The Great Prosthetic Challenge: Difficult to Fit Cases
Case Study 1: Walking After 40 Years in a Wheelchair
The combination of bilateral transfemoral amputations, short residual limbs, and a decade or more without ambulation previously might have meant that a patient's remaining lifetime would be spent using a wheelchair. The task of ambulating at full height requires well-tuned balance, developed musculature, and sensitivity to the demands of various terrains. Relearning to ambulate as an adult also requires great psychological resilience.
Dynamic Brace Beats Post-Polio Boomerang
When a 72-year-old retired physician with post-polio syndrome (PPS) presented at Prosthetic Orthotic Associates (POA) in 2008, he was unable to ambulate and used a scooter for mobility. He suffered from left knee pain, medial and lateral knee instability, genu recurvatum, and low endurance.
He now can walk, clean the swimming pool, and help his wife with household chores and meal preparation.
R&D Ethics: The Case of the $20 Knee
From left: Stanford's JaipurKnee and LeTourneau University's LEGS M1 Knee: How similar are they? Photograph courtesy of LeTourneau University.
Two university teams working to provide highly functional knee joints to the world's poorest amputees have come to public loggerheads over accusations of ethics violations.
The first party is LeTourneau University, Texas, a small Christian undergraduate institution.
Tackling Tarsal Tunnel
Tarsal tunnel syndrome (TTS) was first recognized in the early 1960s and described as "pain in the proximal medial arch and paresthesia along the lateral and medial plantar nerves. " Paresthesia is the pins-and-needles prickling sensation that occurs due to nerve entrapment or restriction. TTS is a painful and debilitating condition of the foot that results from compression of the posterior tibial nerve.
Soldier On: How a Landmine Gave Jody Mitic a New Life
Mitic rests briefly on the battlefield, just days before losing both legs to a landmine.
Master Cpl. Jody Mitic's future came to him in a farmer's field, on an earthen embankment beside a narrow path in the heart of Afghanistan's Arghandab Valley.
Ski Spectacular Brings Speed to the Slopes
Youth racer Alex Tomaszewski attacks the slalom course at DS/USA's National Race Festival Photograph courtesy of Reed Hoffman.
At Colorado's Breckenridge Ski Resort, it's not surprising to encounter speed. Some of the top snowsports athletes in the country can be found schussing on its slopes, which have hosted the Snowboarder Hall of Fame and a 2005 World Cup Race.
Save the Environment, Save an Amputee
"Go green, watch your carbon footprint, save the planet, and recycle"—I just can't take it anymore. I secretly wonder how many of those who spend their time and effort recycling like crazy find their business slowly slipping below the surface of the tumultuous ocean we call the business world?
Is there any room to embrace the "go green" mentality within the O&P community? For the most part, owners are just like me—small business owners trying to eek out a modest living as we fight ever-shrinking fee schedules. Recycling ranks almost dead last on my list of priorities.
Fall into Spring
It's the most wonderful time of the year—especially if you are a student. As of this writing, O&P clinicians are rushing to get deliveries out before the end of the year, and now that they've met their annual deductibles, O&P consumers are coming in with prescriptions to get their new devices. But for O&P students, the moment we put our pencils down and turn in our last final exam of the semester, everything in the world is great.
Face to Face: Bryan Reich, RTPO
Face to Face
Bryan Reich is a man who is hungry for knowledge. An amateur astronomer who says he "finds the challenge of pinpointing deep-sky objects relaxing and intriguing," Reich finds his greatest professional satisfaction in mastering materials and techniques—from state-of-the-art epoxy/carbon matrices to old-world leatherwork. After completing his training at what was then the 916 Technical Training Program (now Century College), White Bear Lake, Minnesota, he served in a variety of practices, learning each facility's specialties and methods before moving on.
When you need help with your toughest billing questions, count on ‘Got FAQs?' to provide you with the information you need to help keep your billing on track. This month's column tackles your questions about reimbursement for Ossur's Proprio Foot, diagnosis codes, new and discontinued L-Codes for 2010, and more.
Q: I have billed Medicare in the past for the Ossur Proprio Foot using L-5999 and was reimbursed.
Over the course of your O&P career, you have no doubt developed a number of partnerships with vendors, doctors and referral sources, physiatrists, physical therapists, and occupational therapists—all of those individuals who comprise the "O&P team. " It's always beneficial to align yourselves with those who share similar goals and interests. The O&P EDGE is no different.
The Weight Activated Locking Knee (WALK) and Single Axis Friction Knee (SAFK) are compact, durable options for patients requiring extra stability and performance. Independent friction and mechanical stance-control adjustments make it easy to fine-tune the knee. Adding the SFx to the WALK or SAFK provides adjustable stance flexion and greater heel-strike stability. The SFx increases balance during initial weight loading and adds a moderate amount of shock absorption for a smoother gait. Weighing just 241g with a build height of 3.34 in., the SFx comes in three adjustable load levels for optimized function.
PEL Supply now offers the Orthomerica ready-to-fit prefabricated TLSO stockspinal orthoses. Braces are finished and ready to fit and can be kept in stock for same day, late night, or weekend fittings.
Designed to fit 75 percent of the adult patient population, the bi-valve TLSO is offered with or without an ATE (Anterior Thoracic Extension). Anterior and posterior shells are interchangeable in same size. Available in twelve sizes-six male, six female (XS-XXL)-in neutral or pendulous-abdomen fronts in 0-degree or 15-degree lordosis.
PEL Supply Company
The S.T.O.P. orthosis is an extremely versatile spinal immobilization device fabricated in multiple configurations. SADMERC classified.
- Bi-valve with molded tongues for maximum adjustability.
- Anatomically contoured to facilitate superior fit on a wide range of patients.
- Removable, washable lining for increased comfort and compliance.
- Available rigid molded side panel to increase lateral stability.
Spinal Technology Inc.
New: EWHO Rotation Design Eases Fitting of Neurological Patients with Forearm-Rotation Patterns
The EWHO rotation design facilitates slow, gentle movement of the forearm toward supination or pronation and simultaneous extension or flexion of the elbow during the patient fitting. After applying the proximal elbow section and the distal forearm section, the forearm section can be gently rotated and fixed into the desired position.
Ultraflex therapeutic/stretching bracing provides precise dynamic stimulus and proper posturing to maintain/increase muscle length for improved grasp, pinch, and release functions. It is ideal for challenging neurological conditions such as CP, post-stroke, and TBI.
Now through March 31, 2010, SPS has extended a special price reduction of $100 on the purchase of all Flex-Foot® Talux feet. Additionally, during this limited-time offer, you will receive a free foot cover for the Talux at the time of purchase, together a $204 value!
The unique tarsal core and Achilles Strap of the Talux provide multiaxial function, while the latter enhances forward motion. This perfect mix of balance and agility is applicable for users who have low-to-moderate activity levels.
Mention the promotional code NYP0109 when placing your order.
Easy to fit for practitioners and even easier for patients to use, this integrated, low-profile joint provides the best in electronic stance control and helps your patients get into a more active lifestyle. The E-MAG Active calibrates itself to capture the user's unique gait pattern with the help of the simple onboard programming. This unique feature adds a whole new dimension of functionality for people who previously have had limited bracing options, such as a locked knee brace or manual device. Help your patients get back into the swing of things with the E-MAG Active!
Otto Bock HealthCare
The UltraQuick Release™ is a universal component used for quick and easy conversion from a KAFO to a KO or AFO and back; or from an EWHO to an EO or WHO and back.
Address the changing physiology of post-stroke patients with the Ultraflex Adjustable Dynamic Response™ (ADR™) KAFO/AFO with the UltraQuick Release.
Use the UltraQuick Release for multiple treatments goals like increasing muscle length and strength and providing functional assist during ambulation, by connecting an Ultraflex therapeutic/stretching KO to an Ultraflex Adjustable Dynamic Response (ADR) AFO.
Orthofeet is adding new models to its collection of Two-Way Strap shoes, combining chic design with a stretchy fit and exceptional comfort.
Additional functional features include:
- Innovative Two-Way Strap System that allows fastening on both sides of the shoe as well as an easy adjustment of the strap's length.
- Padded strap that protects the foot from pressure points.
- Lightweight cushioning sole with Ergonomic Stride™design helps propel the foot forward.
Covered by Medicare.
Friddle's offers chafes and loops in a variety of shapes and sizes. We offer the chafes by themselves, with a stainless steel oval or rectangle loop or with a polycarbonate loop. We also offer loops only. Our chafes are available in 1 in., 1.5 in. and 2 in. triangle sizes, and in a 2 in. rectangle size. Our chafes and loops are now sold in packages of 25.
Friddle's Orthopedic Appliances
Orthomerica, a leading worldwide provider of prefabricated and custom orthoses, is pleased to announce the new Spectrum AFO System. These superiorly designed custom AFOs offer optimal fit without comprising comfort. Orthomerica's dedicated custom fabrication team of certified orthotists, skilled technicians, and customer-service representatives are continually focused on delivering prompt and exceptional service at highly competitive prices.
Spectrum products include:
- Mid-Calf AFOs - Split Upright, Free Motion, and Dorsi-Assist.
- Leather and synthetic ankle gauntlets.
Visit Orthomerica's website to see its comprehensive array of prefabricated, semi-custom, and custom orthotic products.
SPS has immediate availability of the new Silhouette VS prosthetic foot which provides shock absorption and multiaxial ground compliance to ease progression onto otherwise unforgiving surfaces.
The new Silhouette VS, manufactured by Freedom Innovations, provides the following benefits:
- Vertical shock absorption softens impact at heel strike to provide comfort and preserve residual-limb health.
- Multiaxial function and +/- 15 degrees of inversion/eversion provide excellent ground compliance and stability.
- Optimized sole plate with tri-durometer urethane strips transfers load from lateral to medial plane with each step for more natural medial roll-over.
- 3/8 in. or 3/4 in. heel heights broaden footwear choices from dress shoes to work boots.
For more than 20 years, Orthomerica Products Inc. has been offering effective, non-operative and post-operative treatment solutions for lower-extremity fractures and range-of-motion restric-tion. And today, Orthomerica introduces the Orlando® KAFO/HKAFO Lower-ExtremityFracture Bracing System. It is modular, lightweight, and can be ordered and stocked as components, making them immediately available, or custom assembled to your measurements. Orthotists choose from a wide selection of femoral and tibial components, hip joints, knee joints, and shoe inserts to meet individual patient needs.
XTX is easy to mold and comes in four rigidities and three colors. It's produced using high-strength carbon and glass fibers in a tough, unique polypropylene matrix.
XTX allows for deep contour molding using conventional equipment. It molds deep heel cups and directional rigidity for greater foot support and control. XTX is very lightweight, thin, durable, and is high performance, yet economical.
Thermoplastic composite materials represent the most versatile orthotics material today. We give you more options and more convenience since all of our products are in stock and ready to ship! See our full page ad in this issue.
Pursuant to notification by CMS of the HCPCS L-Code assignment for Endolite's Echelon Foot, SPS' list price for the Echelon Foot has been reduced by 33.3% in consideration of the HCPCS coding decision. Effective December 1, 2009, the Echelon Foot should no longer be billed under the L-5999 code, but billed under codes:
- L-5981: All lower extremity prostheses, Flex-walk system or equal.
- L-5968: Addition to lower limb prosthesis multiaxial ankle with swing phase active dorsiflexion feature.
Similarly, the price of the KX06 Polycentric Swing and Stance Knee has been reduced by 30% and is now recommended to be billed using codes L-5611, L-5930, L-5850, and L-5810.
No Compromise? No Problem!
The ultimate in versatility, shock absorption, rotation, and stability in one compact package.
- Dynamic, precision-engineered spring incorporates vertical compression and axial rotation.
- Progressive response to axial loading, which is most similar to the elastic properties of the natural muscles.
- Compact, maintenance-free design allows for easy cosmetic finish.
- Foot shell and glide sock included.
- Ships fully assembled.
- 365 lb. weight rating, 36-month warranty.
Fully designed and developed for the EndoFlex system by Ortho Remedy, this new, lightweight tube clamp adapter allows for attachment to the latest pyramid foot technology. With superior strength and manufactured to our exact specifications, this clamp keeps the EndoFlex system evolving at the forefront of prosthetic technology.
The Ortho Remedy
The new Black Iron Trainer is a lighter version of the heavy-duty, high-performance Black Iron Master. While the Black Iron Trainer is smaller and lighter in weight, it is capable of handling the wide range of handle diameters that are encountered in modern fitness and exercise facilities.
The completely manual operation and positive locking and unlocking design provide uncompromising security and stability for bench pressing, dumbbell flys, dead lifts, pull-downs, and more. The Black Iron Trainer, with a load-rating of 440 lb., also carries a smaller price tag than its larger cousin.
Mechanical advantage with NO STRINGS ATTACHED!
The innovative NINJA is a 6X mechanical-advantage orthosis that is like a string brace, but it uses straps instead of strings. The straps are more durable; they won't fray, tear, tangle, or wedge.
The NINJA belt is the foundation of each brace (L-0627, L-0631, and L-0637) in the NINJA Progressive Spinal System. It has a soft mesh inside and an aggressive loop outside. The one-pull strap is so easy to tighten and fasten. The NINJA Mid LSO is pictured.
HOPE Orthopedic: "WHEN YOU NEED IT RIGHT FAST."
Listen to the experts at http://releasecentre.orthotics-cadcam.com/
The Delcam orthotic CAD/CAM solution replaces the traditional orthotic design and manufacture methods with a totally digital process that is:
- Clean-No more messy plaster casting and dressing.
- Fast-Orthotics are produced in minutes, not days.
- Easy-New users become proficient in under a day.
- Precise-Repeat prescriptions identical to the original.
- Profitable-Speed, ease of use, repeatability, and reduction of storage space all add up to a rapid return on investment.
Delcam Orthotic Solutions
The TSS Vaculink Vacuum Pump from MICA Corp. was created for elevated vacuum socket management, enhanced suspension, and moisture control. The Vaculink is a mechanical pump mounted to a tibial component and driven by stance phase or combined foot and ankle flexion. The pump design is simple and effective, ensuring extended life, efficiency, and zero maintenance.
Features and benefits include:
- Zero battery dependence.
- Enhances blood circulation.
- Stabilizes limb volume and prevents fluctuation.
- Firmly secures socket to limb.
- Increases user awareness of limb/prosthesis position.
- Easily adjustable vacuum and lightweight.
Stop by table #320 at the Academy meeting in Chicago.
Titanium pyramids are now standard with Dycor's new K2 DR2 (unassisted transfer/assisted ADL) and K3 DR3 (unassisted ADL) feet. The K2 version is 30 percent more flexible than the K3.
Dycor's DR feet are lightweight and resilient because they rely on deflection of the varying-thickness leaf springs imbedded in the upper keel member, rather than compression of rubber bumpers. The DR feet are ground compliant because they incorporate uni, bi-, or tri-axial ankle articulation with low- or medium-profile options.
Weight, including titanium pyramid and foot shell, is 312g (11 oz.).
Provel offers cost-effective, fast, easy-to-use, and reliable O&P automation. The D2 digitizer, C5 carver, and T6 thermoformer are appropriate for small clinics as well as large central fabs. All are AOP-file compatible and backed by a two-year warranty. The D2 digitizer allows automated shape capture of prosthetic casts with unmatched accuracy. The C5 carver is not only fast and precise, its self-contained dust-collection system is extremely quiet. The T6 thermoformer consistently produces high-quality thermoplastic sockets from industry-standard preforms.
Pediatric AFO casting socks are now available from the STS Company. Four different sizes cover a broader range of anatomy and ages. The fast-setting, water-curable resins are impregnated into the casting socks, setting in approximately two minutes. The impressions are as accurate as plaster of Paris and can be easily removed with small scissors. The casts are ideal for CAD/CAM.
No cast-room clean up is required, which saves practitioners a lot of time. If central fabrication is chosen, the casts can be shipped immediately with little chance of damage. A cast cutter is not required nor recommended, making the removal process much easier. An ideal choice for children requiring custom AFOs.