—–Original Message—–
From: ted@amputee.com [mailto:ted@TROWER.COM]
Sent: Wednesday, February 25, 2015 04:19 PM
To: OANDP-L@LISTS.UFL.EDU
Subject: [OANDP-L] Adjustable AK socket / Pregnancy
I have a teenager with a relatively new transfemoral amputation. She has had her prosthesis for approx. 4 months, it was made in another community. She is now 6 weeks pregnant. I would like to consider fitting her with an adjustable socket to accommodate the coming changes in her limb shape and especially volume. She is slender of build and has about 80% of her femur remaining.Does anyone have experience with an adjustable socket they can recommend as effective? My experience with such devices is very out of date.Ted A. Trower CPO, A-S-C Orthotics & ProstheticsJackson, MIwww.amputee.com ******************** *********************************************************
Look into the CJ socket. We use it in those instances
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Check out the infinite socket from LIM Innovations. Www.liminnovations.com. it can accommodate lots of volume fluctuation and can also be remolded when you exhaust it’s adjustability. Let me know if you have any questions, I’m a wearer as well.
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I’ve had this experience twice in my career. An adjustable socket is a perfect way to allow for volume changes. The original design was by Bill Schumann at Boston children s hospital, if memory serves me, for children going thru chemo therapy and having volume changes in their limb. Same idea with pregnant women.I would suggest a custom socket for the best fit and consider a roller type shoulder harness like the old days.. Not the best situation but will get her thru the pregnancy
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I would love to gain experience from your responses if you’re willing to repost them! Like you I have limited experience with adjustable transfemoral systems. However, I have had very good results fitting patients within their pregnancy with elevated vacuum systems. For a transfemoral patient this would involve a sub-ischial socket with a seal in line are using movable seal ring or a suspension sleeve without a seal in liner. It seems to help control volume fluctuation related to fluid retention.
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Check out Revofit. I made a TF socket for a patient who has historically fluctuated lots in volume. Other than the large protruding tightening know it was a success, at least at the outset. We haven’t done a huge amount of adjustment since so I can’t speak to that. It’s important to remember though that, with a flexible liner, you can only squeeze so much.
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Just saw lim innovations new tf socket you may consider. No direct experience, it may be an option.
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Check out the CJ Socket system developed by Keith Cornell
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Call Keith Cornell CPO in Beverly, MA- ask about the “CJ” socket…. Your patient will be jubilant- trust me!
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The only one I know of is the CJ Sail, which is pretty awesome. My first patient I tried it on really liked it a lot! Good luck.
http://www.cjsocket.com/
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I have had a few women, both ak and bk, that have gone through pregnancy. As long as she keeps her weight in check while pregnant she may not have any problems at all with volume. The most recent pregnant ak amputee I had gained about 40# and her suction socket still fit well at the end of her pregnany. I myself had no problems with socket fit ( I am a bil bk) through my pregnancy. I would say wait and see instead of trying to fit an adjustable socket just yet.
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It may be worth looking into the BOA system of adjustable sockets.
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The following link will take you to the abstract and renderings for an AK adjustable ischial containment socket I developed and tested several years ago:
http://www.google.com/patents/US6991657
It is straightforward and easy to fabricate and can incorporate a 3S design.
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Talk to Keith Cornell with CJ Socket. Massachusetts (978) 922-0413. Terrific adjustable. He will teach you and help build.
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You can try the LIM Innovations socket. It adjusts to volume change nicely. You can look it up at www.liminnovations.com
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I’m only a student so I have no clinical experience, but I came across the LIM Innovations Infinite Socket during my clinical rotations last week. The practitioner mentioned the adjustability was very nice, which uses a snowboard-boot-type ratcheting buckle. It seems like a really great socket innovation, but I’m sure reimbursement will be difficult for something like that. Hope this anecdote helps.
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I haven’t done an adjustable socket for a pregnant woman, but I did have a system for patients with severe fluctuations in edema. The socket was made with a removable inner liner and a 6 mm Alps liner. The patient was given a 6 mm liner and a 3 mm liner. When the swelling was down he wore the 6 mm. When the edema was up he used the 3 mm. And when it was really bad he would remove the inner liner also.
It was a very easy way to manage his fit. Good luck.
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I have fit 4 or so LIM inavation, and things have gone well
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I have not personally used it, but consider looking into LIM industries.
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Hello Ted, have you seen or tried the Sail System with the flexible posterior wall?
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I wondered if:
1. you could make an onion skin SFS set up w/ multiple flex sockets.
2. the revolimb is an option? evoii labs can fab them
3. the adj Aks that I have used have been disappointments.
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Our prosthetist has had great success with the CJ socket for patients who need more adjustability. Designed by local prosthetist here in Massachusetts – Keith Cornell.
www.cjsocket.com
Definitely recommend
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You may want to look into www.revolimb.com
Speak to Joe the owner and prosthetist.
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Call John Hattingh…we use REVO all the time. 703-7232803
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End of replies.
Thank you to all who responded. Now it comes down to what Michigan Medicaid will allow.
Ted A. Trower CPO,
A-S-C Orthotics & Prosthetics
Jackson, MI
www.amputee.com
