Pediatric Prosthetists Adapt to New Ways of Practice During the Pandemic

On January 11, 2021, Glenn Easton answered a Facebook post made by Lorraine Torres, a clinical social worker, on the Ozone Park Residents Block Association community page requesting a prosthetic arm for a six-year-old boy in Queens, New York. The certified prosthetist and orthotist agreed to donate $120,000 to $500,000 worth of services and products over the next twelve years to the boy and his family.

Easton has been practicing in the field and managing clinics to treat children, adults and animals for the last 30 years. Based in the tri-state area, Easton has a practice specifically for pediatric patients called Centerpedes Pediatric Orthotics & Prosthetics.

Jefferson Rodriguez, 6, was born in Ecuador and lost his arm four years ago in an accident there involving a bread machine at a bakery his mother, Roció, previously worked at.

As a Spanish-speaker, Torres was assigned to assist the Rodriguez family with their needs as a recently-emigrated family through the non-profit organization she is employed by. The organization is contracted by the New York City Administration for Children’s Services. When she saw Jefferson’s arm, she asked her supervisors whether she could go ahead with finding additional care for the child.

Torres was familiar with the community group and the work it does, such as hosting a food pantry each Saturday. She began following the group’s Facebook page during the pandemic and earlier this year, Torres decided to make the post requesting help but did not expect the result.

During the height of the COVID-19 pandemic, many medical procedures came to a halt due to the risk of virus transmission. Pediatric orthotics, however, found a way to pivot to upkeep its treatments for its patients with certified practitioners using the postal service, telehealth appointments and personal home visits.

On October 6, Easton visited the Rodriguez home to begin the treatment.

Orthotics is the medical specialty where an external device is used to help a person’s limb function skeletally and/or muscularly. A prosthesis is the actual device used to replace one’s limb. Limb amputations typically occur because of injury or disease.

According to Easton, there is no difference between pediatric orthotics and adult orthotics, other than that the limbs the healthcare professionals are catering to are smaller and the service is more kid-friendly.

“I also get more gratification helping a young child than a 75-year-old, grumpy man who’s in the nursing home and his children don’t visit him,” Easton said. “Children are much more motivated to use the prosthetics.”

Easton said that eighty percent of patients lose their limbs because of the chronic health condition, diabetes, with pediatric patients losing their limbs due to congenital issues or trauma.

“Prosthetics, in general, is still a mix of art, science, technology, electronics [and] biomechanics,” said Donald R. Cummings, a Dallas-based certified prosthetist who has been practicing for the last 34 years. He currently serves as the Director of Prosthetics at the Texas Scottish Rite Hospital for Children, specializing in pediatric prosthetics.

He grew up in Ecuador, which also happens to be where the Rodriguez family emigrated from. In 1978, as a freshman in college, he contracted bacterial meningitis, causing him to lose portions of both of his legs from the knee down. Though antibiotics were given to him to treat the infection, his legs had lost circulation, prompting the need for amputations.

Cummings’ familiarity with the profession as a patient is what got him started in practicing.

At the Texas Scottish Rite Hospital for Children, an interdisciplinary team meets with the child’s family. The typical team consists of a physician, orthopedic surgeon, physical medicine and rehabilitation doctor, nurse, physical therapist, occupational therapist, child-life specialist and psychologist, in addition to the prosthetics team.

During the pandemic, the large team was dismantled as mail orders were sent and telehealth utilized.

While Cummings did not prefer it for his line of work, his patients did. “There’s only so much you could do if it requires any modifications to the prosthesis,” Cummings said. Many of the hospital’s patients lived far from Dallas, some even internationally, so the distance made telehealth appointments preferable. At the height of the pandemic, in March and April 2020, Cummings’s patients were worried that coming in for an appointment, in a big city such as Dallas, would jeopardize the rest of their family’s health.

The appointments could be used for evaluations during this time period, according to Cummings, but poor internet connection and lack of technology presented problems. Cummings also ran into a pediatric-specific complication — a child not sitting still for the telehealth appointment.

Some issues were an easy fix over the phone or computer, though. The video could point out the need to add or remove prosthetic socks for thickness, or ply, as it is known in orthotics. The quick troubleshooting fix would save some patients the time and cost of a flight to Dallas, Cummings said.

Simple adjustments, such as those below the knee, were mailed by Cummings and his team to international residents who could not make it in for an appointment. They followed up with the patients to make sure the fitting took place and determine if there were any issues that would warrant an in-person visit.

While not ideal, this version of appointments has seen an uptick during the pandemic at the Texas Scottish Rite Hospital for Children. At times, this was the only option the hospital had to be able to get devices to the patient to enact care. “That’s just the nature of our work,” Cummings said.

Younger children are better able to adapt to prosthetics because they can adjust and grow with them, Cummings said. However, because they are in a natural state of growth, that typically means they will outgrow a prosthetic every 12 to 15 months. Fitting a young child for a prosthetic requires adapting to their needs if they are playing sports or undertake certain activities. The prosthetic can be built with this in mind.

According to Cummings, medicaid and private insurance usually covers prosthetics but the family is responsible for a deductible. Sometimes a fee is negotiated and the family pays approximately 10–20% of the cost of treatment.

As a parent to four children, Easton is used to donating his time and services. His orthotic center for animals operates by fully donating its treatments. “It’s a part of doing business. You make money on other patients and you help other ones,” Easton said. “That’s what makes the world go around.”

Easton hopes to have Jefferson fitted with an initial prosthetic by Thanksgiving.

Though Rodriguez’s case is not complicated, Easton said he will run into one challenge and that is figuring out a way to have the Spiderman-themed prosthetic shoot webs.

Torres, the clinical social worker who made the Facebook post, is still in awe of the result. “Despite us not knowing each other, despite everybody being strangers, it was because of what they had in their heart,” Torres said.

“Because God led them to do what they did for Jefferson that we’re here today, out of one act of kindness.”