Newsletters

Sandy Dukat of Denver, Colorado, an above knee amputee and Paralympic athlete, shattered the world record for female above knee amputees at the PF Chang's Rock n' Roll Marathon in Phoenix, Arizona. On Sunday, January 18th, Sandy, a proud member of Team A Step Ahead, took on another athletic challenge by running her first marathon in a time of 4:40:46, breaking the previous above knee record of 5:27:04 held by another Team A Step Ahead athlete, Sarah Reinersten.

Prior to venturing into long distance running, Sandy has had a long and illustrious career in sports, competing in skiing, swimming, running, cycling, and triathlon. She has competed on the national and world stages in alpine skiing, culminating in a bronze medal in slalom at the 2006 Paralympic games in Torino, Italy. She has held records in swimming from the meters to 5 kilometer open water swims. She took first place at the New York City Olympic-distance triathlon in both 2007 and 2008, and won first place at the International Triathlon Union World Championships in 2008. In addition to her many competitive athletic accomplishments, in 2007 Sandy and her friend and teammate, Kati Rooney, successfully climbed to the top of Mt. Kilimanjaro - the highest mountain in Africa, with an elevation of 19,330 feet.

Reflecting on her first marathon after the race, Sandy said, "It is amazing how long you can push it and run fast and feel good and it is amazing how quickly it changes and you hit that wall. My marathon experience was fantastic and I'm thrilled with my overall finish. My result is a true testament to everyone who came together to support me. I want to thank Team A Step Ahead for always believing in me and for always challenging me, Coach Dave Balsley, Amy Palmiero-Winters for keeping me going and of course Erik Schaffer, owner of A Step Ahead Prosthetics who keeps making my legs faster!"

Sandy was accompanied throughout the entire race by her teammate Amy Palmiero-Winters, who is the world record holder in the marathon for female below knee amputees. Commenting on Sandy's marathon, Amy stated, "Anyone who knows Sandy knows there is nothing she can not do. Sunday's race was a true example of this. It was an honor to be a part of something so amazing."

When not training and competing in sports, Sandy works for The Hartford as assistant program manager, coordinating their Paralympic Sponsorship program as well as doing motivational speaking. Sandy was featured in the Denver Post on January 26:

http://www.denverpost.com/headlines/ci_11494085

Sam Cila of Riverhead, New York joined the New York National Guard shortly after the September 11th attacks. Trained as a sniper and motivated to serve, Sam quickly rose to the rank of Sergeant as a member of the 1st Battalion, 69th Infantry Regiment.

In October 2004, Sam deployed with his guard unit to Iraq for a year-long combat tour. On July 4, 2005, Sam was wounded in an IED blast while on patrol just outside of the Green Zone in Baghdad. Near death, Sam's life was saved by the quick reactions of his platoon medic who stabilized his wounds and evacuated him for further care. Within days of his injury, Sam was evacuated to Walter Reed Army Medical Center in Washington, D.C. where he underwent more than 40 surgeries. The severe blast wounds Sam sustained to the left side of his body left him with limited left arm mobility and no use of his left hand.

After consultations with physicians and the staff of A Step Ahead Prosthetics, Sam made the decision to undergo amputation of his left hand and is now a below elbow amputee. On January 22nd, four weeks after his amputation, Sam received his myoelectric prosthesis with the i-Limb hand, a Sensor Speed hand with a Skin Tones custom silicone skin cover, Greifer hand, and a custom terminal device for cycling.

Sam with the i-Limb	Sam with the Griefer Hand	Sam with the Sensor Speed Hand with Skin Tones Cover.

Sam is an avid cyclist and triathlete who competes in road racing and multiple-distance triathlons including the 1/2 Ironman. He and A Step Ahead Prosthetics will be featured in a Sesame Street special entitled "Coming Home." The show focuses on military families who are coping with a mom or dad injured in the war. It will air on April 1st at 8pm nationwide on P.B.S.

The National Meningitis Association, Inc. was founded in July, 2002. NMA's mission is to educate families, medical professionals, and others about bacterial meningitis and prevention approaches to the disease. NMA is focused on raising awareness and protection among adolescents and young adults, many of whom can be protected through education and vaccination.

A Step Ahead is all too familiar with the seriousness and devastation of this disease, having a number of patients who have lost limbs as a result of meningococcal infection. A Step Ahead is also encouraging others to join us on May 12th in strengthening NMA's mission to create awareness of and encourage immunization against the disease, which strikes 3,000 toddlers, adolescents, and young adults annually.

A Step Ahead patients Peter Purdy (Bilateral B.K./partial fingers), Michael LaForgia (B.K./transmetatarsal) and Heather Tufano (B.K./fingers) and their families are actively involved in promoting the mission of NMA.

Help support the NMA. Go to their web site to learn more about the disease: http://www.nmaus.org/programs/getting-it/

For more about NMAs work, visit: http://www.nmaus.org/

How to buy tickets to the Gala fundraising event: http://www.nmaus.org/gala2009.htm or call 1 (866) 366-3662

The 32nd annual ASPIRE 10 kilometer race will be held on Saturday, April 4th at 9:00 am in Plainview, Long Island. Team A Step Ahead is looking forward to the largest turnout yet for this annual fundraising event for ASPIRE.

The ASPIRE race is one of the primary fundraising events of the year for the APSIRE organization. As you know, for many years APSIRE has supported and funded programs for individuals with limb loss who are seeking to improve their lives through physical activity and sports. Your participation in this event demonstrates the successes of ASPIRE as well as the continued need to raise funds for these programs. ASPIRE is planning an expanded program this year with an emphasis on events and programs for children with limb loss.

A Step Ahead's facility and staff are available to assist you in your training for this race. Please let us know if you will be there as an active participate in this event. If you are unable to participate in the race the athletes can really use your support on the day of the race.

This is an annual race that raises money for ASPIRE, a non-profit organization that provides financial support to individuals with limb loss who participate in sports and recreational activities. The larger the turnout of amputee runners at this event, the greater potential for increased fundraising for ASPIRE and future events.

The  ASPIRE  race includes a 10 kilometer (6.2 mile) event; amputees will also have the opportunity to do a 5K (3.1 mile) race, and children under 12 can participate in a 1/2 mile "fun run." For more information on how to enter the race or to just be part of the event, please contact our office at 516-681-3484.

Back Pain

Many amputees frequently report occurrences of lower back, upper back, and neck pain. In the general population, an estimated ten to fifty percent of people experience lower back pain.  Several research studies have reported that between 72% and 81% of lower-extremity amputees report some degree of lower back pain with above-knee amputees reporting a greater incidence of pain then below-the-knee amputees. A research study of lower-limb amputees in 2001 reported that fifty percent experienced back pain with mild intensity, twenty-five percent with moderate intensity, and twenty-five percent with severe intensity. Upper-extremity amputees may be more prone to upper back and neck pain.

There are a variety of causes for potential lower back pain in lower-limb amputees. Back pain can be due to prosthetic issues, musculoskeletal issues, and/or postural problems. If the prosthetic socket does not fit well and is causing residual limb pain, the lower-extremity amputee will reduce the weight bearing on their prosthetic side causing an asymmetry in posture when standing, sitting, and walking. This will put more weight on the non-amputated limb as well as strain the muscles in the lower back on the non-amputated side. This causes excess strain on those muscles and lower back pain.

If the height of the prosthesis is either too short or too tall compared to the non-amputated side, a similar pattern can develop, causing undue strain on low back muscles. Other potential causes of low back pain can be weak muscles in the residual limb and lower back as well as tightness and loss of range of motion in muscles in the residual limb. Above-knee amputees are more prone to tightness in the hip flexor muscles (located in the front of the upper thigh), which causes an increase in the lordotic curve of the low back and an increased strain on lower back muscles. Bilateral lower-limb amputees are especially prone to lower back pain due to compensatory movements in their abdominal and low back muscles to maintain good posture during standing and walking.

Upper-extremity amputees can be more prone to upper back and neck pain for similar reasons. Many upper-extremity amputees will eventually overuse the muscles on their non-amputated side, causing undue strain as well as asymmetry in upper back and neck posture. Upper-extremity amputees who use a body-powered prosthesis are required to overuse their shoulder and back muscles to activate the prosthesis for all of their activities of daily living, which may also lead to upper back and neck pain. Above-elbow amputees may be more prone to upper back and neck pain then below-elbow amputees.

In the next issue of our newsletter, we will discuss prevention and treatment of back pain.

A Step Ahead now offers prospective as well as current patients around the world live video consultations with our prosthetists via Skype video conferencing. With this technology, we can demonstrate prosthetic designs and components using photographs and direct visualization. In addition, video consultation allows us to more accurately assess a new patient before he or she travels to our facility in New York. Current patients are now able to discuss and visually demonstrate to their prosthetist any ongoing issues they may be having.  Anyone with a computer, webcam, and broadband internet connection can take advantage of this exciting new opportunity. For more information and details about how to set up a video consultation, contact our office at (516) 681-3484 or click the following link: http://www.astepaheadonline.com/video_consult.html

Staying Active with Winter Sports

Skiing, snow boarding, and ice skating are fun winter sports. At A Step Ahead, we can custom align your prosthesis so you can enjoy these activities safely. In addition to alignment, we custom fabricate knee orthoses and stump helmets to protect your residual limb. Knee braces are essential for below-the-knee amputees who ski. While skiing, your knee will be subjected to side-to-side forces that will place excessive strain on your knee joint. A custom brace can be fabricated to attach to your prosthesis and will provide improved side-to-side sstability reducing the risk of injury to your knee.

If you are an above-the-knee amputee, skiing without your prosthesis is common. A stump helmet is a device that will encompass and protect your residual limb if you fall. They are designed to reduce the risk of bruising and possible fractures of the bone in your residual limb.

Some above-knee amputees are beginning to ski using a specialized prosthetic knee called the XT9. The XT9 Energy Storing Prosthetic Knee made by Symbiotechs USA, LLC for high-activity AK amputees is the first prosthesis designed to enable AK amputees to enjoy extreme sports and an active life at the top level. Thanks to an aerospace-grade lightweight knee frame and other space-age materials and components, the XT9 prosthetic knee can withstand the forces generated in extreme sports by even the most active amputees. For more information on the XT9 knee call our office or go to Symbiotechs' website: http://xt-9.com/ 

If you are gearing up for winter sports or are interested in a custom prosthesis for any sport, call our office to speak to one of our prosthetists.

Team A Step Ahead has a lot of exciting plans for events for the adult and junior teams. The following is the list of the main events that Team A Step Ahead will be participating in this year:    

Team A Step Ahead:

• ASPIRE 10K - April 4th 
  
• Escape From Alcatraz Triathlon - June 14th
• Hope & Possibility 5 Mile Run, N.Y. - June 24th
  
• Philadelphia Triathlon - June 27th
• New York City Triathlon - July 26nd 
  
• SheRox Triathlon - August 2nd
• Westchester Triathlon - September 27th
  

Many of the adult athletes will be training for and competing in other events including running, cycling, triathlon, skiing, and rowing.

Junior Team A Step Ahead:

• Horse back riding/sleepover - 1/31- 2/1
• Laser Tag - March 
• Ice Climbing - March
• ASPIRE 10K April 4 
• Empire State Games May 28-30 
• Hope and Possibility 5 mile run June 24
  
• Philadelphia Triathlon June 27 
• Fire Day at N.Y.C. Fire Academy July 
• Volunteer at the NYC Triathlon July 26 
• Golf Program July 
• SheRox Triathlon August 2 
• Westchester Triathlon September 27
• Volunteer at the NYC Marathon 11/4
• Swimming lessons, Soccer Clinics CW Post
  

For more information about the 2009 programs for Team A Step Ahead and Junior Team A Step Ahead, contact our office at 516-681-3484.

The next ASPIRE amputee support group meeting is scheduled for Wednesday, February 25th at 6:15 pm at the Hospital for Special Surgery located at 535 East 70th Street, NY.  For more information about the ASPIRE support group, contact Charlie Steele at charlieatl@aol.com or (212) 877-7050.

New York-Presbyterian Hospital Amputee Education and Support Group Every First Friday of the Month 9-11 AM in the Hoyt Board Room, Children's Hospital of New York  in Room 121, 3959 Broadway New York, NY 10032 (Enter on West 167th and Broadway at the glass Energy Court). For further information and to RSVP, contact Sharon Clark at 212-305-3964.  

The Long Island amputee support group meets the first Saturday of each month at South Side Hospital, 301 East Main Street in Bayshore. If you are interested in joining this group, contact Jodi Adler at 631-968-3330.

Join Dave Balsley, P.T. and Phil Kreuter, P.T. at the Jericho High School track on Long Island for their monthly mobility clinic at 10 am on Sunday, February 15th. They will provide instruction in gait training and running techniques as well as advanced mobility skills. Dave and Phil have extensive experience working with amputees of all ages and activity levels. Come work out with world-class athletes and learn from experienced coaches and physical therapists. The setting is relaxed and enjoyable. There is no pressure; come learn and see what you can do to improve yourself or just to watch. For more information and directions to the mobility clinic, call the office at 516-681-3484.

Last year was an exciting time in the fight for parity. The Amputee Coalition of America (ACA) helped to introduce bills in fifteen states and pass four new parity laws. By enacting legislation, New Jersey, Indiana, Vermont, and Louisiana joined Colorado, Maine, New Hampshire, Rhode Island, California, Massachusetts, and Oregon created a consistent, appropriate standard for prosthetic coverage. Two of the new bills also extend protections to orthotics in New Jersey and Indiana.

There are now eleven states with prosthetic parity laws in place. This year, the ACA is helping nineteen states push through bills to ensure access to prosthetic care with another ten looking to introduce bills in future sessions. With the hard work of local activists and the continued support of their allies, the ACA is confident that it will be adding additional state parity laws to the books in 2009.

Several states completed cost estimate studies on the proposed parity bills while the sessions were in recess in the fall. Each report has come back in favor of adopting parity legislation on both a social and economic basis. Socially, the analysis looked at the financial hardship faced by patients if their health plan has a cap on annual costs or if devices are not covered. Given the potentially significant cost to an individual or family for obtaining a medically prescribed prosthetic device, the proposed mandate is consistent with the role of insurance.

Economically, the impact of enacting parity legislation would be minimal in terms of the premiums charged to customers. Furthermore, amputees who have appropriate access to prosthetic devices show a reduction in the secondary conditions caused by increased sedentary lifestyle, have decreased dependence on caretakers, and a reduced chance of additional medical complications leading to further amputations. Mandating coverage may reduce the overall costs of health care due to a reduction in secondary complications.

The provision of prostheses results in a variety of benefits. Some are fiscal in nature, while others are related to quality of life issues. The findings in recent reports echo the results of studies conducted in other states.

The ACA is working hard to make sure people with limb loss or limb difference are able to access the prosthetic care and devices they need, but they need even more individuals to get involved in this effort. This is a grassroots movement. The more individuals they can get to take part at the state level, the more likely state legislatures will enact this common sense legislation. There are many ways to get involved. You can write to or call your legislator. You can attend a hearing. Make your voice heard on this important issue!

Daniel Ignaszewski is the National Advocacy Specialist for the Amputee Coalition of America. To learn more about the ACA's state legislative efforts, contact Daniel at state@amputee-coalition.org or 202/742-1885.