Trust in Every Step: How Personalized Prosthetic Care at Salisbury VA Transforms Lives
Prosthetics and sensory aids teams across VA work to provide the highest standard of care for Veterans, regularly researching new ways to help them lead more active lifestyles.
According to the National Institutes of Health, functional mobility for lower-limb prosthetic users is classified using the Medicare Functional Classification Level, or "K-level," scale. As the numbers increase, so does the Veteran's activity level. "K0" describes a patient who is not a candidate for a prosthetic, while "K4" describes someone capable of high-impact, paralympic-level activity.
The orthotic and prosthetic team at the W.G. (Bill) Hefner Salisbury VA Medical Center, Salisbury VA Health Care System, led by Lab Chief Cody Reimers, wanted to try a Quattro microprocessor knee (MPK), typically used for high-scoring K3 and K4 patients, to see if it could also help higher-functioning K2 and lower-scoring K3 patients become more active, due to recently published studies.
While fitting two Veterans at the K2-to-K3 transition point, the team noticed the knee behaving differently than expected during normal walking activities. The pattern was consistent enough that the team knew something needed a closer look by the manufacturer.
"We made several adjustments and tested different approaches to fine-tune the function for these Veterans," Reimers said. "When we saw the pattern continue, we knew it was time to bring in our manufacturer partner to get their expertise."
The manufacturer sent a clinical specialist on-site in Salisbury within 24 hours and issued a loaner knee same day, with no safety risks and no interruption to the Veterans' mobility.
"They found that the calibration protocol and default toe-load threshold yields this particular knee as not the best option for low-impact users," Reimers said. "The knee is a default stance knee, so when the toe-load threshold is not met, the smart knee activates its stumble-recovery to prevent falls for Veterans."
Reimers then asked the manufacturer to check how the same knee was performing for similar Veterans nationwide. The manufacturer's engineering team ran remote diagnostics and found comparable patterns tied to the same toe-load calibration.
More than 4,000 Veterans across the nation utilize microprocessors. This knowledge sharing and in-depth insight between the manufacturer and Salisbury VA staff highlighted a functional gap within the knee technology that, when corrected, has the potential to benefit many K2 and K3 users in pursuing a more active lifestyle nationwide.
"It speaks to the importance of forging strong partnerships with our manufacturers and outside vendors to ensure that the Veteran always remains the primary focus," Reimers said.
What started as a routine adjustment for two Veterans in Salisbury became an opportunity to strengthen care nationwide. It is proof that close attention to even a small number of cases can improve care for Veterans everywhere.
"This created a learning lesson for both our VA staff and our vendor partners," Reimers said. "This kind of collaboration helps raise awareness, along with the standard of care, regarding OPPCS (Orthotic, Prosthetic, and Pedorthotic Clinical Services) care."
Confidence in Every Step: Personalized Prosthetic Care Helps Veteran Regain Stability
For U.S. Navy Veteran David Graham, his Quattro microprocessor knee has boosted his confidence beyond measure.
This newfound confidence isn’t measured in miles walked or steps counted. It is found in the simple moments many people take for granted, such as standing up and moving every day without wondering whether his prosthetic knee will give way.
“Just getting up, getting a snack, or using the bathroom at home, or going for a walk; it just gets easier to get around,” Graham said. “I’m more confident in this leg than I was in the other one.”
That confidence has been hard-earned.
After living with an above-the-knee amputation for nearly six years, Graham knows firsthand how much a prosthetic device can impact every aspect of daily life. Before receiving care through Salisbury VA’s Prosthetic and Sensory Aids Service, he often worried about his previous prosthetic knee unexpectedly collapsing.
“The other one, it might collapse on me,” Graham recalled. “This one hasn’t collapsed on me.”
Today, that difference means more than improved mobility. It means peace of mind.
At VA, prosthetic care goes far beyond simply fitting a device. Every appointment is an opportunity to fine-tune advanced technology on a personal level, so it works for the individual and makes a lasting impact for Veterans for years to come.
“When someone gets a new socket or a new device, we follow them closely,” Reimers said. “We’ll see them after a week or two, then a month, then three months, and eventually every six months if everything is going well. None of our Veterans leave without a return appointment because we don’t want anyone falling through the cracks.”
Reimers believes that level of follow-up is one of the greatest advantages of providing prosthetics care at VA.
“We’re able to take our time. We’re not rushed. People like David sometimes have challenging presentations, and it takes longer than 30 minutes to make sure you get the best possible outcome. Taking the time, that’s what allows us to provide high-quality care.”
For Graham, that commitment is evident every time he puts on his prosthesis.
“I trust him,” he said.
That trust, combined with innovation and personalized care, has transformed more than a prosthetic device. It has restored confidence in every step Graham takes.
About Salisbury VA
At the Salisbury VA Health Care System, our mission is to fulfill President Lincoln’s promise to care for those who have served in our nation’s military and for their families, caregivers, and survivors.
Learn more at https://www.va.gov/salisbury-health-care.
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