pop culture

Lives & Limbs – Ancient History

My series of articles inspired by Nicole Ver Kuilen‘s visit continues.

I noticed over Thanksgiving that a lot of TV channels seemed to be embracing “Throwback Thursday” by airing old but awesome episodes of their most popular shows. I’m a few days late to the party, but I thought that this would be a good opportunity to highlight a couple of fascinating figures from our distant past.

The Original “Iron Man”

Iron artificial arm, 1560-1600.

We have evidence of prosthetics being used by the ancient Egyptians, but the first documented example of a prosthesis being worn to restore function to an amputee was a metal arm worn into battle by the Roman General Marcus Sergius Silas, who lost his right arm while fighting in the Second Punic War, which took place from 218 to 201 B.C.E. We don’t know how it came about, but Sergius managed to obtain an immobile prosthetic arm made of iron, which he attached to his residual limb with leather straps. His prosthesis allowed him to wear his shield again, so he returned to active duty, where he served with valor and distinction in many battles.

He was wounded almost thirty times over the course of his career. At the time, the mortality rate for soldiers wounded once in battle was north of 80%. Sergius not only survived, but he quickly returned to the front lines each and every time. His iron limb and incredible durability made him famous, and people eventually gave him the nickname Ferrous, which is Latin for “made of iron.”

Sorry, Tony Stark. Marcus Sergius was the original Iron Man.

Sergius’ reputation for dedicated military service eventually earned him a place in public politics, where he served as a Roman Praetor. He faced a certain amount of adversity while in office because of his amputation, with several of his colleagues attempting to bar him from taking part in public ceremonies because of his perceived “deformity.” Sergius was apparently quite successful in defending himself against his detractors, which probably makes him the world’s first advocate for the rights and dignity of amputees.

The World’s First Prosthetist Was a Barber

#2 - Pare Prosthetics

If you were unfortunate enough to need surgery in Europe during the Middle Ages, you wouldn’t have gone to see a doctor. Doctors at the time considered surgery to be barbaric practice that was beneath the dignity of their profession. If you needed surgery done, your local barber had the sharpest blades and the surest hands in town and was often trained to use them for medicine as well as shaving. Ambroise Paré, a barber who served in the French military during the mid to late 1500s, is widely considered to be a founding father in the fields of surgery and prosthetic care.

Paré is particularly celebrated in prosthetics circles for his ground-breaking work in the field of amputation surgery. He popularized the use of ligatures to repair severed arteries and developed an ointment that promoted healing in wounds, both of which greatly improved the survival rate of veteran amputees. Unfortunately, Paré’s brilliant new treatment methods weren’t enough to save all of his patients. Many of the soldiers that he had worked so hard to save on the battlefield later chose to take their own lives rather than live without their amputated limbs.

Horrified and saddened, Paré decided that it wasn’t enough to simply heal an amputee’s wounds or fill the space left empty by their missing arms and legs. If he truly wanted to save lives, he needed to restore a sense of wholeness and function to his patients. With this in mind, he was the first to take a holistic approach to managing prosthetic care. He also created the first artificial leg with a working knee joint as well as the first artificial hand with articulated fingers. Many of his designs are actually still in use today.

I don’t necessarily recommend that you let your barber perform your next surgery, but I would invite you to recognize and celebrate the achievements of this one barber in particular. As a surgeon, a scientist, and a humanitarian, Ambroise Paré was a cut above the rest.

Lives & Limbs – Athletes

Last week, I announced a series of posts inspired by a visit with Nicole Ver Kuilen. Since Nicole has chosen to use running as the vehicle for her advocacy on behalf of her fellow amputees, I’d like to start with a couple of impressive amputee athletes.

The Blade Runner

#9 - Aimee Magazine Covers

Oscar Pistorius got a lot of attention for being the first amputee to make the transition into the regular Olympics, and that’s probably appropriate. He didn’t run particularly well though, and he stirred up a bit of controversy over his poor sportsmanship. He’s also serving a 13-year prison sentence for killing his girlfriend. Not the most inspiring stuff. Everyone seems to forget that Aimee Mullins was also at the 2012 Olympic Games, and that the Flex-Foot Cheetahs provided to Pistorius by OPGA partner Össur out of Iceland were originally designed for her.

Mullins wasn’t in London to run. She was too busy serving as the Chef de Mission for the United States. That’s the highest honor the U.S. Olympic Committee gives out, and Mullins earned it after a lifetime of barrier-breaking athletic achievement that was accomplished without the use of her legs.

Aimee was born without fibula bones, leading her parents to make the difficult choice to amputate both of her legs below the knee when she was only a year old. Had she kept them, she would have been wheelchair bound for the rest of her life. The amputation allowed her to learn to walk using prosthetics, but Aimee wasn’t satisfied with walking. By the time she got to high school, she’d learned to run. Fast. Mullins participated in high school track and field events while wearing a pair of clunky wooden legs. As she did so, she set records.

Aimee went to college at Georgetown University, where she became the first amputee to compete in standard NCAA Division 1 track and field events. She became a Paralympic phenomenon, setting world records for the 100-meter dash, 200-meter dash, and the long jump while competing at the 1996 games in Atlanta. She was named the USA Track & Field Disabled Woman of the Year in 1997, and her athletic prowess brought her world-wide fame.

Her stunning good looks and competitive spirit were an inspiration to legendary fashion designer Alexander McQueen, who invited Mullins to be the first down the runway at one of his fashion shows in 1999. She’s been challenging our standards of beauty ever since as a model and Hollywood actress, often posing proudly in her running blades.

The Rock Climber Turned Biophysicist

#8 - Hugh Herr (Cropped)

Hugh Herr was born the youngest of five siblings to a Mennonite Family in Lancaster, Pennsylvania. I’ve read that being the lastborn in a family can have a big effect on your personality as you grow up. Being the youngest means that you’re always surrounded by people who are older, bigger, faster, and smarter than you are, which means that you’ve got to try pretty hard to differentiate yourself. Some kids do it by being rebellious. Hugh Herr did it by being amazing. By the time he was eight years old, he’d climbed almost 12,000 feet to the top of Mount Temple in the Canadian Rockies. By the time he was set to graduate high school, he was considered one of the best climbers in the U.S.

In January of 1982, Herr was climbing with a friend in New Hampshire when a blizzard stranded them for three days in temperatures well below freezing. Both men were eventually rescued, but not before they had suffered severe frostbite. Both became amputees, with Herr losing both of his legs below the knee. Herr’s doctors told him that he would never climb again. He proved them wrong in a matter of months, designing and building an ingenious pair of prosthetic legs that allowed him to firmly stand on even the narrowest and most slippery of surfaces.

Herr’s new legs gave him the distinction of being the first professional athlete that could actually perform better at their sport than a non-amputee, and his success at rebuilding himself after his brush with death gave him a new interest in biomechanics. He earned a bachelor’s degree in physics, a master’s in engineering, and finally a Ph.D. from Harvard in biophysics. Armed with his new knowledge, he secured himself a position at MIT, where he serves as the head of their biomechatronics program. His work there has led him to boldly and controversially declare that the end of disability as we know it is close at hand.

Lives & Limbs: A Celebration of Prosthetic Advancement and Amputee Achievement

I recently had the pleasure of being visited in my office by an impressive young woman by the name of Nicole Ver Kuilen. Nicole has been named as the inaugural Health Policy & Advocacy Fellow at the National Association for the Advancement of Orthotics & Prosthetics (NAAOP), having lost her left leg to cancer at the age of ten. As she grew older, Nicole’s desire to be an athlete brought her new challenges. Obtaining a prosthesis that could meet her needs was difficult, as was navigating the financial complexities that often come with seeking prosthetic care in our country.

Nicole found herself asking a lot of questions during her sixteen years as an amputee: Why is prosthetic care so time consuming and expensive?  Why are all but the most basic of prosthetic devices often deemed “cosmetic” or “convenience” items by insurance providers? Why are people who lose their limbs under certain circumstances afforded better access to care than amputees like her who lose limbs to things like cancer? Nicole’s quest for answers led her to take a 1,500 mile jog down the west coast to raise public awareness of the issues facing American amputees. Her journey has been recorded in a documentary called 1,500 Miles, which she has used to take her message to our elected leaders in Washington and demand change.

Nicole’s story, thought leadership, drive, and sprawling list of accomplishments were a great reminder that amputees are often some of the most determined, hard-working, and impressive people around. The history of prosthetic care is packed with fascinating accounts of people like Nicole who overcame tremendous odds to make important and impactful contributions to society. Those contributions were made possible by others who saw the dignity and worth of amputees and developed the technologies and medical procedures necessary for them to live their lives to the fullest.

Inspired by Nicole’s visit, I’ll be presenting a list of people (in no particular order) who have  changed the way we look at amputees and the prosthetic care that they rely on. I’ll introduce you to a couple of people every few days until I make it through my material, so check back often!






Wheelchair Image

I offer my list of events in the timeline of wheelchair development, the acceptance of people in chairs and key milestones which forged people’s perceptions of wheelchairs and the people who use them.  Please join in the conversation – what’s on your list?

Image of Wheelchair Ramp

#1. Americans with Disabilities Act.

In 1990, Congress passed the comprehensive civil rights law addressing the rights of people with disabilities.  The ADA prohibits discrimination based on disability and requires reasonable accommodation to the disabled.  The original bill was introduced in the Senate by Iowa’s Tom Harkin and was signed into law by President George H.W. Bush.  The ADA has had a profound impact on workplaces, schools and public spaces – but not without controversy.  In the big picture, the ADA has brought millions with disabilities out of the shadows and into the mainstream leading to much higher quality of life for those with disabilities and a richer life experience for all.

Image of boy in wheelchair

#2. Superman in a wheelchair?

In 1995, actor Christopher Reeve, best known for his role as Superman, was paralyzed in a horse-related accident.  Reeve was a quadriplegic.  His fame and his determination to advocate for those who required the use of a wheelchair brought tremendous visibility to the cause.  In particular, Reeve’s efforts revealed the importance of complex rehab technology used in wheelchairs and the way it enabled users to pursue a high quality of life despite being confined to a wheelchair.

Image of couple in wheelchair

#3. Marilyn Hamilton and the Quickie Wheelchair.

In 1979, Marilyn Hamilton and two partners launched the Quickie wheelchair, a revolution in lightweight and fashion-forward chairs. Due to a hang-gliding accident, Hamilton became a T-12 paraplegic, but wasn’t willing to surrender her active lifestyle to partial paralysis. This Quickie chair was designed with an active lifestyle in mind but also, for the first time in a wheelchair, introduced a focus on design and visual appeal, in addition to enhanced freedom and movement. The Quickie represented wheelchairs and wheelchair users going on the offensive against paralysis – living an active, quality life regardless of any limitations. All the elements of the Quickie would be enhanced over time, but it was Hamilton’s vision that ignited a very big change.

Image of Student in wheelchair

#4. Judy Heumann overcomes bias and adversity to teach school.

Our Country’s treatment of people with disabilities has come a long way since Judy Heumann was forced out of school in the 1950’s. Her crime? She was confined to a wheelchair. With the help of persistent and dedicated parents, Judy got an education, graduated from college and qualified to become a teacher. She was very bright, articulate and caring. But the Board of Education refused to grant her a license to teach school because she had the audacity to be confined to a wheelchair. Her struggle ignited a passion to fight for the rights of people with disabilities and her efforts were instrumental in creation of two landmark laws, the Individuals with Disabilities Education Act (1975) and the Americans with Disabilities Act (1990). Today, people would not imagine this blatant discrimination, but in that era it was commonplace, which is why her battle to overcome it is in my top 10.

Person in wheelchair playing tennis

#5. Wheelchair developments make life more accessible

The ability to fully participate in the regular activities of life may be the holy grail for wheelchair users.  Recent engineering and technology advances have opened up the world to people using wheelchairs in a way that was never before possible.  One of the best examples is the standing powerchair, a product greatly enhanced and mainstreamed in recent years by Permobil.   Standing chairs offer clear health benefits such as pressure relief, advantages in bowel control and respiratory function.  But perhaps more importantly, standing and moving are life-changing.  Standing allows reach, function and social interaction which removes many barriers and equalizes in a way not before available to a wide range of wheelchair users.

Image of US Capitol

#6. Reduction in Reimbursement

Around the dawn of this century, Congress and bureaucrats from Medicare began a fifteen year run of reducing Medicare and insurance reimbursement for wheelchairs. This took various forms, including many steps to restrict access to wheelchairs and power mobility equipment and to reduce the amounts paid for wheelchairs. The effects of this multi-pronged effort was a reduction in the curve of innovation, a downgrading of the equipment available to wheelchair users and significant reduction in the number of people able to improve quality of life through wheelchair products. Some of this policy change was driven by a dramatic escalation in direct to consumer advertising which, on the positive side, made millions of people aware of how wheelchair technology could enhance their quality of life, but many payers and regulators took a negative view of the significant increase in the number of people using such medical devices. Bizarrely, Medicare, by policy, covers power wheelchairs used “inside the home” only. Policies created by the bureaucrats at Medicare don’t have to make sense, and often don’t.

Mobile Wheelchair Image

#7. Invacare’s First Power Wheelchair.

Invacare, led by maverick Mal Mixon, launched its first power wheelchair (the Rolls Arrow) into the marketplace in 1983. The chair was user-centric and was equipped with electronics, which were advanced for the time. That chair was the first of many advancements in power chairs brought to the market. More and better chairs would come, but this one spurred the market, drove innovation and led to a much greater focus on the needs of the wheelchair user.

Vote Buttons Image

#8. The 2016 U.S. Senate election in Illinois.

This contested election was between two candidates who are physically disabled, both of whom regularly use a wheelchair. Tammy Duckworth lost both her legs and partial use of her right arm in the line of duty after a helicopter she was piloting was shot down in Iraq in 2004. Mark Kirk, the incumbent Senator, suffered a massive stroke in 2012 leaving his left side partially paralyzed. Both candidates, understandably, downplayed the presence of their disabilities. Nonetheless, it is impossible to deny the historic nature of this race. Duckworth won the election and now represents Illinois in the US Senate.

image of couple in mall shopping

#9. The use of wheelchairs becomes “acceptable” in Popular Culture.

Pop culture is often a signal of changing societal norms and conventional wisdom. In the decade beginning in 2006, there was an emergence of people with disabilities, specifically those using a wheelchair, in our pop culture. A few of the key inflection points were:

* The hit TV show, Glee, which prominently featured a character in a chair.

* American Girl actively marketing a wheelchair accessory in its doll line as well as the first of its doll girls who had a disability.

* Barbie launching a wheelchair accessory.

* The ABC show Speechless, in which one of the characters uses a power chair and assistive speech technol

Presidential - Wheelchair Image

#10. Woodrow Wilson is first US President to rely on a wheelchair.

Wilson was a visionary president who ended the First World War and set in place strategic and diplomatic measures, which ultimately led to sustained peace and prosperity across the globe. Deteriorating health in the latter part of his presidency resulted in Wilson’s reliance on a wheelchair. Both the norms of the era and the limitations on media allowed his wheelchair usage to be largely concealed from the public. A protégé of Wilson’s would later become President and he also required a wheelchair for mobility. Franklin Roosevelt, like Wilson, concealed his wheelchair usage. The longer-term impact of Roosevelt was an acknowledgement and acceptance of people in wheelchairs – but it started with Wilson.

Image of woman in wheelchair with daughter

#11. Jeff Minnebraker builds the first ultra-lightweight wheelchair.

In 1975 Minnebraker built a chair to specifically fit his body, disability and lifestyle. In the 1970’s and early 1980’s, University of California-Berkeley was the hub of an independent living movement. People with mobility disabilities leveraged that hub to integrate into a community. Minnebraker’s Berkeley Power Chair emerged from that community. It never became a commercially available product, but it was an important breakthrough establishing means to meet the needs of the wheelchair bound person demanding an increasing level of independence.

Couple in wheelchair hugging

12. Color in wheelchairs

Color has nothing to do with function, so why would it be a top 12 development in wheelchairs?  For people who rely on a wheelchair to get around, the chair is their car, their desk and their house in many ways.  It’s the place they spend most of their time.  And it’s a first impression.  Just as Steve Jobs brought color to the computer, which then led to advances in style, color in wheelchairs has done the same.  This is especially important for children confined to a wheelchair.  We all have an innate need to belong, and in this context color can help.