Thank you to all who responded…That was the type of variety that I was hoping to see and I appreciate your time as well as your knowledge. Some of the replies were quite intriguing and showed a great deal of knowledge on the
topic which was very beneficial. Here are the responses.
The search for the Holy Grail is never ending. Everything that everyone will tell you will be true and in the same breath it will be a pack of lies! Every method that any one of us uses is a valid and valued way to accomplish our goal. You are going to have to find the method that suits you AND your talants best. No matter that no one else in the world uses it, if it works well for you, then it’s the best method. So what if five hundred people use method A and a thousand use method B, if you can’t get results with them, what good are they to you?
All of the brims, digitizers and what have you, are tools. A tool is meant to be used to its best advantage. When there is no tool to do what you need to do, you make one.
Far more important than the tool you use is the result that you get. Knowing and following criteria to obtain excellent fit and function will lead you to the tool that will work best for you. Asking for input, as you have, is a good place to start, but ultimately, you will be on your own to figure out what works best, in your hands.
Now, back to your question. For IC sockets, I use the Otto Bock ETS tool. They guanantee a socket that will not fit. However, I have found that with modifications I can make a very good fitting socket from the first test socket that they send me. It takes two days to get it and you don’t subject your older patients to a 20 minute, standing, casting procedure. I use the Scandanavian IC pattern only.
The Quad sockets take more time to modify, because the Germans have no clue what a U.S. quad socket is supposed to look like. Most of the time a second test socket is necessary, usually on the suction suspension sockets. Before I began using ETS, I used to keep old test sockets. I probably haven’t casted more than 1 to 2 % of my TF patients in the last 20 years. Most of those either demanded to be casted or they were PFFD or KD patients whose residuums are not accomodated by previous test sockets or ETS.
Remember, a cast of a TF residuum is not one that you can smooth and laminate or pull. It has to be modified appropiately. I’m just using a different starting point. One that is at least as close as most casts and closer than many.
Hand Cast for the last twenty years
Cannot take a brim into the home or clinic.
Improves the image/reality ratio, in not forcing the limb into a certain shape. All older patients go into a custom liner, with patient adjustable VGAP socket. IC shape is a quad modified shape; just don’t cut off the medial or posterior part of the socket but use the quad seat. There is no reason to use brims
Robbie, I think the answers to your questions are going to be as varied as the style sockets you see. My self personally, I prefer hand casting. My experience suggests that your hands on a clients anatomy is far superior to any brim technique due to the inherant anatomical differences in us all. You need your hands to give you the proper shape, ischial line of progression orientation, and the ischial contours and size.
I spend several minutes palpating different muscle groups noting relaxed vs. contracted orientation etc. I use a sock similar to boxing shorts pulled high into the gluteal fold and rectal regions, this gives me my line of progression after cast removal. I wrap several layers of plaster beginning with elastic and finish with rigid to secure my contours and preserve my mold. I will then contour my negative mold after cast removal orienting the location of my muscle groups in relation to the line of progression. My vote is for hand casting, think of it, you have a full selection of lefts and rights in all the various sizes with you at all times!
Robert – Two AK test sockets is considered normal and that is why Medicare doesn’t blink when you bill for them. Three is perfectly acceptable. I went through the Sabolich course and their casting brim on a stand method using measurements for the distal circumferences works great. Their philosophy is that the brim fitting is the first test socket. Then the test socket from the cad-cam measurements is fitted and alginated for an exact fit which is test socket #2. To fit another socket to test your algination is prudent. But you also need to know hand-casting as not everyone fits into pre-fab brims. Two or three test sockets are normal. Five is excessive.
I haven’t casted for an IC Socket in over 5 years. I have had great success using Otto Bock’s ETS System (Electronic Test Socket). They offer a wide variety of brim styles and made to measure sockets. The material used for their test sockets is Thermolyn Stiff. This is a very unique material as it is clear yet not fragile like the typical test socket material. This material is very easily heat moldable, so any modifications can be made simply by heating during the fitting process. The material also allows the patient to wear for a limited trial period outside of the office.
Otto Bock’s Tech Center is very good about turning around faxed orders, usually in a couple of days. They will pull over most adapters including various manufacturers. They will do complete set ups and provide their plug valve for suction test fittings.
I highly recommend this service. It still requires a good knowledge of proper socket fit, and attention to modification details.