Inspired by the advocacy work of Forrest Stump, a nonprofit organization dedicated to equitable access to physical activity for individuals with disabilities, four national nonprofit partners joined in collaboration in the pursuit of this national initiative including the American Orthotic & Prosthetic Association (AOPA), the National Association for the Advancement of Orthotics and Prosthetics (NAAOP), The Amputee Coalition (AC) and the American Academy of Orthotists and Prosthetists (AAOP). Since launching in 2022, five states have enacted laws to provide individuals with state-regulated commercial insurance with coverage of prostheses and custom orthoses to participate in fitness, physical activities, and sport. Over two dozen states are expected to introduce and consider such coverage in their upcoming state legislative terms.

A prosthesis is an artificial limb that replaces all or part of a missing arm or leg. An orthosis is an orthopedic brace that supports or restricts motion in an arm, leg, the back, or neck. Both prostheses and orthoses improve biomechanical function and require diligent clinical care from licensed/certified prosthetists and orthotists educated in the design, fabrication, and fitting of devices to ensure optimal patient outcomes.

No one orthotic or prosthetic device can replace the vast array of fundamental human movements lost from amputation, disease, or disorder. That is why specialized orthoses and prostheses designed for use in high-activity environments – such as running, hopping, skipping, jumping, swimming, dancing, bicycling, and more – are needed to prevent damage and minimize injury to both body and device. Without them, equal access to physical activity cannot be achieved.

Let’s look at running. It has different biomechanics than walking. For example, in running, more push-off energy is generated by the ankle than during walking, and upon heel strike, the vertical impact of running can equate to around four times one’s body weight.1 Given this, a specific prosthesis has been designed for running to maximize shock absorption and energy return, while improving comfort and minimizing injury.2

Sources:

1 – The anatomy of running – Vox

2 – Ossur-Science-of-Sprinting-Femita-Ayanbeku-2020.pdf (cloudinary.com)

O&P care is essential for individuals living with limb loss, limb difference, and/or mobility impairments. Limb loss can either be acquired (due to trauma, amputation, or disease) or congenital (a condition acquired at birth or during prenatal development); limb difference is solely due to congenital condition. Mobility impairment stems from conditions that affect gross and/or fine motor skills, including arthritis, stroke, muscular dystrophy, cerebral palsy, spinal cord injury, and many other musculoskeletal or neurological conditions. Currently, there are approximately 5 million people living with limb loss and/or limb difference in America.

Yes. One of the categories of benefits covered in the ACA’s “essential health benefits” or “EHB” package is rehabilitation and habilitation services and devices. Legislative history on the EHB package makes clear that orthotic and prosthetic care was intended to be included under this EHB category.  In addition, two entities tasked with defining the EHB package after passage of the ACA, the National Association of Insurance Commissioners and the National Academies, clearly established that O&P benefits are routinely covered in private insurance plans and publicly supported programs and are considered EHB benefits.

They should be. In fact, the So Every BODY Can Move Initiative is designed to highlight and clarify that prostheses and custom orthoses for physical activity are, in fact, already included in the EHB benefit covering medically necessary O&P care. Unfortunately, many commercial payers have taken a more restrictive view that only one prosthesis or orthosis is covered to ambulate, or walk. However, one custom orthosis or prosthesis cannot replace the vast array of fundamental human movements lost because of mobility impairment needed to perform Activities of Daily Living (ADLs), including exercise and physical activities to maintain and improve health. More than one prosthesis or custom orthosis is often necessary to restore human function to the maximum extent possible.

In the United States, the Department of Veterans Affairs (VA) and Department of Defense (DoD) provide active-duty military and retired veterans with limb loss, limb difference, and mobility impairment access to prostheses and orthoses designed for specific physical activities. Additionally, five U.S. states now mandate that state commercial insurance plans cover O&P care for physical activity including: Arkansas, Colorado, Illinois, Maine, and New Mexico. Beyond the United States, other industrialized nations provide more holistic access to O&P care. For instance, Australia, England, France, and Norway provide access to activity and sports prostheses.

Orthotic and prosthetic services are often directly comparable to surgeries and procedures that enable mobility or physical activity. For example, ACL surgery, while considered an elective procedure, is typically covered because the treatment is necessary to restore the body to its full potential. Between 100,000 and 300,000 ACL-related procedures occur in the U.S. each year.1 Yet, comparable care for patients in need of orthoses or prostheses that also enable the body to perform physically is not covered. Health plans should not be able to deny a prosthesis or custom orthosis for an individual with limb loss or limb difference that would otherwise be covered for a person without a disability seeking medical or surgical intervention to restore or maintain the ability to perform the same function.

Source:

1 – Macaulay, Alec A et al. “Anterior cruciate ligament graft choices.” Sports Health vol. 4,1 (2012): 63-8. doi:10.1177/1941738111409890