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Individuals with amputations find rehabilitation in competitive sports.

Individuals with Amputations Find Rehabilitation in Competitive Sports

Participation in athletic competition has emerged as an important tool of rehabilitation for scores of persons with lower-limb amputations. The combination of traditional and modern rehabilitation methods, state-of-the-art dynamic response prostheses and the will to win has made competitive sports a way of life for many of them.

Todd Schaffhauser, a sprinter, and Matt Bulow, a tennis player, typify this new breed of athletes. Both had amputations, through rehabilitation to become highly competitive, well-trained athletes. Both endure rigorous training and wear advanced dynamic response prostheses to stay competitive.

According to David Balsey, RPT and track coach at the 1988 Paralympics, "they have to be competitors just to handle their amputations." Director of the Sportsmedicine Performance and Research Center in the Manhattan-based Hospital for Special Surgery, Balsey provides physical therapy and training for dozens of persons with amputations who want to be athletes. He was worked with Schaffhauser extensively and coached Bulow at the Paralympics.

Rehabilitation following amputation is an immediate and ongoing process. Typically, persons are fitted with a temporary leg as early as five days following surgery. While sutures remain to close the residual limb wounds, patients use crutches to bear partial weight on the involved leg. Both Schaffhauser and Bulow were up on their temporary legs within one week.

Paddy Rossbach, R.N., director of the Amputee Rehabilitation program at the Hospital for Special Surgery, thinks those steps are just the beginning. Rossbach holds the current female amputee world record in the marathon.

"First you go for basic balance, muscle strengthening and gait training," she said. "Routine physical therapy gets individuals with lower-limb amputations on the right track to walk correctly. Aerobic training and rehabilitation help make them more efficient overall."

For his patients, including Schaffhauser, Certified Prosthetist Mike Joyce is part of the interdisciplinary rehabilitation team from the start. "We try to get together prior to the amputation as often as possible. The faster a person with an amputation gets up and moving, the less muscle tone and strength they lose."

Therapy eventually is geared to the person's desired activity level, according to Balsey. He underlines the importance of working on the "good leg" and the upper body.

"Strengthening the good leg increases stability. They spend lots of time pedaling a stationary bicycle and hopping," he said.

Rehabilitation obstacles include stump shrinkage and, for chemotherapy patients, limiting the level of cardiovascular activity. Shrinkage of the residual limb occurs as training becomes more aggressive and the individual loses body fat. Chemotherapy slows the healing process of surgical wounds.

Central to the rehabilitation of a lower-limb amputation is the control of oxygen consumption. Whether highly active or functioning routinely, a person with an amputation can use 50 percent more oxygen than persons not having had an amputation. Reducing additional oxygen consumption to the fullest extent possible is a prime reason for what seems to be a new wave of high-tech lower-limb prostheses.

Significant advances in prosthetic technology have created opportunities for individuals with amputations to approach their athletic potential. "The devices made available during the past year or so enable individuals with amputations to reach their full potential," said Joyce, prosthetist to Schaffhauser and more than a dozen other competitive athletes.

Several suppliers have developed lightweight, durable prosthetic limbs geared for highly active athletes. One such example, which stores and releases energy to re-create normal heel to toe action, is the unique design and fabrication of the prostheses from Flex-Foot Inc., based in Laguna Hills, Calif. Schaffhauser and Bulow both wear Flex-Foot dynamic response prostheses.

"The new Modular Flex-Foot II is ideal for highly active individuals with amputations on several counts -- including its ability to maximize spring action, its ultralight weight and its compatibility with productive oxygen consumption levels," Van Phillips, research prosthetist, amputee and inventor of the Flex-Foot. "The amount of energy released increases as the wearer's running or walking speed increases."

Phillips believes that an important part of the rehabilitation process is getting to the point where you're "not thinking about walking on an artificial leg." He feels that a benefit of Flex-Foot protheses is the potential of helping to "free the thinking process."

"I used to have nightmares that I'd take a step and may leg wasn't there," said Schaffhauser. "After a while I decided that I wanted to run and play baseball again. I realized I had a second chance to be an athlete -- now I want to be the best."

"Competing in sports helped give me self-confidence," said Bulow. "My challenge was to meet my potential and prove to myself that I could do it," Bulow admitted.

Among his accomplishments, Schaffhauser, 19, won the gold medal in the 1988 Paralympics in the 100-meter dash for athletes with above-the-knee (AK) amputations. His winning time was 15.77 seconds, just shy of the new world record.

Bulow, a 20-year-old with a below-the-knee (BK) amputation is a collegiate tennis player who competes with and against only able-bodied athletes. His record in singles matches in the last two years is a perfect 10 wins, no losses. the Tennessee Technological University junior from Cookeville, Tennessee, also competed in the Paralympics and won bronze medals in the long jump and 4x100-meter relay.

Schaffhauser was 15-years-old when his cancer was diagnosed. "I was going to try out for football just for fun," he reported. "I was doing some training but my leg would hurt at night. Eventually it swelled up to about twice normal size. The doctors said to forget about saving the leg, but they could save my life." One month elapsed between the diagnosis and the amputation. In one day my life changed from being a normal kid to not knowing what to do," Schaffhauser said.

Bulow, who was 14 at the time, looks back at his cancer and amputation almost philosophically: "I've learned that I could make up for the deficit by working hard to improve in other areas. I worked harder at tennis than anything in my entire life."

Prior to the amputation, Bulow played baseball and basketball with the hope of someday competing in sports on a Division I collegiate team. Tennis is his forte but Balsey sees great potential in Bulow to be a runner. "David thinks I can do even better in track," said Bulow. "He's urging me to go for it."

Through focused rehabilitation, and with the emergence of modern technology in prosthetic design, they both have been able to realize their potential as athletes.
COPYRIGHT 1989 National Rehabilitation Association
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Title Annotation:includes additional information
Author:Garvey, Ruth S.
Publication:The Journal of Rehabilitation
Date:Jan 1, 1989
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