But a few weeks after making the change, I dropped my car off at the mechanic's to get some work done. His shop was a little more than half a mile from town. I had a choice: do I wait at the mechanic's, or do I walk into town and come back and collect my car later? I chose to do the latter, and ended up walking well over a mile round trip in scorching summer heat.

When I got home that night, I suddenly realized that I never would have done that in my old prosthesis. I would have waited in this dingy repair shop because the energy and effort it would take me to walk that distance would have led me to conclude that it was better not to make the trip.

That was a real eye-opener for me. The technology had, effectively, changed how I perceive distance. And I realized for the first time in 14 years that I unconsciously organize my life around subconscious limitations that this prosthetic device had now exposed.

At its best, that's what prosthetic advances do for patients.

Q: The advances are very exciting. Whom are these new prosthetics reaching and whom are they not reaching?

DM: This is a great question, because the best prosthesis in the world is useless if you can't actually get access to it. Unfortunately, many private insurance companies attempt to restrict access to anything other than low-cost technologies, or alternatively, set forth medical criteria to access new technologies that restricts them to a very small population of patients. (Ironically, often the groups that benefit the least from them.)

Fortunately, the Amputee Coalition has led efforts to ensure that all people with limb loss have access to medically necessary prostheses, and 19 States have passed "insurance fairness" laws that focus on prosthetics. In addition, both the House and Senate have introduced a Federal insurance fairness law, so this is a potentially very exciting time, as the possibility of consistent and appropriate access to prosthetic devices could be in reach. 

Q: How will these advances affect children with limb loss or limb difference as they grow up?

DM: Historically, children have tended to get less technologically-advanced prostheses because they simply beat the snot out of them, and because they frequently require new components because they grow. Ultimately, as the standard of care for adult amputees trends towards more complex devices, I expect there will be a trickle down effect that children ultimately get the benefit of. 

However, for that to happen, manufacturers will need to figure out how to make the current adult technologies small enough for children, while also increasing the durability of those technologies so that any additional cost associated with them can be spread out over a longer period of time than current knees permit. It's a difficult balance, because giving a 10 year-old a great technology to walk on but telling them at the same time that they're not permitted to do activities A-D - like jump in a puddle with their friends - isn't fair to them.

Q: What prosthetic are you using now, how is it different than what you previously used?

DM: I'm an above-the-knee amputee, so my prosthesis includes both a knee and foot. The knee I use is the first motorized prosthetic knee available in the United States. (In the interest of full disclosure, I'm an employee and officer of the company that sells both this device and the prosthetic foot I use.) The main differences between this knee and the microprocessor-controlled knee I wore before are that the Power Knee has a motor that (a) moves the knee for me, which makes walking much easier and reduces the pounding on my residual limb, back, and sound leg, and (b) is much more stable than anything I've walked on before. Take those two things together, and you've got a device that allows me to do more, to increase my activity level, while at the same time simultaneously reducing the number of times I stumble and fall. More walking; less pain, skin breakdown, tripping, and falling - that's a pretty good combo.

The prosthetic foot I use is a dynamic, energy-storing carbon-graphite foot. It's different from the foot I used to wear in that it doesn't have a vertical shock. I made the switch when I started wearing the Power Knee last April, as that knee is slightly bigger from top to bottom than my previous one. Because I'm fairly short, when we tried putting the vertical shock foot under the Power Knee, it made my prosthetic side longer than my sound side. So we switched to my current foot, which has been a pretty seamless transition.  

Q: Finally, would you share the story of how you became an amputee? 

DM: The short version is that I walked out into the middle of the street to push a young woman's stranded vehicle off the road while my wife watched. I got hit from behind and was crushed between the cars and then tossed about 15-20 feet from the initial impact. The longer version, which I wrote from the perspective of my wife - since I have no memory of the accident - can be read in this post, "the most important people," on my blog, less is more.