Centre at Tan Tock Seng Hospital offers hope to amputees

SINGAPORE - On the surface, it is a nondescript workshop inside a refurbished building at Tan Tock Seng Hospital.

Yet the 3,700 sq ft centre - about the size of three five-room HDB flats - is where hope blooms for people who have lost limbs to injury or disease.

Welcome to TTSH's Foot Care and Limb Design Centre (FLC). It might be littleknown, but it is the only centre with a specialised workshop which makes and assembles customised prosthetics.

"There's a design for everything," says Mr Trevor Binedell, FLC's unit head of the prosthetics and orthotics department.

While he acknowledges that there will be limitations when it comes to replacing full functionality, he notes that "anything" can be replaced, or re-attached.

The centre can produce high-quality sockets for patients and where needed, it can import high-tech parts to assemble high-performing prostheses.

At first glance, the FLC seems like any ordinary clinic, complete with a typical patient's waiting area.

But walk around the corner past a rehabilitation circuit and through a door, you'll see workers in a bright white room equipped with a computer-aided moulding design machine, an infra-red oven, lamination machines, carbon fibre tools, vices and clamps.

And limbs. Lots of prosthetic limbs everywhere, stored on shelves, tables and in boxes.

According to Mr Binedell, the centre fits around 300 patients a year.

The limbs cost between $1,300 for a basic below-knee prothesis to more than $50,000 for a high-end bionic leg, which has artificial intelligence to detect movements of the leg.

With few or no complications, it can take as little time as three months, from amputation to prosthetic fitting, to get a patient up and walking. Special care, he explains, has to be taken with the socket.

It holds the patient's stump and is customised by the centre according to the detailed measurement of the patient's stump.

"If the leg tolerates the pressure, then good, but sometimes the wounds can reopen or if there's scarring or blistering then we stop walking for a few days and try again.

"Which is why it is the most important part that the patient wears. If the part is uncomfortable, he's not going to wear it. That's the part which needs the most customisation," says Mr Binedell.

Other prosthetic components, such as the foot, adaptors and knee units, are ordered from overseas.

But it is not as simple as a mechanical fitting. Patients have to be medically, physically and emotionally ready.

Some patients refuse to consider prostheses for either financial or emotional reasons, reveals Mr Binedell, 34, an Australian who has been working here for nine years.

The majority of the patients are diabetes sufferers in their 60s who have had limbs amputated due to gangrene. Many cannot accept the fact that their limbs have to go.

"They think: 'I don't want to lose my whole leg because I think my life is over. I cut my toe off, I can still walk'," he says.

They often find themselves on the operating theatre months later, having the operation that they'd avoided.

But the centre takes them through the entire spectrum of the recovery process.

"Patients, after an amputation, are referred to an amputee clinic. We have a rehabilitation doctor come in and they will assist the patient with the prosthetist and physiotherapist.

"Then we have a medical social worker come around, so if patients are deemed potential candidates for artificial limbs, the medical social worker will give financial counselling to those who need financial assistance."

Like the training conducted at a driving school, patients start learning basic movements of the body and limbs.

"We teach them how to get used to their new legs, how to protect themselves when they fall on the floor, getting down stairs, how to negotiate kerbs.

"We also have advanced physiotherapists for the guys who want to learn to run, ride bikes and do sports and who are a bit more active."

The important thing is the patient's attitude, reveals Mr Binedell.

When they realise that their lives are not over when they lose a limb, much can be achieved, he declares.

Young people take their amputations the hardest. But they are the most motivated too.

"They expect more from the leg and they don't want to limit themselves."

But Mr Binedell says that sometimes, enthusiasm has to be tempered somewhat, to minimise lofty ambitions before patients conquer the basics of the rehabilitation process.

"So from the start when I see a patient, I try to control their expectations a little and if you can control the expectations, the acceptance of the leg is quicker.

"So if they have these high ideals about what they want to do with the leg, I just say, well, focus on this part first rather than them going 'yeah, I want an arm, I want a leg for running, I want a leg for cycling'.

"How about we just make one for walking first, I would ask them. Show me you can use it."

Cheekily, Mr Binedell, who speaks passionately about wanting patients to be motivated, confronts their ego.

"Sometimes I like to challenge the patients as well. I tell them 'you prove to me you can do it' then I'll make that leg."

"You've got to talk the talk and then walk the walk," he adds with a laugh.

The best part for the team is when they see patients who don't allow themselves to be limited by their artificial limbs.

They've made high-performance legs for some of their patients like Mr Abdul Alim Mohamed Hanifah, who will today aim to complete 42km in The Challenge category of the OCBC Cycle Singapore 2013 in under two hours - a feat many able-bodied people would find challenging. Mr Alim lost his right leg when it had to be amputated below the knee after a road accident .

Mr Binedell says patients come back at least once a year for re-fittings, upgrades and maintenance.

This means they are in the prime seat to watch their lives evolve along the way, from tragedy to triumph.

"Sometimes they come with different things. I saw a guy and he said he wanted to run.

"He wasn't running before. But now he wants to run."

Which is why in his 13 years of dealing with amputees, Mr Binedell gets satisfaction from people who beat the odds, and is always open to patients wanting to try a new adventure in their lives.

"Yeah, no problem. I never limit a patient, the technology doesn't limit the patient. The patient limits the patient."


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