Reflecting on the Past Decade of Serving Children

Home > Articles > Reflecting on the Past Decade of Serving Children
By Andrea Spridgen
Don Cummings

Don Cummings. Photograph courtesy of Texas Scottish Rite Hospital for Children.

Small patients sometimes have big needs. Two facilities renowned for their specialized pediatric care are Texas Scottish Rite Hospital for Children (TSRHC), Dallas, and the Shriners Hospitals for Children (Shriners) network, headquartered in Tampa, Florida. The O&P EDGE contacted practitioners from each of these institutions and asked them to reflect on some of the significant developments they have witnessed regarding O&P care and within their O&P departments over the past decade.

Don Cummings, CP, TSRHC director of prosthetics, shared his views on the top areas of change in the prosthetics department. His response highlights a commitment to operating a lean practice, technological opportunities, and the changing O&P education landscape.

At TSRHC, patients receive treatment regardless of the family's ability to pay. "In order to become more efficient and cost-effective, we are merging orthotic and prosthetic services [and] cross-training technicians, practitioners, and office staff," Cummings says.

One of the nation's leading pediatric centers for the treatment of orthopedic conditions, TSRHC is a teaching and research hospital. Cummings says the department pays close attention to O&P research and development trends affecting the adult population, which he believes will lead to improved outcomes for adolescents in the future.

Dan Muñoz

Dan Muñoz. Photograph courtesy of Shriners Hospital for Children-Northern California.

"There is a lot of federally funded research going on to improve prosthetic outcomes for wounded warriors. This will eventually filter down to the adolescent and pediatric populations in the form of improved upper-limb prostheses, lighter and more durable materials, and perhaps even improvements such as sensory feedback or neural control of prostheses," Cummings says. "Keeping an eye on the future can help us provide better information to families now as they are involved in decisions related to amputation level, elective procedures, prostheses, and the training to use those devices."

Beyond possible future advancements, however, technology has already had a positive influence at TSRHC. Cummings says, "We now have a greater array of components and materials for children. This gives patients and families more options and enables us to problem solve more easily, to build in adaptability, and to better accommodate activity or growth changes."

The change in O&P education requirements has also influenced TSRHC. Cummings explains that TSRHC is now coordinating internships and residencies, in terms of what is taught and timing, to be compatible with the P&O master's degree programs.

Like all healthcare systems, Shriners Hospitals for Children has experienced many changes over the past decade. Dan Muñoz, CO, manager of orthotics and prosthetics at Shriners Hospital for Children-Northern California, Sacramento, told The O&P EDGE about some of the changes he and his colleagues have experienced at that hospital, most notably, technological shifts in operations and patient care, as well as transitioning to third-party payer reimbursements.

New technology has provided opportunities to advance patient care and hospital operations. "We made the shift to electronic medical records last year," Muñoz says. "This is directly related to the increased demand for outcome-based measurements."

Muñoz says technology has had a positive impact on orthotic product development by making it easier for vendors to meet the needs of the pediatric population. "Rapid prototyping and 3D printing have made it possible for us to work more effectively with independent manufacturers on prototype development and product design," he says.

Recent technological advances in upper-limb prostheses have not translated to the pediatric population, according to Muñoz. In fact, he has seen a reduction in the number of myoelectric prostheses used by children. Instead, Muñoz says that the advances in pediatric prosthetic designs have led to improvements to lower-tech, body-powered systems, making them more functional and cost effective.

Technology aside, Muñoz says the changes his O&P department has experienced have grown out of a need to meet the unique needs of the pediatric population. For instance, the department's shift to reimbursement after years of delivering all care free of charge has strengthened the hospitals financial foundation by allowing families to use their insurance when they come to Shriners. The philanthropic mission, however, is still a guiding principle. All care is delivered regardless of a family's or patient's ability to pay.

"I believe Shriners has been an ideal leader in the pediatric O&P field...," he says. "The goal is to always maintain our mission, provide even better care to more kids, and further enhance our status in the pediatric O&P community."

Andrea Spridgen can be reached at