The Unsung Heroes: The Dedication and Hard Work of VA's Orthotics and Prosthetics Department

The department has seen significant growth and innovation over the past decade, led by Adam Jacobsen, chief of Orthotics and Prosthetics.

Jacobsen, who started his career in engineering before transitioning to prosthetics and orthotics, joined the VA in 2009 to establish a comprehensive orthotics and prosthetics service. Jacobsen said the service began somewhat humbly.

 "We started with just an office and a Dremel I brought from home," Jacobsen recalled. "Now, we have a team of problem-solvers who can create and build just about anything."

The VA's orthotics and prosthetics service covers a wide range of devices and services, from custom braces and artificial limbs to diabetic shoes and wheelchair modifications. The department works closely with other VA services, such as vascular, orthopedics, podiatry, physical therapy, and occupational therapy, to provide holistic care for Veterans.

"Our service adds to the interdisciplinary approach to care," Jacobsen explained. "We work closely with rehab teams to close the loop on devices needed for patients to recover and improve their quality of life."

One of the department's major initiatives has been expanding services across multiple sites. In addition to the main clinic in Omaha, the team has established outreach clinics in Grand Island, Shenandoah, and North Platte, bringing care closer to Veterans who may have difficulty traveling long distances. 

The Grand Island service has seen significant growth, said Jacobsen. "We started an outreach clinic in Grand Island and built it up to the point where we now have a full-time staff member there," Jacobsen said. "They also have mobile prosthetics clinics that provide weekly outreach to North Platte and Holdrege."

The mobile clinics are part of a larger initiative called Mobile Orthotic Prosthetic Care (MoPOC), which aims to increase access to care for Veterans who cannot easily travel to VA facilities. The VA Nebraska-Western Iowa Health Care System was among the first expansion sites for the program, which started as a pilot in Seattle.

"We were in the first expansion year for PoPOC in fiscal year 2022," Jacobsen said. "It was a pilot project out of Seattle, and we were one of the first four sites, along with Grand Junction, Colorado, and White City, Oregon. We've helped grow the program from that initial pilot to now 15 or 20 sites nationwide."

The MoPOC program includes a mobile van that allows the orthotics and prosthetics team to bring their services directly to Veterans. "It's all about trying to increase access to patients and get to them when they can't get to us," Jacobsen said. "We see some of the most complex patients in the VA with wheelchairs or amputations, and sometimes our patients, who are mostly male, are also providing care to family members, making it difficult for them to get to appointments."

In addition to expanding services geographically, the orthotics and prosthetics department has also been working to improve access and efficiency within their clinics. The Omaha clinic recently moved into a new space, leading to a 45 percent increase in walk-in patients.

"In the last 30 days, we've had around 300 patients walking in, which is significantly more than our previous location," Jacobsen noted. "I think the ease of access to our parking lot-facing clinic is driving a lot of that — we're here to help improve quality of life!"

To accommodate the increased volume of patients, the department has implemented a same-day access clinic for soft goods, such as knee sleeves and back braces. "We try to have a one-stop shop so patients can see their doctor and then come see us right after," Jacobsen said. "It's like how you might have pain, stop to see X-ray, then the pharmacy, and then prosthetics to pick up a knee brace."

The department has also been working to streamline the process for diabetic shoes and inserts, which account for a large portion of their workload. "The volume of shoes is a challenge everywhere in the VA," Jacobsen said. "We've addressed this through our strategic planning, where we try to address larger problems as a group."

One solution has been hiring specialized staff, such as pedorthists, who are trained in fitting shoes. "We have pedorthists now who are specialized in fitting shoes, so we can try to see those patients faster and not have such lengthy delays," Jacobsen said.

The department also invests in the profession's future by establishing a funded residency program through the VA Office of Academic Affairs. The residency program includes a structured curriculum to help residents develop the skills and competencies to pass their board certification exams. 

"Part of your prosthetics education is to finish your master's degree and then do two years of a residency program," Jacobsen said. "It's kind of guided training, and we have a curriculum set up for our resident to check off competencies and make sure she's ready to go for her boards."

Beyond providing essential devices and services, the orthotics and prosthetics department is also focused on helping Veterans stay active and engaged in their communities. Jacobsen and his team have been involved in various adaptive sports programs, such as the Winter Sports Clinic, PGA Hope golf lessons, sled hockey, and adaptive climbing.

"Getting connected with the adaptive sports world has been cool," Jacobsen said. "Some of our patients struggle with depression when they have an amputation or a nerve injury that doesn't allow them to lift their foot. Giving them those options to participate in something they didn't think they could do is awesome to see how that impacts their life and improves their outlook after a life-changing event."

Jacobsen recalled one Veteran who wasn't happy with the services she was receiving for her device. "I continued to work with her and try to address her needs, and also got her involved in some of these opportunities in the community," he said. "She's told me numerous times about how great those are for her and how much she's appreciated them. It's a reminder always to ask people what they like to do or what they liked to do before their injury and see if we can get them back into something similar to keep them engaged."

For Jacobsen and his team, the most fulfilling aspect of their work is seeing their direct impact on Veterans' lives. "Doing the management piece is great to work with the team that I have, but getting in to help patients address their problems is probably what I find the most fulfilling," Jacobsen said. "When my employees tell me about a successful case they've had, it's just incredible."