The Importance of Advocacy, Embracing Innovation, and Finding Your Mountain in O&P

Published in Orthotics & Prosthetics on April 21, 2023

This blog is written based off our podcast with Nikki Grace Strader.

April is Limb Loss Awareness Month, and we want to highlight an individual who has made a major impact on the O&P profession. Nikki Grace Strader is the Director of North American Operations for the Osseointegration Group of Australia and Osseointegration International, as well as a certified peer visitor and certified peer visitor trainer with the Amputee Coalition. She has a nonprofit in the state of Illinois called Central Illinois Amputees. Nikki is also an above-the-knee amputee.

Nikki lost her right leg above the knee in 2016, and that came after a spinal cord injury in a motor vehicle accident that led to a number of complications.

“When I was first facing the challenges of learning how to be an amputee, I actually never knew an amputee,” said Nikki. “I'd never known an amputee before I became one, so I didn't even have a place to go and ask questions.”

While in the hospital, Nikki was focused on her rehabilitation and worked towards getting her mobility back. While she was there, she was given the first steps guide from the Amputee Coalition, which provided Nikki with a wealth of information. It also sparked a lot of questions, so Nikki was in frequent communication with the Amputee Coalition in that first year.

Nikki also made many friends in her rehabilitation group. Towards the end of her stay, there was someone who was ready to be released to go home. Due to the Medicare laws and that she lived in a rural area, a home visit was conducted. It was determined that it would be unsafe for her to go home because she had three stairs to get up into her home, but she didn't have the means or the ability to build a ramp.

That is when Nikki began to ask questions about how to get her home. She discovered an “avalanche” of information in that goods and services cannot be donated to build a ramp. However, it was mentioned that if there was a nonprofit, this would all become very easy.
Nikki also realized that living in a rural community could be a challenge in getting the care needed for amputees. She discovered that there was a need for those who may reside in a rural population who seemed to be forgotten about.

“I used to drive 85 miles one way to the closest prosthetist,” said Nikki. “When you think of someone who maybe doesn't have a driver in their home or doesn't have the resources to get (to where they need to go), you're really talking about some very specific barriers that are put in place that get in the way of having access to care, continuity of care, consistency, or even having the support of someone that wants to see you thrive."

Nikki continued to engage with the Amputee Coalition and received a lot of support from them.

“My kids were seven when I lost my leg. Going to my first coalition conference and having my twins walk into the lobby of that hotel and suddenly they were just normal kids in a room full of amputees instead of kids who had a mom in a small town that's an amputee, there were so many things that made this learning curve less abrasive,” said Nikki.

From there, Nikki got more involved in the profession and went on to become a peer visitor and peer visitor trainer. She also participated in a number of coalition initiatives, such as the Limb Loss Education Days, conferences, and more.

Advocacy has always been something that Nikki was naturally inclined to, but because of her own experience with challenges as an amputee, she was able to identify these challenges and discover the true need for advocacy in the O&P profession.

A History with Advocacy

Prior to her accident, Nikki was involved with advocacy in her own community. She grew up in Northern California and was a firefighter paramedic in the Bay area. Part of her duties included working with people who were unhoused or disadvantaged and unable to have opportunities for primary care. She was able to participate in programs there where they were given some expanded scope and allowed to bridge those gaps.

"I have always loved being involved in things that were about figuring out the solution instead of rehashing the problem,” stated Nikki.

Nikki was also the fellow for the National Association for the Advancement of Orthotics & Prosthetics (NAAOP) George and Dena Breece Fellowship in 2022, where she looked forward to observing how healthcare policy and language were formulated. In addition, she looked forward to learning how the O&P profession could be more solutions-oriented for patients, clinicians, practitioners, and more by embracing emerging technology and innovation.

Embracing Innovative Technology in Prosthetic Care

Nikki has a unique perspective about the needs of the profession because she utilizes innovative technology herself. As a new above-the-knee amputee, she discovered that a socket was not the best solution for her. She did some research that learned that osteointegration may be better suited for her. The technology itself is a direct skeletal implantation of a prosthesis. Rather than the prosthesis connecting to a socket, it comes through the skin at the residual end of her femur and a microprocessor knee connects directly to it. For Nikki, this osteointegration restores osteo perception, which is feeling what's beneath her feet, and proprioception, which is balance. This solution significantly improved Nikki’s mobility and broadened her access to the care and equipment she needed.

Nikki’s experience with finding the solution that works best for her highlights the importance of the clinical expertise and how the prosthetist and orthotist are the individual clinicians that have the most information about those solutions for their patients.

Nikki was able to find the appropriate solution for her, but that's not going to be everybody's solution, and her prosthetist is still part of her journey today. It also exemplifies the importance of continuing to encourage communication with policymakers, lawmakers, clinicians, and the community as a whole about embracing innovation and technology and not fearing it.

What’s Your Mountain?

For years, Nikki has looked at amputation and prosthetic care from many different angles, and from the many peer visits and patient interactions has discovered that identifying one's “mountain” is crucial.

“The truth is knowing what your mountain is, knowing where that personal fulfillment or those amazing endorphins that come from that feeling of success is really important to identify,” said Nikki. “What's your mountain? How do you feed that?”

[What's your mountain? How do you feed that?]

For some amputees, it could be a literal mountain that they hope to climb someday. For others like Nikki, it can be as simple as being able to successfully walk on a prosthetic limb without crutches.

“When I look at my journey and the decade of issues after my spinal cord injury, my mountain was very small in the big picture,” said Nikki. "My twins were 13 months old when I was in my accident, so they'd spent their entire toddler years and all that time growing up, and I was never able to hold their hand in public because my hands were always full of crutches or of wheelchair wheels. I was (also) never able to hold my husband's hand in public."

Overcoming her “mountain” and being able to overcome her challenges has been key to Nikki. It’s also important to know that it’s okay for people to identify success in their own ways.

“It doesn't have to be an actual mountain. It can be something very simple, and I think that's a takeaway for most amputees,” said Nikki. “Not comparing yourself to how other people are doing or not gauging your level of success based on how someone else's success is represented, but identifying what your success is and then working towards it.”

Listen to the original podcast episode with Nikki Grace Strader here.

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