This veteran O&P professional calls for a return to the lost art of creating prostheses and a more collegial business environment.
In April, Al Pike, CP, retired from the Minneapolis Veterans
Affairs Regional Amputation Center after 48 years in the O&P field. He
wants to continue in O&P as a consultant, but is focusing on his long time
interest in photography and maintaining his organization’s website,
Amputees in Hollywood. O&P Business News talked to Pike about how
the field has changed in the last half-century.
How has O&P evolved since you started?
I came into prosthetics during the mid-1960s, and attended the
prosthetics program at Northwestern University, where there was a heavy
emphasis on professionalism. They pushed us to being professional right down to
what we wore. We had to wear lab coats and ties on certain days, and we did not
leave the floor for other parts of rehab center without a lab coat on. The
philosophy from our instructors, like Paul Meyer, CPO, was that we were
professionals like the orthopedic surgeon. That was my introduction to O&P.
Al Pike, CP, advocates government-supported advanced socket research.
Image: Courtesy of Al Pike, CP
I recall Larry Friedmann, MD, saying many years ago, “We need to
decide if we are a business or a profession.” I feel that we have taken
the business fork in the road, and everybody wants their own business today,
making for serious competition among them. Years ago in Minneapolis, we only
had three or four facilities, but now there are many more trying to cut that
same small pie into even smaller pieces. At one time we had Christmas parties
and softball games with all of the O&P people in town involved but no more.
I feel sad about that loss of friendship.
Socket research is badly needed today. We have new hardware, the C-Leg,
Genium, Plie, Rheo and Power Knee, but a really good interface for connecting
to the human body is lacking. We need government supported research, on what I
call socketology. I believe in the 21st century, we should have a better socket
connection to the human body in addition to osseointegration. The socket
technology that we are working with today comes out of basic research of the
1960s. We have variants on sockets, but they are just variants of the basic
socket technology I was taught as a student almost 50 years ago. Any socket
research since then has been privately funded by prosthetists like Carl
Woodall, CP; Ivan Long, CP; John Sabolich, CPO; Tony van der Waarde, CP; Marlo
Ortiz, CP; Randy Alley, BSc, CP, LP, FAAOP, and others.
We seem to be losing the art of prosthetics in prostheses. We don’t
delve deeply enough into how to produce prostheses that are both functional and
cosmetic. We seem to be focused on attaching hardware to a person, not fitting
a piece of art.
We talk about the master’s degree for O&P, but we’re not
changing the scope of practice of the individual. A prosthetist with a
master’s degree will have the same duties and responsibilities as the
prosthetist with a bachelor’s degree, without, for example, the added
respect in the medical community a nurse practitioner receives over a nurse
with a bachelor’s degree.
We need a one-on-one professional relationship with surgeons and
physical medicine professionals rather than be a business selling a product, as
we are seen by them today.
Tell us about working with the Minneapolis VA Regional Amputation
Operation Enduring Freedom and Operation Iraqi Freedom transformed the
Department of Veterans Affairs (VA) in many ways and impacted what is called VA
Prosthetics. An important point of clarification is needed here. Within the VA,
“prosthetics” means just about everything that is not a
pharmaceutical; in other words, durable medical equipment, prosthetics,
orthotics and supplies. This makes for confusion when VA staff communicates
with those outside of the VA.
A review of VA Prosthetics O&P Labs mandated that effective January
2007, they were to meet O&P industry standards of accredited facilities and
required prosthetists and orthotists to be board certified. The name changed to
O&P Services to include the broader scope of services provided.
In 2008 the VA put in place the Amputation System of Care and
established seven regional amputation centers in Bronx, N.Y., Richmond, Va.,
Tampa, Fla., Palo Alto, Calif., Denver, Seattle and Minneapolis. The goal for
these seven locations is to be VA flagships of amputation care that give all
amputee veterans access to the highest level of care. Prosthetists at the
regional amputation centers have access to the latest in education and
technology for prosthetic management of amputees. These regional amputation
centers can become the perfect setting for a prosthetist to practice the art of
prosthetics, including research, and makes the master’s degree worthwhile.
What makes the VA system different?
It is different in that it is a holistic multidisciplinary team approach
to amputee rehabilitation. The team approach to amputee care was the goal of
the prosthetic programs at New York University, Northwestern University and
University of California Los Angeles when I was a student prosthetist. The
prosthetist is a member of the multidisciplinary team involved in the
pre-amputation evaluation of the individual. They are a part of the
rehabilitation team following surgery and pre-prosthetic care.
During the fitting of the initial prosthesis the prosthetist works
closely with a physical therapist with specific training in amputee
rehabilitation. They are involved in the prescription of a prosthesis that
meets the amputee’s needs without other distractions. It is the ideal
setting for the prosthetist wishing to be the clinical prosthetist they trained
Tell us about Amputees In Hollywood
Amputees In Hollywood was an idea at the right place at the right time.
The conflicts in Afghanistan and Iraq provided the media with a visible symbol
of the wars, followed by the entertainment industry introducing amputees into
the story line of television shows like Law & Order. Because of my
experience at Otto Bock HealthCare involving the movie industry and public
relations for the American Academy of Orthotists & Prosthetists, I felt it
important that the media get it right and Amputees In Hollywood was born.
Understanding the power of the internet and being an amateur webmaster, I built
a website. We had some major requests at the right time along with exposure in
USA Today and the Chicago Tribune. Directors and producers
started finding us, networking began, and now when an amputee role is in the
script we get casting calls.
What are your plans now that you are retired?
To enjoy and participate in the freedoms that retirement allows while
being creative through the lens of my camera. — by Megan Gilbride
Disclosure: Pike has no relevant financial disclosures.