This area is extremely hard to define. There are so many different scenarios that it is hard to cover them all. Hopefully in this section we can define the general basics and the individual can find what fits their situation.

Some Scenarios:

• New Amputee before surgery
• New Amputee after surgery
• Amputee who has never had a prosthesis
• Amputee who has a prosthesis but is not satisfied with it.
• Amputee who has a prosthesis but is looking for a new one.
• Amputee who has moved to a new location and is now looking for a new prosthetist.

The first and most important thing for the amputee to know: You are the team leader of your rehabilitation Team. In this role you have the right to assemble your rehabilitation team to best suit your needs. This team is composed of several members - Your surgeon, prosthetist, physical therapist, and any other person/organization who is involved in your rehabilitation process. You are the Consumer (Customer). You are paying someone for their services and therefore have the right to be a part of the Team. You determine what an addition to your home is going to look like and contain therefore you are the primary member of this team since the device you are paying for is going to determine the amount of functionality and level of activity that you return to.

If you have the "luxury", as crass as that may sound, to know ahead of time that you will require an amputation you should shop for a prosthetist immediately. Then approach your surgeon and request that your prosthetist be included in the surgical decisions. Most prosthetists can advise the surgeon what level of amputation would best suit the fitting of a prosthesis thus eliminating many fitting problems in the future.

Some amputees have a choice of who their surgeon is, some don't. It depends on how the amputation is acquired. Most amputees are referred to a prosthetist by their surgeon or hospital staff. It is important to realize that you do not have to accept this particular prosthetist, unless of course it is the only prosthetist your insurance will work with. Most Surgeons will refer you to someone they are familiar with but it is not necessarily a recommendation. You will learn throughout your life as an amputee that many surgeons know nothing about prosthetics.

The Prosthetist is a Major Player on your Rehabilitation Team. It is the prosthetists skills and desire that is going to determine your abilities and comfort with your prosthesis. Choose your prosthetist wisely. Buying a prosthesis should be similar to buying a car, shop around for the best "salesman" (Prosthetist), price, and "options" (components). Find a prosthetist who you get along with well. Personalities are different but find one who suits your personality, will include you in the process of designing and building a limb, listens to your concerns, and is willing to work within your financial guidelines. When given an estimate of costs you can check the price of the components against the High/Low limits of your state by downloading a copy of the L-Codes for your State. Insure that the prices are within the limits of your Financial provider whoever that may be. Insure that the Prosthetist will accept the payment provided by Medicare/Medicaid (if that is your provider) or be prepared to pay the difference yourself. Make sure you get all this in writing. While a "gentleman's agreement" is fine in principle it doesn't stand up in court should you need it.

The first task of purchasing a prosthesis is to talk to a number of prosthetists. Inform them that you are looking to build a Rehab Team. Ask questions - Are they willing to discuss your concerns?, Include you in the rehab process? Inform them of what your goals are, what is it you are expecting to be able to do when this prosthesis is complete? Explain your lifestyle to them, what activities are you most anxious to return to, what activities must you return to, is there a point of compromise? Tell them what your expectations are and ask that they be honest with you if they feel they can not provide these to you. Are they willing to discuss options? Components? training required, do they accept your form of payment? Ask to talk to current customers with the same level of amputation as yours. One thing to keep in mind, many prosthetists become "specialists" in a certain level based on the customers they have. For example if the majority of their customers are above knee amputees it would be uncertain as to what level of competency they have with upper extremity or below knee amputations. Will they let you pick the customers you talk to or do they have "canned" customers they will give you. These may be the customers with the best results.

Find a support group in your area, talk to amputees there with the same level of amputation. Ask where they get their prosthesis, ask if they are happy with it and their prosthetist or would they be willing to recommend their prosthetist.

The first step of this process should be taken as a fact finding tour. You are out to educate yourself in a completely strange field. Most new amputees have never had a need to become familiar with prosthetics so be sure you become armed with knowledge before actually making the decision to begin the purchase of one.

Perhaps you would find talking to a consultant more comfortable. There are several prosthetists who are willing to work with you on this level. They can make recommendations to you concerning who they feel are good prosthetists in your area, what firms are well respected, what level of certification is available etc. They are also willing to discuss componentry with you and some are even willing to travel to your location, at your cost, to manufacture your prosthesis. If this is what you are interested in then might we suggest two that we feel are very good - Al Pike C.P. and Tony van der Waarde.

Get estimates in writing, contact your financial provider with the information to insure they will cover the costs, if they will not what percentage would you be required to pay. Check with the prosthetist to insure they will accept the payment of your financial provider as payment in full. Find out from the prosthetists, in writing, what is covered by this payment. Are adjustments covered in the payment, if so for how long? Does the payment cover a new socket as shrinkage occurs or are you required to pay for them, if so will your insurer pay for them. The first guarantee you have is what you leave the office with will probably not work for you 3 months down the line. As the residual is contained in a socket physical changes occur which require a new socket or adjustments be made. How long will this payment cover adjustments to the limb. What if you are not satisfied with the componentry, will the prosthetist allow you to "Experiment" with other components? if so what is the charge to you?

One point to keep in mind. Sometimes the best prosthetist is in the "mom and pop" facility. Generally speaking these facilities have existed from repeat business over the years. They don't grow to the point of needing tremendous amounts of money to exist but exist on repeat customers and pride of craftsmanship. So biggest isn't necessarily the best! Big facilities require large amounts of money for advertising, Overhead, Payrolls and inventory. Beware of facilities with the big Promises. While some amputees can gain tremendous talents with a prosthesis each person is different and there is no guarantee that you will gain the same levels. If they promise you something then no doubt there is a price for it. The level of ability you gain is going to be determined by your willingness to work, practice and the level of competency of your Physical Therapist.

Also while certification is good, remember it does not insure quality. There are many excellent prosthetists in the field who are not Certified.

CHECKLIST

• Do you need a Surgeon?
• Do you need a Prosthetist?
• Do you need a Physical Therapist?
• What are your Goals and Expectations?
• What financial support do you have?
• Will you have to help defray the costs from personal finances?
• Is your prosthetist willing to give you current customers as references?
• Are these references of the same level amputation as you are?
• Is your prosthetist willing to include you in the decision process?
• Is your prosthetist willing to discuss components and explain anything you don't understand?
• Is your prosthetist willing to go out of his way to ensure the most function and comfort of your prosthesis?
• Is your prosthetist willing to try "new" things without charge to determine the best fit possible for you?
• Is payment of primary importance to your prosthetist - i.e. do they want you  to sign the release form before completion of the product?
• Is your prosthetist willing to accept your financial providers payment as payment in full?
• Is your prosthetist willing to work with your surgeon and Physical Therapist?
• What kind of after purchase support is provided?
• Can you "experiment" with components?
• Do you need a consultant?
• Is there a support group in your area?