Contributing Attorney

Andrew G. Finkelstein

the Topic

Advancements in the Technology of Prosthetics

Trial attorney’s responsibility to catastrophically injured clients includes understanding not just what a client has gone through, but what is available to help improve the quality of their life. This is never more important than when representing someone who is an amputee as a result of a corporation, or one of their employees, choose to violate a common-sense safety rule causing a traumatic event.

Most traumatic amputation clients have no experience or knowledge regarding technological advancements with prosthetics. Often times, an amputee is limited to the limited knowledge of their local prosthetist. The uninformed amputee frequently assumes all prosthetists are the same and offer the same selection of prosthetic devices. Most prosthetists are certified. The main organizations involved in such certifications are the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) as well as the Board of Certification (BOC). The difference between an orthoptist and a prosthetist centers upon the type of device they work with. Orthotist design and fabricate orthopedic braces while a prosthetist custom-fit artificial limbs. Often a prosthetist will design and fabricate their own prostheses for a patient. While this may sound ideal for an amputee, a prosthetist not affiliated with a major research institution or research company will not offer the full range of advance options currently available. It is important the prosthetist working with a new amputee consider a design that accommodates appropriate function and durability while evaluating most aspects of the amputee’s day to day living and using all technological advances available.

Choosing the right prosthetist is important for long term function and regaining the highest possible quality of life post-amputation. It is critically important you are comfortable with the prosthetist as you will be relying upon their advice and guidance during recovery. One simple way to confirm they are right for you is to ask a lot of questions and measure their responses. Do they know the answers quickly? How much experience do they have? Do they limit their offerings to prosthesis they custom design and fabricate or do they purchase prostheses? One failsafe way to evaluate a potential prosthetist is to see if they will refer you to other amputees that they worked with in the past. A sure red flag should go up if they are reluctant to do so. If they do provide other amputees be sure to contact them and confirm the prosthetist provides a broad range of prostheses options. Be wary of the prosthesis who is hyper-technical and speaks in a way you do not fully understand.

All prosthetic devices are not equal.  Some prosthetic devices are rudimentary and are nothing more than a tool. 

All prosthetic devices are not equal. Some prosthetic devices are rudimentary and are nothing more than a tool. Depending on the activity sought to undertake, a particular prosthetic device will suffice. Custom activity-specific prostheses are often designed for more vigorous heavy-duty activities. For the legs, it may be a special running, hiking, golf, backpacking, heavy-duty, or even skiing prostheses. We have all seen the specialty legs used by Professional Paralympic Athletes. Since most prostheses are made for everyday use that does not react well to water, special swim, shower, or scuba legs are used. Any prostheses part made of aluminum or steel will corrode when exposed to water. Custom activity-specific water prostheses are designed to withstand prolonged water, sand, and salt exposure. For the upper body, it may be a prosthesis with a fine dexterity hand for gripping or a simple prosthetic to perform manual labor. They are all substitutes. Substitutes to enhance mobility. Substitutes to enhance functionality. Substitutes to improve the ability to perform the activities of daily living.

Central to the success of an amputee’s use of the prostheses is the fit of the socket. The socket must fit properly and securely. A poorly fitted socket will cause pain and often lead to blistering. Without a properly fitting socket, the amputee will never achieve maximum benefit from the prostheses, regardless of technological advancements with the device. Ultimately, the skill of the prosthetist will result in a properly fitting socket. If your socket routinely is not fitting, it is likely not the prosthetic device and it is more than likely the prosthetist. A good prosthetist doesn’t just get a secure fit initially. A good prosthetist has insight and knowledge of the likely changes that will occur with the stump and makes adjustments accordingly.
Understanding the positive impact of high-quality prosthetic devices is central for trial lawyers representing amputees. We are in the early stages of technological prosthetic advancements. New micro-chips, wired pressure sensors in the fingers of artificial hands to sensory nerves in the arm are being developed and tested in private laboratories and universities around the world. Out front on research includes Case Western Reserve University in Cleveland, Ohio, where advanced studies in artificial limbs are ongoing and Massachusetts Institute of Technology. One of the most exciting advancements in recent years happened at the Rehabilitation Institute of Chicago where researchers confirmed that thoughts controlled a prosthetic leg. A patient was able to move from a seated position to standing, and even climb some stairs, solely in response to neurological signals sent from the brain, to the stump, to the prosthetic device. It is called pattern recognition.

The advancements are not limited to legs either. Pattern recognition and sensory feedback have been central to the research being done in research centers in Italy and Switzerland. At the Ecole Polytechnique Federale de Lausanne in Switzerland, scientists have incorporated technology directly into mechanical tendons. By so doing, fingers feel like fingers to the amputee because the wires in the prosthetic connected to the mechanical tendons lead to electrodes on the sensory nerves of the stump. The sensation travels to the brain providing the sensation of a real hand.

Scientists are tapping into a large number of sensory nerves on the stump by innovating sensory connectors that have computer chips within them. It should not be overlooked that no wires penetrate the skin. Rather, computer chips are affixed to the stump through sensors. The sensors and chips have wires leading to the prosthetic. The integration of such advanced prostheses depends on the amputee mastering mental integration. To increase the likelihood of success, most higher-level institutions encourage the amputee to participate in yoga and sometimes meditation. An amputee must be emotionally ready to control the prostheses rather than the prostheses controlling the amputee.

In addition to many Universities, companies like BionX is a leader in the field of prosthetic innovations and is working on developing intuitive prosthetic legs. The company was founded by a Professor at MIT in Boston where he also directs the Center for Extreme Bionics. What may be unique about the founder is that he is also a double leg amputee. He not only creates the most cutting edge bionic legs, but he also uses them daily. Bionic prosthetic with powered propulsion enables amputees to walk farther and faster, normalize their gait so less stress is placed on the joins and they provide confidence in control to walk over uneven surfaces.

Prosthesis’s advancements are not limited to the device itself. Progress has been made regarding the comfort and functionality of the socket. Technology has been created to use computers to measure the stump. Three-dimensional printing is being used to manufacture the socket so it fits perfectly. The materials used in printing are not limited to the socket. Skin coverings made from silicones, gels, and urethanes are being deployed to protect the friction between the stump and the socket. 

While much of the work currently is experimental and won’t be readily available for five to ten years, trial lawyers must consider all future alternatives for their clients. As an example, when the i-phone came out, there was the 1.0 version. Then the 2.0 was introduced. After the 2.0, Apple was working on the 3.0, 4.0 and was planning the 5.0. If a trial lawyer argues the amputee should only recover the existing available technology, the amputee will be forever limited. Imagine being limited to the i-phone 5 when the i-phone 8 is released. With the typical life-span for prosthetic devices due to normal wear and tear being 3-5 years, the ability to upgrade into the latest technologies is significantly important for the long term quality of life of the amputee. In addition to a limited life-span for prosthetics, prosthetic sockets generally average a life span of only twelve to twenty-four months. Let’s not forget about all of the liners an amputee uses when using their prosthetic device

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The positive psychological impact to amputee’s who transition from phantom pain to actually feeling senses in the limbs has been dramatic. Sensory feedback materially improves an amputee’s ability to do many things, including controlling the prosthetic device itself.

The positive psychological impact on an amputee’s who transition from phantom pain to feeling senses in the limbs has been dramatic. Sensory feedback materially improves an amputee’s ability to do many things, including controlling the prosthetic device itself. No longer do amputees have to watch their prosthetic devices as they manipulate it through whatever task they are undertaking. Once again their thoughts take control. 

Positive psychological outcomes from advanced prosthetic devices are most important because several studies have reported that the risk of death due to suicide is higher for amputees. As a result, a well-informed trial lawyer will consider the long term mental health of the recent amputee. Lifetime mental health support must be incorporated into the lifetime needs of amputees.

While all of these advancements are exciting and offer hope to the amputee, it cannot be overlooked that central to the amputee’s success is their motivation. Many prosthetists utilize a subjective/objective evaluation tool known as the Amputee Mobility Predictor Assessment Tools to help determine the prosthetic designs that will most meet the needs of a new amputee. The evaluation tool is not a stagnant evaluation and may be utilized several times as the stump changes over time.

A trial lawyer experienced with representing amputees will consider all potential technological advancements for further prostheses, emotional care, and support for the amputee as well as both the medical inflation rate and the technological advancement rate. A life care planner knowledgeable about prostheses, sockets, and fittings should prepare a comprehensive life care plan that supplements the prosthetist’s life-time prostheses needs estimates. A Life Care Plan is a dynamic document based upon published standards of practice, comprehensive assessment, data analysis, and research that provides an organized concise plan for current and future needs with associated costs for individuals who have experienced a catastrophic injury. The goal of the life care plan is to assist in maintaining the medical stability as the functional ability to perform activities of daily living decrease with age due to the catastrophic clinical consequences flowing from the underlying injury. A well-qualified life care planner also considers medical necessity to prevent further predictable, but preventable, medical complications. Lifecare planners should consider the following when evaluating future needs for an amputee: Orthopedist visits; diagnostic testing; therapy evaluations; medications, potential surgical interventions, aides for independence; supplies; home health care workers; and home modifications.

The life care planner’s evaluation is based on current costs. Since a trial lawyer must consider the lifetime needs of the amputee, an experienced trial lawyer must also retain an economist to perform an economic analysis using generally accepted economic methodologies to project the future value of the present-day costs outlined in the life care planners report. Generally, the economist will rely upon National Vital Statistics as the bases of their opinion. Central to the economic forecasts is the age of the amputee. Estimation of future life care expenses demands projections regarding both general inflation (i.e. Consumer Price Index (CPI)); and medical inflation. When comparing CPI to medical inflation, an economist will come to the unmistakable conclusion that medical sector costs have been rising at a faster rate than the consumer price index. Additionally, further evaluation of the technology advancement rate of prostheses over the past twenty years far exceeds the base medical inflation rate. As such, sound economic principles require the economist to apportion the life care plan expenses by different inflation rates. Indirect medical services provided as a commodity type service would follow the basic CPI rate. Direct medical services provided by medical providers, therapists, mental health counselors, and prosthetists would increase at the medical inflation rate. Lastly, the prosthetic devices, currently undergoing significant research and development and which will result in materially higher prices, should increase at a technological advancement rate over the lifetime of the amputee.

About the Author

Andrew is a noted consumer activist who represents injured people against corporate wrongdoers or irresponsible parties. Andrew has successfully litigated wrongful death and personal injury cases arising from defective drugs and products, automobile accidents, falls caused by defective conditions, dog bites, bus accidents, motorcycle accidents, construction site accidents and aircraft crashes. He has handled dozens of multi-million dollar cases. Andrew has been appointed to several committees overseeing Nationwide litigation in Pharmaceutical litigation cases. Andrew is a frequent lecturer of Continuing Legal Education courses. Some courses he has taught include “Science in the Courtroom,” “ Technology in the Courtroom,” “Prosecution of a Pharmaceutical Case,” “Ethics of On-Line Advertising,” and “Structured Settlements and the United States Supreme Court Personal Injury Settlement.” In New York, Andrew served as a Captain of the 9/11 Victim Compensation Fund in a pro bono capacity through Trial Lawyers Care. Andrew was later honored by the Association of Trial Lawyers of America for his leadership participation in the program. Andrew received the NYS Trial Lawyers Civil Justice Award in 2006, the NYS Trial Lawyers Presidents Award in 2002, 2003, and 2004. Andrew earned an undergraduate degree from Syracuse University and attended Brooklyn Law for law school.

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