 Hello my beautiful internet friends. I'm very excited for today's video because I actually get to bring in some real professionals. I just arrived in Denver and I'm here to meet with Zach Harvey, my Prosthetist, and a para-olympian to talk about the direct socket, which is the new kind of socket that I have. A lot of you guys ask questions about it. It's a very different process than more traditional sockets. I had a lot of questions. A lot of you guys had questions. Like who is it good for and can above any amputees use the direct sockets and what are pros and cons? And so we're going to tackle those today with Zach and Noah. Zach Harvey sitting here to chat with me today about the direct socket. I know you guys were really really interested in that. I'm curious about what that balloon thing was and why the socket was being made directly on me and who it could work for and how it actually is working. And so I thought who better to answer those questions than the man himself. So Zach, thanks for chatting with us today. Thanks for having me. What about it do you like? Like what excites you about the direct socket? I think to understand what it means and what it is, you have to first understand the mold making process that we traditionally use. And as you know, first legs we made, we had, it was pretty labor intensive and it took a lot of steps and a lot of appointments. We had the castor leg, we had to do a check socket. You came back for a follow up, maybe another check socket. Yeah. We had to pour that up, convert that to a carbon fiber socket. This man is a lot different in the sense that the laminated socket is done on the person. It was same day for me. Like I came in and I got it out. And I mean, you guys kind of made a work of art in the back and I had a socket and we were good to go. Yeah, it's a longer appointment. But the idea is that we knock out all the work in one visit. And then we have more time to do things like experiment with different saving everyone time. But it's also, I think more importantly, the accuracy of fit with this is really good. It's taken a fluid dynamics approach to the fitting. And I'll explain that in a minute compared to pressure distribution approach. Traditionally, we look at loading the soft tissue areas maybe with a little bit more pressure than we do the boning prominences. Where this is compressing everything equally from all sides. One of the the biggest questions I had was like, who is it good for? You know, what it worked for me or I mean, who is it good for? Yeah, so right now it's available through us for Bologna and above knee amputees. The above knee system works a little bit different. It's not pressurized. It has a silicone brim that's flexible that flips up over the socket when you put the leg on. Okay. And that contains all the soft tissue. A lot of above knee amputees complain they can put their hand down in their socket. Yeah, got it. This it's nice and tight and supportive around the upper section but it's flexible so it's more comfortable. And that band of silicone provides a second means of suspension. So they might have a CLN liner primarily to hold on but then they have this brim that's not only supportive but it's an extra form of suspension. How long has this been around for? So it was developed in the Scandinavian countries. It's been in practice there in Sweden in particular for one iteration or another for 15 years or so with the transtylbial. Okay. And it seems like a pretty new thing over here. Yeah, in the U.S. it's definitely new. A lot of processes have, prostatis have been familiar with the older form of the transtylbial direct socket where we had a bladder that we go over and pressurize but we're still doing the traditional like plaster cast. Oh, right, okay. So we arrived at that fit but we used more traditional. But right now it's ready for prime time I feel like the materials, the look of it is really good. There's not problems with leaks like they were in the earlier versions. It's not that ugly yellow color it used to be. I mean how it looks does matter to some extent I think. But it's about 30% lighter than a traditional socket for below the knee. I definitely felt that. I mean like there was a very clear difference in the weight of this leg versus the other ones that I had. And it fits clothing really well. Yeah that actually is another thing for real it's easier to get like pants on. And another cool thing we can switch from like a pin lock to suction or vice versa in the same socket it's just a matter of real bolting some hardware. So if you wanted to try a pin lock or suction weren't sure about it. We're really able to go either way or even seal in lighter. That seems like a really good option especially maybe for newer amputees. Is it a good idea for new amps? Yeah or somebody who's on the fence like because the way I look at suspension methods a lot of times it's a lifestyle thing if you're going to be taking your leg off. Who would direct socket not be a great option? So it can work with new amputees but brand new amputees can be like a bulbous. And we wouldn't want to get it stuck during the process. But you know it could work we have some ideas. One thing that I wondered about going into this option was like okay I was seven weeks out from amputation and it's kind of like a final wake almost right away. Is that does that commonly become an issue or because it's so fit to you is that? Yeah volume so volume fluctuation is a thing that we can't really solve with you know static technology. If I anticipate that okay you're just going at your first leg and you're going to be changing a lot we would consider this a diagnostic socket and do it again two three weeks later when the volume is smaller use socks and pads to that point and then call that the definitive. Okay so there's still wiggle room and options within that. But it's still a really it's safer than going out on a check socket which isn't intended for long-term use. Yeah that's always kind of freaked me out actually walking around. Weight rated 350 plus yeah so they're really strong. So the weight restriction on drag sockets is 350 plus is that right? Yeah I can't remember the exact number. Yeah okay cool. Material options. Yeah okay. So the material options would be basalt which is a volcanic material and that's more environmentally friendly from my understanding. Okay. Then like either fiberglass carbon fiber the look is a little bit different. I personally like the basalt. It's kind of got a thicker like weaved. Yeah it looks like snake skin. Yeah exactly it does it looks like snake skin yeah. From my standpoint working on the basalt is less itchy because when we grind the fiberglass and the carbon it speckles gets on your skin and it's a little itchy. I never thought about the poor prosthetists who have to deal with it in the back. So not only is it more environmentally friendly. It's more prosthetist friendly yeah. What about colors what about you can't do fabric with these yet can you? You can I haven't done it yet but apparently we could get like a friend's legs uh spandex kind of thing to go over okay and a lot of different patterns um as our last layer and it just gets laminated in about any color that you want okay we have little dies that we put in and I also want to try embossing powder at some point uh oh to make it sparkly. I would totally be a guinea pig for that. Okay that's awesome. If someone was comparing the pros and the cons of direct socket versus fill in the blank what are some considerations that they should keep in mind? The pros of it would be lightweight it's taken some of the human error out of the process because it's a step by step procedure that can be duplicated. And it's actually on you yeah that doesn't take away the skin of the process. Sure because there's a lot of subtle decisions like we can put pads on bony prominences. Yes uh in order to create relief so that's done under the casting liner but then the pads removed the create a relief which is what he did for me which worked really well because it gave it space. Exactly yeah yeah so without that you'd probably be in a lot more pain yeah um so yeah the skill the process still is there to determine that but as far as the the fit of the socket the volume fit um that's the thing it's taken some of the error out. We to date really have not had to do any modification to the inside of the sockets. Really? What we're adjusting is trim lines. Okay that's pretty simple. And now that we're more familiar with how we're having to do that we've added some pads that we're putting on the patella in the back behind the knee back to your question on the uh like who it's indicated for yes I'd say some congenital like scimes amputee who has a real bulbous distillant and is narrower um they wouldn't be a candidate because again it would get stuck and it wouldn't be able to sit through. Sounds like a bad day. Drag socket for sports it seems to me like it's a fantastic option. Yep. Are there any considerations when it comes to extra active? No not really it's their weight rated pretty high I think it's actually 365. The way I look at it I'm doing direct socket unless there's a reason not to. Cool okay um it's really changed our practice we have a room dedicated to direct socket we have all the liners in stock everything we need right there and a super comfy expensive chair um it moves a person along in every uh position imaginable just so we have the right work environment to do our best work makes so much sense you know kids to take off school and their parents to take off work to bring them in yeah if we can get everything knocked out in one appointment it's better for everyone. It seems like there's a lot of variance across the country and the world when it comes to you how this process goes because as I've kind of documented my process people are like wait you're doing this already or you have another I mean it's just I mean that's how the internet works to some extent but everyone's experience is so different and one thing that people have expressed some kind of frustration with is how long the process can take and I totally get that because when you are lacking mobility and it's kind of within reach you want it as soon as possible and it seems like this is a really cool option to get people there a lot faster especially with like insurance approving appointments or depending on who you're working with it can be one and done to some extent yeah and I've been doing this for 20 years so I take a lot pride in my my hand skills or yeah being able to take a cast and modify it and know it's going to fit yeah but when I can make those fits even better with a new tool it's kind of like backing up in a car when you have a rear view camera yeah it's like well like wow you see so much more of what's behind you than yeah looking in your mirrors and turning your head around even if you're great at backing up this is a this is a tool that's going to help me yeah better sockets and get better outcomes yeah that's what it's all about getting more comfortable sockets I was really excited to get the chance to sit down with Noah who is an above knee amputee to talk about his experience with a direct socket as being an above knee amputee is going to be totally different than being a below knee amputee so how does it work for above knee amputees I'm here with my brand new friend Noah who is a fellow amputee who snowboards which I definitely need to get into because I've I live in Colorado and I've never still boarded in my life but you got to go yeah it's pretty good it from what I understand I love it it's so much fun and yeah you know I'm an above knee amputee I lost my leg uh four years ago I decided to amputate it after I was going through chemo and cancer but I've had many different sockets I've had everything from like skin fit to liners and velcro to suction and I've had all those different kinds of suspensions but out of all of them the direct socket is really like something that fits better for me awesome and it's more comfortable because I've had an issue in the past where like when I start to do sports or activities or something my leg can't really flex and oh right yeah all that carbon's just like being tight on the muscles but with the the new direct socket like it's the seal of it gives my my muscle space to flex I wouldn't even think of that that's actually really kind of that's really cool yeah it's super sweet yeah that's awesome for sure how is it for um like if someone isn't super athletic because I know people who watch are kind of across the spectrum for just general walking how do you like it general walking I really love it um because of the the type of fit it is it's so issual so it doesn't go all the way up to like your butt cheek which is like another thing I don't like seems like it'd be really uncomfortable it's very uncomfortable you're like walking like dude come on yeah like yeah like dang yeah like who's touching me but um it ends up working really well because it's more comfortable you don't get like any rubbing and it's not like your butt cheek the whole day and for walking it's just yeah it's just more comfortable one thing it does take though is because it's not as high up yeah you do have to have a little bit more of strength in your leg that's good to know yeah because you want to have that stability and that's what that the higher socket that has gives you that stability yeah so with a cut a little lower you definitely have to work a little harder to walk okay but it's totally worth it and the muscles are there for a reason so when I use them yeah seriously yeah that makes sense yeah yeah are there any other um I don't want to say downsides but precautions are things to to keep in mind if someone was a aka considering a direct socket yeah I would just say you know look what's out there and see what's gonna work best for you I don't want to persuade you one way or the other but for me I found that it really works well I really love it um but but definitely check into all your options like there's so many different systems out there but I personally love the direct fit and it's I mean it's sweet yeah it's cool it's done in like 45 minutes yeah which is awesome yeah it's super sweet I hope you guys are all doing well keep walking keep killing it and uh follow me on Instagram Elliot underscore Cindy and uh be sure to watch some snowboarding yes absolutely so I'm a creative technology prosthetics in Denver we have three Denver locations I have been doing prosthetics for about 20 years so why do you do what you do Zach uh I do it uh for awesome patients like you that are able to take stuff that I build and do awesome things with I'm so glad that Zach and Noah agreed to chat with me today now to head back to the springs and rush hour traffic I really hope this video answered some of your questions about direct sockets let me know if it did let me know if you guys have any additional questions down below thank you so much to creative solutions for allowing me to come film there and chat with Zach today you guys all rock and I really appreciate you being a part of this I love you guys I'm thinking of you and I'll see you in the next video bye guys