Although they may feel like a distant memory, the recent Paralympics highlighted the importance of access to prosthetic technologies. Together with former postdoctoral fellow Dr. Alfiya Battalova and PhD student in Kinesiology Kassi Welch, OSOT Professor Dr. Bill Miller and PhD student Brittany Pousett penned an article in the Conversation which pointed to the challenges of securing prostheses and the need for a national strategy to provide them. We sat down with Brittany and Dr. Battalova to ask them more about the limitations in current policies and the changes needed to ensure equal access to essential assistive technologies.
For those of us unfamiliar with the process, how does one go about procuring a prosthesis?
The funding process has many variables, including the cause of amputation (such as if it was a congenital or acquired limb difference, or whether the amputation is a result of an injury or accident). In British Columbia, people can get in touch with PharmaCare, who are the main insurers of prosthetics. Getting funding for the prosthesis is a complex process, requiring extensive paperwork and reimbursements. PharmaCare is responsible for determining your deductible, and will only cover 70% of eligible costs. If you have extended health plans that may cover some of the costs of a prosthetic, an upfront payment and reimbursement is common. To offset some of these costs, people can elect to seek assistance from charitable organizations such as The War Amps. Generally, prostheses are expensive, ranging from $10,000 to $100,000, depending on the individual, and often, funding processes are complex with different operational and administrative procedures between providers.
What do you mean when you say that people are “scrutinized” when trying to get prostheses? How much time and paperwork does it often take to get a prosthesis?
Acquiring a prosthesis is a lengthy process, where someone has to continuously prove their need for the prosthetic even if they have lived with limb loss for a long time. The process of submitting the paperwork, getting a prescription from the doctor and acquiring pre-approval from funding agencies can take anywhere from 2 weeks to 6 months. Throughout this process, the individual and their prosthetists are not viewed as experts who understand their own needs. Instead, their eligibility for a prosthetic is attached to the notion of “basic functionality” which does not help set people up for success.
Once approved, the prosthesis can take several days to week to be created, depending on the level of complexity.
You mention that fear of damaging prostheses can limit people’s activities and participation. How long can repairs take, and how much do they cost?
Again, costs and repair times will vary based upon the person’s coverage. Although simple repairs can be completed in hours, complex procedures that requires the replacement of the prosthesis will require another round of funding approval which is subject to the timelines of the agency. People sometimes miss out on important life commitments as they may be scared of environments that can cause damage to their prosthetic as the process for repairs can be challenging.
What would it take for everyone, from policymakers to the general public, on the same page about the provision of prosthetic technologies?
There are a lot of great international level recommendations that are related to the provision of assistive devices and technology. The current policy landscape is a patchwork of different approaches and definitions that send a conflicting message. In principle, Canada supports the UN Convention on the Rights of Persons with Disabilities but in practice it keeps promoting the medicalized, deficit-oriented model of disability that has nothing to do with reducing barriers. Revision of the existing policies and alignments of these policies across the jurisdictional boundaries and medical/insurance complex would be necessary to change that.
What would you say to someone who believes that the provision of prostheses to ensure basic function is good enough?
Relying solely on basic prostheses can lead to a variety of mobility challenges and health issues. For example, someone’s ability to enjoy everyday activities can be impacted if a prosthetic knee buckles with each step. As the knee buckles, it can be difficult to navigate certain terrain. On the other hand, some basic prostheses lack the components that reduces pain, which results in further disablement.
The current funding model is a key factor in determining someone’s ability to enjoy their everyday lives, both professional and personal. Without a people-centric approach, there is the risk we will continue to perpetuate a patronizing attitude towards those with disabilities, especially if key decision makers, such as insurance companies, crown corporations, and provincial policy makers fail to prioritize the lived expertise of people with disabilities.
There is also a notable difference between the medical coverage for injuries such as ligament tears caused by accidents and prosthetics. While coverage for ligament tears aims for a full recovery, prosthetic coverage often settles for “basic functionality”. We need to call into question why it is acceptable to only aim for the minimum support for prosthetic users, while others enjoy full support. Everyone deserves the opportunity to enjoy their daily lives, better solutions must be implemented to enhance the quality of life for individuals with disabilities.
Finally, what would a more inclusive image of people who use prosthetics be than the “cyborg-like” bodies of Paralympians?
A single narrative can’t summarize the experience of being an amputee, rather, experiences are diverse. When we associate the achievements of people with disabilities solely with sports, we are limiting ourselves to a single perspective. While Paralympians are definitely admirable, we need to show prosthetic users being engaged in various other activities and professions.
In our research, we have spoken to seniors, adults, students, parents and children all varying in age. Statistically, most people with limb loss are over 50, so a more inclusive and representative image of people who use prosthetics would focus on older adults as well.
Addressing these gaps in accessibility to prosthetic technologies is essential for fostering a society that values an inclusive environment for those with prosthetics.
To learn more about research on the creation, use and evaluation of assistive technology, please see Dr. Miller’s Matters Lab.
Images: UBC OSOT, except for person attaching prosthetic arm (@ThisisEngineering / Unsplash)