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Bill Craggs, CPO, a certified prosthetist and Jeffrey Ackman, M.D., a pediatric orthopedic surgeon talk about what to expect when children need braces, prosthetics and prosthetic devices. And the services offered on-site at Shriners Children's.

Bracing Prosthetics and POPS

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Melanie Cole (Host): Our topics today are bracing, prosthetics and POPS, which stands for the Pediatric Orthotic and Prosthetic Service, at Shriners Hospitals for Children Chicago, and my guests are Dr. Jeffrey Ackman, he's a pediatric orthopedic surgeon, and Bill Craggs. He's a board certified prosthetist and orthotist and manager at POPS, and they're both at Shriners Hospitals for Children - Chicago.

Dr. Ackman, I'd like to start with you. What type of orthopedic conditions do children need braces for typically, and what does bracing do for a child?

Dr. Jeffrey Ackman, M.D. (Guest): Well, they can run from a variety of conditions such as flat feet or other foot abnormalities for normal children or children with conditions such as cerebral palsy or spina bifida. We also do bracing for the lower extremities, some for the upper limbs such as hand deformities and things, and what a brace does, the basic line is to improve the function of the child, whether it's enabling them to walk better, or have more even wear on their shoes, or have a better gait, straighten their legs for children with angular deformities. So it's a variety of conditions, and the brace is theoretically to keep the condition from getting worse, possibly improve the condition, and improve the child's function.

Melanie: I understand that would certainly depend on the situation for which the child needs to wear the brace, and their growth, and what's going on, but how long do patients typically wear a brace?

Dr. Ackman: Again, it depends on the underlying condition. For someone, a child with cerebral palsy, they may wear it for several years. If it's a child who has say knock-knees or bow legs and they need bracing, it may be for a year or two, or until the deformity corrects. So it kind of depends on what you're treating and what you want the outcome to be.

Melanie: And Dr. Ackman, I'm going to stick with you for just one more minute. How do you evaluate whether a brace is working?

Dr. Ackman: We usually check the child about every six months or so, sometimes sooner depending upon what we're treating, make sure the brace is fitting properly, we look at their walking in it, or if it's an arm or hand, look how they use it. Do they have improved use of the hand or leg? Do they have improved function? Are they walking better? Running better? That's how kind of we assess whether it's working or not, and make sure it's fitting properly, being worn as prescribed. Those are all important factors.

Melanie: Bill, tell us about Shriners Hospitals for Children, that has the largest clinic in Chicago for children with limb differences and prosthetics. Tell us a little bit about POPS.

Bill Craggs, CPO (Guest): Well, POPS is new to the Shrine system. Here in Chicago, we're a little over two and a half years into the POPS process. Prior to that, outside vendors were being used for these services. Shriners Hospital as a whole went to the POPS system to allow for a little bit more of a streamlined process, and what that's enabled us to do here is we're right within the clinic, right in with the doctors, the therapists, the nurses, and we're able to see the kids right away, and take a team approach talking to the other team members as far as either prosthetic or orthotic design, and come up with optimal solutions for a patient.

Melanie: Bill, sticking with you for a minute. Tell us what is an orthotist or a prosthetist? These are not terms that are typically thrown around out there. Tell us a little bit about what you do, and how you evaluate braces, and adjustments that patients may need.

Bill: Okay, an orthotist is somebody who makes braces for a limb or for a body part, and a prosthetist is somebody who makes an actual replacement for a limb or a limb deficiency. What we do is, same as what Dr. Ackman was talking about, that the end-all goal is to make the patient as functional as possible, and especially in the bracing side of it, create whatever corrections need to be done to the patient's limb, or spine, or whatever it may be, through the bracing.

So a lot of our devices need to be adjusted and changed as a patient grows, and we're here to do that. When they come into clinic, we see them, and are able to do that kind of stuff usually right on the spot.

Melanie: Dr. Ackman, how do you evaluate a child with limb differences or a missing limb? What types of care and services does Shriners Chicago offer them?

Dr. Ackman: Well, we take a good history and examine the entire child, ask about any problems during the pregnancy, are there any family members with the same condition, et cetera. And then sort of what are the child's needs and wants, in terms of do they do any sports activities? Do they do recreational activities? Sort of we fit the prosthesis to the child instead of fitting the child to the prosthesis.

So we meet with the family, it's very much a team approach; the physician is there, the prosthetist is there, the physical therapist or occupational therapist, the nurse. And so we all kind of sit and discuss things, very much involve the family, educate them about what it's going to be, what it's capable of doing. And then the great thing here about being at the Shrine Clinic is it's kind of one stop shopping. We see the family, and we can write the prescription, and the prosthetists are right here to take it to the next step, and they can do the casting and molding that very same day.

Melanie: Wow, that's really amazing. Now Bill, so as Dr. Ackman is talking about the process, tell us how a patient gets a brace through POPS, and what is that process like? Do they get to pick their design? Tell us how you fit it.

Bill: Well it starts, again with what Dr. Ackman stated, being seen here in clinic, at this point in the process, we only fabricate orthotics and prosthetics for Shriners' patients. The prescription is written, and then one of our POPS teams comes in and evaluates the patient generally by taking some kind of measurements or cast of either the limb or the residual limb, and the measurement process is generally done on the day that the prescription was written.

We make everything here at Shriners through a CAD system. So everything is modified and done in CAD, and then the actual orthotics and prosthetics are fabricated at our CAD site at the Portland Shriners Hospital.

Melanie: And Dr. Ackman, speak about how children respond when they get a prosthetic, or a brace for that matter. How do they respond and what is their life like when they come back to you to get it adjusted, or because they've grown? Tell us a story about that.

Dr. Ackman: Well, it takes sort of a little weaning in period. The younger kids sort of take to it, and they don't really need much physical or occupational therapy, especially for a lower limb prosthetic. They need that to walk with, so they sort of get it put on, and after a little adjustment period, away they go.

For the upper limb, it sometimes takes a little more time. The rejection rate may be a little bit higher depending upon the level of the amputation, and the age of the child, and things.

Brace-wise, kind of the same thing. There's a weaning in period to get them used to it, and then there's a prescribed wearing pad, where most of the time it's during the day, sometimes the evening and nighttime hours as well, again, depending on what we're treating. And a lot of the kids come back, and it's just like, "Wow." It's just amazing what they're doing. Especially with the prosthetic kids, it's they get their leg or they get their arm, and away they go, and they're doing all the sports and other activities that all the able-bodied children are doing. That's very gratifying for us, because we want to sort of provide a normal life for these children.

Melanie: Well along those lines, Dr. Ackman, sometimes children need prosthetics for specific sports or activity. Can you tell us about some of those, and how that works?

Dr. Ackman: Sure, there's a whole array of different products available for sports activities ranging from fishing, and archery, and hockey, and baseball, and then musical instruments like guitar and drums. So we want to be able to provide those to the child so they can pursue whatever interests they have. We don't want to say, "Oh, you have an amputation, so you can't do this." It's like, "You have an amputation, let's figure out a way how you can do this," and having the POPS system sort of enables us to provide some of that to these children.

Bill: I can add to that a little bit. Yesterday was a perfect example. I had a young man come in for a fitting for a weightlifting arm, which obviously is a little bit unique. There's a company that makes a specific attachment that allows this boy to be able to do two handed type weightlifting exercises that he wouldn't otherwise be able to do with just one hand. So that was a good example of a sport or activity-specific type prosthetic.

Melanie: It certainly. Bill, so first last word to you. What would you like the listeners to take away from this and to know about POPS at Shriners Hospitals for Children - Chicago? And just some of the cool technology, and really what you do for a living, and how gratifying it is.

Bill: Well, I'd like to start with the gratifying side. The whole reason I think me and my team are involved in this is because treating children with disabilities is immensely gratifying, especially prosthetic fitting, and seeing the kids get up and walk. Watching their family and their parents, how they react to the first time their child has maybe ever taken steps is very gratifying.

POPS has the unique ability, being right within the clinic and interacting with the doctors and the team on a daily basis to be very involved with all their care and their treatment, and be able to go back and forth with the doctors and the physical therapists to produce the best outcome we can for the family.

On the technology side, we have everything here available that they would have anywhere else. We offer, for the orthotics, a bunch of different types of custom designs that they can put on their plastic. That seems to be a really big hit with the kids. I never had moms and dads coming back saying, "Little Johnny couldn't wait to come back and get his new brace so that he could pick a different pattern for the outside of the brace," which allows them to individualize their device, and take some ownership in it, and they love to go back and show the kids at school, and things like that.

And that's also the case in prosthetics. We have some children that choose to have more of a cosmetic flesh tone finish to it, and we have other ones that put lightning bolts on their legs, or have Spiderman or Superman, or anything like that. So we're able to individualize the device to the patient and give them exactly what they want, and try to make them as comfortable with what they're receiving as possible.

Melanie: And Dr. Ackman, wrap it up for us with what you would like listeners to know about growing children and the need for prosthetics, and really what you do, and how gratifying it is for you as well.

Dr. Ackman: Well, we've been doing this for probably over twenty-five years. I think we have the largest sort of limb deficiency clinic here in the Chicagoland area. We have a team approach and it's always good to have another mind and another set of eyes looking at the child and talking to the family.

We provide opportunities. As I iterated earlier, we're not going to tell you what you can't do, we're going to try and figure out how you can do it. If this is what you want to do, we'll try and put our heads together and figure out a way you can do it through a prosthetic and a prosthetic attachment, or an apparatus, or something or other. And having the POPS team here, we can put our heads together and figure out a solution for the children to get them in to- everything is about living the life, living what they want to do, and doing sports, doing recreational activities, doing things after school with their friends, and it's very sort of gratifying to be able to deliver that to the patient and the families.

Melanie: Thank you both, gentlemen, for joining us today, and for sharing your expertise and explaining prosthetics for children. What a wonderful inspirational topic that we had today, and what you both do is so gratifying, and thank you again for joining us. This Pediatric Specialty Care Spotlight with Shriners Hospitals for Children - Chicago. For more information, please visit www.ShrinersChicago.org. That's www.ShrinersChicago.org. This is Melanie Cole, thanks so much for joining us.

About the Speakers

Jeffrey Ackman, M.D., Bill Craggs, CPO
Jeffrey Ackman, M.D., is a pediatric orthopedic surgeon and co-medical director of the motion analysis center at Shriners Hospitals for Children — Chicago. He runs the largest prosthetics clinic in the Chicagoland area with a multidisciplinary team, including a prosthetist, nurses, therapists and a psychologist. Dr. Ackman believes it’s all about fitting the prosthesis to the child, not the child to the prosthesis.

Learn more about Jeffrey Ackman, M.D.

William Craggs is a board certified prosthetist/orthotist and manager at POPS “Pediatric Orthotic and Prosthetic Services” at Shriners Children's Chicago. He has 30 plus years of pediatric orthotic and prosthetic experience servicing patients at Shriners.