In a recent interview, Kerstin Caine-Winterberger described her more than 40 years´ clinical experience in the rehabilitation of upper limb amputees, and the dramatic impact that the introduction of bone-anchored prostheses has made on her patients’ quality of life.
As an occupational therapist, Kerstin’s focus has been the rehabilitation of hand injuries and amputations of the upper limb. She received her OT training during the 1970’s in London, where she also worked clinically for a year after graduation.
In 1975, she started working with myoelectric prostheses, which helped patients regain both grip-function and cosmesis in their prosthetic limb. She began to work closely with Stewe Jönsson, a prosthetist, working at the Prosthetic & Orthotic Dept, Sahlgrenska University Hospital. In 1990, Stewe Jönsson, prosthetist specializing in upper limbs, asked Kerstin to join the osseointegration team; led by pioneer professors Per-Ingvar and Rickard Brånemark. That is where Kerstin’s journey working with osseointegrated amputees started.
Together the team developed a standardized protocol ranging from the first team-visit, to surgery, rehabilitation, prosthetic fitting, and follow-up visits. The protocol was based on team assessments using X-rays, measurements, functional tests, and questionnaires. Patients were reviewed at regular intervals, meeting a team consisting of orthopedic surgeons, a prosthetist, an occupational therapist, a nurse, and a clinical coordinator. The team also called the patients once a year to ask questions concerning the skin-penetration area, if there was any indication of pain, and general prosthetic use.
“But nowadays living in a more digital world, “Teams” and “Zoom”, could also be a good way to follow up in the long-term patients. However, it is very important with a personal tone in the relationship with the patients for the best treatment results”. Today, this method of team assessments is the recommended approach. Kerstin feels that interaction with the patient is crucial. “At the team visits each team-member should have sufficient time for each patient, to be able to give specific training instructions and advice; in addition to going through all the necessary questionnaires and tests”.
In your opinion, which patients are best suited for osseointegration (OI)?
” Those patients who have a functional need such as a short stump, are difficult to fit with socket prosthesis, and have skin problems are best suited for OI. It is also essential that they are well motivated and compliant. The patient must be willing to follow the program and given instructions. A psychologist in the team would also be helpful, to secure the acceptance of the treatment, ensure that the patient is compliant, and can accept the cosmetic appearance of the implant and the prosthesis. To be able to meet another patient with OI, with the same level of amputation, is also of great value. They can ask personal questions and see the abutment in real life. It´s important to have an accurate expectation of the results, and maybe someone with whom to share the experience”.
Why would you recommend osseointegration to your patients, what benefits/disadvantages are there compared to a socket prosthesis?
“The advantages are very clear:
- Osseointegration offers better range-of-motion and function than traditional socket prostheses
- There is less discomfort since there is no sweaty socket that gives pain and chafing
- The prosthesis is easy to don/doff
- The patients can manage activities in daily life more easily
- Our research shows that 92% have a better quality of life after treatment
- Better sensory feedback through osseoperception, especially in OI-thumbs
- The patient can use more advanced prostheses, due to the stable attachment which osseointegration gives
- Best of all, the user can wear the prosthesis all day without discomfort”.
What do you think OI will look like for patients in 10 years?
“I sincerely hope that more suitable patients, all over the world, will have the opportunity to receive an osseointegrated upper limb prosthesis. Selected people should be given the opportunity to receive an e-OPRA prosthesis, with a chance to improve function in daily living and quality of life. I also hope that patients with phantom limb pain will be able to use new effective treatments available for home treatment. The digital tools available nowadays, such as Teams and Zoom, can facilitate follow-up and support for the patient without travelling”.
To conclude the interview Kerstin summarizes her career:
“The teamwork has been most rewarding, working together with extremely qualified colleagues to form a complete rehabilitation for the patients. The patients were really fantastic! It has been a privilege to meet and work with all these wonderful people”.