Alberta’s prosthetic funding model outdated and unfair, say amputees


After months in a wheelchair, Angela Oakley walks again, slowly descending the steps of her parents’ house in Edmonton’s Highlands neighborhood as she walks to a physiotherapy appointment at Glenrose Rehabilitation Hospital.

Oakley, a veterinarian who lives in Grande Prairie, Alta., Began battling a bone infection in her left leg when she was in vet school in 2010. After numerous surgeries and part amputation from her leg a few years ago, she became an above-knee amputee in March.

Last week, after months of complications and delays from the pandemic, she finally received a new prosthetic knee that is expected to allow her to walk, cross-country ski and ride horses again. A long-time multisport athlete, she also dreams of representing Canada at the Paralympic Games.

Its mobility, however, comes at a high price. Her new knee costs about $ 57,000 and Alberta Aids to Daily Living, the provincial program that funds long-term disability medical equipment, will pay no more than $ 6,000.

If she lived in England, her prosthetic limb would be fully covered. But in Alberta and other Canadian provinces, amputees are responsible for paying most of the costs.

“How many Albertans can turn around and drop $ 50,000 on one knee?” Oakley said in an interview with CBC News last week.

Oakley, who has petitioned for changes in prosthetic funding and contacted the Alberta health minister, believes the current funding structure is outdated and unfair, preventing amputees who cannot afford the members they need to do activities they love and fully contribute to their communities.

In a country known for its universal health care system, “we are letting all these people down,” she said.

Why are some knees so expensive?

There are generally two types of prosthetic knee: mechanical and microprocessor.

A mechanical knee replaces the knee joint with a mechanical hinge, but a microprocessor – also called “computerized” – the knee is much more sophisticated – and expensive.

With a computer and sensors, a microprocessor-based knee automatically adapts to real-time information about the user’s gait and walking speed.

How many Albertans can turn around and drop $ 50,000 on one knee?– Angela Oakley

For some amputees, a cheaper mechanical knee is sufficient, but not for Oakley, who is very active with physically demanding work. She also did not feel safe using a mechanical knee due to nerve damage and lack of muscle strength in her left leg.

“I didn’t have the quadriceps strength to pull it through and lock it in,” she said. “When I walked, the knee wouldn’t be locked, so it would just collapse under me.”

Oakley was shocked to learn that the microprocessor-based knees cost between $ 35,000 and $ 95,000, and that the maximum she would receive from Alberta Health would be a $ 6,000 grant covering about 10 percent of the cost.

Watch | Amputees call for changes in funding for prostheses:

Amputees and advocates call for changes to provincial prosthesis funding

Angela Oakley and Ben Proulx say they need computerized prosthetic legs to walk safely, but Alberta is only funding a small fraction of their cost. 2:36

As a below-knee amputee, she only paid a $ 500 deductible for prosthetic components.

Her friends, family and coworkers helped her raise funds through a crowdfunding campaign and other online fundraisers, but she was only able to afford the microchip knee thanks to her employer. who contributed to the rest.

His new knee won’t last forever, either. Oakley, 32, expects her to need five to eight replacements in her lifetime, as prosthetic knees typically last six to 10 years.

Oakley managed to pay for her knee, but amputees who can’t afford it often end up using prosthetics that are less suitable for their body, she said.

Ben Proulx’s microprocessor knee allows him to play sports like tennis and go hiking with his family. He has advocated for more prosthetic funding for years. (Nathan Gross / CBC)

Years of advocacy, no results

Ben Proulx, who lost a leg to cancer at the age of four, received his first microprocessor knee as a teenager.

Like Oakley, he struggled to use a mechanical knee, experiencing back problems and hip pain.

His current knee, which he paid for with crowdfunding proceeds and War Amps funds, allowed him to train in youth sports and hike with his family pain-free.

“It allows me to have a more normal lifestyle and it does less damage to my body,” said Proulx.

He has advocated for increased funding for prosthetics from the last three provincial governments without success.

Proulx’s prosthetist accompanied him to meetings with decision-makers, armed with studies and data showing the long-term cost savings associated with funding microprocessor-based knees, but he said the conversations “still don’t lead to zero. go”.

“It would actually be a minimal expense for the government to improve its game and take care of Albertans who have prosthetic legs and fund them properly up front. But they are unlikely to win any votes because there is not many. from us. “

His current knee, which cost $ 40,000, will likely need to be replaced in four or five years and Proulx is worried about how he will pay for a new one.

“It gets very demoralizing over time to ask yourself, ‘Hey, where will my next body part come from? “when it’s really not something you should have to worry about,” he said.

Alberta Health spokesperson Carolyn Gregson said the Alberta Aids to Daily Living program “is designed to meet basic needs to help Albertans stay independent.”

Gregson said the program provided microprocessor grants to eight Albertans in the 2020-2021 fiscal year.

Provincial funding for microprocessor knees is minimal in Canada, according to Calvin Howard’s research. (Madeleine Cummings / CBC)

“We must increase the coverage”

In an article for the Canadian Prosthetics & Orthotics Journal, Calvin Howard and his colleagues examined prosthetic coverage in all 10 provinces, finding varying funding levels.

They discovered that amputees could receive up to $ 15,000 for microprocessor knees in Saskatchewan and up to $ 20,000 in New Brunswick. Coverage for Nova Scotia was similar to that for Alberta. No province has fully funded them.

Howard, who is now a doctor in Manitoba, said the cost of prosthetics has skyrocketed in recent years, but provincial policies have not caught up.

“We have to increase the coverage if we are really going to be able to take care of amputees,” he said.

Although advanced prosthetics are expensive to start with, he said, research has shown that high-quality prosthetics can lead to cost savings for society over time.

A person using a microprocessor-based knee for a decade, for example, will put less strain on their hip, thus reducing the likelihood of needing a total hip replacement than if they had used a “minimally functional prosthetic device.” did he declare.

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