Orthotics/Prosthetics

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 Center

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 to become.

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.