Driving with a Prosthetic Leg

Many people wonder if it’s possible, driving with a prosthetic leg after undergoing an amputation. Limb loss (amputation) affects the ability to control a vehicle. Depending on upper or lower limb amputation, it can affect usage of the steering wheel, controls or pedals, or even your stability in the vehicle. You must be assessed for the level of impact, which will determine the conditions on your license, any vehicle modifications, or additional training with a rehabilitation driving instructor to enable you to drive. Below is some general information to get you started on the journey to get back on the road.

Can you Drive with a Prosthetic Leg?

man driving with a prosthetic leg

Steps to take:

It is a legal requirement that you notify the transport authority in your state or territory of any change in medical condition or surgery that affects your driving, including an amputation where you find yourself driving with a prosthetic leg.

The driver licensing authority in each state and territory has slight variations in its policies and standards. The standards apply to private, commercial, light, and heavy vehicles and motorbikes and you may need to complete multiple driving tests.

To be able to drive a vehicle you must complete a variation of the following steps based on your state/territory:

Make an appointment with your doctor/GP
  • They will need to provide a complete medical record.
  • Fill in any forms from your state/territory authority.
  • You may need additional medical reports from specialists.
Complete off-road assessment
  • Including asking you about your driving and medical history, testing your knowledge of the road rules, and assessing visual, sensory, and thinking abilities.
Complete occupational therapy driving assessment
  • Health professionals such as an accredited occupational therapist assess a patient’s medical fitness to drive to advise the driver licensing authorities about how the patient’s health and medical conditions might affect their driving ability.

(AFTD Guidelines have basic standards for each states process).

User Ability & Car Modifications

Depending on the user’s ability, you can drive a car with the original pedals if you have had a lower limb amputation.

  • You will need to learn how to manoeuvre your limb differently and this may also be dependent on the sensation in your limb for feedback.
  • As you can no longer move your ankle joint you will rely on feedback from your residual limb and proprioception (the feeling of where your limb is in space).

Features of your prosthesis are also important:

  • You should speak to your prosthetist about wanting to drive as they may need to consider this in the componentry used for the prescription of your prosthetic limb.
  • Adaptive equipment can also be installed in many vehicles.
  • Hand-operated brake and accelerator, automatic transmission and height-adjustable seats, etc.
  • Modifications enable many drivers with impairments to operate vehicles safely.
  • Power steering makes driving much easier for upper limb amputees.

License Conditions When Driving with a Prosthetic Leg

You may have a license condition that states you must wear your assistive device, only drive a specific vehicle or you can only drive an automatic vehicle.

Please contact your local state or territory for further information, alternatively, you can contact your state’s amputee association for guidance.

 

Written by:

Darrel Sparke, President of Amputees NSW.

APC would like to thank Darrel Sparke, for collaboration in writing this resource article.

Content created and adapted from:

 

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Myoelectric Prosthetics

Myoelectric prosthetics (prostheses) differ from other upper limb prosthetic options in the way the terminal device (e.g. hand or hook) is controlled (open and closed). While other styles use harnessing and gross movements of the shoulder, myoelectric prosthetics use the movement of residual limb muscles to control the myoelectric hand. This is done by sensors placed within the socket that detect muscle movements and intuitively create movement at the hand. A benefit of a myoelectric prosthetic device is that they have a much more natural, intuitive way of using moving a prosthetic arm.

There are different types of myoelectric terminal devices that can be used, depending on the needs of the user and their ability to operate the various functions.

Single Grip Terminal Devices

These are simpler myoelectric devices that allow the opening and closing of a single grip position. These could be either a hand or a hook, depending on the users’ needs and requirements. In general, a hand is for lighter-duty activities and a hook would be used in heavier-duty and dirtier environments.myoelectric prosthetics

Multi Grip Devices

These are more sophisticated myoelectric devices that offer multiple grip positions. These always take the form of a hand and use a combination of thumb rotation and varying uses of fingers to allow various grip patterns.Myoelectric hand

Myoelectric Prosthetics Control Strategies

There are different control strategies that can be used in a myoelectric prosthetic arm. These are dependent on the users abilities and available funding.

  • Single Site – as the name suggest this uses a single sensor to detect and initiate movement of the myoelectric hand. this is the simplest form of control
  • Dual site – This uses two sensors to allow voluntary opening and closing of the myoelectric hand. This can also be used to adjust the grip when using multi-grip devices. This is one of the more common control strategies used.
  • Pattern Recognition – This uses a series of up to 8 electrode channels and allows recording/training of muscle movement “patterns” to create the various movements of the multi-grip terminal device. This also allows more intuitive use of powered wrists and elbows.

As with any prosthesis it’s helpful to have a conversation with your prosthetist to figure out what is appropriate for you and suits your needs. Get in touch with our friendly team below through our contact form and we’ll help you in any way we can.

Myoelectric grip options

 

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Support for Amputees

What support is available to amputees?

Whether its practical advice for new amputees, finding an amputee support group to connect with, or navigating the funding system, access to quality services and support networks is paramount for amputees. You can find a list below of amputee associations and amputee support groups that provide relevant information for new amputees and ongoing support throughout your life as an amputee. Here you can find prosthetic advice, peer support, health resources, funding information, prosthetic service information and more!

Amputee Support Groups/Associations

  • Amputees NSW – A non-for-profit amputee association, recognised by NSW Health, that provides a comprehensive range of support services for all people affected by amputation and limb differences. Amputees NSW provides support for individuals, families, schools, allied health professionals, government agencies, interstate support groups and the broader community.  www.amputeesnsw.org.au
  • Limbs4Life – The peak body for amputees in Australia with the vision of providing information and support to amputees and their families, while promoting an inclusive community so that no person is going through limb loss alone. www.limbs4life.org.au.
  • Limbs4Kids – A national program that supports parents of children born with limb deficiencies and children or adolescents who undergo an amputation early in life.  www.limbs4kids.org.au.
  • National Disability Insurance Scheme (NDIS) – The NDIS is an independent Australian Government statutory body that funds costs associated with disability and providing the necessary ongoing support for Australians who acquire a permanent disability before the age of 65. www.ndis.gov.au.
  • EnableNSW – A state-wide service of HealthShareNSW that provides assistive technology and related services to people in NSW with specific, short term or ongoing health needs to assist them to live safely at home. www.enable.health.nsw.gov.au.

Amputee support groups in Australia

APC Prosthetics is a certified registered NDIS provider.

For more information regarding Prosthetics please head to our resources section found here.

What Materials are Commonly used for Prosthetics?

The prostheses that are delivered to our clients are broken down into two groupings of prosthetic materials. The top of a prosthesis is a custom manufactured socket which is fabricated onsite within the APC prosthetic workshop. Moving downwards on the prosthesis is the second grouping of materials including structural components, prosthetic joints (i.e. hands/feet) and everyday consumables (i.e. liners/knee sleeves). These are always client-specific and ordered from a variety of prosthetic wholesale providers around the globe. Read below to find out further information on these materials used for prosthetics.

Materials used for Prosthetics

1. Prosthetic Sockets

Diagnostic Socket

To begin the journey of a definitive prosthesis, our clients are initially fit with a ‘Diagnostic Socket’ which is manufactured from their plaster cast. The primary aim of this socket is to optimise the socket fit, refine the alignment and ensure the prosthesis absolutely meets all necessary functional and comfort goals.

Materials Used for prostheticsA diagnostic socket utilises materials in prosthetics which are suitable for a short-term trial period. These include thermoplastic sheets which are heat blistered and vacuumed onto the clients plaster cast. Following this step, the socket is attached to a lamination anchor which provides the connection between the custom-manufactured prosthetic socket and the remaining prosthetic componentry (ie. Prosthetic foot). To ensure safety and security, the anchor is secured to the socket. This can be done in a variety of ways from wrapping it in a fibreglass bandage, laminating carbon fibre or fibreglass over it. Once this is achieved, the diagnostic socket is ready for a short trialling period!

 

Utilising a rigid thermoplastic is beneficial in two ways. Firstly, it allows for reheating and adjustment so that pressure areas can be relieved. Secondly, the clear plastic allows the prosthetist to inspect the fit across the entire residual limb whilst the prosthesis is donned.

Definitive Socket

Once the prosthetic socket fit and alignment have been optimised, the diagnostic socket is ‘duplicated’ creating an identical plaster mould which allows our client to continue to wear their prosthesis whilst an APC technician concurrently manufactures their ‘definitive socket’. In addition, the duplication process allows for an identical alignment to likewise be captured which streamlines the definitive fitting process and removes the need for major alignment adjustments.

The materials used for prosthetics and the definitive socket vary considerably depending on the client’s presentation, suspension method and socket interface. Irrespective of these variables, all definitive sockets will undertake at least 2 separate laminations, they can manufacture with a single lamination however 2 is more common with varying amounts of prosthetic materials.

The plaster cast will be first either sealed with lacquer, a compressible liner, PETG or a flexible inner depending on what the prosthetist has deemed most suitable to the client. Next, a client-specific amount of carbon fibre, aramid fibre or fibreglass braid/matte is laid onto the socket and reinforced with unidirectional carbon fibre tape. It’s then sealed under vacuum with an acrylic resin which penetrates and solidifies the material. The initial lamination is focused on creating a strong, structured framework.

As the alignment has been duplicated in a jig transfer, the lamination anchor is attached in a similar process to diagnostic sockets. However, for the fabrication of the definitive socket, a great deal of detail and attention is paid to create a cosmetic appearance with the use of foam and putties.

The second lamination utilises similar materials to the first, however, its focus instead shifts towards strength and security of the lamination anchor to the socket. Importantly, each lamination is completely different because every client presents slightly differently in terms of, mobility, weight and intended activities (such as running).

Specialised Sockets (Design)

Many clients opt for a specific design to finish their prosthetic sockets ranging from Indigenous Art to sports teams – there is such a variety! Clients are encouraged to bring in fabrics, old t-shirts or designs which they desire on their final socket.

Specialised Sockets (Waterproof)

As an Island Nation with blistering summers, waterproof prostheses are essential! The lamination process is largely similar; however, it includes two additional laminations to finish with a cosmetic appearance which reflects the sound side limb. The APC technician precisely shapes foam around the socket according to the client’s measurements. This process removes the need for standard tube clamps and pylons which rust in water-based environments.

Specialised Sockets (Cosmetic Finish)

Similarly, to a waterproof prosthesis, a cosmetic finish utilises a foam which is shaped by an APC technician according to client measurements. Tracings of the sound side limb can be taken to ensure the prosthesis is as aesthetically appeasing as possible.

Specialised Sockets (Recreational)

Recreational socket materials used for prosthetics

The initiation of the National Disability Insurance Scheme (NDIS) has allowed many clients the opportunity to explore a recreational prosthesis such as running blades, rock climbing arms/legs, weight-lifting arms, surfing legs, cycling legs and many more. The custom design and materials used in prosthetics, allow for many recreational prostheses to be achieved.

Final and definitive prostheses reflect the great deal of detailed hours undertaken by both the prosthetist and technician to create custom-manufactured prosthetic sockets.

2. Prosthetic Componentry

Underneath the prosthetic socket is the second grouping of prosthetic materials – componentry. These are manufactured on a large scale by prosthetic wholesale companies across the globe producing materials in prosthetics such as feet/hands, connective componentry, pins/locks, valves, pylons, adaptors, liners etc.

Importantly, despite being mass-produced, the prosthetist orders componentry which specifically meet a client’s presentation, goals and intended activity. For example, one prosthetic foot may entail up to 10 different weight categories, it’s essential to obtain the current category for the client to ensure the best possible outcome.

I. Feet

  • Wood, plastic, and foam are usually materials used in prosthetic feet designed for individuals who have low activity levels and require stability
  • Carbon fibre feet is also one of the materials used in prosthetic feet designed to meet one’s functional needs for shock absorption and energy efficiency

II. Connective Componentry

  • Aluminium, stainless steel, carbon and titanium are materials used in prosthetic connective componentry.
  • Standard adapters are used to build the prosthesis, connecting the socket to a prosthetic joint and/or to a terminal device/foot.
  • Functional adapters such as torsion and rotation adapters help make every day and/or recreational activities easier for patients by expanding the abilities of their prostheses.

For more information on materials used for prosthetics please get in contact with the team below!

 

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Care for your Skin

How to clean your residual limb

Being a new amputee now requires you to take care of the skin on your residual limb. We have created a simple 3 step process that shows how to best clean your residual limb. A combination of washing the limb with soap and moisturising the limb regularly will not only make it easier to wear your prosthesis, but will also reduce the frequency of rashes, bacterial infections etc., from appearing on your residual limb. For more information about other skin issues, please download the Residual limb care guide at the bottom of the page.

Step 1: Wash with a mild soap (pH = less than 7)

Step 2: Moisturise after wash to prevent dryness. Only apply moisturiser in the evening.

Tip: If you are a new amputee or have high volume fluctuations in your limb, it’s recommended to shower at night. The heat of the shower and your limb hanging down can make it harder to don your prosthesis in the morning when most users experience their highest volume of the day already. Give it a go!

Care for your Prosthesis

Upper Limb (UL) users: Your socket should be cleaned weekly. You should regularly clean the hand and/or cosmetic glove.

Transtibial (BK) users: Your socket should be cleaned weekly.

Transfemoral (AK) Users: Your socket should be cleaned daily.

 

How to clean your socket & components

When cleaning your socket, wipe your socket with a damp cloth and a mild detergent and dry it thoroughly before you put it back on. It is not necessary to use an antiseptic to clean your socket.

Tip: Never use Dettol or other solvents to clean your socket or liner.

 

Wet/Dirty Prosthesis: It’s important to clean the components as well as the socket. Tip your prosthesis upside down to empty any water out of the foot shell. Use a shoe horn to lever off the foot shell. Remove, clean and dry the spectra sock (nylon sock between the foot shell and carbon fibre foot). Rinse out and dry the foot shell. Put the spectra sock back over the carbon fibre foot and use a shoe horn to reattach the foot shell.

 

Cosmetic Cover: If you have a cosmetic cover, it is important to keep this clean as well. A hard cover can generally be cleaned in the same manner as your socket. A soft/foam cover with stockings – you can wash the stockings as you would any hosiery/delicates. Wipe the foam with a slightly damp cloth and allow to dry before redonning the stockings.

Tip: Remember, keeping your prosthesis clean and drying after getting wet is crucial for maintaining longevity of the components and preventing rust or damage.

New Amputees

New Amputees Treatment

The amputation of a limb for new amputees is a life changing experience, and the requirements of each client are different and will change throughout their life.

Our philosophy is to work with new amputees to comprehensively assess their needs, establish their requirements and then deliver the appropriate solutions.

All of our clients’ needs are unique, so our highly experienced prosthetists work closely with multidisciplinary health professionals to establish a customised treatment solution for each of our clients. The team includes Medical Specialists, Physiotherapists, Occupational Therapists and other health professionals.

APC Prosthetics has a strong support system to assist clients in challenging situations and work closely with Government/Health authorities and national professional bodies including EnableNSW, DVA, the NDIA and AOPA. We also maintain close relationships with global prosthetic technology groups, which allows us early access to the latest technological developments in both prosthetic components and manufacturing technology.

At APC Prosthetics, we are dedicated to achieving the best outcome for our clients, aiming for the best possible comfort, the best possible function and the best possible lifestyle.

Treatment Pathway

Interim Prosthesis:

The first phase of the prosthetic rehabilitation is the provision of an interim prosthesis. This generally occurs approximately 6 weeks after amputation when the suture wounds have sufficiently healed. The aims of the interim prosthesis are to establish early mobility and commence gait re-education as early as possible.

After a comprehensive assessment with the rehabilitation team, the rehabilitation specialist issues a prescription for the interim prosthesis. The prosthetist will then take a plaster cast of the residual limb, which is called a plaster negative. The plaster negative is then used to make a replica of the residual limb, which is modified to achieve a comfortable socket. The socket is then moulded over the plaster model.

Various liner materials are used to act as a cushion between the socket and the residual limb, absorbing and dissipating shock, shear and torque forces that occur during walking and standing on the prosthesis.

Next, the prosthetic components are connected to the socket and the client returns for their first prosthetic fitting. During this process one of our highly skilled prosthetists assesses the socket-fit and analyses gait to determine optimal alignment. The correct alignment of the prosthesis is essential to ensure maximum comfort and function.

You can expect regular modification to this first prosthesis, as the residual limb undergoes significant changes in shape and volume during the first months. After approximately 3 to 4 months the prosthetic interim socket will be replaced with the first definitive socket.

Definitive Prosthesis:

For your first definitive prosthesis, the prescription process is then repeated (dependent on your funding body, eg EnableNSW, NDIS, Insurance, etc.). The prosthetist will take a new cast of your residual limb and the manufacturing process begins again. The materials used to manufacture the definitive socket include fibreglass, carbon fibre or specially designed plastics. Utilising the latest manufacturing technologies and high-tech materials ensures a durable and extremely light socket.

The prosthesis is trialled for several days. It’s important you trial the check socket in as many real-life scenarios as possible in order to give your prosthetist quality feedback on the suitability of the fit and function. After the successful completion of the trial period, the prosthesis is cosmetically finished, to deliver a pleasing aesthetic result.

As the shape and volume of the residual limb will change over time, it is very important that the client sees their prosthetist on a regular basis (every 3 to 6 months), to ensure the socket is still fitting properly. Sometimes it is necessary for the prosthetist to make adjustments to the prosthesis to compensate for any changes. However, if the changes are too significant, a new socket (socket replacement) might be required.

Ongoing Care

Physiotherapy:

Physiotherapy is a vital factor throughout the entire rehabilitation process for new amputees, including muscle-strengthening exercises and gait training. Your amputee clinic will have onsite physiotherapists who specialise in amputee gait training, and APC also offer specialised Physiotherapy sessions in our modern and fully equipped gymnasiums tailored to the individual needs of each client.

Funding for your Prosthesis

Depending on your individual circumstance, your prosthetic care will be funded by one of the following funding bodies:

EnableNSW

EnableNSW – Prosthetic Limb Service provides funding for a basic prosthetic limb to all eligible amputees. Residents of NSW are eligible for admission to the PLS, provided they hold a valid Medicare Card. If you would like to find out more about the PLS please click on the following link:

http://www.enable.health.nsw.gov.au/services/pls

NDIS

The National Disability Insurance Scheme provides funding for eligible amputees under the age of 65. The team at APC Prosthetics have vast experience in navigating this scheme to ensure our client’s prosthetic care is optimised. See our guide here.

If you would like to find out more about the NDIS please click on the following link:

https://www.ndis.gov.au/

Insurance Clients

Patients with an insurance claim will be assessed comprehensively by a multidisciplinary team to determine the prosthetic management plan.

Once approval has been granted by your case manager, we will commence the prosthetics treatment immediately.

If you would like to find out more about this, please contact your case manager or alternatively, contact APC.

Private Clients                                                      

APC Prosthetics is Australia’s leading private prosthetic clinic and provides comprehensive services to private clients.

Private clients are free to determine what prosthetic technologies they wish to incorporate in their prostheses without restrictions. The specialists at APC are happy to provide consultations and advice without any demands or commitments to our clients.

Please feel free to contact APC if you wish to review your current and future treatment options.

Comfort, Function & Lifestyle – The APC Philosophy

At APC Prosthetics we are committed to providing our patients with the best possible outcome. We are focused on achieving maximum comfort and function to allow our patients the best possible lifestyle.

There are two essential factors to achieve comfort

  1. Socket design and fit
  2. How the forces are absorbed by the stump/socket interface

Socket design and fit revolve around correctly determining the shape of the prosthetics socket and successfully distributing forces created when you are walking or standing on your residual limb. The appropriate socket design and liner material is determined by a skilled Prosthetist to ensure optimum socket comfort.

The keys to achieve best possible function are a comfortable socket, selection of the right components and the correct alignment of your prosthesis.

The selection of the appropriate components is a very important factor to achieve a successful outcome. Because most components are designed for specific activities and specific lifestyles, a comprehensive patient assessment is necessary to determine the right components for each patient and enable them to lead the lifestyle they desire.

The correct alignment of the prosthesis is a vital element to successful function. It means determining the correct position of the socket and components relative to each other.

When all these factors work together in harmony, the result is optimum comfort, function and lifestyle.

Stump Socks – How To Care For Them

The two main reasons for wearing stump socks are:

  1. To protect the residual limb from excessive rubbing against the socket.
  2. To allow the prosthesis to fit better as your residual limb changes. You may find that you wear only one sock in the morning, but have to add a second one as the day progresses. In this case, the sock is used to fill the space between your residual limb and the socket.

Socks & Pelite liners

It is important to find the right combination of socks when using a prosthesis with a pelite liner. This combination can change both throughout the day, and over the life of your prosthesis. With a pelite liner, as you reduce in volume, you may find you need to fill the space between your residual limb and the liner, and/or between the liner and the hard socket to snug up the fit. If you have any queries on how to do this, you can ask your prosthetist.

Socks & Silicone liners

Unlike in traditional pelite liners, when using socks with silicone/gel liners, the sock is used outside the liner between the liner and the hard socket which maintains contact of the silicone/gel with your skin.

Pin liners: It is important to ensure the pin is completely through the hole located at the end of your sock so that the fabric doesn’t get caught in the lock body. If this happens, it can cause the lock to stick and you will have trouble doffing your prosthesis.

Seal-in liners: If your prosthesis uses a rubber sealing ring to create a vacuum suspension, talk to your prosthetist to ensure you understand volume management for your liner type. Some do not support the use of socks. If it does, make sure that the sock is neatly tucked under the sealing ring prior to donning your prosthesis.

If you find you have reduced in volume to an extent that you are slipping inside the liner itself, contact your prosthetist as you may need a new liner, or an alternate solution to be found.

 

Cleaning your stump socks

It is very important to keep your stump socks in a clean and hygienic state. It is important that any socks you wear are cleaned daily.

It is important that you look after your socks and make sure you have enough to wash and wear.

Not washing your socks properly can lead to build up of dirt and other nasties, which may cause skin irritations such as redness, rash, itchiness, bumps, pimples, etc.

Tip: Never wear your shrinker sock with your prosthesis. The shrinker is to be worn to provide compression when you are not wearing your prosthesis. Wearing the shrinker with the prosthesis can cause skin irritation and/or breakdown.

DO’s and DON’TS that will help you clean your prosthetic stump socks correctly

Do’s:

  • Do squeeze suds gently through the prosthetic socks and rinse with clear warm water.
  • Do use an approved wool detergent to wash your socks, preferable by hand.
  • Do roll the socks in a towel to blot out the extra water.
  • Do hang socks to dry.

Dont’s: 

  • Do not use hot water as this might cause your socks to shrink.
  • Do not twist and rub wet socks as this may cause the socks to loose their shape.
  • Do not wring the socks out.
  • Do not use a clothes dryer to dry the socks.

Tip: Be careful of wearing too many socks. If you experience blisters, localised swelling and or a purple tinge to the very end of your residual limb, often accompanied by the tissue consistency firming up over time, you may be packing yourself out of your socket. It’s important to maintain contact with the end of your limb and the socket to avoid this hyperplasia. If you are wearing more than two thick socks consistently, it’s a good idea to check in your prosthetist to assess socket fit.

 

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