The Prosthetics and Orthotics Podcast
The Prosthetics and Orthotics Podcast is a deep dive into what 3D printing and Additive Manufacturing mean for prosthetics and orthotics. We’re Brent and Joris both passionate about 3D printing and Additive Manufacturing. We’re on a journey together to explore the digitization of prostheses and orthoses together. Join us! Have a question, suggestion or guest for us? Reach out. Or have a listen to the podcast here. The Prosthetic and Orthotic field is experiencing a revolution where manufacturing is being digitized. 3D scanning, CAD software, machine learning, automation software, apps, the internet, new materials and Additive Manufacturing are all impactful in and of themselves. These developments are now, in concert, collectively reshaping orthotics and prosthetics right now. We want to be on the cutting edge of these developments and understand them as they happen. We’ve decided to do a podcast to learn, understand and explore the revolution in prosthetics and orthotics.
The Prosthetics and Orthotics Podcast
Insights on Innovation, Education, and Inspiration with Michael Leach
In this episode, Michael Leach joins us, a certified prosthetist and orthotist who began his career as a high school volunteer in 1975. Michael shares his journey, highlighting key mentorships and the evolution of education in the field, from certificate programs to degree-based training. He emphasizes the significance of hands-on learning in developing skilled professionals.
We also explore the impact of climate and financial factors on prosthetic fitting and accessibility. Michael discusses how issues like sweat in humid environments and the need for waterproof systems affect prosthetic design and usage. Additionally, we examine the financial dynamics of the industry, comparing reimbursement practices across countries like Germany and Scandinavia, and how these practices influence innovation.
The episode covers the latest advancements in prosthetic technology, including microprocessor knees and 3D printing, which are redefining the possibilities for amputees. We hear the inspiring story of Robert, an amputee athlete who motivates others with his determination. Through engaging stories, the conversation emphasizes the importance of personalized care, professional support, and the role of clinicians in advancing patient care and inspiring the next generation of prosthetic specialists.
Special thanks to Advanced 3D for sponsoring this episode.
Welcome to Season 9 of the Prosthetics and Orthotics Podcast. This is where we chat with experts in the field, patients who use these devices, physical therapists and the vendors who make it all happen. Our goal To share stories, tips and insights that ultimately help our patients get the best possible outcomes. Tune in and join the conversation. We are thrilled you are here and hope it is the highlight of your day.
Speaker 2:Hello everyone, my name is Joris Peebles and this is another edition of the Prosthetics and Orthotics Podcast with Brent Wright. How are you doing, brent?
Speaker 1:Hey, joris, I'm doing well. Man, how does it feel after recording the 100th episode?
Speaker 2:episode. It feels amazing, dude. I feel blessed that we can do this and that we keep getting to do this, and it's a really wonderful time. Every week we do this and I enjoy it still, and I hope you do too, right.
Speaker 1:Oh yeah, for sure. I mean, what's been crazy is there are people that I talk to that aren't even in the orthotic and prosthetic field, that are curious, and so they'll actually say hey, man, I just listened to such and such episode Because we have had some kind of cross-linking right. We've had Duan on and we've had a few other people like Brooke Drum you know he's not in O&P and so that's been really fun to have interest from people that are kind of sidebar, can see how additive manufacturing specifically for orthotics and prosthetics can be so valuable.
Speaker 2:Yeah, super cool yeah. I'm just still. I'm really happy we can still get to do this. Uh cool and um yeah. So who is sponsoring this, this episode?
Speaker 1:for this episode continues on with advanced 3d. Um, so advanced 3d as a contract manufacturer, we meet you wherever you are, uh, along with paul and tyler, and you met katie actually just a little bit ago, on a couple episodes ago and, um, whether you're trying to figure out, hey, how do I start scanning? Or I'm looking at definitive sockets. We're here to help you on your digital journey.
Speaker 2:Super cool. So who is our guest today?
Speaker 1:So I'm super excited to have Michael Leach on the show today. I've known Michael for a long time and he's been in the field for a long time, so he's seen a lot of progress over the years on where we've gotten to and what's brought us to today, and so I'm really excited to dive in to some of the history of the prosthetics, of what he's seen, what he's seeing in the future and he is newly retired, so I know he still has his finger on the pulse, but he's getting a lot of time in the outdoors and also with grandkids, so I think that's pretty cool.
Speaker 2:Welcome to the show, Michael.
Speaker 3:Thanks Great to be here. I appreciate the invitation.
Speaker 2:So, michael, how did you get started in OMP?
Speaker 3:Well, like I mentioned, I've been in the field a long time. I started in 1975 when I was a senior in high school. Going to college was not really an option. Not going to college was not an option for me. So I knew I was going and my high school had a program where if you volunteered in a career path you might be interested in, you could get credit towards graduation. And I had two older sisters, an occupational therapist and a speech pathologist, audiologist, who introduced me to O&P.
Speaker 3:So I grew up in Detroit and I volunteered at the Detroit Rehabilitation Institute in downtown Detroit and I really got kind of excited about it. It was hands-on for me and they were really a great group of people. I still consider that cadre of professionals that I met there as some of my best mentors. They really drove my sort of professional compass where it needed to be and led to a summer job and halftime job when I started going to college.
Speaker 3:And back then the field was transitioning from certificate programs to baccalaureate programs. I know that kind of seems funny now that there's the master's degree pathway, but they were just starting the baccalaureate programs. I know that kind of seems funny now that there's the master's degree pathway, but they were just starting the baccalaureate program. So, being a senior in high school, it only made sense for me to go in that direction. And there were only two schools back then University of Washington and New York University. So as a kid growing up in Detroit, it was kind of exciting to know that I would either be living in New York or Seattle to pursue a professional path.
Speaker 2:Okay, that's cool, and then, and how would you like to study back then? Was it very practical or was it kind of like? Did you really feel, felt like it did a good job of informing you what you were actually supposed to do?
Speaker 3:Yeah, I think it did. And I started in the field primarily interested in orthotics and so this volunteer work that I did really exposed me to that in a very practical way. I saw patients and casted and fit devices and so forth so I knew what I was really getting into when I went to school. I think it was very practical at the time. You know you don't fit a lot of devices. At least back then when you went to school you didn't fit a lot of devices. You know if you in your trans-tibial prosthetic course you may fit one or two, I remember transferable I fit one.
Speaker 3:So you're hardly an expert, you know when you leave but you get the fundamentals and there was no residency program when you graduate. You just uh, sort of entered the field and you had to have a certain number of years experience before you could you could sit for the exam. It was a year back then. So you know I don't know how graduates feel now, but I know that I became a certified orthodist first before a cpo and um I I I didn't feel like I was particularly, I was competent really in certified orthodist until I had about five years under my belt, even though I was credentialed. It took a number of years before I I could reflect on my career and say you know if anything walked through the door, now I have enough experience that I can figure it out. Okay, and then and say you know if anything walked through the door, now I have enough experience that I can figure it out.
Speaker 2:Okay, and then did you go for your own practice? Did you work for other people? What was your path after that?
Speaker 3:I never did my own practice. I worked for other people my entire career. I was not kind of entrepreneurial or a risk taker in that way, but throughout my career I've worked in almost every professional setting you could think about. I worked for a large. You know like I worked for Wright and Phillips. When I came out of school they had 30 offices in Michigan back then, so they were very large. I worked in a couple of institutional settings along the way the Detroit Rehab Institute, university of Michigan Hospital. I worked for small, single-owned mom-and-pop practices along the way and then I worked for the large sort of multinational organizations the Hanger, nova Cares until I transitioned into the kind of medical device manufacturer side, transitioned to the kind of medical device manufacturer side after about I don't know 27 years. I worked for Autobach. For 18 years I worked for PhilHour. So I enjoy the education aspect and the product development aspects of those experiences.
Speaker 2:This is really interesting because, like, okay, so imagine, if you contrast these mom and pop stores, the more chain kind of medium chain stores, the larger chains, and then the device manufacturers, and then the institutionals right, those are like the main groups, I guess. Right, there's more, I guess. Do you think that they're optimal for a different stage in your career or a different type of person, or are you like no, no, everyone should just work for autobalk. That's the end of everything, that's the best employer ever, or something well, I think there.
Speaker 3:I think there are a number of stages in your professional career, I think when you first are, when you're doing your residency and you're you're first in the field. So maybe your first five, ten years, um, I think it's a good idea to expose yourself to a very busy practice that sees a wide diversity of work. If you want to be, you know, so you can determine what you want to maybe focus your career on. If there's a particular aspect of the field that interests you, like pediatrics, for example, or you prefer orthotics versus prosthetics, or whether you want to be more of a generalist, you know. And then after that it sort of has to fit your personality.
Speaker 3:There are certain work related. You know, pressures and obligations that go with each sort of niche that you were there, like when you, when I worked for university of michigan hospital, I worked primarily in spinal orthotics and pediatric orthotics and the spinal orthotic was very intense. It was an on-call practice. I could I remember this was long before uh scanning. I mean I remember casting for, you know, 10, 12 TLSOs on a clinic day and then being called in at 2 o'clock in the morning to fit a halo. So I think it's good early in your career to get a lot of exposure and then you can see where you fit. If you want to live in a rural community, you need to be a jack-of-all-trades, because it's hard to. There's no niche in uh or specialty. There's not enough. You know critical mass of any one thing where you would be a specialist uh per se, if you follow my meaning and so, and how about working for like, like these device manufacturers, because that could be very different, right?
Speaker 2:we? We see, the people we've talked to so far, all did this after doing going to practice first and are going to professional life first. Is that a very different thing, cause that could be very corporate, I guess, or very or, and you also, all of a sudden, you don't see patients anymore. That could be very different, right.
Speaker 3:Well, uh, yes and no. I mean you do see patients, but you don't have the lifelong relationship. You know, if you work in a clinical practice and you're there for any length of time, you have this long-term relationship with the people that you work with. When you're working for a medical device manufacturer, depending on your role, many of these roles are clinical education, right. So the devices are sophisticated and you would go out and partner with your colleagues in clinical practice to make sure that they would always get an optimal result. That was the goal to make sure they felt comfortable and familiar enough with the technology that when you weren't there, they could be outlandishly successful with it. You know each human being that you work with presents with a unique set of circumstances. No transfemoral amputee is like I fit. I don't know thousands and thousands of sea legs, but everyone was a little bit different because each human you're working with is a little bit different. So that's, you know the education role and it's a road warrior role for anybody who's doing that. You're traveling 75% of the time, so you have to appreciate that. I would say it's a lifestyle. You have to appreciate it. So you are seeing patients, but the longer you stay in that role, the less how familiar you are with the rest of the field, if you will, because you're fitting a brand all the time. When you're in clinical practice you're choosing what componentry is going into a prosthetic system and I'm sure you know your experience has been that most prosthetic systems represent a number of different brand manufacturers. I've seen many medical device manufacturers want to try to capture the entire system from foot to socket, but I rarely see that in practice. Now that may change as the current paradigm is changing with consolidation in the industry. So that's sort of the education role. You get very good at a very specific type of thing and you are often also called into troubleshoot, which is also a lot of fun. You know if someone's not getting an optimal outcome. So that's the education side and that's what most clinicians are doing.
Speaker 3:I was fortunate enough to also get into the product development side of it. I transitioned into the R&D group at Audebach and in the last, I'd say, 10 years of my career for Audebach and Phil Hour I did a lot of R&D. I was involved in a lot of product launches, so I really enjoyed working with the engineers in the industry. You know your role in that team is to make sure they understand the clinician's mindset, what the clinician's work environment is like, what they confront, you know, in their day-to-day. So it was fun working with the engineers. It was fun fitting prototypes and various iterations of prosthetic components before they went to launch. And for me, it allowed me to travel the world and work with clinicians throughout the world Because, you know, autobot, for example, is the largest manufacturer in the world the largest manufacturer in the world. So I got to see various different perspectives and views on what was important to people in different parts of the world and for users in different parts of the world when it came to their devices.
Speaker 1:That's what I want to hear about is I want to hear about some regional differences, because I've heard and I've seen, because I've done some traveling not like what you've done, but like even regional differences of how people practice in the US. But then I'd love to hear some of your international stories of like some of the differences between, say, a US practice and and somewhere else, and what kind of struck you as interesting or eye-opening.
Speaker 3:Oh, yeah, sure, you know regional differences. Climate has a lot to do with how a prosthetic system is fit and what some considerations are and how the list of priorities might change for a clinician or for a human being. You know using the device. The southeast, for example, is a very, you know, humid, hot climate and you know clinicians and users struggle with liners. With liners, you know, I remember early in the day after Autobach acquired tech interface, I was teaching and fitting a lot of elevated vacuum. You know harmony systems back then and it was perspiration management was a daily conversation with a clinician in the southeast. But working with someone in the northwest, for example, it wasn't nearly as common. I mean, the northwest is very dry. Now I live near Portland. It's very dry in the summertime, hardly any rain, low humidity, and so even when it gets hot, perspiration isn't as big as an issue, like also like arizona compared to savannah, georgia, um, but when they do get rain it's in the wintertime, but it's it's cooler, so the perspiration isn't as much of the conversation. Uh, when it comes to liners and suspension systems and you know those sorts of considerations, you know having a system waterproof is a big thing in the industry now and that's. You know, that can also be regional depending on where you live.
Speaker 3:An interesting story globally would be how reimbursement drove clinicians to have to make decisions on what to include in a prosthetic system. I remember I was in Germany doing some training for some of my colleagues in Scandinavia, sweden, switzerland, uh, sweden, switzerland and, um, you know, when I was teaching I was talking about, in a perfect world you would fit a custom liner on everybody. I mean, they just fit better. It's, it's made for unique individual. You're, you're making some sort of compromises in and off the shelf liner, uh, you know, they stretch a lot, they can accommodate a lot of shapes, but they're, uh, they're creating different tensions at different points along the limb depending on how they they make the shape of the limb out of the box.
Speaker 3:And one of the breaks um, one of my colleagues was talking to me says you know, I just can't fit custom liners because I I don't get reimbursed in a way that I could make that work. You know, I get a flat fee for a trans-tibial prosthesis, for example, and so I have to make my selections of componentry and try to optimize everything for each individual that I work with in a way that I can stay in business. It's not that they didn't want to fit custom liners on, everybody can stay in business. It's not that they didn't want to fit, you know, custom liners on everybody, just so that the the uh reimbursement environment, you know, just wouldn't permit it.
Speaker 2:In essence and also like do you see, like uh, is there like something where you have an optimal reimbursement environment, or do you have an idea that everyone, ever, all over the world, has?
Speaker 3:like every system has its advantages and disadvantages oh, there's yeah, I would say the latter to that. It's unique everywhere you go, and so it's a different conversation that you know, that you have. You know we're seeing some nice things happening now in terms of, you know, reimbursement, but there was a period of time that you guys all remember not too long ago where there were lots of audits and there still is a lot of administrative oversight. I can't speak to that as intimately to some. Maybe Brett can touch on that, since he still does some clinical practice.
Speaker 3:I've been out of it, you know, too long, but every province in Canada is different. It's not even though they have a national health care system. Each country in Europe, part of the EU, it's all different from country to country. So it really is different and unfortunately, decisions about building the optimal prosthetic system is not in the clinician's hands as much as it should be. They should be the ones making the decisions, along with the people that they work with, the actual users of the devices, whether it's an AFO or a prosthetic, a trans-tibial prosthesis or a trans-tumor prosthesis. That ought to be made locally between the clinician and the user, certainly backed up by clinical evidence and outcome measures, but not driven by things like prior approval or an unregulated insurance industry.
Speaker 2:And how about these different people? You mentioned trained Germans and other people? We noticed we talked to a bunch of people from different countries. The training seems to be very, very different, right? Do you see a lot of difference in people, how they approach a certain case, or how they kind of look at it or how they solve it?
Speaker 3:I think that is critically important early in one's career. You need to have a foundational uh uh approach, um, so it's good to have sort of uh a specific process you follow. But again, we work with unique humans and individuals and they don't always fit into that so neatly. So as you get experience and you start getting successes around the edges and solving unique problems and you're left or right from textbook uh solutions, you uh gain some experience and develop some personal you know know philosophies and techniques and we see some you know really you know, sort of super exciting innovations happen. The hard thing about that is it's still very human experience.
Speaker 3:So what one clinician can do around fitting a socket is different from the next clinician. It's hard to have you know uniformity around that. I've seen a lot of socket styles over the years that I've, you know, been in the field. In transfemoral there's hi-fi sockets, narrow MLs, narrow mls mass sockets, uh northwestern university sub-issue type socket and some clinicians are wildly successful with with those techniques and approaches and some clinicians have tried them and have not had that success and moved away from that. So, um, I think it's a very hard thing to teach socketology, if you will. I don't know if that's a real world. Real to teach psychotology if you will.
Speaker 2:I don't know if that's a real word, but I think it's very hard. That should be a word.
Speaker 3:I like it. I think it's very hard to teach clinicians. Of course they have a cross to bear when it comes to adopting these technologies because there's a learning curve to it and they're constrained financially. How many iterations can you do in an office and are you willing to accept, as you try to adopt a new technology you think might be, you know, promising, or new approach that you think might be promising before you can't keep going on that path because you haven't had the success that you want or desire, or your access to um mentors, uh, to help you along the way isn't? Uh is available, uh, you know, as you you would like.
Speaker 3:I remember when I, when, when vacuum first came out, I was teaching harmony systems where I always struggled. The adoption of the vacuum still to this day is not widespread in my view. I mean, I'm a big believer in the benefits of that technology and we struggled with developing a paradigm that would keep someone engaged with it and use it as a more regular part of their tool bag. For example, when we first started teaching these courses, a clinician would come to a course in person with the amputee they were working with and we would work with them for two or three days and build an entire system in-house to get success. But then they went home and you have to confront again the unique presentation of a human being and you didn't necessarily have the experiential breadth to confront that, and so your success was maybe marginal the next time. Or you took on a challenge that was beyond your reach at that specific, you know, moment in time.
Speaker 3:Often clinicians would come to these courses with patients they've tried everything on and we were the you know, depository of last, you know resort, if you will.
Speaker 3:But really what was going on was that there was some condition beneath the skin that you couldn't see, that the patient had, that needed to be resolved before they could have a prosthetic outcome. Anyway, long story short, this paradigm of teaching would change over the years. I would go out, we would ask clinicians to give us permission to come in and see them once a month for three months, and we would fit two patients the first month and then on the second month we'd file those two patients, fit another two patients, and the third month we'd file those four patients and fit another two patients, all trying to get them you know as much exposure and experience with a newer approach to fitting amputees so that they would be comfortable and have had enough breadth of experience and fail enough times along the way and overcome those failures to become confident. But if you look at the utilization of vacuum technology, it's been pretty static over the past 10, 15 years.
Speaker 1:I'd love to dive a little bit more into that because you know, we, we I say we struggle with some of the 3d printing side of things. So I'd love to get your perspective from the product development side. And, as you, you know, you with the C leg coming to market and there's a little bit of a lag in adoption of that and then it became more mainstream and then, you know, I think we're kind of in that, as you were talking about this like vacuum technology thing with the 3d printing it's like there are benefits, we don't have the experience or the know-how to do it, so we're just not going to do it. And I'm seeing that a lot with 3D technology printing and even just scanning and design. Can you kind of extrapolate some of your experience and maybe put it onto this idea of additive manufacturing or digital technology?
Speaker 3:Yeah, I mean, I think I can. I mean it's like so when does something become one of the bill? Every day it reaches enough critical mass that it's, you know, common, you know common practice. I think you have a number of things work against any new, innovative approach to technology. One, of course, is reimbursement and the other is having. Others are a wide breadth and depth of knowledge in a particular technology.
Speaker 3:3d printing is a big bucket. You know that, brent. There's a number of methodologies to 3D print. They all have pros and cons and price points. Print. They all have pros and cons and uh price points. And so when do you select uh, which methodology or another? Um, the uh. You know to me if uh, 3d printing offers something I can't do in legacy techniques. And so, um, when do I?
Speaker 3:When does the light bulb go off that I'm designing in an entirely different way? I mean, we see a lot of 3D printed devices in social media, for example. To me, many of them are duplicates of what I in essence could do in legacy techniques. Why would I do that? Am I printing something that I could just laminate, for example? Well, maybe there's a cost argument for that. I'm not exactly sure, but really, I don't see enough people designing for additive manufacturing, and to me, that's the light bulb of it all, as I think 3D printing manufacturers have somewhat shot themselves in the foot, if you will, because the first approach to this is trying to create a business argument for it. It's more profitable to do this, it's more efficient and it may Don't get me wrong, I'm not arguing that it isn't. But if I'm going to and this is just me personally if I'm going to get excited about something, I need to be able to do something I could never do before. I want to say holy, freaking christ, this is amazing. I mean, I just want to be wowed by, uh, what I can do with it. So I don't want to.
Speaker 3:I think too many people are 3d printing devices that are really not functionally different for the user in any substantial way. So I think there's you know, some of that. So there's a lot of education. People don't fully understand it. A lot of people believe they have, you know, magic hands.
Speaker 3:I remember three or four years ago I was doing a presentation at the Pacific Northwest Chapter meeting about 3D printing and it's come a long way in three or four years since then, but I remember the audience was just not very receptive to the idea. Everybody thought there was some magic in their hands that they had to be involved with and that they were the best technician or the best clinician I mean the, the. I hope this comes out as humorful, but in as much as I've traveled around the globe and met thousands and thousands of clinicians and thousands and thousands of clinicians, I've yet to meet the second best prosthetist in the world or the second best technician in the world, if you get my meaning. So I think you confront. You confront all of those things and there's a huge learning curve right With the kinds of software programming that you use in design. Most clinicians either don't have time or the vested interest to learn proficiencies in those.
Speaker 1:I think that's great insight and 100% agree, and I think that's important for our listeners to note. What you said is if I can laminate it and pull plastic and it's the exact same function, why? Why would I change? And that's really the answer that people have to make or have to find an answer to um for them specifically. I think that's so great. Um, I'd like for you to kind of step back to the, the sea leg stuff on the, the, the, especially the product design stuff, and as you rolled it out, um, what did you see as some of the biggest benefits? Um from people, especially over all those fittings, literally thousands of fittings. That was just consistent along the way. And so I'm saying C-leg, but then we can put it into and the C-leg still is the number one microprocessor knee in the world as far as selling, and patients seem to prefer that more. But what is it about a microprocessor knee that does make such a difference for these patients? What did you see? Sure?
Speaker 3:Well, first thing I want to do before I go down that path is to challenge all clinicians to really understand how the microprocessor needs in the industry work. They're not all the same. It's not that one is good or one is bad, or one is better or one is worse, but they all don't work the same. But you need to know what they do and what they don't do. So when you're helping an amputee make a decision about selection, you're doing the right thing. Okay, because they're just not all the same. So, anyway, but if you want to broaden the bucket of microprocessor needs, I would say that trust was the number one thing. I mean, most people have a fear of falling as an amputee, particularly transferable amputees, and they fall on enough where it's very real, and we know statistically that the fear of falling is one of the number one cause for falling. And so when a prosthesis can replace function in a way that removes that that fear and gives you trust, then it it opens the world to you. So it was the first microprocessor product that provided a replacement for the quads, that allowed an eccentric contraction right so you could load a bent knee. That meant that you could sit using the process, share sit using the prosthetic side. You can go step over step descent using, uh, the prosthetic side. You can go step over step descent using the prosthetic side. It had a stumble recovery feature that would minimize your risk for falling.
Speaker 3:Now there were some mechanical needs. That had this function already. The 3R80 had this function already. The Malk S&S unit did. But they were mechanical so they didn't understand the world around them from a condition point of view and they were unreliable. They were in the sense that they required the user to put a lot of mental effort into always being aware of what they were confronting with so that they could have the need, give them that function. So I knew very few Malka SNS users that actually went step over step downstairs, for example. The need didn't work enough times. It's got to work every time. It can't work nine out of ten times for you to embrace the trust.
Speaker 3:So the microprocessing gave you sensors which collected data at a fast enough period of time where it went into a rule set. It was a series of sort of for lack of a better way of expressing it yes or no questions, the C-LAG in the beginning. Every 50th of a second it made a decision about what the condition the user was in and whether it needed to have stance stability, this yielding rate, the bending, or whether it needed to be free swinging. And so the original C-Leg had two data points and that was reliable enough that it was a huge wow factor for users. They just couldn't get over that. I mean it was. It was really impressive.
Speaker 3:We would go out and do these road shows and, uh, clinicians would bring in patients in the morning. We would take videos of them before and then, uh, we would, uh, we got very efficient at fitting these things and we brought along an extremely good C-leg user. So I would set it up, program it, do some initial training and hand them off to an experienced amputee with it. So I would set it up, program it, do some initial training and hand them off to an experienced amputee with it, and then we'd do after videos. And it was just amazing and incredibly impressive.
Speaker 3:There's two stories I'll tell you about the C-leg class I did probably in the late 80s in Indianapolis. There was a young woman who had been an amputee 17 years and came off a three-hour 45 knee. For those who don't know it, it's just a swing control microhydrovanie that Anabach made very lightweight, very nice little unit. But it just controlled swing, it didn't control stance, it had no mechanical lock, so the user had to pull back on their hip extensors and always be aware. And when you start doing the training, you start teaching them about step-over-step descent. So it's a two-day course and after day one I'm leaving the hotel to go out to dinner and I meet this woman, susan. She's waiting for the elevator to go upstairs. I said, susan, what's going on? She says, well, I'm practicing'm practicing, so we need. Well, I go up to the 17th floor and I go down step over step descent, then I go back up to the 17th. So I've done it 15 times.
Speaker 3:Wow, that's great in that same class there was an 87 year old gentleman who came in on a exoprosthesis. I'm sure it was just swing control knee but the honest I can't remember it and he was. He didn't walk very well, every gate deviation you can imagine. He was very fearful walker so he hardly bent the knee. There's hardly swing phase. He circumducted whatever and he got inspired by everybody in the class. He learned how to do step over step descent, mostly because all these younger amputees in the in the room were doing step over step descent and I'm convinced that he probably never did it when he got left that classroom. But he, he pushed himself and you know in in the course of those two days with cueing and good supervision and having the motivation, seeing people around him perform in a certain way. He had a pretty normal gait at the end of two days where he didn't when he walked in. Yeah, so it's pretty amazing. And you know? Just another story I remember a young woman in orlando I was teaching a course.
Speaker 3:She was wheeled into the course in a wheelchair by her boyfriend. She had an ill-fitting prosthesis. She had fallen a lot. She never trusted it. We fit it. We fit her to. We fit her with the sea leg on day one and the and the next thing, you know, like you know, late afternoon she's starting to walk around the classroom and she spontaneously leaves the parallel bars and starts walking around without any assistive devices in the room, and the room just stopped and oh, maybe 15 people were there, just formed a circle around her and started to applaud and the room was crying. I was breaking out in tears. It was just formed a circle around her and started to applaud and the room was crying, I was breaking out in tears. It was just like a magical moment.
Speaker 1:I'm well up thinking about it now. Wow, I think that's amazing and what I love about that is that overall confidence.
Speaker 3:But I think the other thing that's interesting and I'd love for you to speak to this too, because it sounds like you guys did this a lot is how important it is for other people that are missing limbs to see other people being successful. Oh, it's incredibly important. You know, I'm not an amputee. I can't walk a mile in their shoes. I can have a lot of compassion and sympathy and empathy, but I can't walk a mile in their shoes. I can have a lot of compassion and sympathy and empathy, but I can't walk a mile in their shoes. But if another amputee can demonstrate for them the full range of the capabilities you know we talk about, you know step over, step, descent and sitting, but when you trust your prosthesis and you're functionally replacing the use in a passive way, the use of the quadriceps muscles, then your whole world opens up to you in in important ways that are small but, you know, still super important. Um for, uh, you know, robert was the name of one of the amputees that I traveled around with and he was really athletic. He would blow the room away with his ability to kind of run and jump and, you know, land on a bad knee on his prosthetic side in a real kind of forceful and dramatic way.
Speaker 3:As a clinician, motivation is one of the key success factors for any human being using any device that I provide, orthotically or prosthetically. Their drive to be successful is key. Injury can see someone like them doing something. What I consider is, you know, pretty amazing, um it. It inspires them. I mean robert, for example.
Speaker 3:He lived in rural arkansas when he got his sea leg for the first time. He hit a barn and he built his own parallel bars and put a mirror on either side of the parallel bars. He walked for hours back and forth in the barn in front of those mirrors, perfecting his gait, because he wanted to be he wanted him to be imperceptible to anyone in the world that he was an amputee. So he just worked at it hours and hours every day. So having people come in and share that bit of a story is really super important. And again I'm going to challenge our clinicians out there to make sure that not only do you try to create opportunities for the people you're working with to meet people like them in a shared experience, a shared experience, but to also really push and try to motivate the folks that you're working with to push the envelope as far as they're, you know, willing to take it.
Speaker 3:For all these inspirational stories, I can also tell you stories that you know break my heart. I would go into a clinician's office and someone had been on a sea leg for 10 years and she pulled me inside and said you know, no one showed me how to go down slopes or step over, step downstairs. How do you do that?
Speaker 3:and I and I just was devastated because she's had this technology that could open the world for her, and she got it and she wasn't able to take advantage of it because, as far as I'm concerned, we fell short professionally for her and you know, naturally I took the time to teach her how to do that. She was just so. She was crying happy tears at the end, you know. So we have to do better.
Speaker 2:It's a wonderful story and is that what really? If you look back in your career and stuff, is that the most rewarding stuff, like stuff like that? Or is it solving the problems or is it like just really literally helping people?
Speaker 3:experience with them and you know helping them realize their fullest potential again, whatever that means to them, whether it's uh, you know, walking down the driveway to get their mail because they're in a gravel driveway, that's up and down a slope or or whatever that is. But but you know that's. You know, if you're helping people one at a time, that's a slow process and I can only help so many people that way. The other part of it to me that was so rewarding was working with my colleagues in the field and seeing them embracing these types of technologies and get excited, and having them be able to do that for the people they work with. That's the quintessential pebble in a pond, right where the ripples go out. So for you know, if I help a thousand clinicians and over the course of their career they help 25,000 people, you know they inspire a few more people to become clinicians and they help people. That's the big's, the big win, joe. So that's really the big win.
Speaker 2:All right. Well, michael, I really think we could probably go on for a couple more hours, I guess, but it was really wonderful to hear you talk and, yeah, it's been really, really great. Thank you so much for being on today.
Speaker 3:Oh, I really appreciate it. Thank you for having me, guys. I wasn't. I wasn't so sure I would bring much to the table, but it's been a lot of fun and I hope it's been useful.
Speaker 2:Totally right, brent, you love this right.
Speaker 1:Oh, I think it was great, yeah, and Michael, it was great to hear your kind of the historical perspective, but then also breaking it down. And I think this is what is important for people to hear some with our listeners as well is that there are ways to have an impact even if you don't have direct patient care. So the people and the engineers that make the C-Leg, and the people and the engineers that have come up with the ideas of the vacuum, all that has a direct consequence on an outcome for patients, and a lot of times in a very positive way, and so you get a front row seat and I know, michael, you would always take that feedback back to those engineers and say, hey, this is the life change that you're making and that makes all the difference in the world. So, yes, thank you for sharing that. I thought this was great. I know our listeners will love it.
Speaker 3:All right, Thanks guys. You have a great day. Appreciate it.
Speaker 2:And thank you for listening to the prosthetics and orthotics podcast. Have a great day.
Speaker 1:And that's a wrap for another episode of the prosthetics and orthotics podcast. A special thanks to Michael Leach for sharing his expertise and journey with us. If you enjoyed this episode, please leave us a review. That would mean the world to us. If you want to catch up with us, please join us on LinkedIn and shoot us a direct message. And until next time we'll catch you on the next podcast.
