<b><i>Paddy Rossbach, RN, president and CEO of the Amputee\r\nCoalition of America (ACA) knows what to look for in a\r\nprosthetist.<\/i><\/b>\r\n\r\n<img class="" style="float: right;" src="https:\/\/opedge.com\/Content\/OldArticles\/images\/2005-08_05\/Feature_2-1.jpg" width="246" height="268" hspace="4" vspace="4" \/>\r\n\r\nAs a registered nurse, Rossbach is familiar with the healthcare arena, and since 1984 she has specialized in educating, supporting, and advocating for persons with amputations or born with limb differences. She also consults for Landmine Survivors Network (LSN), traveling to its network countries and teaching outreach workers about peer visitation. She has been an amputee since the age of six, but this has not slowed her down. She has competed in marathons, horsemanship events, and she skis and scuba dives. Having studied the effects of an aerobic conditioning program on the energy cost of amputees at The Hospital for Special Surgery in New York, New York, she co-founded and is the president of ASPIRE Inc., a nonprofit organization which encourages young amputees to be active through sports.\r\n\r\n"As an educated consumer, I would look for someone who is\r\ncurrently certified or state-licensed," says Rossbach. "I would\r\nlook for someone with a clean, accessible facility and friendly,\r\npeople-oriented staff." She also would ask to meet some of the\r\nprosthetist's clients who have a similar amputation to see if they\r\nwere comfortable, happy with the care received, and able to have\r\nthe function they wanted.\r\n\r\nHaving a good personal relationship with the prosthetist and\r\nfeeling comfortable and confident with him or her are also\r\nessential, Rossbach believes. "Just because somebody can fit you\r\ndoesn't mean you can have a good relationship with them for the\r\nrest of your life. You have to be able to interact and communicate\r\nwith them and feel they are listening to you. You have to feel sure\r\nthat what they are telling you is correct."\r\n\r\nRossbach is appreciative of the quality of care she has\r\nreceived, but painfully realizes that not everyone is able to have\r\nthe same high standard of care. "Because I've had really good care,\r\nI have been able to achieve what I want to do and stay as healthy\r\nas I am. But I look at some other people and see that they are not\r\ngetting that sort of care, so their outcome is going to be far\r\ndifferent than mine."\r\n\r\n<b>Consumers: Know Your Options<\/b>\r\n\r\nRossbach continues, "Like any other profession, there are\r\nexcellent prosthetists and some that are not so good. That's why\r\nit's so important for patients to make an educated choice regarding\r\ntheir prosthetist."\r\n\r\nRossbach does not agree with the idea of a prosthetist simply\r\nbeing brought into the hospital to fit that patient. "If that\r\nperson is the best one for the job, then that's okay, but if not,\r\nthe patient needs to be aware of their option to have someone\r\nelse." With elective amputations, Rossbach encourages patients to\r\narrange in advance for a prosthetist of their choice. Not only is a\r\ngood patient-prosthetist relationship important, but with the\r\ndifficulties of insurance coverage, if the patient receives an\r\nuncomfortable, ill-fitting prosthesis, he or she may not be able to\r\nobtain another one in a timely way.\r\n\r\nHow common are ill-fitting prostheses? "You just have to look\r\naround at some of our meetings and see some of the prostheses,\r\nwhich are not aligned and fitted correctly," says Rossbach. "You\r\nhear about people that have four prostheses in their closets before\r\nthey finally find someone who fits them correctly and\r\ncomfortably."\r\n\r\nOf course, an enormous limiting factor for amputees is the\r\nextent of their insurance coverage. Prosthetic and orthotic\r\ncoverage often is something people are unaware of until they need\r\nit. "A good facility will be able to give them an answer regarding\r\nwhat their insurance will cover and what they will have to pay\r\nout-of-pocket," says Rossbach. And insurance coverage can be a\r\ndetermining factor in choice of prosthetist-for instance, is their\r\nprovider of choice in or out of the provider network used by the\r\ninsurer?\r\n\r\nOften, amputees find themselves feeling lost, especially if the\r\namputation is a sudden, unexpected one due to accident or other\r\ninjury. Rossbach recalls a time when she talked to an amputee who\r\nwas given no help at all after leaving the hospital. The amputee\r\nlooked for a prosthetist in the Yellow Pages. "That turned out to\r\nbe disastrous," remembers Rossbach. "That is why we are trying to\r\nget our <i>Because We Care<\/i> program into hospitals, so\r\npatients and parents with limb-deficient children will have the\r\ninformation they need at the right time. Thus, they will not be\r\nfloundering or simply going to the prosthetist contracted with the\r\nhospital."\r\n\r\n<b>Prosthetic Parity Laws<\/b>\r\n\r\nThe ACA, along with other advocates, is striving to achieve\r\nprosthetic parity laws in all states. The ACA defines "prosthetic\r\nparity" as "insurance companies covering appropriate prosthetic\r\ncare."\r\n\r\nDiscussing prosthetic parity, Rossbach says, "Right now we are\r\nworking very hard, but it's going to be a very long, difficult\r\nstruggle. It's certainly not going to happen this year." Currently,\r\nthree states have passed slightly different versions of a parity\r\nlaw based on Colorado's experience, and several more are in the\r\nprocess of getting bills introduced, notes Rossbach.\r\n\r\nOn its website, <a href="https:\/\/opedge.com\/72">www.amputee-coalition.org<\/a>, the ACA provides\r\nupdates on what's happening with prosthetic parity legislation in\r\nthe various states and a Prosthetic Parity Law State Organizer's\r\nToolkit, which can be downloaded in PDF format. For more\r\ninformation, visit <a href="https:\/\/opedge.com\/2828">http:\/\/www.amputee-coalition.org\/aca_advocacy_stateparity.html<\/a>.\r\n\r\n<b>Improving Prosthetic Care<\/b>\r\n\r\nTo help elevate the prosthetic profession and standards,\r\nRossbach says, "First of all, I think they need to unify, if they\r\nwant to be thought of as professionals on a level with other\r\nhealthcare providers, and stop fighting amongst themselves when\r\nthey could be spending their time trying to do a better job.\r\n\r\n"There needs to be a better way of assessing their skills before\r\nthey are let out into the field than is being done at present," she\r\nadds. "They need to continue their training; it is a very\r\nspecialized field. It's not just a matter of book learning; it's\r\ndefinitely a very hands-on profession."\r\n\r\n<b>'Team Approach Best'<\/b>\r\n\r\nRossbach is a strong proponent of the team approach to\r\namputation and rehab care. "Each member of the team should\r\nunderstand the role and responsibilities of the others, and someone\r\nneeds to be in charge of the program to see that each part takes\r\nplace, and that a patient doesn't get dropped through the cracks.\r\nEveryone needs to know what everyone else is doing-and that doesn't\r\nalways happen. Sometimes the different disciplines act in\r\nisolation: for instance, the surgeon does his job, and that's it.\r\nThen someone else picks up the physical therapy, and that's the end\r\nfor them. Then the prosthetist works with the patient for awhile,\r\nand then finds another physical therapist to do the gait\r\ntraining.\r\n\r\n"But it should be one long seamless plan of care," she\r\ndeclares.\r\n\r\nRossbach emphatically stresses the need in elective amputation\r\nand, if possible, in traumatic amputation, for the surgeon and\r\nprosthetist to discuss and work together to coordinate surgery and\r\nprosthetic fitting. For instance, she says, "It's too late three\r\nweeks later to say, 'If the limb length were longer or shorter, I\r\ncould put much better componentry on this patient, etc.'"\r\n\r\nThe prosthetists doing the best jobs are the ones who have a\r\ngood relationship with the surgeons who refer patients to them, she\r\nbelieves. "They interact together so that each one respects the\r\nother's job and is able to do a program of care that is best for\r\nthe patient."\r\n\r\nPhysical therapists too need to know enough about prosthetics to\r\nhelp the patient best use their new limbs, says Rossbach. "They\r\ndon't need to know how to build or adjust them, but they do need to\r\nknow when a prosthesis is fitting, not fitting, or needs\r\nrealignment or other adjustment, so they can call this to the\r\nattention of the prosthetist."\r\n\r\nA problem Rossbach see with various members of the rehab team is\r\nthat other disciplines frequently know little about prosthetics.\r\n"Unfortunately, healthcare providers get most of their education\r\nabout amputation in their initial training. Amputees make up a\r\nsmall percentage of their practice, and they don't get continuing\r\neducation in up-to-date technology and techniques." She cites the\r\nsituation in which a new amputee may have a physical therapist say,\r\n"Oh, I'm so happy I'm going to rehab you! I've never rehabbed an\r\namputee before, and this is so exciting for me!"\r\n\r\n"Well, I wouldn't want someone learning on me!" Rossbach\r\nexclaims.\r\n\r\n<b>Encouraging Others<\/b>\r\n\r\nAlthough recognizing current problems in insurance coverage,\r\nprosthetic care, and other challenges amputees must confront,\r\nRossbach is upbeat. She encourages other amputees: "Amputation can\r\neither destroy you or you can make it work for you. You are not\r\ndefined by the fact you have lost a limb. You are defined by what\r\nyou make of your life with what you have."