Rough and Tumble: Meeting the Prosthetic Durability Challenges of Your Youngest Patients
Jameson Davis. Photograph courtesy of Advanced Arm Dynamics.
Risk Factors for Plagiocephaly
In a previous article, I discussed the commonly expressed concerns
of parents of infants with deformational plagiocephaly regarding
potential functional deficits associated with the condition
(" Beyond Cosmetic Concerns: Functional Deficits Associated
with Deformational Plagiocephaly ," The O&P EDGE , April 2012).
Another common concern is uncertainty about what might have
caused or contributed to the development of the condition. Parents
are often eager to know whether they inadvertently played a role
or if they need to modify their parenting style to prevent it from
occurring in subsequent children.
Standing Out by Trying to Fit In
THE FIRST DAY OF SUMMER VACATION
"Accept what you can't change and change what you can't accept,"
as the saying goes. When that change happens to a six-year-old
girl, you accept it with the naivety that only comes with the
innocence of childhood. My story begins on May 28, 1975, in the
small town of New Ulm, Minnesota.
Measuring the Usefulness and Importance of Outcome Measures
While physicians are tasked by the Centers for Medicare
& Medicaid Services (CMS) to assign K-level
functional classifications to lower-limb amputee
patients, some turn to prosthetists for guidance.
Compassion, and even profit margin, can drive
prosthetists then to suggest to the physician that he or she assign a
lower-limb amputee patient with a higher K-level based on potential
rather than reality. If that occurs, the patient has to live with the
consequences, be it a device that is too cumbersome or perhaps
HHS Delays ALJ Hearing Scheduling by Two Years: Continues to Fail to Adhere to Its Own Regulations
The provision of prostheses and orthoses to Medicare
beneficiaries has come under heavy fire over the past few years
with the imposition of new documentation requirements that
were issued without the Centers for Medicare & Medicaid Services
(CMS) following proper procedures. This created extensive
auditing and shifting medical necessity criteria. The advent of the
Recovery Audit Contractor (RAC) program, along with ramped
up efforts by benefit integrity contractors such as Zone Program
Integrity Contractors (ZPICs), have fueled auditing to reach new
Reversing Scoliosis and Brace Treatment of a Proximal Structural Curve
Academy Society Spotlight
In the conservative management of scoliosis through orthotic
treatment, it is the orthotist's responsibility to provide an optimally
fitting and functioning scoliosis brace and to achieve the
orthotic intervention's objectives to reduce or hold the Cobb
angle and improve the patient's clinical presentation at the end of
skeletal growth. There are many factors that can influence curve
patterns during the course of treatment, including good brace
correction. For brace correction to be effective, the orthotist must
identify changes in curve pattern that arise both predictably and
unpredictably during the patient's growth and adjust the brace
to those changes.
C. Ralph Hooper Jr., CPO: Scoliosis Bracing Pioneer
Hooper marks the trim lines for fitting the Charleston Bending Brace. Photographs courtesy of Ralph Hooper.
As a young practitioner, C.
Pedorthic Treatment of Pediatric Foot Problems
Years ago, the use of children's orthopedic shoes was a well-established, medically accepted, and oft-prescribed solution to pediatric foot problems. Each year, pedorthists and orthotists measured for, fitted, and dispensed thousands of straight-last and outflare shoes with modifications like Thomas heels, wedges, and torque heels, as well as orthopedic contraptions like Denis Browne splints. It was big business.
Getting the Most from Your Practice by Looking Within: Part 1 of A Four-Part Series
Accounts Receivable Workflow: Is It Working for You?
Analyzing your O&P business can be intimidating. The necessary time, resources, and money to examine your
business from the inside out are not always available. To help you in this endeavor, The O&P EDGE is offering a
series of four articles that will focus on key elements of your business and provide some tips for performing analyses
and improving your processes.
Master’s Program Profile Series: University of Hartford and St. Petersburg College
The O&P EDGE continues its series of National Commission on Orthotic and Prosthetic Education (NCOPE)-accredited
master's level O&P educational programs.
This month we feature two programs. The first is the
University of Hartford College of Education, Nursing
and Health Professions (ENHP) Master of Science in
Prosthetics and Orthotics (MSPO).
Designing a Paralympian’s Device
Jeff Erenstone, CPO, chief designer of
Performance Orthotic Design and president
and head clinician of Mountain Orthotic &
Prosthetic Services , both located in Lake
Placid, New York, specializes in crafting
personalized adaptive sports equipment
from his office at the site of the 1980 Winter
Olympics. Recently, he built a cross-country sit-ski that will be used by Dan
Cnossen in the 2014 Paralympic Winter Games in Sochi, Russia. The O&P EDGE asked Erenstone to describe the process of developing Cnossen's sit-ski.
Fernando “Nandito” Gallego: Spina Bifida Doesn’t Slow Down Five-Year-Old
Nandito pictured here before therapy allowed him to stand independently without the aid of his walker. Photographs courtesy of Fernando Gallego.
Fernando "Nandito" Gallego was born five years ago in San Diego,
California, with myelomening- ocele level L4-S1-the most severe
form of spina bifida, where the spinal cord and the tissues covering
it protrude from an opening in the back.
O&P: We’ve Come a Long Way
I've loved watching sci-fi movies since I was a kid. Star Wars was the first movie
that I saw in the theater. Aliens and The Terminator were my go-to movies when I stayed home sick from school, the Matrix was the first DVD I owned, and Inception was the first Blu-ray I owned.
Erin Rice, CO, ATC
Face to Face
Erin Rice, CO, ATC, says she always wanted to work with children, so when
she got the opportunity to stay on staff at Children's Care Hospital and
School/Rehabilitation Medical Supply (CCHS/RMS) Sioux Falls, South
Dakota, after her residency, the decision wasn't difficult. "It humbles
me to think that I get to do this every day," she says. In her current
position she treats pediatric patients who need cranial remolding helmets
or orthoses in the CCHS Children's Care Rehabilitation Center
outpatient-rehab setting facility, and follows up with pediatric patients
with special needs at CCHS.
Billing and Collections Q&A
Billing for O&P devices and care is complicated. When you have questions, count on "Got FAQs?" to help keep your
claims on track. This month's column answers your questions about prosthetic devices not delivered until after the
patient entered an SNF, and medical necessity for custom knee orthoses.
Notes from US ISPO: PacRim 2014
Industry Review - Associations
Pacific Rim (PacRim) 2014, a Pacific Forum for Physical Rehabilitation,
sponsored by the U. S. Member Society of the International
Society for Prosthetics and Orthotics (US ISPO) in cooperation
with The O&P EDGE , took place Sunday, January 26, through
Wednesday, January 29, at the Marriott Waikoloa, Hawaii.
“Secret Santa” Makes a Young Girl’s Wish Come True
Industry Review - Consumer
Most nine-year-old girls have clear ideas of
what they want Santa to bring them for
Christmas: an American Girl doll, a Nintendo
DS, Harry Potter books, or board
games. Ella Rodriguez's request this past
Christmas, however, was something that
couldn't be purchased at a store or made in
"Dear Santa," she wrote.
In early December, I received a message from an
old friend who told me about the daughter of one
of her friends. The daughter is an amputee and had
written in her letter to Santa that all she wanted for
Christmas was to meet other kids who were like her.
The story pulled at my heartstrings, and I reached
out immediately to the O&P community for help.
New Alpha Liner Absorbs Heat and Reduces Sweat
WillowWood brings temperature control to prosthetic liners for the first time with Outlast®, the original heat management technology that was developed for NASA. Now amputees have a viable solution for a comfortable prosthetic liner that works to delay the onset of sweat with the Alpha® SmartTemp Liner.
The Bledsoe Jet™ knee brace is designed specifically for children. Its shorter frame fits proportionally to a child's leg length, and the hinge is reduced to match the anatomy of a smaller knee. The frame contours around the medial condyle to prevent brace migration. Made of lightweight aircraft aluminum, the frame provides support, strength, and durability. Spacer-designed padding allows adjustment for growth. By removing or stacking the spacers, a three-point load system can be created. Comes in S, M, L (9-in. frame), or XL (11-in. frame), and in hot pink, neon green, and black.
PEL Supply Company
The new version of our Summit Lock, the
Proximal Lock, mounts the same way,
but with an easier-to-use, flexible, silicone
adhesive. The Proximal Lock glues to most
fabric-backed liners with no problem, and
locks into the socket with nothing needed on
the distal end; use the adaptor of your choice
to maximize clearance. The Proximal Lock
controls rotation and offers suspension and security.
Features and benefits include:
- Zero-clearance lock.
- Controls rotation.
- Ideal for long limbs with minimal clearance.
- Flexible attachment rolls on easier.
- Can be used with liners with a seal band.
- Lock can be retrofit.
Compressogrip® by Knit-Rite-the original
tubular compression prosthetic shrinker-has
been widely accepted for more than 30 years!
- New extra-large transfemoral size accommodates up to a 40-in. (102cm) circumference!
- Compressogrip shrinkers offer lower cost and easier donning, and they are easier to stock than traditional shrinkers.
- Tapered B/K shrinker option has an additional width at the top to accommodate larger thigh girth and reduce rolling and bunching.
- Available in white, beige, or grey X-STATIC® silver fiber.
- Every latex-free Compressogrip roll is quality tested for consistent compression.
Amfit is a world leader in
technology for digital casting,
design, and fabrication of
custom foot orthotic devices.
The process allows a user
to quickly cast and create a
full custom product quickly,
accurately, and at low-cost.
Choose from two 3D scanners-the Contact Digitizer™
or Impress Scanner-and combine with an on-site Amfit
CAD/CAM Mill or Amfit Lab Services offered by our skilled
technicians. Correct & Confirm™ design software allows detailed
prescriptions to be easily satisfied. Amfit combines cutting-edge
technology and more than 25 years of experience serving foot
care professionals worldwide.
Keasy is a prefabricated cone for manufacturing high-quality thermoformed liners in a blink-no welding, no gluing, and it's seamless. Keasy's regular thickness allows a vacuum thermoforming that perfectly takes on the cast. According to the Keasy dimension, we recommend a 338° F heating temperature for 75 seconds to three minutes. Sweat and cleaning agents do not soak into the EVA closed cells structure. Keasy is easily washable and hygienic. Keasy withstands friction, crushing, and stretching for patient's durable comfort over time. Available in six sizes.
New for 2014! Our latest K2 foot provides a good range of motion and high weight limit in a lightweight and affordable product. This service-free design also has a full-length toe lever for excellent stability and performance.
College Park Industries
The new Iceross Dermo Uniform Liners
are designed to easily retrofit the
uniform profiles commonly found in
the market today, while still offering the
popular features of our Dermo liners.
Recommended for low to moderately
active transtibial users, Iceross Dermo
Uniform Liners are ideal for vascular
patients and those with sensitive skin.
A new feature will soon be available for Motion Control terminal devices (MC ETD and MC Hand ProPlus versions).
- Force Limiting stops grasp force at approximately 2 lb., allowing grasping of delicate objects and reducing the fear of injuring someone by over-gripping.
- Each "pulse" increases the gripping force by approximately 2 lb.
- Auto Grasp detects a socket or electrode slip and automatically increases grip force.
- Suggested L-Codes: L-6881, L-6882, L-7009, and L7499.
A practical guide for preparing for,
adapting to, and living with limb loss.
Provide your amputee patients with the information
and resources they need to help them
adjust to life with limb loss.
Customize Your Guides:
Include your company's full-color logo and
contact information on the bottom back cover
of the Limb Loss Resource Guide. Minimum
4-box order required for customization.
Place Your Order Today!
Volume discounts are available. The Limb Loss Resource Guide
is being published by Amplitude Media Group, a new media
company owned by the publisher of The O&P EDGE.
Amplitude Media Group
- Raised GripGel™ bands grip the socket wall to form a secure interface between the socket and liner to prevent slippage or premature release.
- Low modulus GripGel bands stretch against the socket wall, while the inner wall conforms easily to the residual limb to ensure there is no blood-flow restriction or stiffening to inhibit donning.
- Full-length inversion for ease of donning.
- High-performance, knitted fabric cover.
The guide provides information about:
- Terms to know.
- Types of audits.
- Planning ahead.
- The RAC audit process.
- And more!
Ask your Endolite territory manager about getting your guide today.
Made specifically for pediatric patients,
Allard's SoftSHELL Covers for Kiddie
GAIT and KiddieROCKER combine
the SoftKIT interface system with fun
yet functional textile covers that cater
to a child's sense of style! The Kiddie
GAIT SoftSHELL features a slip-on
sleeve design, allowing the anterior shell
to slip between the SoftKIT interface
and the printed cover, and D-ring cinch
closure straps for easy tension adjustments.
Available in a grey and white skull or pink heart pattern
(or baby blue or baby pink for Kiddie GAIT SoftSHELL only),
both products are machine washable and in youth sizes S-XL.
PEL Supply Company
Harmony between security and fluidity.
The Symphony is a six-bar polycentric knee
designed for patients who need both safety
and dynamics. It orchestrates the phases of
the gait cycle to offer a harmonious solution
with security, comfort, and fluidity. The
p-MRS system mechanically detects the
different gait phases and adapts stability
accordingly. At heel strike, the system locks
the knee geometrically and cushions with
a stance flexion dampening feature. The
selective lock function enables the patient to
lock the knee manually whenever security is
needed. At the preswing phase, the Symphony unlocks for an
effortless switch to swing phase.
Find out why CPs and amputees are raving
about this new, low-profile prosthetic foot. Our
Flexeon™ fiberglass composite material is two
times more flexible than carbon
fiber and nearly indestructible.
This translates into zero dead
spots, zero repairs, reduced
socket issues, and higher patient satisfaction-all of which are
good for your business and your patient.
Our unique design ensures the most stable, natural K3
mobility and lifestyle experience for your patients. Try it and
see for yourself.
Call today and receive a special introductory discount on your first two orders.
The avalon foot provides 12° of controlled ankle motion, allowing the user to safely negotiate stairs, ramps, and environmental obstacles with increased confidence and security.
- Dorsiflexes from midstance to toe off for a smooth rollover.
- Remains dorsiflexed through swing phase for improved toe clearance, to minimize the risk of falls.
- Provides a more natural gait; reduces the need to compensate by hip hiking, circumduction, or lifting the knee to clear the toe during swing phase.
- Biomimetic ankle motion encourages equal loading during ambulation, which leads to less stress and thereby preserves the sound side.
Features and benefits include:
- All stainless steel construction for stronger, longer-lasting control.
- Lightweight—weighs only 1.5 oz. per hinge.
- Sold in pairs, with an ultrasmall joint head to reduce overall bulk.
- Taller, reversible, stainless steel upright helps to corrugate the plastic strut, reducing the need for thicker plastics.
- AFOs can be fabricated with plastic as thin as 3/32 in.
- Adjustable stops allow movement from 0-30 degrees in both directions or anywhere in between.
- Contourable distal stirrup attachment increases strength connection of the molded footplate and allows for thinner plastic in AFO fabrication.
A new low-friction fabric technology dramatically reduces friction and
related shear forces between the skin
and prosthesis. GlideWear™ prosthetic
liner patches are indicated for amputees
who encounter irritation and skin
breakdown from prosthetic liner and
socket use. Simply position the patch
between the prosthetic liner and skin
each day for continuous protection.
Choose from two sizes. GlideWear
prosthetic liner patches are sold in a pack of two patches.
The Freedom DynAdapt™ foot is a
slim-profile, carbon-fiber foot system
with a slender, anatomic design for easy
fit and finish. Its multiaxial function
provides maximum comfort and the
uninterrupted strands of carbon fiber
in the full-length heel provide patients
with effortless rollover and a more
natural gait. The new EnduraCore™
Technology composite laminate delivers up to three times
the fatigue life of a standard laminate in a design that also
returns more energy. The result is a highly durable product that
preserves users' energy so they can do more with confidence.
The Spinomed® IV is the latest proven orthotic advancement for the conservative treatment of osteoporosis spinal conditions. The Spinomed IV boasts improvements that increase patient compliance and ease of use. These improvements include ergonomically shaped shoulder straps designed to ease application, flexible pelvic strap designed to form fit around the patient, modern strap design using intelligent strap loops that improve upon the patented design, and a revolutionary garment system that allows air to transfer through the orthosis, creating the most comfortable Spinomed ever!
The Camber Axis Hinge® is now available with modular uprights to further enhance your orthotic design options. The 3/16-in. x 3/4-in. aluminum proximal upright and 1/8-in. thick stainless steel stirrup have been specifically designed to fit the proximal and distal uprights of the Camber Axis Hinge.
The Camber Axis Hinge Modular Upright Kit is supplied fully assembled and comes complete with seven color-coded, range-of-motion keys that eliminate the need for posterior stop mechanisms. This joint permits a solid ankle design that can be easily changed to articulated motion with variable stop settings.
Dr. Comfort's Shape To Fit socks
and compression hosiery line
combines function, fashion, and
comfort for preventive, medically
correct support that's attractive
too. Features include an easy-on
graduated compression and Shape
To Fit's signature nonbinding
comfort band, which provides
superior, nonslip support.
Uniquely designed seamless socks and smooth-seam hosiery
with fresh-weave odor control make them an ideal choice for
people with diabetes and foot health considerations.
KiddieROCKER™ is the newest addition to Allard's pediatric
dynamic response AFOs. Developed for your pediatric population
with more involved pathology, the extra rigidity offers enhanced
balance and posture control, especially for weak quadriceps.
Features and benefits include:
- Carbon composite with anterior shell, lateral strut, and engineered footplate with open calcaneal design.
- Allows integration of your custom foot orthotic to help control ground-up forces.
- Lateral strut can serve as a base for a T-strap to control excessive ankle eversion.
- Anterior shell assists in management of proximal deficits by helping manage either knee hyperextension or crouch gait.
The medial Arch Suspender is
an innovation that provides an
adjustable lifting strap under the
talonavicular joint to resist collapse
of the medial arch and ankle and
hindfoot eversion. This modification
is indicated for severe PTTD and
severe pronation disorders of the hindfoot.
The lateral Arch Suspender resists ankle or hindfoot inversion.
Indications include peroneal tendinopathy and varus deformity of
the ankle and rearfoot.
Casting methods and tips are available on our website. Certified
pedorthists are available to answer questions regarding Richie
Hersco Ortho Labs
The new medi 4Seal TFS Liner combines a revolutionary sealing technology with a unique self-gliding surface, providing extraordinary suspension, comfort, and ease of use for those with transfemoral amputations.
Features and benefits include:
- Integrated seals for easy inversion and a highly secure fit.
- Easy Glide PLUS outer surface-no donning aids or sprays required.
- Excellent tissue control due to a highly effective, full-length matrix.
- Optimal radial stretch for greater comfort.
- Simple to use gel-grip spacer socks for easy application (available separately).
We now offer a new way to
simultaneously disengage our bail lock
knee joints. The BLISS, model MX-003-
BLISS, was developed in collaboration
with Trinity Orthopedic as an alternative
to traditional lever-release systems. The
BLISS does not require any specialized
tools and can be installed in a matter
of minutes. Simply loop the bail straps
over both levers, insert the plastic plugs
into the lever openings, and secure the
proximal straps to the thigh section of
the KAFO. The BLISS is lightweight, durable, cost effective, and
available in one universal size.
Join the celebration at
and visit the anniversary
page on our website.
American Board for Certification/ABC
Until now, all advanced vacuum systems have required a sleeve to maintain vacuum. The problem is that sleeves are bulky; they bunch behind the knee, restricting range of motion. They can also puncture, leading to a loss of vacuum.
Enter Unity™. Building on established Seal-In® technology, the Unity Sleeveless Vacuum system by Össur® is the first advanced vacuum solution to generate 15-22 in Hg of vacuum without a sleeve.
Visit www.ossur.com/unity to learn how to get certified and check out the entire line of Unity-compatible Flex-Foot feet including low-profile and microprocessor solutions.
The 1C30 Trias® is an extraordinary prosthetic foot-a combination of creative design and innovative, lightweight technology. Interconnected, dual-spring elements provide dampening at heel strike and enable a physiological rollover with excellent energy return. The result is movement similar to a natural foot.
- Dual carbon forefoot and heel springs for easy rollover.
- Adapts to various walking speeds and uneven terrain.
- Lightweight carbon construction in an attractive design.
- Functional foot shell in normal and slim versions, two colors, and two heel heights.
- New look as part of the TriAngular foot family.
Mounting Plates VMP-007, VMP-002, and VMP-001.
Now Evolution's most popular mounting plates are available in black! Call us for more information.
Evolution Industries Inc.
The Freedom Agilix™ is a multiaxial, shock-absorbing, flexible foot system designed to manage loading impacts, reduce socket shear forces, and improve comfort while walking on nearly any terrain. The ultra-lightweight design offers low-impact K3 ambulators shockingly comfortable performance at a value like no other. Learn more about the Agilix on our website.
The Compact Double Action Ankle Joint
(Model 725) is supplied fully assembled
and is designed specifically for use with
thermoplastics. The precontoured stainless steel
upright and stirrup reduces fabrication
time, while the low-profile and lightweight
design enhances the clinical application.
The Compact Double Action Ankle Joint,
intended for both small-adult and pediatric
patients, is designed to provide optimal
control in the sagittal plane and increase
Features and benefits include:
- 50 percent stronger than conventional triple swivels.
- Simplified design and construction outlasts conventional models.
- Stronger, heat-tempered, stainless steel materials.
- Extra-long ferrule provides "double swage" capability.
- 3/16-in. and 9/32-in. diameter terminals for both standard and heavy-duty cable.
- Use with TRS Python cable for the ultimate in strength and durability.
Hersco Ortho Labs is now a Richie Brace® partner lab! Podiatrists often insist on dispensing the original Richie for cases of PTTD, ankle instability, arthritis, and more. For faster turnaround on your Richie orders, send casts directly to Hersco.
Download prescription forms at www.hersco.com. Click on our Education tab for great tips and casting methods.
Certified pedorthists are available to answer any prescription questions you may have.
Hersco Ortho Labs
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New PLUSeries E-Series was developed
to better address specific chemical
regulations and reduce cost. Just like our
+PLUSeries adhesives, but with a few
minor differences, PLUSeries E-Series is a
versatile and fast two-part urethane adhesive
system that is used for bonding and
repairing plastics, composites, aluminum,
steel, plaster, and nearly anything else.
Sold in our popular 50ml and 220ml sizes,
25- and 60-second gel times, and in tan
and black colors.
At Naked Prosthetics, our goal is not to hide injuries or
amputations; instead, we provide simple, elegant, fully
functional, and high-tech solutions that are worn with pride.
Now Accepting Applications!
NUPOC's 21-month MPO program allows
you to complete your first two quarters
(6 months) and final quarter (3 months)
online, plus four quarters (12 months) of
supervised practicum on campus, where you practice P&O skills
with individuals who live with neuromusculoskeletal impairments.
NUPOC graduates are eligible for NCOPE residencies and
P&O certification examinations. The NUPOC MPO prepares
students to become proficient, compassionate clinicians; assess,
prescribe, and deliver comprehensive P&O services; apply
research to clinical practice; and contribute meaningfully to the
P&O profession. Apply today!
Northwestern University Prosthetics-Orthotics Center
Feinberg School of Medicine