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Fitting the prosthetic mold

Artisan Orthotic Prosthetic Technologies provides tools to aid amputees, such as 22-year-old Erica Bruns

Photo Credit: TIMES PHOTO: JONATHAN HOUSE - These are tools of the trade for Artisan Orthotic Prosthetic Technologies.Tools hang on the wall the way they would in any workshop, and plaster dust coats nearly every surface.

Molds and casts line the shelves, and sheets of plastic wait to be heated up and contorted into their future shapes. On the ground, prosthetic legs stand in various stages of completion.

Without the legs as a giveaway, the lab at Artisan Orthotic Prosthetic Technologies in Tualatin might have been ready to build anything. But Certified Prosthetist Orthotist Warren Mays and his team build the necessary tools to help amputees walk again.

“We design the man-machine interface,” Mays said. “There are two things that you want a prosthesis to do: comfortably support a patient’s body weight as they stand or put weight onto it, and stay on when they take weight off of it. So (we) are designing a socket that will accomplish both of those things.”

In order to design a socket that fits with a person’s residual limb as best as possible, a cast is meticulously taken by Mays. From there, he instructs his technician on how he wants the prosthesis to be made and what it needs to be able to do. The fit of the socket, Mays said, is extremely important, as it will affect how a person walks, how they feel and what level their quality of life is. Last week, 22-year-old Erica Bruns, a below-the-knee amputee since July, received her first prosthesis, and started on the next phase of her journey.

“Think of a new amputation as a brand new foot that you’ve never walked on before. So there’s no callous and no toughness to that skin. You have to learn to bear weight on this new foot all over again,” said Mays. “So that’s what Erica is discovering right now, that she can only tolerate wearing that thing for 15 or 20 minutes at a time, then take it off and rest for awhile ... Marathoners don’t start running the marathon; they start at shorter distances.”

This story is Part II in a series following Erica Bruns, a 22-year-old Dundee woman who lost part of her right leg in a motorcycle accident in July.

Precise casting

As a prosthetist, it’s Mays’ job to provide his patients with the tools they need to get up and start walking, but it’s up to the patients to take it the rest of the way. Giving his patients their best chances for success is why Mays, a former architect, is so careful when he’s casting their molds. Photo Credit: TIMES PHOTO: JONATHAN HOUSE - Artisan Orthotic Prosthetic Technologies' Warren Mays shows the Plaster Room, where much of the molding takes place. While current technology has greatly improved the lives of amputees, the process of fitting a prosthetic remains decidedly old school.

The technique of using plaster casts is an old and traditional one, but so far, he says it’s the best way to get a true rendering of a person’s leg. Sockets can be made from scans of legs as well, but Mays said this rarely turns out to be a true reading, as it can only pull typographical information. To build an accurate and comfortable socket, the cast has to be made by rubbing in the complete shape of the residual limb’s anatomy, he said. Once Mays feels the right prosthesis has been made, it’s time for the patient to learn how to walk again.

“When you start, like with Erica, my guess is that she had a very insightful weekend. Everyone thinks that they’re just gonna go gangbusters and put this thing on, and stand up and walk out of the room and walk off into the sunset. But it just doesn’t work that way,” he said. “They’re reinventing their sense of balance. They’re learning how to problem solve. They’re learning how to manage the fit of the prosthesis.”

And after two-and-a-half decades in the business, Mays has a pretty accurate idea of what the first days with the preparatory prosthesis are like. For Bruns, who’s currently fighting an infection on her leg, she hasn’t been able to extensively use her prosthesis because it hurts her wound. But even when fully healed, the transition from not being able to walk for months, to all of a sudden having a new leg, can be a rough one.

“It’s a lot of work, and I will really have to rise to the occasion. I really still have mixed feelings about it because I guess it has finally hit home for me that this is the rest of my life — that frankly my leg isn’t going to grow back,” Bruns said. “The first steps weren’t bad. (But) I was really scared, actually. I knew I could do it, but I was just scared to. I think I was just afraid of how it would feel and what it meant for my journey.”

Levels of discovery

Mays agreed this journey is a long one, but one he tries to make sure all of his patients are equipped to tackle, regardless of what their situation is and how they’re handling it.

“It takes all kinds of people, and we see all kinds of people. There’s no right or wrong way to lose a limb,” he said. “There are levels of discovery. Immediately after surgery, figuring out the things that you can’t do, and then having many of the things that you could do before returned to you as you get a prosthesis and you learn how to use it. You get a lot of those things back.”

As for Bruns, who is still in the earliest stages of figuring all this out, she’s excited to get back to the active lifestyle she’s always led and has continued to lead as much as she can. Though she admits she’s not entirely excited about the difficulties of learning to walk all over again, she is willing to put in the work to get to where she wants to be.

“I can’t wait to walk around the store and have nobody look at me because I’m missing a leg. I can’t wait to dance and run and bike. I’m excited to wear high heals again ... I’m excited to open people’s eyes to the world of prosthetics and teach them as I learn, too,” she said. “And I am excited for my leg to seem less foreign to me, and to just be more a part of my daily routine.” Photo Credit: TIMES PHOTO: JONATHAN HOUSE - Certified Prosthetist Orthotist Warren Mays shows how difficult the transition can be for a new amputee to adjust to life with a prosthetic.

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