Adaptive Wound Care and Sports Medicine: A Convergence of Care
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At the Symposium for Advanced Wound Care Spring, a panel of experts discussed adaptive medicine and its role in wound care. Two of those panelists spoke with Podiatry Today to share more details about the concept of adaptive medicine, and how it can positively impact patients.
What is adaptive medicine, and specifically, what is adaptive wound care?
Alton R. Johnson, Jr., DPM, FACPM, FASPS, FFPM RCPS, CWSP, shared that patients in an adaptive medicine-oriented practice may have varying disabilities or conditions, such as amputations, spina bifida, spinal cord injury, cerebral palsy, or others. Through their care, often in a sports context, providers medically support these individuals to perform at their desired levels, whether amateur or professional.
“(This may mean) helping make sure their wheelchair is accommodated or that they have the appropriate prosthetics or shoe wear,” he said. “It’s also important to be aware of the possible risks that these athletes can face.”
Jeffrey Waldmuller, CP shares that adaptive medicine, and specifically adaptive wound care, is a field that challenges one to think outside the box when working with people who have disabilities. He points out that these patients’ challenges may or may not be visually evident, but that the care team needs to understand their needs and how to help them achieve their goals. He adds that he finds that these scenarios result in strong patient relationships with clinicians.
“When it comes to adaptive athletes, they really push boundaries. If it's a wheelchair marathoner, they're pushing their upper body strength, their shoulders, their elbows, their arms and wrists, their hands, and their skin health. If it's an amputee, they may be dealing with wound prevention within the prosthetic system or maybe chasing a good fit that allows them to run a marathon and still return to work the next day. For many adaptive athletes, the biggest challenge to perform at their peak is their ability to train consistently.”
Looking at a care plan through a different lens is often required, said Mr. Waldmuller. He noted that many aspects of the medicine are the same, but that the thinking is different than that in a traditional medical environment. For instance, if a patient has a wound within their prosthesis system, they need treatment. However, they still need to perform daily living activities or work and may still desire to perform their athletic activities.
“But, you have to think about what's happening within the socket system of the prosthetic or what's happening (for that) pushrim athlete as they're sitting. The treatment is definitely different.”
He adds that some techniques might vary from what most clinicians think about and that information on this population is not widely available. As a result, he advocates for finding knowledgeable champions, ideally in one’s community, to help advance one’s training and thought processes.
What are some of the unique challenges that athletes with disabilities face when it comes to wound care specifically?
Athletes in general push boundaries, said Mr. Waldmuller. He shared the example of an ultramarathoner developing blisters on the feet or toes and possibly losing a toenail. In those cases, he said, many will make adjustments and keep running.
“But for an adaptive athlete, like for me wearing a prosthesis, I have to (act) the very instant that I know something is happening. I have to make an adjustment immediately. So I, as a prosthetic user need to have the knowledge of what to do.”
He cited the importance of education from clinicians to patients so that they, too, can gain that knowledge and participate in the process, keeping the athletes going when possible.
“I believe we think of athletes in the context of competition. Competition is an athlete’s victory lap. They must first put in the work. But for an adaptive athlete, just being able to stick to their plan day in, day out, and return to practice the next day or to complete their entire workout, that's the big challenge.”
Mr. Waldmuller, who works in Research and Product Development for Ottobock, shared that there are additional layers to putting in the work for these patients. They may face additional challenges in accessing their training environment, transportation, or accommodating for known complications.
“We as healthcare professionals must help them to develop some method to help them continue training so that so they can go and perform.”
Dr. Johnson, a Clinical Assistant Professor at the University of Michigan, discussed the unique point of view that clinicians must employ to appropriately address these athletes’ needs, recalling that skin and wound considerations in a diabetic population is often very different than that for an adaptive wound care population.
“Certain materials react differently (with) certain dressings, and maybe they can't have certain dressings when they're doing a certain activity.”
Why is this population so important to care for in a targeted fashion?
Mr. Waldmuller shares that many of these patients are elite athletes, or at minimum, very committed to their sport. He noted a shift and increase in available sports to athletes with disabilities that clinicians would benefit from understanding, from recreational to paralympic levels.
Dr. Johnson advocates that further guidelines and/or councils are needed for thought leadership in this area to best serve these patients and understand exactly how their skin behaves in this unique context.
What are some important clinical pearls for providers to know as they begin to learn more about adaptive sports medicine?
Those working with these athletes will see limb differences frequently, said Mr. Waldmuller, and getting to know the prosthetic systems is key.
“It's sealed, (with) a gel liner typically that's over the limb, which can be hot and cumbersome. Then you have a hard socket on the other side of that. (Patients can) get pressure wounds or wounds from maceration from sweat at the distal end of the limb. Ingrown hairs and abrasions can also be a significant issue inside a prosthesis.”
Dr. Johnson agrees that learning about the liners and other materials such as shoe gear, or the anatomy of a wheelchair, are all important pathways to consider. He also echoes the clinical questions surrounding the impact of sweat on adaptive or prosthetic materials as being a current and timely investigation.
He goes on to say that biomechanics are also a vital component of helping these patients succeed.
“Try to understand their gait, because each patient is different,” he said. “You’ve got to apply pretty much all of your learning, including surgical due to amputations and skin flaps, to truly understand how that limb is going to strike.”
Mr. Waldmuller also pointed out that the mental health component of care is paramount. Although removing the prosthesis and not using it for a period of time may be the best answer sometimes, this can take a significant emotional toll. “For many of these athletes, they’ve had their legs taken away from them once, the last thing they want is to be without again”.
What resources are available on this topic for clinicians and for patients?
“It's our duty as healthcare providers to help guide our patients to receive the best care and the best resources we can. ‘Athlete’ is a mentality. Just because I run a marathon, that's not what defines me as an athlete. To help them reach the athlete mentality, they need resources.”
He cited the Amputee Coalition of America, Ottobock, and other prosthetic manufacturers as places to start that often have educational materials to consider. The Challenge Athletes Foundation, Team Catapult, Amputee Blade Runners, are also great resources, he mentioned.
Dr. Johnson recalled that much of what he has learned about this field did not come from a textbook, but instead from collaboration with colleagues and hands-on work with patients.
“Attending events like the Paralympics, which is pretty much worldwide, is a great opportunity to work with these athletes firsthand,” he said.
Mr. Waldmuller, a prosthetist, a prosthetic user, marathoner, ultra-marathoner, and mountain bike racer himself, reflects on the overall experience of being involved in the adaptive medicine space.
“I truly hope that you all have the opportunity and experience to make that kind of impact on someone's life.”
