episode of DisAbility
Talks.
Outro (38:27):
Thanks for tuning in to this episode of DisAbility Talks
want to keep the conversationgoing then visit our website at
Abilities in Motion.org, orconnect with us on social media.
And remember don't dis myability.
Welcome to DisAbility Talks, a podcast produced by
Abilities in Motion.
I'm your host, Shelly Houser.
Join us for real conversationsand no nonsense.
Talk from everyday people withdisabilities, living their most
independent everyday lives.
Tune in for the latest newssurrounding disability,
accessibility and independence,where conversations aren't
(00:25):
dissed and stories that need tobe told aren't missed.
So let's talk.
Shelly (00:28):
Welcome back listeners.
I'm your host Shelly Houser andtoday's guest is prosthetic
genius, John Hattingh, who'soriginally from South Africa.
John and his team now reside inLeesburg, Virginia, where they
create some of the latesttechnologically advanced
prosthetics at Prosthetic Careof Virginia.
Good day, John.
Thanks for being here with us.
John (00:48):
Good morning.
Thanks for having me.
Shelly (00:50):
Absolutely.
Now I need to start with ourlisteners to preface that I
think John is a prostheticgenius because he is my
prosthetist for, I think six,six, seven years?
John (01:10):
Ten years! Yep.
Shelly (01:10):
I forgot how long it was.
Okay.
So I have, I have made friendsthrough this office and we have
a loving community on one oftheir Facebook pages to support
each other as amputees.
John for starters, tell ourlisteners more about yourself
and how you got involved inprosthetics.
John (01:28):
So I'm been in the field for 45 years this year.
I got my Master's inEnvironment, Chemical
Engineering, and one of the,chiefs in charge at the research
center was an amputee.
And that's how I got involvedwith prosthetics.
I did an internship in Germanyand then, w ent back to South
(01:52):
Africa.
I had to go back to school inSouth Africa because in Germany
it's a, it's a technical course.
They call you aOrthopadischemiehankemeister and
in South Africa you had to go toschool.
So al though I had alreadyqualified in my internship, but
when I went back to South Africato go back to school, write the
(02:14):
exams, and we have a medical anddental board in South Africa,
and I ha d t o register withthem before I could ac tually p
ractice clinical prosthetics.
We immigrated in 1990 and ourport of entry was Seattle.
I did research at the Universityof Washington and also, i n
(02:35):
stitution called ProstheticResearch Foundation.
And once that was done, Istarted in as a clinical
prosthetist in a privatefacility.
And we stayed there for 26 yearsbefore Michelle got sick with
rheumatoid and we had to leavethe very cold and wet climate.
(02:58):
So one of the big corporationsbought me and I had a
continental non- compete.
Aft er my non-compete hadexpired, we looked for a climate
that was similar to Cape Town.
And Northern Virginia was asclose as I could get to Cape
Town.
But overall it's not too bad.
Yeah, it's working.
Shelly (03:19):
So Michelle for our listeners is his lovely, very
talented wife who has her ownnon-profit that she started with
her equine therapy, right?
John (03:33):
Correct.
Yeah.
So she rescues horses and thenshe trains them and they become
therapy horses.
And mostly what she does is ifone of my patients is interested
in getting back in the saddle ortrying to get onto the saddle
for the first time, they can goover to the farm and she'll get
(03:57):
them in the saddle and I'lladjust the prosthesis so that it
can accommodate riding and shereally enjoys that.
Shelly (04:05):
I think Michelle rescues every animal that needs to be
rescued.
John (04:09):
No kidding.
Shelly (04:14):
So what are your most unique prosthetics, kind of
prosthetics that you work withis osseointegration.
And I did a little research onthis thing and it seems like
it's new technology for theUnited States, but it's been
developed years ago.
So how long?
John (04:32):
That goes back years in Europe.
I think Invar Brennamar and Ricard Bennamar's father, he did
the first implant.
The first implants were dentalimplants and the dental implant
surgery is huge.
I mean i t, and it w orks sowell.
(04:54):
Dental i mplant surgery has verylittle contra indications
because we've g ot so muchbacteria in our mouth that f
ight any viruses that comealong.
And he did that 50 years ago.
I mean, it's, it's been going onforever.
And then R icard became anorthopedic surgeon and he was g
oing t o work with his dad.
(05:16):
And then, a b ilateralabove-knee amputee from England
wrote him a letter.
And you know, this is about 25years ago.
She wrote a l etter to Ri card and said, Hey, if you guys can do
dental implants, why can't youdo prosthetic implants?
So that's when the pennydropped.
And then Ricard started doingresearch, t hrough his research
(05:40):
company, c alled Integrum.
And she was the first amputeethat they did implant with.
And in fact, she's st illwearing them.
Speaker 1 (05:51):
Okay.
Explain to our listeners whatosseointegration is.
Because I know I have friendsthat have had this done, and I
think you go into the surgerywith the doctor sometimes.
John (06:01):
Sometimes I do.
It's really not that necessary,but it's always just good to see
what they're doing and whatthey're putting in, because then
I have a better clue as to whatI need to do to attach a
prosthesis to the skeletalimplant.
So what they do is there twodifferent thought processes.
(06:24):
The first thought process is theBrennamar procedure, which is a
two-stage procedure.
So what he does is he reams thefemur or the tibia or wherever
they go, they ream, they tap itand then they screw the implant
in with adhesive and then theyclose the surgery back up.
(06:45):
And the patient normally waitsabout three to six months,
depending on the patient'sphysiological c ondition.
And then once the implantsecures into, the long bone.
Then they go back in and theyopen it and they either put the
stoma in or the tapered sleeveor whichever system they use.
(07:07):
And then they bring it throughthe s kin.
And the most important part isthat the soft tissue myodesis
has to be done really well.
So what that means is they isthey have to trim all of the
tissue and fat away from theskin.
They have to anchor the muscleto the end of the bone and they
(07:27):
have to anchor the skin tightlyto the end of the bone.
The first procedure is theBrennamar one, tw o s tage,
normally a t hree to six monthsbefore between stages.
Th e o nce, once th e s tomacomes through the skin, then
they, they have to teach thatbone to do weight loading.
(07:52):
So you don't get the prosthesiscoming out of the gate.
You have to do weight loadingthrough your physical therapy
department.
And they started with 20 pounds.
They increase it by 20 poundsevery week until you can get 50%
of your body weight.
And if you can put 50% of yourbody weight through the bone and
you don't feel pain or discomfort, that's when th e p
(08:14):
rosthesis is attached.
And that's when the prostheticrehabilitation starts.
Shelly (08:18):
How do they attach the weight to the arm or the leg?
Do they hang it off the metalrod that comes out?
John (08:26):
There's a component that we make.
And it's also commerciallyavailable that attaches to the
stoma.
And then we, we make theweight-bearing device with this
scale and then they put pressure, through that pod, into the
implant and they check the scalemeasurement and c ontinue to
(08:48):
stay within the way that theyfeel comfortable.
So, so back up a little bit.
So the other system that isused, that was developed by a
fellow called Munjed inAustralia, and that's the
press-fit system subsequentlyquite a few other companies have
adopted the press-fit system.
The Dutch have adopted it, theGermans have adopted it.
(09:10):
Munjed still everybody flies toAustralia and he does it in
Australia and they fly backhome.
The press-fit system isn't a two s t age s ystem.
They normally do both stageswithin a couple of weeks.
And patients are actuallyambulatory within a couple of
weeks post the second stage.
(09:32):
So those are the two trains ofthought.
They're both efficient, theyboth work well.
It really is just who you preferto have it done with.
The way that you attach itdepends on the implant.
So the Australian system, theDutch system, they have, a
tapered sleeve with a collar.
(09:55):
And there's a, it looks like atube cl amp t hat attaches to
this tapered sleeve.
Shelly (10:02):
Once they're ready for that prosthetic, how does it
physically attach to that rodthat comes out of their stump?
I kind of explained it likeattaching your beaters to your
mixer.
John (10:15):
Very similar.
So this is the press-fit system.
You'll see at the distal end,there's a taper sleeve and then
there's a collar.
And then this is the tube clamp.
It looks like a tube clamp andit just attaches to that collar.
Shelly (10:34):
So that abutments about a two inch steel or titanium
rod.
John (10:38):
Yeah.
And then the Brennamar systemuses what we call an Exor, It's
a breakaway system as well.
So if the patients fell, thisthing can actually breaking in
half and swivel and it doesn'tbend the stoma that goes into
the implant.
And then they have a differentsystem that comes through the
(10:59):
skin and they call it anabutment that comes through the
skin and that Exor actuallyattaches to that abutment.
The advantages of havingOsseointegration is that, you
don't have any socket i ssues.
And we know that that's t he,Alpha and Omega of successful
(11:22):
prosthetics.
If the socket doesn't work, theprosthesis doesn't work.
And patients struggle a ndstruggle And there unfortunately
are prosthetists that just don'thave enough experience to make a
socket that works well.
And therefore, this is a verygood system because you don't
have ever have any s ocketissues.
(11:43):
It connects directly to the, tothe skeletal system and your
skin is always free of anysocket environment.
Shelly (11:53):
And that's good for diabetics.
John (11:55):
It is, but in the same term, it's bad for diabetics
because you always have an openwound.
So you, you always prone toinfections.
And in the majority of failuresof the system is that patients
constantly had chronicinfections and then they would
(12:15):
have the whole thing removed andthey would go back to a socket
system.
Shelly (12:19):
That's a shame.
So let me ask you something.
Sometimes when people gettransplants, they have to be on
medication the rest of theirlife, because their body's
trying to reject it.
Is that the same thing for whenpeople get this kind of surgery
done?
John (12:34):
No, this isn't, this is like your total hip replacement
or your total knee replacement.
Some people are allergic tometal though.
I mean, you've seen so many hipreplacements and knee
replacements that fail wherepatients constantly get
infections because they, theyare allergic to metal.
And certainly there's a smallpercentage of patients that's
(12:56):
just flat out allergic to themetal that protrudes through the
skin.
But in the majority of cases, ifpatients have a sound hygiene
where they wash this in saltwater every day, they, you know,
apply some Vaseline to keep theskin nice and moist and soft.
(13:16):
And, and they watch where theygo.
I mean, you can't go into publicpools.
It's, I mean, it's a bit of aPetri dish, you know, you know,
stuff like that.
I mean, you, you just have to beconscious of your environment.
Then you can keep this thing atBay and sure, some your patients
get infections, but able-bodiedpeople getting infections from
(13:39):
getting a cutting and gettinggerms in it.
So, and wait, they're going on acourse of antibiotics and the
infection is kept at bay.
The biggest issue is when theprosthetist makes the prosthesis
and attaches it to the patient,he has to be sure that there's
always direct vertical loading.
(14:01):
So he c an't get all funny andcreative with the alignment by
putting offset perimits on andmoving the knee out.
And t he, it has to be avertical loading.
If there's an alignment issue,then the patient has to correct
it through muscle t herapy.
So muscle toning and learninghow to walk w here this implant
(14:22):
is really most patients don'thave a problem.
It's just intuitive.
The line of progression of thefemur or the line of progression
of the tibia is normally exactlywhat you need and everything
just falls into place.
The other issue is that patientsc an't be super active because
the stoma or the part that thatcomes through the skin is
(14:46):
sacrificial.
So if patients fall or they, orthey jump off a boulder or t
ruck b ed or something, if theyland o dd, then the stoma will
bend because that's thesacrificial p art and it bends
so that the implant doesn'tfracture the whole femur.
(15:08):
So, so you can't be super activewith osseointegration.
You c an't do the running andjumping that you would have done
had you had a soccer.
But so what?
I mean, you know, that's just,you just have to live with the
limitations of the system.
Shelly (15:24):
Right.
I don't think there's any onetype of prosthesis that does
every single thing you want yourlife to be.
I mean, but it gets us, I think90% of where we want to live our
life.
John (15:38):
True, true.
I mean, if you look at ourParalympic athletes, they have
four or five differentprosthetics that do different
jobs.
If you look at the combatsoldiers at Walter Reed, each
one of them gets four or fivedifferent prosthesis, one for
swimming, one for cycling, onefor running, blah, blah, blah.
But because it's a socketsystem, they can do that.
(16:02):
However, with this system, thereare limitations to the level of
activity and not severelimitations.
You have to comprehend whatyou're going to do next, because
the consequence can be that youend up in ER, and they have to
replace the stoma.
Shelly (16:19):
So somebody with osseointegration, wouldn't be
able to have a cheetah runningblade.
John (16:24):
They can, but they have to understand that it's, it's
purely just a linear loading.
They can't do, they can't do therunning and the jumping.
And the thing that they wouldn'tbe able to do is do a Spartan
race on a blade.
You know, there has to be morestability in the prosthetic
(16:45):
device to be able to do that.
But then it's such a dirtyenvironment that they most
probably wouldn't want to do itbecause they're in mud and they
do low crawls and all kinds ofstuff.
So it's, it's like a toughmutter.
I mean, it's, that's probablynot the best environment for an
open wound.
Shelly (16:59):
It's just asking for trouble I think.
John (17:00):
It really is.
You know?
And I mean, when you choose tohave osseointegration, you have
to understand that those aregoing to be your limitation.
If you want to do that stuff,then you need to stick with a
prosthetic socket.
Shelly (17:16):
Well, with that, I think we're going to take a short
commercial break and we'll beback to talk about
myoelectronics with JohnHattingh.
AD (17:23):
Abilities in Motion is one of Pennsylvania's premier
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Our programs are focused onproviding opportunities for
individuals with disabilities tolive independent,self-determined
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Abilities in Motion, advocatesfor local, state and national
laws that protect the rights ofpeople with disabilities.
(17:44):
We are proud to createinnovative and sustainable
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For more information aboutprograms and services, Abilities
in Motion provides Call(610)376-0010, or visit our website@
(18:10):
www.abilitiesinmotion.org.
Shelly (18:11):
And we're back with John Hattingh, prosthetist from
Prosthetic Care of Virginia.
John, another high-techprosthetic that you work with is
the myoelectronics withelectrical sensors that are
embedded into patient's muscles.
Tell our listeners more abouthow this technology works.
John (18:27):
So previous years we had surface electrodes.
So the mayoelectric systems wereutilized using surface
electrodes.
So we would do a surfaceanatomical and neurological
tests.
We will see where we get thehighest milivolt to contraction
(18:48):
of the muscle underneath theskin.
And then we would coincide thesurface electrode with where
that muscle fires and that gaveus in most cases, it was a two
electrode system.
One electrode was four opening,and one electrode was closing.
And then we, the, the, wedevelop devices that could move
(19:14):
power from one device toanother.
So we called it aco-contraction.
So if the patient's fired boththe muscles and gave both the
electrodes input, then theelectrode would tell the
electronic device to stop thepower from going to the hand and
(19:35):
redirecting that power to thewrist or to the elbow.
But everything worked off twoelectrodes.
So then a guy called Kaican atNorthwestern University
developed a system called TMR,and it was short for Targeted
Muscle Re-innervation.
So when they amputate the limb,the nerves that used to supply
(19:58):
the forearm and the fingers,those nerves are still there.
So what he did is he took thosenerves that were amputated and
he reconnected them into musclelobes into the motor neuron of
the muscle lobe.
And so then you would get aextra nerve input.
And then we could actually go tofour electrodes, but it took a
(20:23):
lot of physical therapy becausethe patient had to learn to
redirect the power from where itused to go to the forearm or the
hand to go to this muscle.
And they had to fire that muscleto be able to run four or even
six electrodes.
So then we would have twoelectrodes for the hand, two
(20:46):
electrodes for the wrist, twoelectrodes for the elbow, and
the patient could actually dosome of the simultanious
function.
So previously he could only doone function at a time.
Now with these four and sixelectrodes, he could operate the
elbow while opening and closingthe wrist or rotating the hand.
So it was a huge improvement.
(21:07):
The problem was this, thephysical therapy to teach the
patient to fire the other musclelobes was really intensive.
And in some cases, patientswould have a wonderful day where
everything works and the nextday they would have it dead day
and they could not make aanything work.
(21:28):
So then a guy, a fellow calledMax Ortiz that worked in
Gothenburg in Sweden, came upwith neural electrodes.
So what they would do is theywould go and find the main
branch of the nerve.
(21:49):
And then what he did, if you cankind of think about it, he would
take an electrode and he wouldroll it up like a piece of
paper.
But what this could do is itcould expand, or it could
retract around the nerve.
So they would, they were goingto do the surgical intervention.
They would open up the nervesheath.
They would put this neuralelectrode over that.
(22:11):
And then the patient couldchoose, thought, have multiple
functions.
But this only work withosseointegration because what
they would do is they is theelectrode would then come
through the middle of the stoma.
And so they would then attachthe arm to the stoma and then
they would attach the neuroconnection to the arm.
(22:36):
And then the patient wouldactually have multiple function
through thought, through realthought.
Because they got in at the, atthe origin of the nerves, as
opposed to at the termination ofthe nerve.
And this was really the start ofneuro electric function.
It's, it's, it's really notmyoelectrics anymore It's neural
(22:58):
electrodes as opposed tomyoelectrics.
So then they started working onmapping and they call it nerve
mapping.
And there's, there's quite a fewcompanies now that have a
software where the software canactually indicate where the
concentration of, of thestimulus is.
(23:21):
And then the whole socket thatattaches to the residual limb
actually has multiple electrodesembedded in the socket.
And then it can pick up a signalfrom anywhere and have multiple
functions.
And now they've actually gotteninto neural attachments in the
brain.
So they go to the absoluteorigin and that gives them the,
(23:45):
to have touch sensation.
So now they can actually feelhot and cold.
They can feel soft and hard.
So this is really the next step.
The problem is that it's soexpensive that unless you become
part of a research program, noinsurance company in America
(24:08):
will pay for this stuff.
Shelly (24:09):
They're not going to touch that.
No.
John (24:12):
No insurance company will pay for this stuff, but Johns
Hopkins has been really on theforefront of this nerve mapping
and they have multiple subjects,you know, that they use to
develop this stuff.
And we're hopeful that as itbecomes more mainstream, that
it'll become easier for patientsto afford.
(24:34):
The terminal devices have becomea lot more intelligent as well.
I mean, you name it.
Everybody has come out with anintelligent hand where we have
multiple finger function.
We have multiple rotation.
You can actually flip the thumband you can now insert a credit
(24:54):
card into a credit card machine,which you couldn't do previously
because you just had thisfunction.
Shelly (24:59):
The pincher function.
John (25:01):
You only had opposition post previously, so you had
multiple finger, but the maingrip was opposition posts.
But now what they've done isthey've allowed you to flip the
thumb this way, and you canactually do this now.
Shelly (25:13):
So when you swipe your debit card.
John (25:15):
Right, you can use a credit cards.
You go into, into a parking areaand insert the ticket.
So this function it's reallyimproved a patient's overall
function, but again, we'retalking of of$150 to$200,000 for
the prosthesis.
And it's still TMR.
It's not even neural connectionsanymore.
(25:37):
The awesome with nerve mappingthat, that falls into that price
category.
So it's a little bit costinhibitive at t his t ime as is
osseointegration.
Now that the FDA has acceptedthat the Integrum system has now
been FDA cleared.
So there i s insurance coverage,but it takes a lot of legwork to
(25:58):
get insurance companies to payfor this.
But then once they pay for theimplant, then they still have to
pay for the prosthesis, which is$50,000.
I mean, y ou k now, it's j ust,it's just huge amounts o f
numbers.
But then, I mean, so is medicinetoday, you know, m edicine in
America is t his i s expensive.
Shelly (26:16):
Are either one of these surgeries done in the United
States yet, or no?
John (26:21):
So the neurosurgery at Johns Hopkins has done quite a
bit of the neural surgery byimplanting the electrodes
neurally and the nerve mappingsoftware is also freely
available in America right now.
Shelly (26:37):
This is not done for lower limb prosthetics.
This is just upper extremity?
John (26:44):
Neural implant.
So again, Kaican, he has doneresearch in doing TMR in thighs
and, and they tried to develop aknee that could in fact and a
knee and a foot, a symbioticsystem.
They ordered a symbionic systembecause they need the foot work
in unison with one another.
(27:05):
And they developed a symbioniclower limb part that was
actually activated throughthought.
So the most important part ofthat research was that patients
could actually walk upstairsbecause if they fired the
extensors, the extensors wouldin fact, almost hoist the
(27:27):
patient to the next step.
So in lower limb, it has beendone, but it's still sort of in
the testing stage.
And I'm sure that that, uh, thesame neural electrodes that they
do for upper extremity, they'llmost probably start thinking of
doing for lower extremitybecause with osseointegration
(27:48):
and the electrode can comethrough the stoma, they can
connect to a prosthetic knee andfoot system as well.
So I'm sure that's coming.
Shelly (27:57):
And we have larger muscles in our limbs, in our
legs.
But the problem is it's moreweight-bearing than arm.
Correct?
John (28:05):
Correct.
Yeah.With, with arms the onlytime it would be weight bearing
i s if the patient did p ush-upsor, you know, did exercise
programs, but in most cases it'sreally dexterity in upper
extremity as opposed to weightbearing and lower extremity.
Shelly (28:23):
I wanted to have you explain to our listeners about K
levels, because I know I'm likea K three or four, but a lot of,
especially new amputees don'tknow what K levels are.
So could you explain what Klevels are and why a certain
amputee that's more active wouldbe more appropriate for these
kinds of myoelectronics than,than somebody else?
John (28:47):
Sure.
So the insurance company andmostly Medicare started
categorizing patients into Klevels.
And the reason for that was totry and save money, because if a
patient wasn't going to activelyuse a prosthesiss, then it
(29:08):
didn't make sense to give them amicroprocessor component.
So they categorize patients in Kzero to K four.
K zero means the patient purelyis in a wheelchair.
There's no ambulatory status.
K one, they can transfer fromthe wheelchair to the toilet but
(29:31):
in most cases they stillwheelchair bound, but they use
the prosthesis as a transfercomponent or a tool to transfer.
K2 the patient can ambulate, butwith an assistive device.
So there's always upperextremity support for the
patient to be able to get frompoint A to point B.
(29:54):
K three, the patient can walkunassisted.
The patient can walk on uneventerrain and the patient can walk
at variable speeds.
K four the patient can run,jump, shoot hoops, do what we
do.
There's no limit to what thepatient can do.
So, and then what the, what theinsurance companies did is they
(30:14):
assigned particular groups ofcomponents to these levels.
So, K one, the patient couldonly get a very unsophisticated
door hinge for a knee, you know,that could lock if they needed
to.
K 2, The patients, you know,would get, a non hydraulic non
(30:39):
anything, but then somemanufacturers started bringing
out, not as sophisticated u nitsfor particular K t wo levels.
And they got it p assed.
Y ou k now, for those that don'tknow, everything that we do in
prosthetics is durable medicalequipment.
We are unfortunately not aprofession in this country.
(31:00):
We fall under durable medicalequipment, which means we fall
under wheelchairs and crutchesand everything else.
It's unfortunate, but it's asystem that we've had for 5 0
years when we get to a pointwhere patients can now really,
they are completelyrehabilitated.
They can use the deviceunassisted, they can do whatever
(31:21):
they did prior to theamputation.
Then we get to the K three and Kf our level amputations, which
means that you qualify for muchmore sophisticated and higher
level dynamic activity in thecomponents.
The system is a little bitbackwards t hough, because they
really should havesophistication underneath them
(31:46):
where there's a microprocessorthat can determine whether this
patient is going to fall and,and can do what we call stumble
recovery or s tance flectionfeatures where they actually
hold the patient so that thepatient can catch themselves
before falling down.
Let me tell you something.
If a patient falls, once theyhave lost complete confidence in
(32:10):
that prosthesis,
Shelly (32:11):
It's over.
It's game over.
John (32:15):
It's totally over.
So if you can stop thatcatastrophic incident from
happening, this will be asuccessful patient and they will
rehabilitate and use theprosthesis to the max that they
can.
But you got to give them yourbest shot coming out of the
gate.
The system is a bit backwards,but it is what it is, you know,
and, and it depends on theprosthetist on how he wants to
treat the patient.
(32:35):
If the patient shows that he isable to get to a K three level,
then it would really be worth itfor you as an individual.
Remember my job, okay.
I have to pick a patient up fromhis lowest point in life or her
lowest point in life.
She or he has lost her limb.
They think their life is overand it's up to me to pick them
(32:57):
up and put them back on theirfeet And the better, the job
that I do, the higher, thesuccess rate on that end.
Granted if there's psychologicalissues and the patient just flat
out says, you know what?
My life is over.
There's not too much that I cando.
But if the patient says, listen,I really want to do this.
I just need the right tool.
Then it's up to me.
Shelly (33:18):
Every new amputee will fall at some point.
John (33:22):
Correct.
Shelly (33:22):
And that's just the way it is.
But once they get through thatfear,
John (33:28):
Right.
Shelly (33:29):
You know, and there's the crossroads of, am I going to
pick myself up and dust myselfoff and keep going and get
better?
Or am I just going to go backinto that chair or that bed or
that, whatever and just give up?
John (33:41):
Absolutely!
Shelly (33:41):
And working with new amputees previously it's I think
sometimes more psychologicalthan it is physical,.
John (33:48):
It is psychological, yes, right?
I mean, you came into my officea couple of weeks ago and you
were on crutches because youwere fearful that your
prosthesis was failing.
And yes, it was one bolt thathas failed, but still, there's
an incredible fear that thisthing will just collapse
underneath me.
And I need to get to John tohave this thing fixed ASAP.
So it doesn't matter how longyou've been an amputee.
(34:11):
Whenever you feel that somethingis odd being below you, you, you
need to have it fixed.
Otherwise you're out of sync.
Shelly (34:17):
It freezes you in your tracks.
And I've been doing this since,since I was born, but I think
you had me up and running in anhour.
So I just had a few loosescrews, right?
John (34:27):
Yep.
Yeah, it is screw loose, but,that's, but that's really the
psychological aspect ofprosthetics.
You know?
I mean, you, you have to havethe confidence that this tool,
cause that's what it is.
It really is a tool that thistool will get you from A to B
safely and successfully.
That's what it needs to do.
Shelly (34:49):
Eventually we have to come to terms that you will
eventually decide to retire.
And maybe get caught up on somesleep!
John (35:02):
While Michelle has horses, I'll work until I die.
Shelly (35:08):
You always have a project at the house or on the
barn or in the field.
So, but Darren will take over,your son, Darren will take over?
Most probably.
Yep.
Most probably.
Lastly, I want you to brieflytell us where on social media,
our listeners can find you.
(35:29):
Because we are in everycontinent of the world at this
point.
So we have a broad range oflisteners.
So where can they find out moreabout Prosthetic Care?
John (35:38):
We have a website, Prosthetic Care of Virginia, and
we have on social media, we haveHattingh Inc.
And I normally post stories onthere.
Good or bad.
I mean, if I struggle, I poststories that I'm struggling and,
and trust me, okay, this is themost humbling profession that
anybody can choose because youcan have 10 successful
(36:02):
treatments.
And number 11 will bring you toyour knees! Because nothing that
you do works and you just haveto go in for a walk, shut it off
and start over, and theneventually find the solution.
Thinking outside the box is keyfor me.
But so we have HattinghIncorporated, which is social
media.
(36:22):
And then Michelle has a page,Amputee Help and Support that
has 10,000 members.
And there everybody asksquestions and everybody helps
one another.
So that really works a lot.
And when, and Jesse is one ofthe moderators, and if a
question comes up that I missed,then he'll actually wake me up
(36:43):
and say, Hey, John, can you justtell this person what to do?
And in some cases, patients loseinsurance and they need stuff.
And you know, we get linersdonated.
We, you know patients haveliners at home and they just
send it to another patient onthe page.
So it's a really supportivepage.
Shelly (37:03):
And it's not about how Hattingh prosthetics, it's more
about that virtual internationalfamily.
And that's one great thing aboutsocial media that I didn't have
that growing up.
John (37:16):
Right.
Exactly.
Shelly (37:17):
So we teach, we learn from each other.
We really do.
So it's extremely helpful.
John (37:22):
It really is.
I mean, social media has reallyhelped a lot of patients just by
being able to speak to somebodyelse about it.
Shelly (37:30):
And no amputee would ever disrespect another human
enough to say, do this or don'tdo this.
John (37:36):
Nope.
Nope.
Shelly (37:38):
Okay.
Well with that, I'm going to letyou go, cause I know you have a
patient coming in, right?
John (37:42):
Yes, absolutely.
An out of state patientfinishing off with her today.
Shelly (37:46):
All right.
Well, that's today's episode ofDisAbility Talks.
Thank you so much to JohnHattingh for educating us on
this amazing technology andprosthetics.
Thank you, John.
John (37:53):
Thank you, all the best! Bye!
Shelly (37:54):
And to our listeners.
Thanks for listening and makesure you hit that Like and
Subscribe button so you nevermiss an episode of DisAbility
Talks.
Outro (38:27):
Thanks for tuning in to this episode of DisAbility Talks
want to keep the conversationgoing then visit our website at
Abilities in Motion.org, orconnect with us on social media.
And remember don't dis myability.
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