♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- All right.
- Hi folks.
I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous
physical therapists on the internet.
- In our opinion, of course, Bob.
- See how I emphasized famous on that one?
By the way,
let's talk about what we're gonna talk about today,
How to take care of your prosthesis.
Very informative,
very relevant information
for someone who has prosthesis
- Right? Whether you're may be getting one.
You want this information, a family member,
whatever situations we got experts here.
- Yes we do.
- We have someone who's been
using a prosthesis for
12 years. - 12 years.
- Yep. He does very well.
He is gonna be much better than us.
- Yes.
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- It is.
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If you want a 60 second version of our program.
And Brad, what else do we have?
- We now have podcasts going on
and they're doing outstanding.
Wonderful interviews are going on
from authors, doctors, etcetera.
So check 'em out.
- Real experts in the field, so.
- Not like us.
- Take care.
Okay. Here we are again.
We're talking to Randy and Brandon.
Randy has his prosthesis and his cell phone.
We're gonna talk about the mechanics
and how to care for the prosthesis.
And this is about as update as it gets.
- This is about as cool as it gets.
- Yeah.
- Okay.
A guy like Randy,
he's been an amputee for 12 years
and I've worked with him all throughout that time
and every year or every, you know,
one of the things that's probably interesting to people
is how often do you need a new prosthesis?
- Sure.
- Well, the answer is whenever something breaks
or whenever your limb, your residual limb
that's inside the prosthesis
shrinks up enough to justify a new socket on the top.
- Sure.
- That can vary.
One of the things I tell people,
when we take a cast, a hand cast of their limb,
the prosthesis that we make does not change.
- Sure.
- The only thing that changes
is your skin and your limb inside it, as you use it.
- Right.
- And so we have to be in touch
and constantly making adjustments.
The first prosthesis
will last maybe 6 to 12 months, maybe.
You'll have another prosthesis
that allows maybe one to a year and a half.
- Sure.
- And then from then on out, it's kind of up to the user.
Most people light use, moderate use
are every three to five years.
Randy's kind of every year and a half.
Maybe even every year.
- Every year. Yeah.
- But he pushes the envelope.
His limb is constantly changing.
So we do what we can
with being smart about the socket design.
But we have to keep up with his fitness level,
his activity level.
- Right.
- And it just depends on what people do.
- So you're saying you replace the whole limb
or just from the knee up?
- So let's talk about that.
The most frequent thing to replace is the prosthetic socket.
This is the custom piece that we build.
So as prosthetist, we connect people to the parts.
- Sure.
- From here up is hand built in our office at Limb Lab.
In fact, I make Randy's because he's-
- I told you to.
- He told me to,
so, and I have him help me.
Even sometimes he'll buy me a pizza
and we'll stay late
and we'll laminate the socket, you know?
But from here on down,
we work with, you know
the top six manufacturers in the world.
We have access to every component out there
that's proper for our clients.
This knee is something we buy
from a German based company called Ottobock.
- Okay.
- This is an X3 prosthetic knee,
microprocessor knee, waterproof.
Mud, dirt, anything.
- Yeah, I can go kayaking.
- Go anywhere he wants to go.
He can walk into the water.
He can walk outta snow and mud
down to a forced sensing pylon
that's attached to a prosthetic foot.
And this prosthetic foot is a fiberglass foot.
That's called a dynamic response multiaxial foot.
It's a Maverick foot from a company Freedom.
And now he can walk up and down ramps
with this compliant foot,
this knee that helps him go over
logs in the middle of the woods, heavy grass.
- He helps with everything.
- Whatever he needs.
- So, yeah, Brandon's an avid hunter?
- Randy's an avid hunter.
- I'm sorry.
- I go along with Randy once in a while.
(laughing)
- Well, Brad
most people don't know there's a computer in here.
A battery, have to charge it every five days.
13 sensors,
a gyroscope.
- Whoa.
- So it and knows where it's at in space.
- Yeah.
And there's a cylinder in there too, it looks like.
So that is being controlled by all this electronic.
- Yeah. You know, what's crazy.
So in the old days
there was a hydraulic knee, hydraulic prosthetic knee.
And that would be set up by a prosthetist
to walk at one speed.
- Sure. Yep.
- A person's self selected speed.
Well, if they wanted to walk fast,
it wouldn't quite keep up with them.
- Right.
- If they wanted to walk slow, it would act funny.
So what happened now with a microprocessor knee
is 1000 times a second.
This pylon is communicating the forces in the foot.
- Sure.
- To the knee,
microprocessor control of the hydraulic cylinders
that allow fluid travel
flexion extension of that cylinder, thousand times.
- Is telling the knee what to do.
'Cause there's no muscle there.
- It's telling how slow to make it
how stiff to make it, how loose to make it.
- Yeah.
- It knows if it's going up and down,
forward, backward, side to side.
And it will create the optimal setting
for his walking speed and direction
and incline and decline a thousand times a second.
So it's like having a mini prosthetist in there.
- Sure.
- Controlling those knobs and making it perfect for him.
It's unbelievable.
- So as far as-
Well, is it possible
to go to the point where you could jog a little bit
or is that?
- There is a running point.
- Beyond the point?
- No, this one will recognize.
If he takes off,
it will switch into running mode automatically.
- Okay.
- When you take care of these things
and here's what I was kind of getting to.
The most frequent replacement is a prosthetic socket,
'cause that's the part that connects to the human body.
- Okay.
- Connect the people to the parts.
These components,
all mostly have a three year warranty on them.
- Okay.
- That's kind of the most that manufactures will give.
Certain million cycles or whatever that is.
So these feet and knees will communicate with an iPhone
and tell you.
- Through Bluetooth.
- Yeah.
Tell you when it needs to be sent in for maintenance.
Show 'em how you connect.
- So you just have an app in there for this.
I'm assuming.
- Yep. It's just an app.
You spin the knee.
- Whoa.
- Like that.
This is a great trick for five year olds.
(laughs)
Okay.
When you do this,
five year olds when they're running through church,
you can stop 'em in their tracks
and their moms love that.
- So you have to turn it upside down.
So the knee sends a Bluetooth signal to the phone and says,
"Hey, I want to connect to you."
- Oh, okay.
- And so he has an app on his phone.
This knee has six different modes in it.
Randy has a basic mode, which is a walking mode.
He has a running mode.
He has a cycling mode, a golf mode,
cross country skiing and table tennis.
- Wow.
- He uses table tennis quite a lot.
But all you have to do is select the one you want.
So let's show 'em how
that kind of works. - So it's connected now?
- It's connected. - Okay.
- And you can just by clicking, change it.
So just stand up,
just show them the stiffness of the knee and basic mode.
So you see how there's resistance
in that hydraulic cylinder?
Now watch.
- It's flexing.
Yep. Almost need a profile to really see it.
- It's moving that hydraulic fluid
at a certain rate. - And then if you really wanna
mess with him, we change it to bicycling.
When you sit on a bicycle
you just want it to go into free swing.
So hold my shoulder if you need to.
It's gonna beep and now when he picks it up,
move it back and forth.
Look at that.
- Kinda like a pendulum.
- Yeah.
- It just swings.
- It just a fancy hinge.
- Sure.
- One of the things I think,
do we have golf set up for your walking through the weeds?
- Yes.
- Okay.
So now as he's plowing through tall grass
- Now it will only-
- It locks.
- It'll only move so far
- Right there. Try and bend it.
- Oh yeah.
- So he can hammer through tall weeds and things.
- Yeah.
It gives me a little bit of flexion to get going.
But then when the weeds grab my toe,
I can just pull it through.
- Okay. Yep.
- And so go back to basic mode.
Great.
One thing I wanted to show on this
is there's a little information button here
and it says,
"Hey, this component requires maintenance.
It can be used without restrictions.
Please contact your O and P professional."
So after this session today,
we're gonna go back to Rochester
and I have a loaner knee coming from Ottobock
and we're gonna swap it out,
send his in for maintenance
and he'll go live his life with a loaner unit.
So he is never without a component.
- So does it say what the problem is?
- It's set up for,
this is a regular maintenance schedule.
- Okay.
- There is no issues.
It's not detecting any issues.
So it says,
"You're free to use it without restrictions
but we need to send it in
'cause the time has elapsed.
- Just like an oil change on your car.
- Yep.
- Sure.
Is there any maintenance that you have to do
with this, you know, from the knee down?
- Just keep it clean.
- Okay.
- You know, if I go out to beach,
you gotta make sure you don't get too much sand in it.
- Yeah. I can imagine.
- Though the water is fine.
- Think they're your feet too.
Right? The foot shells.
If you go into mud and snow and dirt and sand
spray those things out, pop the foot shell off,
spray 'em out with some hose, if you can.
- That's what you do?
You just use a garden hose or?
- You can.
- Can you use a air compressor
to blow some of that debris out?
- Yeah.
The foot shell, when I kayak
the foot shell would gather water.
Right.
There's a plastic shell around the foot and-
- Let's show him.
- Okay.
- Yeah. I was kind of curious to see
what's underneath that hiking booth.
- When you come out of the water
the plastic shell is full of water
which makes your foot quite a bit heavier
Which the knee goes,
"I have no clue what's going on.
What's what's happening?"
- Show 'em how you take that foot shell off.
- So then you just grab it.
- Yep.
- Like this,
stretch it and pull it off.
- Wow.
- You can't do that at home.
I don't think.
- Take this off.
- So this is a,
there's no hydraulics or anything below the ankle.
It's just, is that fiberglass?
- It's a fiberglass blade with the ability
for inversion and eversion.
So stand up and just kinda show 'em how that twists.
- It's split down the middle.
- Yeah.
- So that allows that, like you said,
inversion of different weight, bearing angles and whatnot.
- Yeah.
And if you look it has little heel shock here
this J curve gives him some kickoff when he-
- Yep.
- Yep. When he steps on it.
- That's a little shock absorbing two on heel strike.
Sure.
- Squish, can you squish the heel?
Yeah. There you go.
- So we're looking at a little bit.
It's pretty subtle.
I don't know if you'll see it on the camera
but that little bit of shock absorption
I'm assuming is pretty big for you.
- It's very big.
Everything that your foot hits,
translates right into your femur.
- Sure. Right.
- Because right, this is all mechanical.
You don't have the cartilage
and all of those things in your normal God given leg.
- So this is as much,
this doesn't come apart.
There's no plates or anything to keep clean or?
- This is a protective rubber cover on there.
You can pop that off too.
- This is actually a wonderful thing, this cover
because I can sit on my knees,
like doing a deck, redoing a deck board.
I can be on this knee and it doesn't ever hurt.
- Oh, oh sure.
Yeah. There you go.
- So there's the chassis of the microprocessor knee.
It's carbon fiber.
- Yeah. Yeah.
That's absolutely.
- And it's got a little heat sink.
- And every night-
- There's a battery in this?
- He plugs it into a magnetic charger right here.
- Yeah. So that's good for every day you have to recharge?
- You don't have to.
What's the longest you went without?
- The battery is rated for five days.
- Okay.
- And of course it's about how much you use it. Right.
- Okay.
So if you use it a lot,
I typically will charge it every third to fourth day.
- Okay.
Does it matter?
Like what terrain,
if you're walking on a hiking where it's uneven,
does it wear the battery on quicker?
- It does.
- Versus a flat?
- Yeah.
It's just like your regular muscles.
The more you use it, the harder you use it
the more the battery is drained.
- So you walked down to the bottom of the Grand Canyon.
- I did.
- Did you wear out your battery or did you?
Did you get the Grand Canyon?
- [Participant] It's just started about that.
- Nine seconds.
- Okay.
So you went down to the bottom the Grand Canyon?
- I did.
- There's not outlets to charge.
Did you make it down and up with one charge?
- No, I did not.
I actually built a solar charger for it.
- Oh.
- So he's a kind of a smart engineer type.
- Electronics kind of guy.
And so I built a solar charger.
You can buy one, but why buy one when you can build it?
- Anybody can do it that way. Right
- Right, so.
- This is my kinda guy.
(laughs)
- And it's fun for me.
I know it sounds weird, but it's fun.
- Yeah.
- So I built a solar charger and a backup battery
and I carry that with me.
And we spent a full day, rest day down in the canyon
and I let it charge up then.
- Okay.
There's enough sun down there and?
- There's enough sun and the battery.
And I got about a three quarter percent charge,
75% charge on it, down at the bottom,
which is enough to get out.
Which is what I wanted to do.
- Like you said, they're available on the market.
You could buy 'em you don't have to go in your garage
and have fun like that
- Yes, you can.
- Another thing I talk to guys like Randy
or people that are up and about with their prosthesis
how to take care of this thing.
It's using your ears.
Listen for any weird sounds that happen.
If there's a little click or a little, you know
grinding sound or-
No, his hearing isn't the best.
So sometimes you have to maybe ask a friend.
- Yeah. Okay.
I'm an old guy
- Do you hear anything going on with my leg?
And usually it sounds like that
little clicking metal sounds aren't good.
So contact your prosthetist, go in.
They'll take a look.
All these connectors have lock tight on 'em.
They get torque to a specific tension
and those need to stay all fully functioning
for these types of prosthesis to work well together.
- So Loctite is a fluid that you put on there.
So it drys, cures
it's anaerobic actually.
And it locks in tight
- And it stops the threat from backing out and coming loose.
- So it's fun to get those loose in I suppose.
You use a Threadlocker.
- We use a Threadlocker, the blue stuff, not the red.
- Right.
- When I was a mechanic, we used that all the time.
So yeah.
We're talking my language.
These guys are fun.
- Yeah.
You know, it's kinda like-
- I might be a good orthotist or.
- You would be an excellent orthotist and prosthetist.
- Prosthetist, I'm sorry.
You know,
what do you tell people being a prosthetist?
Well, what I tell people is
if you like solving problems
and you need to be half mechanic,
half a psychologist,
half artist, and half what's the other one?
- But Brandon that's four halves?
- I know. That's right.
That's right.
- I'm a math guy.
Explain that to me.
- And really,
do you pay much attention
to the inside of your prosthetic socket?
Do you ever clean it out?
Maybe once in a while?
- Not really.
- Yeah.
- I mean, I'm in and out of water and stuff.
- Yeah.
If it's dirty or there's stuff on it, you know,
from whatever you-
- I brush the dirt out, you know, when I fall.
- Yeah. Right.
So you wanna keep things generally clean.
The level that you're allowed to keep things clean
with the type of mechanism that you have
at a knee or a foot.
You know,
if they're allowed to be sprayed with water,
spray with water.
If they're allowed to be, you know
blown off with air, do that.
But the general thing is to wipe clean
with like rubbing alcohol
or some sort of evaporative you know,
solvent of some sort,
clean out the inside of your socket
and just keep things looking nice.
If you can keep dirt and grime and sand
away from different sorts of moving part
you'll get the most out of
a lifetime of your prosthetic device.
- Wonderful. Excellent.
- Do you wanna try putting it on?
- No, no, because, you know
people are already falling asleep listening to me.
Anyways, it's about time.
We've got another video to do.
- Okay.
- Yeah.
'Cause you're gonna learn,
you're gonna teach us how to fall, I understand.
So I'm kind of excited to get to that.
- Okay.
- So very good.
Thanks for listening.
I hope you had a good educational experience with us
and we'll see you on the next video.