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Johns Hopkins Pediatric

An Insightful Approach to TBI after Limb Loss

June 6, 2014

Marlis Gonzalez-Fernandez says new prosthetic devices can make motor control for patients who also had a TBI a no-brainer.

Marlis Gonzalez-Fernandez says new prosthetic devices can make motor control for patients who also had a TBI a no-brainer.

As the Baltimore blizzard of 1996 raged, Baltimore/Washington International Airport spokesperson Adrienne Walker-Pittman provided updates and reassured travelers and their families. Two weeks later, her career and life as she knew it would end abruptly. While she was packing her car’s trunk, a teenager driving a stolen car slammed into Pittman, severing her left leg above the knee. The car catapulted her high into the air. Seconds later, Pittman landed hard on the ground. She lay in a coma for 15 days at Johns Hopkins Bayview Medical Center and endured months of inpatient and outpatient rehabilitation, including neurorehab for her traumatic brain injury.

Some months later, Pittman, then 37, was fitted for a prosthetic device. Although she persevered with rehab and stayed active—attending her son’s football practices and games and helping with her husband’s business—the device never felt quite right to her. “I kept falling,” she says. “And I feared that I’d have another head injury.” Pittman also found herself easily distracted and frustrated. But she accepted her lot for years, until she found her restricted mobility unbearable.

By the time she saw Johns Hopkins physiatrist Marlis Gonzalez-Fernandez for an evaluation, Pittman was in her 50s. She was highly functional, even able to drive, recalls Gonzalez-Fernandez, but she complained bitterly about her prosthetic device. Gonzalez-Fernandez also noticed that Pittman had trouble multitasking: “She had to pay so much attention to how to make her prosthesis work that she kept falling with any distraction.”

When a patient as articulate, active and resilient as Pittman comes in, says Gonzalez-Fernandez, it’s easy to forget the lingering effects of a TBI. After all, she says, “Cognitive resources don’t only revolve around the mechanics of walking,” which, she says, consumed Pittman’s energy. “What my patient needed was a more intuitive device to relieve her frustration.”

In collaboration with a local orthotics and prosthetics company, Gonzalez-Fernandez helped Pittman’s insurance company understand the need for a more advanced prosthetic leg—one with built-in gyroscopes that  can sense if it’s going to buckle and correct itself.

After a TBI, Pittman has discovered, “you need to practice remembering tasks in order. You have to be over-prepared.” She’s learned to keep hard-copy directions in her car, for example, in case she suffers a memory lapse. But since receiving her new prosthetic, she says she no longer needs to think about how to move her foot, which frees her concentration for other tasks. Similar scenarios are plausible among veterans who have experienced TBIs and amputation, says Gonzalez-Fernandez.

As a young woman, Pittman enjoyed ballet, modern dance and flamenco dancing. But after her accident, she thought that part of her life was over. Inspired by her new device, however, Pittman surprised friends and family last Christmas with a rousing dance performance at her church. “It’s nice when people can help you achieve your dream,” she says, “—and your doctor’s in your corner to support you.” 


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