See ya, Comfort Zone

With the support of the Gilead Global Scholar fund with Baylor Global Initiatives, I had the amazing opportunity to travel to Sri Lanka for two weeks in October to complete data collection for my Master’s research project! For my project, I aim to assess and document prosthetic care in Sri Lanka through three different “lenses”: clinical, technical, and financial. My goal for this experience was to gain perspective on the need for prosthetic care, and then find opportunities and create recommendations that I, and others around me, could enact to make a difference in the current standard of care. I also wanted to find my voice as a researcher, as a future prosthetist, and as a future influencer in the field of prosthetics by getting a view of prosthetic care in a resource-limited environment.

While in Sri Lanka, my research mentor and I engaged in an assessment of the overarching needs for prosthetic care. Therefore, we met with and interviewed stakeholders involved in the provision of prosthetic care. These stakeholders included prosthetists, surgeons, engineers, students, government officials, and hospital administrators. We evaluated various prosthetic clinics, including those funded by the national healthcare system, by (or non-governmental organizations such as Rotary), and by private funds. We also evaluated the Sri Lanka School of Prosthetics and Orthotics to assess the curricula, technical training, and resources that graduates receive.

One of the biggest lessons I learned is the importance of collaboration between engineers and clinicians in the time between product development and product implementation. As an allied health student and future clinician with an engineering degree, I have a unique viewpoint of both fields. From this experience, I saw first-hand that resource-limited environments are often most in need of products that are durable, low-cost, and easily accessible. What an exciting engineering design challenge! By contrast, engineers in resource-rich environments are developing prostheses that are lighter, faster, better…but also with an unattainable price tag. From our connections with both engineering institutions and prosthetic clinics in Sri Lanka, I cannot wait to see the collaborations that take place.

From this experience, I also see a need for “open-access” information for prosthetists and orthotists around the world. This includes educational materials, peer-reviewed articles, and technical manuals. I’ve always had an interest in being an educator, and I think this experience renewed my passion for education by encouraging me to think “bigger.” I’d like to not only educate future prosthetists and orthotists here in the United States, but I’d also love to collaborate with NGOs and international prosthetic and orthotic schools to share our educational resources or even initiate an exchange program for students, so that access to information is no longer a barrier to providing quality prosthetic care.

When people ask me about my trip to Sri Lanka, I often answer in one word: overwhelming! I was overwhelmed by the beauty of the country, the friendliness of the people we met, and the depth of information we were able to collect about the status about prosthetic care. I’m thankful for the opportunity and I’m excited to see how the project progresses and grows.

At this time, any pictures that have anything to do with prosthetics are considered research data and cannot be shared! BUT we were able to do a little bit of sightseeing while we were there, and it was one of the most beautiful places I’ve ever seen. Check out some pictures below:

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Trust Me, I Just Started…

Hi all, hope you had a great Fourth of July! The holiday definitely made the work week interesting, but I survived my first week of residency! It was a busy week, even crazy at times, but I have been LOVING the opportunity to think quickly and stay on my toes.

 

Here are some pictures from my White Coat ceremony a few weeks ago! The ceremony is meant to serve as a transition from didactic coursework to our clinical residencies, and it’s a nice way to have everyone’s families come to town before the craziness of residencies start.

MSOP White Coat 2017

MSOP Class of 2018 Students and BCM MSOP Faculty

MSOP White Coat Ceremony 2017

MSOP White Coat Ceremony 2017 | Last time at my work bench!

MSOP White Coat Ceremony 2017

MSOP White Coat Ceremony 2017 | With the program director and my research mentor, Jared Howell

 

My first rotation site is a clinic that does mostly prosthetics, so I have had the opportunity to see a lot of patients with lower limb amputations. One of the primary goals for these patients is safe and efficient standing and walking. Mobility is absolutely crucial to completing activities of daily living, so it’s important to ensure that the patient is able to achieve their desired mobility level. One of the reasons I chose to pursue a career in prosthetics (and orthotics, too!) is the single moment when a patient walks safely in their prosthesis (or orthosis!). They walk when they didn’t think they could. They walk when they haven’t been able to for years. It’s one of the most rewarding experiences in the world, and it’s totally addicting, in my humble opinion.

 
We as prosthetists do a lot to ensure that the patient can stand and walk safely. We create a socket that fits intimately with the patient’s residual limb, to make sure that forces are distributed efficiently. We pick a foot that is specifically designed for the patient’s weight and activity level. We turn set screws delicately, even by a few degrees, to adjust the alignment of the socket in relation to the prosthetic foot and the rest of the body. We torque each screw on the device to manufacturer specifications, to make sure they aren’t going anywhere (I became a torque wrench master this week, just saying…).

 
There’s one thing that we as prosthetists cannot control, however, and that thing is the patient. It takes just as much work, if not more work, on their end. They have to find the will and determination and grit to stand up and take those steps. They have to put their body weight through this foreign device, this conglomeration of screws and carbon fiber and titanium. They also have to put a great deal of trust in their prosthetist.

 
I was blown away this week by the trust that patients give to prosthetists – and even to me, as a budding new prosthetic resident! It is amazing to see this trust first-hand. The patients were absolutely fantastic, you could tell that they really, truly trusted their practitioner and were willing to take that first step. I had done a good bit of shadowing before starting O&P school, but I never really picked up on the amount of trust that’s required. The patient has to know and believe that you’re doing the best you can for them. I can’t imagine how difficult it would be to design and fit a prosthesis when the patient and the practitioner do not trust each other.

 
While we are supposed to be learning technical skills during our residency, we are also tasked to develop patient relationship skills. It is so important to me to cultivate trust and open communication in relationships with my future patients, and I look forward to practicing this skill in the next 18 months of my residency and beyond!

 

 

For my readers, what is something that you do to instill trust in your coworkers/partners/collaborators/patients/teammates?

 

© Cara Yocum | Heads, Shoulders, Knees, and Toes 2017

10 Things I’d Like to Thank my Classmates For

I was absolutely blessed with the 23 best colleagues anyone could ask for.

We started this journey almost a year ago: June 20th, 2016. Before starting, I knew a few faces, and I knew a few names from meeting people at interviews, but for the most part we were 24 strangers. As one of our professors always says – the first year of O&P school at Baylor is like drinking through a fire hose.

If O&P school can be likened to learning to drive…We’re not learning to drive on a back road or in a parking lot, we’re learning to drive going 60 down the highway. It’s stressful and it’s crazy, and there’s always a chorus of “Are we there yet?!” but our class is living proof that you can’t help but bond on the trip.

We’ve literally poured our blood, sweat, and tears into learning orthotics and prosthetics for the past year, and I’m now lucky and thankful to call these people my family.

In March, we received our residency matches, and in July we will move to the clinical portion of our curriculum, where we will rotate between 6 three-month residencies over the next 18 months. We will be moving all over the country, and we won’t get to see each other from 8-5 every day like we do now.

I’m going to miss them all so incredibly much, and I felt it was necessary to give them a big huge shout-out, because I’m so lucky to have worked beside them for the last year.

1. Thank you for your patience.

There have been SO MANY times that I’ve asked you for help. There has never been any hesitation, whether it was coming over to my bench during your lunch break to help me with alignment, or coming to pick me up in the rain when my car died. I appreciate all of the patience you demonstrated when I asked. There were many times that I struggled in the past year – academically and emotionally. Thank you for being patient and offering 23 (well, 46 I guess) helping hands without a second thought.

2. Thank you for being my home away from home.

I moved to Houston, Texas without knowing a soul. It was scary, but as we grew together in this past year, you all became more than just classmates – you are my friends and my O&P family. You gave me a home away from home, and I never felt lonely, and for that, I am so thankful.

3. Thank you for laughing with me.

There are some days, some projects, some lectures, that were just so confusing or difficult or tedious or frustrating that there  was nothing we could do but laugh. Thank you for the fabrication day dance parties, for the endless inside jokes, and for the laughter that kept me sane.

4. Thank you for pushing me to be better.

You all are some of the most amazing people I’ve had the pleasure to meet. I know you are all going to do amazing things. I am constantly in awe of the work you do at school, and as a result, I am constantly striving to be better. You make me push my limits, which in turn helps me improve.

5. Thank you for dealing with my whining.

We’re just gonna leave this one here. I know it’s bad sometimes, especially when I’m hungry. Just thanks.

6. Thank you for teaching me.

What I love about our class is that fact that we come from a variety of unique backgrounds; everyone has something that they’re absolutely amazing at. I’ve learned so much from every single one of you. Thank you for taking the time to share your knowledge and your passion with me.

7. Thank you for questioning me.

By questioning me, you help make me smarter and more aware. This in turn, will improve my skills as a clinician. By questioning me, you are indirectly giving my future patients a better orthosis or prosthesis and a better quality of life. For that, I am forever grateful.

8. Thank you for picking me up.

I’m imperfect. I’m imperfect. I’m imperfect. For a very long time, and even still to this day, I have trouble with that. I’m a perfectionist, and it often gets in the way of my progress and my learning. By watching and learning from you all, however, I now know that if something not-so-good happens, I can dust myself back off and keep moving forward. Before meeting you all, when I would struggle, I would get stuck in the rut. Thank you for pulling me out of the rut. There were even times when I didn’t even know what to do, and you were there to pick me up.

9. Thank you for the inspiration.

You all amaze me, by the work you do and the compassion you demonstrate each and every day. I’m proud to say I worked and learned beside you, and I’m lucky to know you. I cannot wait to see you all do great things, and in doing those great things, you inspire me to attempt the same.

10. Thank you for being on my team.

I’ve had academic experiences before that were rather unpleasant when it came to comparing performance or grades between classmates. I hated the cutthroat, have-to-be-the-best mentality. I was worried about it when coming to graduate school, honestly; I didn’t know what to expect. However, when starting here, I was (and am still) amazed that we all look out for each other. We want the best for our classmates, and I absolutely love the bond that we share. I know that you will always have my back, and I will always have yours.

Thank you. I can’t wait to see what you all accomplish in the next 18 months!

© Cara Yocum | Heads, Shoulders, Knees, and Toes 2017

Ready or Not, Here I Come

In a little over a month, I will be starting my first rotation of my residency at a prosthetics clinic here in Houston! I’m a little nervous and apprehensive, but mostly excited. This will be my first chance to experience full-time clinical orthotics & prosthetics care, and it’s a crucial part of my overall education. I wanted to explain a little bit to you all about what my residency will be like, so I have two goals for this post:

  1. Explain what a prosthetics-orthotics residency looks like!

  2. Discuss my own personal goals for my residency – so you all can keep me accountable!

So, let’s jump right in!

Prosthetics and orthotics students are required to complete a residency before we can sit for our board exams and become a certified prosthetist-orthotist. It’s important to learn theoretical and conceptual concepts in school, but it’s just as important to get some practice actually interacting with and treating patients as well. It’s similar to how medical students complete a residency after med school! But that’s where the similarity ends (read my previous post Not a Doctor for a quick refresher!)

Traditional O&P residencies follow graduation with a master’s degree from a CAAHEP accredited orthotics and prosthetics school (see a list of all schools here: NCOPE List of O&P Schools). Currently, Baylor College of Medicine is the only program with an integrated, rotation-style residency. This means that I will complete my residency and THEN I will graduate with my master’s degree. I will spend my 18 month residency at 6 different sites, spending 3 months at each location.

One benefit of having the residency integrated into our academic curriculum is that the residency sites are vetted; all of the locations provide excellent care and are extremely busy, which sets me up for success as a resident. Over the next 18 months, I will see TONS of patients of all ages with a wide range of diagnoses and an even wider range of orthotic and prosthetic intervention. That’s a benefit of being at 6 different sites! Also, my program hand-picked my residency sites just for me, based on my personality, learning style, and interests, which is what makes our clinical curriculum so special.

So, ready or not, I’ll be traveling between four different cities in the next year – I have rotations in Boston, San Antonio, Atlanta, and Houston. To protect the privacy of both my patients and my residency directors, I won’t be posting any specific details about the sites or the patients, just as a heads up. But I am planning to talk about my personal journey on the way to becoming a prosthetist-orthotist, as well as the fun things I do in each city, and I do hope you’ll stick around to take the journey with me 🙂

I’m looking forward to giving you a sneak peek into the life of an O&P resident, but for now, here’s what I know about what my residency will look like. I’ll be working one-on-one with a residency director, or preceptor, who is an established clinician in the field. Especially early on, I will mostly be shadowing and observing their work. I’ll see every step of the prosthetic and orthotic care process – from evaluation to fabrication to fitting to delivery to follow-up! Once I get more comfortable, I will be able to assist with (and then independently perform) certain tasks. At the end of my residency, the goal is for me to practice completely independently. However, my residency director will sign off on, and approve, all of my notes and orders. I haven’t even met them yet, but I am so grateful for my directors already! I can’t imagine the patience and trust it takes to work with a resident, and if we’re being honest, I’m anxious about making sure my work is up to their standards. I think communication is going to be a huge factor in my personal and professional success at each of my rotation sites – to make sure my preceptor and I are on the same page.

Question: If you’ve ever worked as a director or mentor, what has been something that has stood out to you about the people you have mentored or taught?

 

Next, I think it’s important to set goals for my residency – and my school thinks so too, as it’s required for our clinical curriculum! I know all about setting SMART goals –  making sure they’re specific, measurable, attainable, realistic and relevant, and timely – but I’m not sure I can do that just yet. We will take CREs, or Clinical Readiness Exams, at the end of our didactic curriculum in about a month, and I think my results from those exams will help to drive my SMART goals. I have some goals running around in my head now that are more personal, so I want to share those with you now, in the hopes that you will help to keep me accountable for them.

I’ve asked a few of the students who graduated before me at Baylor about their residency experience, and everyone says that 3 months will absolutely FLY by. A traditional resident will stay at a site for either 12 months or 18 months, so 3 months is extremely short compared to that. I’m worried about not being able to jump into the flow of the rotation site, and as a result, by the time I feel comfortable, it’ll be time to say goodbye and move to a different rotation. One of the previous students really inspired me, so I hope he doesn’t mind if I share his advice here:

There are two kinds of people at a pool in the summer. There are the people who just jump right in, and the people who walk in slowly, one step at a time, until it gets up to their belly button and they start to whine. Meanwhile, the people who jumped right in are used to the water and are enjoying themselves. In the three months that you are at your first rotation, you don’t have time to walk in. You have to jump, head first.

My mom, who is the absolute best mom in the world, in addition to being my best friend, left me with a quote when I moved into college as a freshman: Life begins at the end of your comfort zone.

If you couldn’t tell, I’m the walk-into-the-pool kind of person typically. My goal for residency is to change that. I want to dive in, I want to cannonball into this experience and soak up every drop of water that I can while I am at each rotation site. I want to step outside my comfort zone and learn absolutely everything that I can in the 18 months of my residency.

Question: How do you push yourself out of your comfort zone?

Ready or not, here I come

cannonball

© Cara “The Cannonball” Yocum | Heads, Shoulders, Knees, and Toes 2017

It Matters: Zombieland

Another week, another round of acknowledgements and accomplishments! Things are starting to get SERIOUSLY crazy around here. This week I saw two different patients, one for a prosthesis and the other for an orthosis. I also had two exams and an abstract due – this is why I’m feeling like a zombie right now…there was a lot to do this week, and not a lot of sleep.

But, I’m officially on spring break now! I know most people are almost done with school for the year, but I’ll keep chugging til the end of June, so we have a second spring break scheduled in the middle of May – and I’m so thankful! I’m getting a chance to go home and also go to Atlanta to see Cory. I’m looking forward to getting away from the grind of school for a little bit!

I would say that my biggest accomplishment this week is that I survived stepping out of my comfort zone! It wasn’t a perfect week, by any stretch. There were ups and definitely downs, but I’m working on remembering to learn from, and celebrate, the downs.

For example, I had a diagnostic check socket fitting for a transfemoral prosthesis on Monday. This means that I was checking the socket fit only – the patient was not walking in the device, they were just evaluating the fit of the interface. This is a crucial step! It doesn’t matter how awesome the components are, if the interface isn’t comfortable or won’t cooperate, the patient will not wear their limb. So in my check socket fitting, the patient had angry red spots on his skin that I could see through the clear socket (and this is why we make them clear!). I FREAKED out – red is not good, and residual limb skin is some very valuable real estate – we don’t want to be doing anything to irritate it. I expected the socket to be causing excess pressure, but to the contrary, the socket was too LOOSE on that end. The slight gapping allowed the blood to pool in those areas, causing redness.

It still needed to be fixed, no matter what was causing it! And doing a global circumferential change on a socket is pretty tricky business…but the patient was scheduled to be here all morning. So, I started all over. I scrapped the socket and decided to jump in, head first, and make the patient a brand new socket, all in the span of two-ish hours.

If you would’ve told me a year ago that I would be re-making a socket while the patient waited, I probably would’ve had a heart attack. I’m typically very meticulous (read: slow) and thoughtful (read: very slow) when I complete a fabrication project. I was determined, however, to get this right for the patient! My classmates were also super helpful, even though we all have our own sockets and patients and areas to fix, nobody hesitated to jump in when I needed an extra hand.

All in all, I finished the socket while the patient was waiting, and my new socket fit better than the first! He even got to take a little nap in the room, which cracked me up, but apparently he thoroughly enjoyed it. I’m grateful for the amazing patient models we have, and I’m so proud of myself for taking charge and pushing myself out of my comfort zone. I think it’s good preparation for residency, which starts in only a few weeks!

What did you do that pushed yourself out of your comfort zone this week?

I hope you all are well! Thank you for reading.

© Cara Yocum | Heads, Shoulders, Knees, and Toes 2017

It Matters: Transfemoral Black Magic 

It’s a lot easier to give advice than to take your own, did you know that?

In my last post, I talked about acknowledging accomplishments, and the benefits that it can have on your well-being. I’m currently trying to practice being gentler and kinder with myself, in the hopes of squashing the perfectionism that’s been controlling my life while increasing my self-compassion.

Whoa, crazy. So, what’s that mean for you?

I’m going to try to start a weekly acknowledgement and gratitude post, in order to keep myself accountable! It’ll be brief, but I just want to talk about what I’ve tackled in the previous week. And I’d love to hear your accomplishments in the comments, below! We can work on this together. No matter how little you think an accomplishment may be, it matters!

 

So here goes! This week, I tackled a second transfemoral socket modification. I met my patient on Monday, casted his residual limb for a socket, and then made modifications to the positive plaster mold throughout the week. I typically struggle when doing modifications in plaster. I mean, I’m not just ON the struggle bus, I’m DRIVING it. Especially with a transfemoral prosthetic socket: there is a lot of soft tissue that must be positioned, compressed, and loaded in a very specific manner in order to ensure patient comfort and success. This week, I felt a little more confident in my modifications – and I’m excited to see how the socket will fit at the appointment next week! I’m very grateful to our patient models, who generously give us their time, patience, wisdom, and trust as we learn.

In terms of fun things this week, I actually got to check an item off of my bucket list! Ever since I was little, I always wanted to be an ice cream taste-tester. I love ice cream, and I thought I’d be the perfect woman for the job. I came across an advertisement on Facebook for a local grocery store, HEB, who was looking for people with opinions about ice cream! I took a brief survey about my ice cream preferences, and then I was contacted later that day to come in for an ice cream tasting focus group study. I’m still amazed! I even got a $25 HEB gift card for my time. AND the ice cream was amazing!

Another gratitude nugget: I’m also grateful to my wonderful partner in crime, who is tackling final exams and moving to a new apartment, all in one week, yet he still makes time to check in on me! I’m thankful for his love and support, always.

Okay, last accomplishment for the week – I found an 8 week “couch potato to runner” program that I started, with the help of several of my classmates! One even tagged along for my first workout, and gave me tips during our jog. I am so grateful for the support of my Baylor O&P family. I have always wanted to pick up running as a hobby, and I decided that since I’m so close to a beautiful park in Houston, I need to start! I’m now on the hunt for a 5k – my first 5k – to keep me motivated with a goal in mind. Are any of my readers avid runners? What advice do you have for me?

Thanks for sticking with my first “It Matters” post! I’m looking forward to hearing your weekly accomplishments!

© Cara Yocum | Heads, Shoulders, Knees, and Toes 2017

Staying Sane

It’s getting to that point in the year where the weather outside is beautiful…but I’m so far buried in the readings and projects and studying that I forget what the sun looks like sometimes.

I’m currently in an accelerated master’s degree program; all of the other orthotics and prosthetics programs consist of approximately two years of classes, give or take, whereas I will be taking classes for only twelve months. Like I’ve said before, we refer to it as drinking through a fire hose. More often than not, I’ve felt over my head this past year. It’s a hard program, and there’s so much to learn. There has been times where I’ve wanted to give up, wanted to go home, wanted to crawl into bed and not come out for a while. But I’m still here! I’m still putting one foot in front of the other, thanks to the amazing support systems I have in my family, my boyfriend, and my friends.

First, I’d like to share with you this article, which I found extremely informative and useful: How to Spot Burnout before It’s Overtaken Your Life
Next, I’m a huge quote junkie, and I find a lot of inspiration in quotes. I’d love to hear your favorites, if you’d like to share! Here are two of my favorite quotes to keep myself grounded when I get stressed:

“If you aren’t in over your head, 

how do you know how tall you are?” 

– T.S. Eliot


“Promise me you will not spend so much time 

treading water and 

trying to keep your head above the waves 

that you forget, truly forget, 

how much you have always loved to swim” 

– Tyler Knott Gregson

So, I’m surviving! I’m not an expert, by any means, but I thought I would share what works for me, especially if it might help someone else. Here are some of the things that help me stay sane, especially when I’m feeling overwhelmed, overworked, and under-slept:

  • Exercise – I know it’s kind of the cliche go-to, but it’s not right for every person, every time. I’ve found that even just walking around the park can be a nice break. Get some fresh air, if you can, and grab a friend to go with you. I use the app Sworkit, which provides you with cardio, strength, or stretching workouts in time intervals of 5 minutes to 1 hour. I love the app because the guided videos take the thinking out of working out – the app tells me exactly what to do and when to do it. The 5 minute Core Strength is perfect to do in the living room as a quick study break!
  • Mental Time-Out – My brain is working so hard to absorb the sheer volume of information given to me. Sometimes I just can’t think about school anymore. Turn on some mindless, silly television (The Office, Friends, and Gossip Girl are my staples) or pick up a book. Several of my classmates love board games – so there is a class game night at least once a month, which I love! Just remember to allow yourself to take that mental time-out, and be present in that relaxing moment. I often fall into the trap of not being able to relax, because I’m so focused on what I *should* be doing instead. Get rid of the coulds, shoulds, and woulds, and give yourself a break.
  • Connecting – We as humans crave connection. Find someone to talk to. Call up a friend or family member. Reach out to see how someone is doing. It’s a simple way to make someone’s day, in addition to your own.
  • Dessert – I have such a sweet tooth, and sometimes you just need chocolate. It’s allowed. Ben and Jerry’s Chunky Monkey and I go way, way back.
  • Acknowledging accomplishments – I really struggle with this! I often fall into the trap of sweeping my accomplishments under the rug, because I’m so focused on the next problem to solve, or the next project to complete. If you acknowledge how much you’re doing, day in and day out, you can develop pride, confidence, and self-awareness. Taking time to acknowledge accomplishments, both in yourself and in others, is crucial. Be proud of who you are, and what you are currently struggling with. Be proud of the people around you, and tell them that you are. They might not be able to recognize it in themselves.
  • Gratitude – As weird as it sounds, I often find that I am grateful for the struggles and the stress. I am lucky to be in the program that I am in. I am lucky to be learning such difficult concepts, because it will prepare me for my future patients. I am lucky that my instructors push me to succeed, because it means that they believe in me. Taking time to write down a few things each day that you are grateful for, will help you reset for the next day.

No matter how you de-stress, or what you do to stay sane, I wish you all the best. Staying healthy and happy is more important than one test grade or one project. I encourage you that if your methods of de-stressing just aren’t cutting it, don’t hesitate to seek other help – whether that’s a psychologist or counselor, or a close friend or a teacher. Know that you aren’t alone, and that it’s okay to ask for help.


Question for my readers: What advice do you have for de-stressing? What helps you stay sane and grounded when things get crazy? 

Thanks for reading & God bless!
© Cara Yocum | Heads, Shoulders, Knees, and Toes 2017

Why can’t we be friends?

Engineering vs. Orthotics ‘n’ Prosthetics: Where’s the Disconnect?

During our Lower Limb Orthotic Management II course, we were assigned to read a series of “State of Science” review articles discussing knee-ankle-foot-orthoses (KAFOs). There articles assessed the efficacy, prevalence, and overall status of KAFO use from a variety of perspectives, including biomedical engineering, physical therapy, physical medicine and rehabilitation, and orthotic management.

All of the perspectives generally shared common areas of importance for KAFO use in patients: the patient’s individual goals, improvement in gait, and a thorough initial evaluation. All of the perspectives also expressed a desire for more evidence to support the standards of care and guide future clinical decision making.

The perspective that interested me most, however, was the biomechanical engineering perspective. My undergraduate degree is in biomedical engineering with a concentration in biomechanics, so I can definitely put myself in that mindset to think like an engineer. When assessing the engineering perspective on knee-ankle-foot orthosis usage, the priorities discussed in the article included materials science, component selection, and integration of new technology.

These are all great priorities: KAFOs are notoriously heavy to wear, and any materials that could decrease the weight of the device could improve patient acceptance, compliance, and satisfaction. When thinking about integrating new technology, powered exoskeletons come to mind. However, I won’t be providing any exoskeletons to my patients for a very, very long time. I can’t. They are too expensive and there is not enough evidence to support their use at this time. But that’s what you see on TV and on Facebook – and rightly so, because it’s COOL! And it’s great to see people who previously could not walk and are now back on their feet again, no matter what device helped to get them there.

However, there is often a HUGE disconnect between engineering research & development and clinical care, especially in the areas of orthotics and prosthetics. This amazes me, because in my engineering design classes, we are taught that user needs are the primary driver for developing a new product. As orthotists and prosthetists, we have many, many user needs that are not being met. Instead, technology is developing in a different direction – often in a direction we didn’t even ask for.

Rather than adding another gyroscope to the internal sensors of a microprocessor-controlled knee joint, could we instead improve motion-activated stance-control KAFO mechanics? Now, don’t get me wrong – there are patients who could benefit from both of the developments I just mentioned. I would love to improve EVERY SINGLE aspect of orthotics and prosthetics care to improve my patients’ lives. I’m not saying to stop any research or development that is currently in progress.

What I am saying, though, is to even the playing field. Let’s not just focus our efforts on the high-tech, state of the art, fancy components. These components are not indicated for every single patient that comes in the door. Some of my patients will need a simple drop lock to control the knee joint of their orthosis, whereas others will benefit from a gravity-activated sensor to control the knee joint. Drop locks are seriously overdue for an overhaul, I’m just putting that out there.

I think the misconception is that more technology, more computers, more sensors, more expensive STUFF automatically means better outcomes for the patients. This is wholly untrue.

Every single one of the patients who walks through the door is a person, a unique individual with their own goals, values, perceptions, and method of interacting with the world. This means that their orthotic or prosthetic needs will be very different than another patient, even if they have the same diagnosis or presentation. There is no one-size-fits-all in our field. Some patients value function over cosmesis. Others prioritize certain activities or motions. It’s crucial for an orthotist or prosthetist to investigate your patient as you evaluate for a device; what factors will make or break this for them?

My suggestion, then, because you shouldn’t talk about a problem unless you are ready to offer a solution, is to increase the communication between those completing the research and development for new devices, and those caring for the patients who will be receiving those devices. It’s a two-way street, so don’t think I’m blaming either the engineers or the clinicians – there are areas of improvement both ways!

Could manufacturers make an effort to gather clinician feedback about their products? Could it be possible to host focus groups to gather opinions?

Could clinicians complete and then share research as they treat patients, in order to gather data about usage that will help engineers as they revise a design?

I’m not sure what the right answer is, but I know that I will work to bridge the gap between engineering design and clinical care.

I want a future where design development is driven by clinical care, and clinical care is driven by the development of new technology.

© Cara Yocum | Heads, Shoulders, Knees, and Toes 2017

Not a Doctor

“So, what is it that you do, actually?”

“I’ve never heard of that!”

“So like, bionic arms and stuff, right?”

“Oh, like foot orthotics!”

I love the challenge of trying to explain to people what a prosthetist or orthotist is. Since we are such a small field, it’s very rare that someone will recognize or understand what I do! Part of a big, huge, lofty goal of mine is to increase the general public’s knowledge and understanding about the field of prosthetics and orthotics – and this blog is my first step. So again, thank you for being part of my journey!

We actually had to memorize the definition of an orthotist for one of our exams (hey, thanks Sally!), so I’m gonna drop the textbook definition before we get started. An orthotist is a person who, having completed an approved course of education and training, is authorized by an appropriate national authority to design, measure, and fit an orthosis. And similarly for a prosthetist, who is able to design, measure, and fit a prosthesis.

So even though I’m attending a medical school, I will not be a doctor when I graduate (though we do wear white coats occasionally – don’t let it fool you!)

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My first fabrication project partner with our thoracic-lumbar-sacral orthoses for pediatric patients! We wear our white coats to see our patient models to help us get in a professional mindset.

I’ll have a Master of Science degree in Orthotics and Prosthetics, and once I sit for (and pass!) my board exams, I will be a certified prosthetist/orthotist. I’ll be a practitioner, but not a doctor.

As a prosthetic and orthotic clinician, I’ll be working in a team of healthcare professionals. This is one of the things I love about O&P – in order to help our patients achieve success, specialists in different areas must work together. A physician is often the head of the team – they are responsible for overseeing the entire rehabilitation process. The physician will write a prescription for an orthosis or prosthesis – and that’s where I come in! The patient may also receive care from a physical therapist, occupational therapist, speech therapist, a psychologist, a neurologist, an orthopedic surgeon, a vascular surgeon, and more. Similar to positions on a playing field, each member of the team is responsible for their own specialty.

One of our professors like to say that O&P is the perfect marriage of people and stuff. This is why working as an engineer right out of undergrad just wasn’t going to work for me. I need to help people, and in this field, I get to work with people, and I get to make the “stuff” that will improve their lives, whether that is an orthosis or a prosthesis. As a prosthetist/orthotist, my responsibility and my specialty on the healthcare team is the patient and the “stuff” we provide to them. It’s super crucial to me, however, that the patient comes first – before the cool stuff.

Taking time to understand the patient as a person, not just the device they’re receiving, actually makes me a better clinician. Once I understand the person sitting in front of me, I can design the device just for them. How cool is that?!

If I know that my patient likes to golf on the weekends, I can ensure that the prosthetic foot I provide will allow for the rotation that comes with swinging a golf club. If I know that my patient wears dress shoes with a one-inch heel to work every day, I can ensure I provide an ankle-foot orthosis that functions in accordance with that heel height.

So even though I’m not a doctor, and I cannot prescribe medications to manage my patient’s nerve pain, I still have an obligation to talk to them about it, to figure out how their prosthesis or orthosis may be affecting their pain, and to make the patient feel validated and heard. Often our patients are juggling so many different appointments and different providers; it’s easy for them to feel a little lost. I like knowing that by taking the time to get to know my patients, rather than just knowing the device I will provide to them, I can help them feel a little less lost, a little more found.

So I’m not a doctor, but I will be a healthcare provider, and I cannot wait to make a difference in my patient’s lives.

Stay tuned for more posts about what prostheses and orthoses actually are, and the magic that goes into designing them! Thanks for reading!

© Cara Yocum | Heads, Shoulders, Knees, and Toes 2017

How Snowboarding Helped Me Survive Grad School (in Texas…)

If you read my About Me page, you’d see that I love, love, love to ski and snowboard in the winter. I had the opportunity to teach both skiing and snowboarding to kids in the Children’s Learning Center at Liberty Mountain, a resort near my home in Pennsylvania. I love working with kids, and I’d love to work in a pediatric patient care setting in the future as an O&P clinician, but I’d also love to volunteer with adaptive snowsports in the future as well.

This was taken on a family vacation to the Canyons in Park City, Utah!

I inherited my love of skiing and snowboarding from my father (if you’re reading this, thanks Dad!) who is an clinician, supervisor, and instructor at the resort as well. My dad taught me how to both ski and snowboard, and when I got older, he also taught me how to teach. I learned all about the progression of a lesson, from how to relate to your students to how to analyze movement while a student is completing a turn. While these lessons from my dad helped me to be a better instructor, they also helped me be a better orthotics and prosthetics student.

It sounds crazy, I know! Just stick with me, okay?

When we teach a student to complete a freestyle move (think rails, jumps, boxes, half pipes, all the fun stuff…) we use the acronym ATML, which stands for:

Approach, Takeoff, Maneuver, and Landing.


Like this guy, any student must Approach the feature in a way that prepares them for success.

Takeoff is the moment before the magic, and by mastering a takeoff, you ensure that you are in the correct position, physically and mentally.

Maneuver is actually doing the trick, and Landing is making sure the student completes the trick safely and continues down the mountain.

All four components are crucial to making sure the student learns to complete a skill safely and effectively. Sounds simple, right? [Side note: all of this snowboarding talk is totally making me miss the snow…we didn’t get much in Texas this winter!]

When taking an orthotics or prosthetics management course at Baylor (we call them “core” courses), we eat, sleep, and breathe that subject matter. We are in class every day from 8-5, either learning in didactic lecture or completing fabrication projects in lab. When I started my core courses, I often felt overwhelmed with the sheer volume of information I was getting shoved into my brain every day. I also felt a disconnect between lectures and labs, and as a result, I felt lost when it came to fabrication projects. I needed a way to organize my thoughts and plan my steps. What did I do? I used ATML!

When approaching a project, I found it useful to go through lecture information and make note of any relevant information that I would use for my projects. This could include trimlines, which are measurements about where an orthosis or a prosthesis will end on the body. For example, the standard medial and lateral trimlines for a total surface-bearing prosthetic socket should end approximately 65 mm proximal to the mid-patellar tendon for an initial fitting. In my approach, I would write down any technical information that I would later use in fabrication. Other information that would go in my approach include any information about my patient model, like their shoe size.

In takeoff, I would write each of the steps for the fabrication. For anyone who is familiar with fabrication, this is often subjective and a little different for each person! But the beginning of a sample progression might look like taking a cast of your patient, then filling the cast with plaster, stripping the cast away to leave the positive mold, and then smoothing the mold. It helps me to have a plan of attack, and by communicating with my professors and my classmates, I was able to write a personalized plan of attack for my projects. Plan your work and work your plan!

Shout-out to my awesome partners for a great cast!

This cast was taken to start our KAFO projects – a knee-ankle-foot orthosis! Time to make a plan!

In my maneuver, I would complete the steps I outlined in the takeoff. Easier said than done, I promise. Fabricating an orthosis or a prosthesis is an art! Now, I OFTEN have to ask for help throughout the course of a project (thanks to all of my amazingly patient professors – yall rock and I’m so grateful), but I find that it’s helpful to know at what stage I am in the process, and what my upcoming stages will be.

Finally, in my landing, I TRY to always debrief after a project. I reflect on what went well, and what could have gone better. I say try because it doesn’t always happen. I get busy! But a lot of our professors will have us complete self-reflections or group critiques following our fabrication process, so we can learn from each other, which I love. I honestly am so thankful for the wisdom I learn from my classmates, each and every day. But the benefit of landing is that you can make improvements for the next maneuver. I find myself taking tons of notes from these critique sessions that I will be able to use in my plan of attack for the next project I tackle.

So, I definitely find myself using ATML for fabrication projects, but it could also be used for patient interactions as well:

ATML for Patient Interactions:

Approach – What is the patient coming in for today? What am I planning to do with them? I’ll review any notes from the previous visit in this step.

Takeoff – Do I have the necessary supplies in my pocket or in the room? Do I have all materials to complete my outcome measures?

Maneuver – Hi Patient! We’re going to take a cast…take some measurements…fit a check socket…complete a follow-up… Just do what you do best!

Landing – Does the patient understand what was completed during the visit today? Do they have all of the tools or supplies necessary for success? What are the next steps? The clinician’s notes will be documented in this stage as well.

The possibilities are endless for using ATML as a student, as a resident, or as a clinician. It has been working for me so far in an academic setting, but I’m looking forward to applying it during residency!

Question for my readers: What do you use during the day to organize your work flow? I’d love to hear what helps you find success in whatever you do.

Thanks for reading!

© Cara Yocum | Heads, Shoulders, Knees, and Toes 2017