Orthotics/Prosthetics

Twenty-eight-year-old Nicole Browder is much like any other woman in her 20s. She likes to wear make-up and she has her sights set on a future career as a lawyer. What sets her apart from others is her enormous determination to, after more than 20 years without a prosthetic device, master the art of not one but eventually two myoelectric arms. For some this would be too daunting, but not for Browder.

Adaptations

Born without arms or legs, Browder has spent much of her life adapting.

Her prosthetist, Erik Olson, LPO, founder of Round Rock Orthotics and Prosthetics in Round Rock Texas, explained that Browder does not have a humerus on either side and she presents like a shoulder disarticulation.

	Before meeting Olson, Browder researched devices and hoped to get a myoelectric device.
	Images: George Blake, Round Rock Orthotics and Prosthetics

On her left side, she has a short femur and a quarter-size foot with three toes.

“That’s how she runs her wheelchair,” Olson told O&P Business News. “She can type and she can she text on her phone faster than I can. It’s amazing to see what she does.”

Despite all she has had to overcome, Olson assures that Browder is incredibly mobile.

“She’s got a powerchair that when she pushes a button the seat comes up and it sets her on the floor in front of the chair. It kind of lowers her like a hydraulic lift and then she walks on her behind,” Olson said. “I can’t really beat that with the prostheses. One of the reasons that she’s not a very good candidate for doing a lower limb prosthesis is she doesn’t have any arms to catch herself, so if she starts to stumble she’s going to crash.”

Introductions

Olson and Browder began working together more than 2 years ago, Browder explained.

“Erik became my prosthetist after meeting him through the Department of Assistive and Rehabilitation Services,” she said. “At the first meeting, I was a bit nervous because I hadn’t had a prosthetic arm since I was five.”

And she was not alone with her nervous feelings. Olson admits that he walked in to meet her and expected someone completely different. All he knew was that he was meeting a patient who tried to use a prosthetic device when she was younger and now was interested in a myoelectric device.

“I get to the room and here’s Nicole,” Olson said. “She’s stunningly pretty and she had these big bright eyes and this smile and I was just taken back.”

During their first meeting, Olson learned that Browder was going to school to become a paralegal and hopefully pursue a career as a lawyer.

Wants and needs

“I spend an extraordinary amount of time doing evaluations,” Olson said. “On the first day we probably sat and talked for almost 2 hours. I was getting to know her, her family, what she wanted to be able to do, what her expectations were.”

	Olson spent a lot of time evaluating Browder to get to know her and learn what she wanted from a device.

Browder had done some significant research on devices available to her and even more so, had drawn conclusions about what she wanted to be able to do through her experiences during the previous 23 years. Olson took his time learning what Browder desired to gain for a prosthetic application. On the list: apply her own make-up.

“That’s the kind of thing that you don’t learn until you put in the time,” Olson said. “I think that means a lot to people. I think she could sense that I cared and I wanted her to know that if we are going to do this, I wanted to make sure it was successful.”

Browder’s ultimate goal was to secure more independence, she said. With the right training and a proper fit, Olson was confident that was something he could give her.

Before Olson started fitting Browder for her first device, she met with an occupational therapist – also an upper extremity amputee – at St. David’s Hospital in Austin, Texas.

Once they met and secured appropriate insurance approvals, Olson made her a deal.

“I told her essentially, ‘If you can show me that you can make this one arm work and you get proficient with it, then we’ll do the other arm.’ She thought that was a pretty square deal,” he said.

About a year ago, Olson set up the Otto Bock MyoBoy system on her laptop and sent her home where she could further explore the possibilities with electrodes that were arranged by her sister, with Olson’s direction.

“She ran video games and became incredibly proficient really quickly,” he said. “Then we fabricated the first arm, set it up with pretty easy controls and she took off with it. The next time I saw her she was playing chess, and actually moving chess pieces around.”

Attitudes

Olson explained that learning how to use a myoelectric device was especially time-consuming and required extensive training.

“I wanted her to know up front how frustrated she could possibly get with it. It was going to be a lot of hard work,” Olson said. “You walk in the room and say, ‘I’ve got the perfect thing for you. It’s going to be wonderful. It’s going to be awesome.’ The patient puts it on and goes to operate it and it’s frustrating. Then and they take it off and they never try it again. I spent a lot of time prepping her for getting psyched up to use it.”

	Olson explained the intensity of myoelectric training to Browder from this initial meeting to prepare her for the long term.

This point was magnified in Browder’s case because she did not have a frame of reference to apply to her therapy.

Olson spoke to the occupational therapist about how the training was going and found that most of their time was being spent on learning how to position the arm.

“When she would come up to an item he would say, ‘Now move the hand closer or reach out for it’ and since she’s never had arms, those words literally have no meaning to her,” he said. “I found it absolutely fascinating that he had to teach her from scratch. During the time I evaluated and fit her, it never dawned on me how much training it was actually going to take.”

Browder acknowledges that the process was not an easy one, but has never looked back on the decision to pursue a device after so many years.

“The process was difficult at times because I had to learn to do daily tasks different,” she said. “Rather than using my mouth, or foot, I used my arm. After having my arm for almost 2 years, I am used to the device.”

Relationship

“Nicole and I have a very special relationship,” Olson said. “I think she knows that I’m going to take really good care of her and that I’m going to do my absolute best to make it just what she needs.”

That close working relationship has resulted in a lot of success. So much so, in fact, that on April 23, she was being fitted for her right arm.

“I try to give her reasonable boundaries and expectations,” he said explaining that he also spent a lot of time making sure she felt comfortable with the process. “That was probably one of the most … intentional things I did.”

All of the good intention is paying off, as far as Browder can see. She is now doing things that she once depended on other to do.

“Since working with Erik and having my prosthesis, I am able to feed myself, and do my own make up.” Browder said.

“Erik has made sure if there are any complications with my arm, he takes care of it right away,” Browder said. “I couldn’t ask for a better prosthetist.”— by Jennifer Hoydicz