Though I still get excited when I see footage of bionic exoskeletons and limb supports — devices that promise greater ability to the disabled and superhuman strength and endurance to all — I doubt that anyone I know will benefit from them in the next 20 years. My optimism is dimming with my current experience trying to obtain a new leg brace. Currently, I’m wearing the brace on the left below. It’s a fine brace, though its technical advancements over Forrest Gump’s braces are mostly in materials, padding metal with plastic and replacing buckles with Velcro.
That brace model must have particularly long legs. I need to extend the calf section to diminish sliding, and with the thigh portion compressed as far as possible, the brace nearly stretches from my ankle to my crotch. Also, since I’m a human female and my legs have curves, the dials at the hinge float away from the sides of my knee. This is the brace I was given in the hospital post-surgery and it’s actually very helpful for stability. However, it’s difficult to walk with a natural gait while wearing it, and to venture into TMI territory, it’s damn hard to get my pants down far enough when I have to pee.
It’s been three months since my surgery and my only remaining movement restriction is no impact: no hopping, skydiving, competition Double Dutch, etc. The stretched ligaments around my knee make it wobbly and it has a tendency to hyper-extend, so my surgeon wants me to wear a brace all the time. I rarely wear it in the house because it’s a pain, but I wear it whenever I go shopping, walking the dog, picking apples in the yard, or whenever my attention could drift for a moment and allow my leg to collapse again. I’d happily wear it more if it was a few inches shorter and fit better.
To that end, my surgeon has written two prescriptions in an attempt to get me a smaller, custom-fit, hinged knee brace. That’s not as simple as you’d think. The one local orthotic provider who would do it doesn’t accept my health insurance and gave me a quote above $900. I’ve spoken with four others in my area and their responses boiled down to: they don’t have a low profile brace option for a tibial plateau fracture, they don’t care that I’m 3 months post-surgery and my doc wants me to have a smaller brace, but they’d be happy to sell me a brace similar to the one I already have. A couple of the people I talked with treated me like I was a whining, non-compliant patient who needed to be spoken to in short, carefully-pronounced words. The one I spoke with this morning insinuated that the problem was insurance. I have a diagnosis that connects to a certain code and that code goes with a certain range of braces, and flexibility is not an option.
What remains is for me to find a brace online and pay for it out of pocket. The braces that I think my surgeon has in mind are too expensive ($550 and above) but I can find some in the $200-300 range that might work. The key features I need are a hinge that prevents hyper-extension and a rigid frame to maintain alignment. I hate to spend more when we’ve paid off the high deductible on our insurance plan for the year, but I don’t see another option.
If it’s this difficult to get a medical device when the product isn’t cutting edge technology — in the US and with good health insurance — how can I be optimistic about wide usage of bionics beyond the military and industry? I read articles like this 2010 piece from Fast Company, Bionic Legs, i-Limbs, and Other Super Human Prostheses You’ll Envy, and I have such mixed feelings. The article cites a gruesome profit motive for creators of kickass prostheses: the increasing number of lower limb amputations due to skyrocketing incidence of diabetes. Awful. But then I think about how medical costs are inflated, looking at things like the prices for knee braces like the one I need,and I wonder how many of those diabetic patients will even have a chance at the sparkly new technology. Diabetes and poverty are positively associated, so many of the people expected to need amputations are also those with the most restrictive health insurance, least ability to shop around for a doctor, and often, challenges with time and transportation that make treatment compliance more difficult. My father-in-law had a prosthetic leg. It was a heavy, uncomfortable, painful piece of crap. My guess is that’s what most poor and many middle-class amputees can expect for many years to come.
I now look at the thrilling videos of bionic prosthetic developments the way I look at Top Gear supercar reviews. I can appreciate the science, technology, and design that went into them, and I can envy the few that get to have them, but I don’t expect to see any in my neighborhood.