#microprocessor-controlled prosthetic knee

Part 1

Leggies and adaptive home gear!

Jack is a BKA/below-knee-amputee and because of that he uses a prosthetic leg.

But, let’s talk a little more about what his amputation means for him.

Jack has a trans-tibial means cut through the tibia (shin bones) amputation.

So, he kept his knee joint, which means it takes a whole lot less effort for him to walk with a prosthetic. It’s not easy, regardless, but it could be harder. But as there is no weight bearing bone remaining, his soft tissue is loaded to take the weight when standing/walking. Which means his residual limb is not stiff, it’s WIGGLY, it’s fat. It’s cushioned, it has to be, so he can walk on it.

Here is a breakdown of a typical prosthetic leg and each part.

Sockets Options:

Patellar Tendon Bearing (PTB): distributes weight over the patellar tendon and takes the pressure off other areas.

Total Surface Bearing (TSB): spreads out the pressure across the entire residual limb/stump, used with a gel liner for comfort.

Hydrostatic or Contoured Sockets: Needs fancy shaping to match the pressure-load tolerance of the residual limb, often used for complex limb shapes/unique amputations or specific high-impact activities.

From looking at Jack’s residual limb, he probably has one or two PTBs for older crappier legs and uses a TSB for his daily use legs.

Which means he has liners and socks for his leg before he puts it on.

Suspension System (what holds the leg on):

Suction: Uses a liner to hold the leg on, with a valve to create suction as air is pulled from the socket.

Pin and Shuttle Lock: A pin in the liner will lock into a mechanism at the bottom of the socket.

Vacuum-Assisted: A pump will draw air out of the socket to make a seal.

These all work for different PTBs and TSBs.

Now, ankles and feet:

SACH (Solid-Ankle, Cushion-Heel): a hunk of plastic.

Single-Axis: allows one movement.

Multi-Axis: allows multiple movements.

Dynamic Response Feet: they help by storing potential energy to be used as kinetic energy, (ie, they have recoil).

Microprocessor-Controlled Feet: they adjust to changing surfaces and terrains.

Now, I guarantee our boy has two other legs in his rotation: a wet leg and a running leg.

A wet leg is exactly what it sounds like, a leg that can get wet. They are specifically designed for water activity.

Unless you are using them for a specific task, like a flipper, they typically don’t do much.

Now, for running legs. Most people think of a running blade, which is absolutely an option for Jack. He could even swap a running blade onto his existing leg, or have a separate one completely. But sprinting and long-distance running typically require different feet. Sprinting feet (shaped like a J) need to be more rigid for better recoil and push off. Longer distances require a slower release of energy (foot shaped like a C).

NOW… adaptive homes!

I need this shit, I assume Jack does too…

Shower chair that unlocks and swivels.

SPACE! So much space.

A wheelchair left upstairs and one left downstairs.

A lift! A not-steep ramp outside!

Soft carpeting! (Or no carpeting! If you are dragging your ass on the floor, you need soft carpeting or you will tear a hole in your ass. If you stay in your chair, no carpeting is better.)

Doorways that are at least 32 inches wide!

A minimum of a 5-foot turn radius!

Lower storage spaces!

ADA-compliant appliances with buttons on the front!

Lower countertops!

Accessible showers! This can be achieved with more space, a shower seat or a shower wheelchair and grab rails with wall reinforcements around the toilet and shower.

Wheelchair Accessible Closets!

Closet rods and shelving tend to be too fucking high for wheelchair users.

No grass, cobblestone, and brick right up to the door.

Welp, if you have any further questions, let me know.

:) Long post incoming. I want to talk about prostheses and FMA (Ed specifically) in a modern setting. Because automail is very cool, but realistically, there's nothing like it outside of fiction (yet). Feel free to use any of the info under the cut in fanfic. Or just to know, because prostheses are cool :)

now a common modification for a below the right knee amputee to have is left foot accelerators, allows the driver to use their left foot for gas and brake, and hand controls, allows the driver to use their hands for gas and brake. no need to use their legs

but here the thing its not guaranteed you'll find these in their car. every amputee is different. it really varies on their comfortablity. some use hand controls, some use left accelerator pedal, some drive with their prosthetic, some drive solely use their left leg

now this leaves us to imagine what type of modification or not that abbot uses

EXCEPT the show actually gives us a small hint that abbot doesnt really drive with modification

now, if you read this post i made taking about abbot prosthesis or maybe you notice abbot has a microprocessor prosthesis ankle

and since this device actually mimicks actual joint and muscle movement. it also means he can drive with his prosthetic without any need of modification

tho i fully believe he had drove before using only his left leg and with the help of a left foot accelerator system. and for sure had to relearn and practice a lot of times to drive comfortably and safely

i also believe that there might be times where jack might just drive with his left leg. like deadass take off his prosthetic and just drive. tho i feel like that can get confusing but once again that is up to fan fic writers to interpret on where to go with that

here are the links on where i got the info cuz once again im no expert

yt video

site

Peeta's Leg Prosthesis

ㅤㅤㅤThrough no real fault of Katniss's actions, we know that Peeta ends up losing his lower leg in the wake of the 74th Hunger Games. The muttations mangled his calf to the bone, and a subsequent infection led to blood and marrow poisoning regardless of Katniss's attempted tourniquet. By the time the pair were brought to medical after being declared winners, even the advanced healing techniques of the Capitol couldn't save Peeta's lower leg.

ㅤㅤㅤ(Or so we are told. Perhaps the Capitol medics didn't want to save his leg. After all, a Victor with a permanent limp makes for excellent marketing.)

ㅤㅤㅤPeeta has a transtibial amputation, which leaves him in need of a below knee prosthesis. As a Victor, he's is provided with a fairly sophisticated prosthetic (comparatively), which is designed to be comfortable for walking and standing for moderate amounts of time. The leg boasts a biomimetic hydraulic function in the ankle and foot to replicate movement with a biological limb, and has a microprocessor to adjust control of its hydraulics. This microprocessor tracks Peeta's movement patterns in order to improve his mobility, but it also ensures the Capitol can keep track of his actions even when they aren't watching. Hypothetically, the Capitol could also utilize the microprocessor to hijack Peeta's leg, leaving him unable to flee/resist if he's gone against Capitol directives.

ㅤㅤㅤIn addition to its mechanics, the prosthetic is fitted with an outer chassis that emulates the shape of an actual shin and calf muscle, ornately decorated in Victor's colors. While comfortable enough for the basics, the prosthetic is ill-suited for any kind of strenuous activity or sport. Fortunately, Peeta is able to remove the leg socket and suspension liner so his remedial limb can breathe, but he's careful to only do so behind closed doors and out of sight of others, even Katniss.

ㅤㅤㅤPerhaps the most important element of the prosthetic is how it is very clearly not Peeta's property. Like the fully furnished houses given to them in Victor's Village and the Clothes provided for their promotional trips to District parties and events, this prosthetic leg belongs to the Capitol. It's only granted to Peeta as part of the required trappings of any Victor.

ㅤㅤㅤBut then the Quarter Quell is announced, and Peeta volunteers in the Reaping (because of course he does). An ornamental prosthesis designed for walking and standing would not last five minutes in an Arena, water-based map or otherwise. The Capitol is left the question of what to do with Mellark's below knee amputation.

ㅤㅤㅤThey don't technically have to give him a prosthetic at all, since they don't provide upper body prosthesis to any other tribute. But considering how well-liked the Baker's Son is amongst the Game's audiences (and how well he manipulates his pre-game interviews), it'd only be more Bad Press if they didn't at least grant him some leg to stand on (ha ha, see what I did there?).

ㅤㅤㅤBut what kind of prosthesis to provide? The gamemakers don't want to give him a swimmer's fin, both because those types of prosthetics aren't designed for use out of water and because it would immediately ruin the "surprise" of the Arena map. So they instead opt for an adaptable waterproof prosthetic with as tight of a fit to his residual limb as possible. Considering the suits they are outfitted with for the Quarter Quell, the prosthetic might even be an integrated part of his suit, or permanently bonded to his leg for the duration of the Game. This is to reduce the odds of sand and debris working its way into his liner and prosthesis socket, as well as seal out damage to the mechanical components of the prosthetic leg (which it almost certainly suffered anyway, due to prolonged exposure to salt water and the electrical shock Peeta recieved from the Arena barrier).

ㅤㅤㅤThe result is a more restrictive, more painful prosthesis that Peeta must wear non-stop for the entirety of the Quarter Quell, which any amputee would know is sheer misery. There's a good chance that either the prolonged exposure to salt water or the electric shock of the force field caused the mechanical joints in the limb to break down, which would further limit his mobility. Even if Peeta had been rescued from the Arena, there's a reasonable expectation that the Gamemakers might have planted his tracker in his prosthetic, which would have been far more difficult to remove. The Capitol could have used this to track the Rebels back to their base in District 13.

US health insurers limit coverage of prosthetic limbs, with some patients facing repossessions

In practice, though, prosthetic coverage by private health plans varies tremendously, said Ashlie White, chief strategy and programs officer at the Amputee Coalition. Even though coverage for basic prostheses may be included in a plan, "often insurance companies will put caps on the devices and restrictions on the types of devices approved," White said.

That means that a patient's costs can also fluctuate significantly, depending on that person's coverage specifics, the plan's restrictions and even geographic cost differences.

Fewer than half of people with limb loss have been prescribed a prosthesis, according to a report by the AHRQ. Plans may deny coverage for prosthetic limbs by claiming they aren't medically necessary or are experimental devices, even though microprocessor-controlled knees like Adams' have been in use for decades...

So, if you end up taking out medical loans to help cover the huge costs?

The federal Consumer Financial Protection Bureau has proposed a rule that would prohibit lenders from repossessing medical devices such as wheelchairs and prosthetic limbs if people can't repay their loans.

"It is a replacement limb," said White, whose organization has heard of several cases in which lenders have repossessed wheelchairs or prostheses. Repossession is "literally a punishment to the individual."

I may get a little irritated at feeling like they're pushing some particular components pretty hard locally, in a one-size-fits-most kind of way. But, the overall situation for specifically lower-limb amputees (mean age: 74) is looking damned good by comparison. (Also, incidentally, compared to what I saw from the NHS up close, but any similar stats other than for Service personnel are difficult to find. That's also another kettle of fish, though one I suspect is similarly driven by cost considerations--just in a slightly different way.)

Where I am now, they are covering more functional microprocessor knees for folks who need them (luckily I've still got the OEM version, which simplifies things an awful lot)--and nobody is likely to get their limb or wheelchair repoed. That is at least one thing I haven't needed to consider. Zero copay on the actual hardware thus far. Like $20-30 per actual office visit until I hit the annual cap.

There really are some aspects of the US healthcare system that I do not miss. As someone who grew up under the threat of losing our house over one cancer surgery Blue Cross deemed "experimental" after preapproving it. At least nobody tried to repo my stepdad's resected liver.

I want to make an amputee character in my dnd campaign in the future. What are the biggest things you'd want to see from an npc/ a character like that? Anything specific for me to look out for while making them? Sorry if you're not familiar with the game, but I thought I might ask regardless

Hey there! Apologies for not answering this sooner, I was on vacation with my partner when this came in and haven't had a chance!

I just want to preface this by saying I am not an amputee or prosthetic user myself - my father has been a single above knee amputee since I was 5 years old and I have lived with him my whole life, which is where my knowledge and emotional attachment to seeing good depictions of amputees and prosthetics users comes from. As such I am not the be all end all and am never going to know as much nor my opinions be as valuable as those from actual amputees - I am simply someone who has some second hand familiarity with an amputee and who gets excited to introduce cool amputee characters to my dad, haha.

Honestly my biggest piece of advice is to decide on what kind of amputee you want to depict (whether it's above or below the joint, and of what limb(s)) and then research into the current adaptive devices available and used by people with that specific limb difference, especially looking into personal writings about the experience if possible (forums are great for this!). You can then go crazy dnd-ifying them!

The most important thing in my opinion is to not go with the "it's just an entirely magic device that functions exactly the same as the limb would" route - it takes the disability out of the disability. You see this more often with futuristic settings (Luke Skywalker is probably the most famous example) with advanced robotic prosthesis but at best it reduces amputation to a solely aesthetic aspect of character design, at worst it's a solely aesthetic aspect of character design that grants them special powers in some way. By all means magic is not totally off the table (my dad recently relearned to walk yet again with a new knee which is microprocessor controlled, for example, and if I were to dnd-ify that I'd probably explain it's a bunch of specifically enchanted mechanical parts) but the shortcut of "it's magic so it works exactly the same as a real limb" is kind of weird and alienating.

One aspect of this is that there are limitations to what can be done with a prosthetic - back when my dad had a simple mechanical knee, gravel and similar uneven surfaces were a nightmare to walk on, and sand/loose dry dirt is still a no go even computerised. Someone with an arm prosthetic with a hook is going to have a different way of picking up and interacting with objects with their hook, and may have some things they can't do. Once again it all comes down to research - people's accounts of their lived experiences are always such a powerful thing within disability research!

There's also that a lot of amputees don't have prosthetics at all! They are extremely expensive, other health conditions or disabilities can make it hard if not impossible to actually use a prosthetic, hell maybe they just don't want one - there's plenty of reasons why a character may be an amputee with no prosthetic. This would be kind of hype honestly - I can't actually think of a fictional amputee who isn't a prosthetic user!

Even people with prosthetics don't use them all the time - they're not the most comfortable things and can be very physically tiring. If you do decide to depict your character with a prosthetic, it could be nice to have them appear without it whilst relaxing or otherwise "off duty" - maybe they chill in the tavern in the evening without it. Look into what exactly is used in these situations too - for example, my dad will use crutches to get around the house/shorter range outside trips, or an active wheelchair for longer days out.

TL;DR decide on what kind of amputee you're looking to depict, do a bunch of research into the accessibility devices they might use, and then get as creative as you want! Forums and subreddits are probably going to be your best friend - I unfortunately don't know any off the top of my head as my dad does his questioning and answering in Facebook groups (he's 66, he's not the best at social media and the internet lol) but due to the wide range of needs, circumstances, and accessibility devices available even amongst groups with one specific limb difference online discussion tends to be lively and extremely illuminating as to a variety of actual lived experiences!

Absolutely don't be afraid of giving it a shot, overall - as with depicting any disability in media you want to do your research, and if possible run it past someone with that disability for both sense and sensitivity checking, but even if it's not perfect it still matters. When I introduced my dad to Hephaestus from Hades 2 he corrected me on one point (the wheelchair doesn't actually look too much like an active wheelchair - the back is too high!) but despite this he was hype to see a SAK (single above knee) amputee character who he shared a lot of characteristics with, haha.