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O&P ListServ Archives
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What are your thoughts on the Centers for Medicare and Medicaid Services (CMS)'s prior authorization and PDAC requirements? Take our three-minute survey to share your feedback about how these CMS changes have impacted the O&P industry.
You may also sign up to receive the findings when published.
Thank you in advance for your time and feedback.
Start survey: <URL Redacted>
Bottle Flipping With a Bionic Hand!?< <URL Redacted>>
Be Safe, Be Kind, Be Strong, Be Bold
SAM BROUILLETTE, CP, CFo
Manager, Clinical Education
SPS Clinical Services
** COVID VACCINATED**
[cid: <Email Address Redacted> ]
Mobile: 770.596.9938
<Email Address Redacted>
SPS
800.767.7776
<URL Redacted> < https://urldefense.proofpoint.com/v2/url?u=http-3A__www.spsco.com_&d=DwIFAg&c=sJ6xIWYx-zLMB3EPkvcnVg&r=KmuawjwNpT9A2bnhzaNVjw8wO7L_TDosEXIk33h_tlw&m=2GXQCZ8ACkNUOTMcysLzGEBbBVz8z4KM8FO4dIlFsidrX8TMHF-mc6skUYhkaUWU&s=b3prII45RqB7vznsZFgRxZwXtEARIQ_BmTExb08an1Q&e= >
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[sam]
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What are your thoughts about Prior Authorization?
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Sam Brouillette
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5/10/2022
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We use 3/16 Volara aka therafoam to line our stretching AFOs for kids. Not available until at least July (maybe). Does anyone have a decent alternative? Aliplast is too soft. We can work around and with other materials but open to suggestions or donations. Thank you
Greg Armstrong, CPO
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Volara (Therafoam) 3/16"
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Armstrong, Greg
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5/26/2022
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Good Afternoon List,
Can anyone share any information about limb loss persons being received in which countries? A local Rotary group has some donated funds that they would like to find out more information about persons being evac'd and demographics (e.g. adults, children etc.) and what types of O&P goods are needed. All responses will be appreciated!
Thanks,
John
John F. Schulte CPOe FAAOP
<URL Redacted> < <URL Redacted> >
<URL Redacted>
https://urldefense.proofpoint.com/v2/url?u=http-3A__www.linkedin.com_in_john-2Dschulte-2D30120629&d=DwIFAg&c=sJ6xIWYx-zLMB3EPkvcnVg&r=KmuawjwNpT9A2bnhzaNVjw8wO7L_TDosEXIk33h_tlw&m=qgTFA-gZlRFtoTXUy7-iRarCFfxg4DGlNN3YerPV_LMXAC_k1FG8xSJjHxSGkfZR&s=3OznuuQ7q2Wx5K4NISrbLWJ3oOSAWjUoUQtuqSrC14M&e= < https://urldefense.proofpoint.com/v2/url?u=http-3A__www.linkedin.com_in_john-2Dschulte-2D30120629&d=DwIFAg&c=sJ6xIWYx-zLMB3EPkvcnVg&r=KmuawjwNpT9A2bnhzaNVjw8wO7L_TDosEXIk33h_tlw&m=qgTFA-gZlRFtoTXUy7-iRarCFfxg4DGlNN3YerPV_LMXAC_k1FG8xSJjHxSGkfZR&s=3OznuuQ7q2Wx5K4NISrbLWJ3oOSAWjUoUQtuqSrC14M&e= >
Tel: 410.533.1960
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Ukrainian Amputee medevac countries
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john schulte
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5/8/2022
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Hello list:
Many requests for a summary ofresponses has resulted in the following editedsnippets, links and discussion with parenthetical comments and names removed. Original post at the end:
If you are not aware of it already, there is a guy doingblogs on YouTube about 3d printing sockets: Limb and Lattice. He is usingMeshmixer and a hobbyist level filament printer. He seems knowledgeable . . .
(Nice series ofvideos linked below, let’s grow this practitioner’s subscriber base, can we clear 2000?)
<URL Redacted>
(PDI Squirt Shape: 26seconds in the hammer comes out. MakesISO 10328 seem restrained and tame):
Here's a brief video showing some of the strength. There are other videos on the PDI channel.
<URL Redacted>
You raise some good points of concern about the HPsockets. That technology has a lot ofpotential but still has some issues too. Cost of printing and associated loss of reimbursement of acrylic andultralight codes are a particular concern for me. There is anecdotal evidence of durability forover a year, but I believe research is still needed, especially related todesign characteristics and how to properly use the HP printer for bestoutcomes. Those machines have variationson settings, and a socket from one machine could be different from a socketfrom another machine that is being used differently.
I personally only use 3D printing for non-structural and/ornon-definitive items right now. Testsockets, flexible inner sockets, covers, non-diabetic foot orthoses, and othernon-weight bearing orthoses.
The narrative out there in the media and being pushed bycompanies selling us their hardware and software ecosystems is not necessarilythe best or only narrative around 3D technologies.
As far as I know there are only 2 options for definitivesockets that are 3D printed... the powder bed fusion (MJF or SLS in PA11 orPA12), and FDM (high flow from Filament Innovations with their copoly CPXmaterial).
That being said, there is a lot of buzz around designoptimization. Basically, how thin/lightweight can we go with thesedesigns and these materials. Unfortunately, it's a really complex answer thatis dependent on lots of variables: type of printer, type of material,(variable) wall thickness, geometry, reinforcements, surface finish, postprocessing, and end use loading conditions (high impact/high body weight). I'vefitted a few of these sockets, designed and printed with the help of [anexpert], and they are pretty tough so far. The weight could be reduced forsure, but I think this is where design will further be optimized, and varioussurface finishes will be utilized.
I haven't used the CPX material on a patient, but I have ademo socket and it is super solid and a lot lighterweight. I think this stuffis going to overtake the MJF/SLS printers due to quicker build times(especially with the high flow printers from Filament Innovations), and muchlower material costs. Unfortunately, the printer machines themselves are stillquite spendy for the everyday O&P clinic.
Another interesting method is to go hybrid... using a lowercost FDM printer to print a flexible inner socket, and then laminate over that.
<URL Redacted> .
I have used multi jet fusion sockets loved them, I usedprosthetic design there fair Coploy, trying a new jet from Ascent fab.
Check out Ascent fabrication in upstate NY: https://urldefense.proofpoint.com/v2/url?u=https-3A__www.ascentfab.com_&d=DwIFaQ&c=sJ6xIWYx-zLMB3EPkvcnVg&r=KmuawjwNpT9A2bnhzaNVjw8wO7L_TDosEXIk33h_tlw&m=fXsbLFyOTAgv4u3YtWRzvZY4OW9grsJSwOg_uVyhBzfGfT9IkcgSxfAFRklA5f1p&s=QK1G7Ufizf4fZJ-gxc2QBDIdq1r_OtMibvAW6uhvU9g&e=
(multiple responses praised ascent fab)
This is a very large question-
I suggest getting on LinkedIn and connecting with others itis a great way to start learning
(I can forward recommended LinkedIn search names uponrequest)
(Original Message):
Hello list,
I recently got my hands on a 3D printed prostheticsocket. It was created using an HPMultijet fusion printer using MJF Nylon 12. Interesting technology but thereare concerns about ultimate socket reliability and corresponding socketweight. What other materials/printersare people having success with? Who isout there making 3D printed sockets? Before a decision is made on this technology, it would be great toexplore other examples of 3D printed sockets.
Thanks!
Charles
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Summary of responses to Printed sockets in the third dimension
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Charles King
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5/17/2022
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I have a thought:
At the rate that insurance companies pay us, and with regard to the minuscule reimbursement, what is the correct answer here:
Two people.
Johnny orders a new car (of course consider supply chain problems).
Tommy’s doctor prescribes him a new brace.
Which person gets their item first ??
Personally, I think Tommy is screwed.
Thanks and have a great day,
From my iPhone
Andrew A. Cinque CPO
(914) 755 - 5145
Manager
JK P&O
699 North MacQuesten Parkway
Mount Vernon, NY 10552
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Turn around time
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BionicRehab
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5/6/2022
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Hi everybody,
Has anyone had a patient who has this unique problem?:
13 y.o girl whose proximal head of fibula is displaced to the posterior when she bends her knee, specially when plays soccer.
If so, what type of knee brace or knee support you fit to prevent this dislocation?
Any help would be appreciated.
Darya Shahrokhi, CPO, FAAOP
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special knee brace/support
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Darya Shahrokhi
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5/26/2022
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Does anyone know where to get commercially available self-stick toe ramps?
Thank you and best regards,
Tom
--
Thomas L. Malone
Orthotic & Prosthetic Lab, Inc.
748 Marshall Ave.
Webster Groves, MO 63119
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Self Stick Toe Ramps
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Thomas Malone
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5/11/2022
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I'm planning to purchase a Structure Sensor and Ipad for 3D scanning. Any tips or advice for purchasing these items?Thanks!Bryan King, CPO,LPO
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Structure Sensor
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Bryan King
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5/10/2022
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I’m interested to hear opinions, experiences, and recommendations for the following situation:
My lab mostly stocks premade straps for our pediatric AFOs. This works for the vast majority of our designs and needs. We do occasionally want to fabricate a custom strap or reinforce a strap.
Sewing machines are great to have, but lab space is tight, and I’ve managed without one for a few years now.
To get to the question - I’ve been looking at some machines and want to know what people are using. We would only be sewing the occasional Dacron-backed nylon strap or custom nylon strap.
I would like to minimize the amount of floor space taken up, and wondered what sewing machines people are using when limited with space and never needing to sew through leather.
Second thought - I worked for a company that had a strap welder as a resident, and it was pretty awesome. Does anyone in the list serve community know of a compact option that would meet the needs of an O&P professional at a reasonable price?
Please let me know your thoughts and experiences with either set-up. Thanks in advance.
Regards & Aloha,
-Cameron Lehrer, CPO, FAAOP
Honolulu, HI
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Sewing v. welding straps
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5/24/2022
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Hi-
Are there any tricks to applying sticky back Velcro directly to copolymer for layover straps?
I know there are two types of adhesives for Velcro and wasn’t sure if one was better than the other.
I’ve had Velcro pull off after a while and if there is a way to prevent that I would love to hear how.
Thanks, Jeremy CPO
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Sticky back Velcro on Copolymer
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Jeremiah Uronis
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5/10/2022
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Thanks to everyone that responded to my original post about the Niagara Foot. I was asked to share the responses with the list. Thanks to Paul for this wonderful resource...
We've used the Niagara foot many times for our Amphibian legs, and are also the US distributor for it. It's been really well received by clinicians and patients as secondary legs in the US. In developing world cases, it has the benefits you outlined, but also the amazing fact that it's a single size foot that can be tuned in length to meet patient needs. So every foot gets used.
The manufacturer also wants to make sure developing countries get it at discounted rates, so we have special pricing there.
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Responses to the question of the Niagara foot
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john schulte
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5/31/2022
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Can anyone recommend any remote/outside billing services that work with Futura/Waystar?
Thank you!
Shaun D. Kaufman, CPO
Board Certified Prosthetist-Orthotist
Hemet Prosthetic Orthotic Group
1133 E. Florida Ave.
Hemet, CA 92543Tel: 951-766-4297
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Remote/Outside Billing Services
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Shaun Kaufman, CPO
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5/26/2022
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Thanks to everyone that replied. I tried to capture all of them for those that asked me to post responses. Thanks again!
1. Add a speedy river to the far end.
2. Gentle scratch the copoly surface with some fine sand paper. Apply polyadhesive to the prepared surface and allow to dry completely. Precut your sticky back Velcro to size. Remove the plastic film from the adhesive and gently heat with a low temp heat gun until the adhesive looks glossy and wet. Apply the Velcro to the polyadhesive area and press/hold into place until cool.
3. Purchase the adhesive back velcro. Clean the surface with alcohol. You can warm up the adhesive back with a heat gun and apply velcro. Remove the last 3 rows of hook with a rasor blade or by heat an awl really hot and melting them. This will ensure that when the strap is removed from the velcro the forces aren't pulling the adhesive back velcro from the edge where it is stuck to the plastic. This has worked for me.
4. Try zapping the adhesive side with a heat gun just before applying, you will get a stronger bond
5. 3m makes a primer to prep the surface. That’s the only good solution.
6. I like to use the adhesive buttons they work for quick jobs and you can buy on sps in a roll. They have quite a bit Goodluck
7. After I peel off the protective layer, I hit it with a heat just until it starts to bubble (it should be too hot to handle). Sometimes, after sticking it on the AFO, I'll place a protective layer over the velcro (if it is hook, not loop), place it on the anvil and pound it with a hammer to ensure adhesion. Seems to hold better this way. This would be on polypro, I don't use co-poly. I have been known to use a couple of tiny speedy rivets on the corners of the leading edge to prevent it from separating when the mating velcro is lifted for doffing.
8. I have typically rounded the corners a little and placed tiny speedy rivets in the corners.
9. Try spreading a little Super Glue type adhesive on the area first and apply your Velcro after The super glue has dried. You can even scuff up the Super glue very gently. Good luck.
10. heat it before you stick it. you could also rivet it on.
11. Use the pile side on the Brace and make it longer than necessary so the edge isn't pulled on during doffing. Sometime I wrap it all the way to the back if it is a calf strap or under the foot plate.
Scuff the plastic on the grinder and heat the adhesive before applying the velcro to the brace.
It will not last forever but it should last longer.
12. Two great ways. Actually 3
For regular sticky Velcro you can add a speedy rivet to the 2 ends. Also I’ve added super glue to the sticky Velcro. Just a tiny tiny bead down the middle full length. Or just a drop on both ends.
Then there’s the plastic clear Velcro. That seems to be the best on rigid surfaces like copoly or polypro or even laminates. Make sure it’s exactly where you want it because it’s a bear to get off.
13. I always put one small rivet in the end that is always pulled off - never have any problems after that!
14. Heat the surface and the glue slightly before applying to greatly enhance the adhesiveness. Use small speed rivets in the corners of the Velcro if necessary.
15. I've found lightly roughing up the area and gently heating the Velcro adhesive has helped.
16. There are a couple of things that can help the velcro hold on longer. One is to cut the corners, which tends to be where the velcro starts coming loose. I also sometimes take a hot wire and singe the hook at the edges for the same reason. I have also cleaned the plastic with acetone to get a better stick. I have some patients that I just use regular velcro and attach it with Masters glue rather than the sticky back. I don't get good results with the 'clear' velcro with the viscous glue on it. It tends to peel off and leave a real mess
17. I've had similar issues with the velcro pulling off. I do not have a brand preference. Couple things I do are
Rivet the ends of the velcro but I know that's not always an option
Extend the velcro by at least a couple of inches from where the layover meets it so when it is removed, the force isn't pulling at the edge of the sticky velcro, causing it to peel away. This usually gives me a few more months out of it.
When applying the sticky back, I heat with a heat gun a few seconds and press firmly and hold a few seconds for a good seal.
18. Try the plastic hook or loop, it seems to hold better on plastics
19. I rough up the plastic with sandpaper to give it some texture first. Seems to help.
20. Use poly adhesive (fillaure)
Trim the hooks of the ends so they don’t lift the ends.
21. I have found self adhesive Velcro brand the most reliable to stick. It seems to hold best when the adhesive side it heated - a micro torch or a heat gun. One can add some poly adhesive to the plastic after roughing the surface a little. I leave the velcro piece about 5-10mm long and sometime narrowed, then when it is in the correct location I burn or grind away the hook or Pyle so when the velcro is stressed - getting the strap pulled off - the edge of the self adhesive is not pulled on.
22. Clean the surface with acetone before applying the velcro and round the corners of the velcro (before you peel it off).
23. This is quite common for me as well. I typically scuff up the plastic and heat up the adhesive on the sticky back velcro before applying. Also, I will add a rivet at the end of they velcro where it pull be pulled from because that is typically where it lifts first when people try to grasp at the strap tail.
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Replies: Sticky back Velcro on Copolymer
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Jeremiah Uronis
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5/12/2022
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Good Afternoon List,
I would like to know if anyone can offer their opinions on the Niagara Foot ( <URL Redacted> ). In specific, costing and utilization in war-torn areas. It appears that the foot itself is neutral L & R and there is a universal footshell that fits over the inner foot. Any assistance would be greatly appreciated.
Thanks!
Best Regards,
John
John F. Schulte CPOe FAAOP
<URL Redacted> < <URL Redacted> >
https://urldefense.proofpoint.com/v2/url?u=http-3A__seakexperts.com_members_14862-2Djohn-2Df-2Dschulte&d=DwIFAg&c=sJ6xIWYx-zLMB3EPkvcnVg&r=KmuawjwNpT9A2bnhzaNVjw8wO7L_TDosEXIk33h_tlw&m=YQW7LauQgtO6s_mX5R9_4C7VOdaGK-gzLm17mOsOjFfKtfMEz7J5iNdXPiYvgzDw&s=qjjiPj2_UrvN_EnyPddi5LLeQd_x00LbUAjB7EZkWdo&e=
https://urldefense.proofpoint.com/v2/url?u=http-3A__www.linkedin.com_in_john-2Dschulte-2D30120629&d=DwIFAg&c=sJ6xIWYx-zLMB3EPkvcnVg&r=KmuawjwNpT9A2bnhzaNVjw8wO7L_TDosEXIk33h_tlw&m=YQW7LauQgtO6s_mX5R9_4C7VOdaGK-gzLm17mOsOjFfKtfMEz7J5iNdXPiYvgzDw&s=hJNAQdDbdLzwKjbYk7HugYpZQuNQtjdT36YXfns0gpI&e= < https://urldefense.proofpoint.com/v2/url?u=http-3A__www.linkedin.com_in_john-2Dschulte-2D30120629&d=DwIFAg&c=sJ6xIWYx-zLMB3EPkvcnVg&r=KmuawjwNpT9A2bnhzaNVjw8wO7L_TDosEXIk33h_tlw&m=YQW7LauQgtO6s_mX5R9_4C7VOdaGK-gzLm17mOsOjFfKtfMEz7J5iNdXPiYvgzDw&s=hJNAQdDbdLzwKjbYk7HugYpZQuNQtjdT36YXfns0gpI&e= >
Tel: 410.533.1960
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Question about the Niagara Foot
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john schulte
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5/23/2022
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For your information. Also, please share with others.
[image: Протези кінцівок для постраждалих від війни в Україні.png]
*Text in English:*
Prosthetic Limbs for victims of the war in Ukraine
‘’Designed to Live’’ is ready to help provide prosthetic limb services to
those that have lost a limb as a result of the war in Ukraine, at no cost
to the patient.
-or-
If the prosthetic provider in Ukraine is no longer able to provide
prosthetic care for prior prosthetic users, we can also assist you in
repairs or adjustments to your prosthetic device
Located in LATVIA
For more information:
<Email Address Redacted>
designedtolivelatvia.com
Katie Leatherwood, CPO
Certified Prosthetist-Orthotist
(American Board for Certification in Orthotics, Prosthetics & Pedorthics)
--
*Katie Marie Leatherwood*
Director, Designed to Live < <URL Redacted> >
Cēsis, Latvia
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Prosthetics for Ukrainian war victims - LATVIA
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Katie Leatherwood
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5/16/2022
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Looking for a source for a pediatric protective helmet. Tried a couple Danmar styles but couldn’t get sizing correct. Other manufacturers/suppliers? Thanks!
Bryan King, CPO,LPO
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Pediatric protective helmet
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Bryan King
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5/3/2022
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Hello all,
I am looking for some recommendations on who is doing custom silicone
partial finger prosthesis. (I am looking for a c-fab.)
I am aware of Ottobock already, though I would like to know some other
options.
Thank you in advance!
--
Chris Stokesbary
CPO
American Orthotic & Prosthetic Center Inc.
Technology Touching Life
8043539077
<Email Address Redacted>
<URL Redacted>
2000 Bremo Road, Suite 205, Richmond, VA 23226
[image: facebook] < <URL Redacted> >
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Partial Finger Px (Cosmetic Solution)
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Chris Stokesbary
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5/4/2022
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Hi all I have someone inquiring about a P.C. orthosis. It was my understanding that they are usually custom made, but I see TruLife has one. Since pricing is a factor, can you all give me some feedback on this orthosis? I don't have a lot of experience with pectus itself, so I am a bit hesitant unless the patient will be following up with X-rays as is done with scoliosis bracing. Thank you, Paula Martinek LPO
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pectus carinatum
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Paula Pivko
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5/3/2022
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Hi and thanks to everyone for responding to my question. The client has decided to seek a second opinion on pricing. Meanwhile, the reviews on the truLife brace were mixed, with most saying it was fine for average males with fairly normal anatomy. Others said custom was better and less bulky; the TruLife needed a lot of adjusting. Given the boy's height and weight, I would probably have gone custom. Spinaltech was mentioned as a source for a custom orthosis and X-rays are usually not necessary. Here are the responses. Paula Martinek, LPO
Not sure this will be helpful but I'd suggest x-rays may not be necessary nor helpful as the additional detail would not influence the treatment, as the outcome is largely cosmetic, subjective. You should receive additional manufacturer recommendations, aside from Trulife. Some designs utilize rigid side bands, intended to bridge the ribs, typically made to tracings and measures. Others like Trulife, use flexible straps that contact ribs.
I have fit tons of Pectus Orthoses over the years as well as helped design the Trulife OTS Pectus Orthosis. To answer your question, it would depend on the position of the deformation whether you would choose an OTS over a custom orthosis. Also, is your patient female or male? I did a very specific custom design for my female patients. The anterior pad needs to be directly over the apex of the deformation to get good outcomes as well as you would need to determine how flexible the Pectus Carinatum is. If you can take the palm of your hand and physically depress the deformity you will most likely have good outcomes. Of course, it will also be determined by the wear time of your patient. I also never had X-rays taken. I used a scanner throughout the patient care to show clinical improvements, very similar to what is done when showing scanned improvements on a cranial patient.
Totally understand you're looking for a more cost-effective option for the patient. However, I don't think you'll have to sacrifice much on price by still staying 100% custom - our Pectus Brace at Protosthetics is 100% 3D scan to 3D print so it perfectly fits the patient, and starts at $450: <URL Redacted>
Our experience with the TruLife braces is that they can be a serious discomfort for kids, and they end up asking their practitioners for a lot of adjustments over time. Ours usually fits right after the first fitting.
I've used the trulife one in the past. I feel like it's every bit as good as a custom. You can also retrofit with a custom sternal pad.
I hope this helps,
We offer the T-Joe Pectus Brace, can be ordered using the Structure Sensor and App - Pectus Scan from the apple app store.
Feel free to call the office with questions or pricing.
Regards,
Joe & Staff Pectus Services
PectusServices.com Phone: 877-732-8876 Intl: 011-973-488-7184 Fax: 973-488-7185
True life is fine – just a bit bulkier than custom. You need to make sure the pectus is COMPLETELY reduced while wearing it – assure family it is a return to normal alignment and not putting pressure on lungs/heart. You may need to add over the shoulder straps to prevent distal migration of orthosis.
I have done a lot of these. The TruLife is the way to go . As long as the patient is a young male, the area is in the center of the chest. You should have no issue.
Compliance is the key to success. The patient must wear 24 /7 in the beginning.(6 months) You should document progress by taking a/p measurements at each followup.
I would follow 2 week after the fitting ,then every month.( Price your brace accordingly. There is no code for this.Your time is worth something)
Each time they remove the brace the protrusion will go back. After 6months if significant progress has been made ,they sleep with it for another 6 months.
The TruLife is low profile and easy to customize. I have added shoulder straps on several cases and extra padding . No need for custom.
It does work as long as the patient is willing.
Hope this helps
Hi Paula. I’ve fit a ton of the trulife pectus and they are great. Easily adjustable and modifiable. Hope that helps.
Unless the patient is very abnormal, the trulife ones normally work just fine. I normally use them unless order specifically ask for custom or patient has abnormal anatomy.
We do quite a bit of pectus bracing in our clinic and I find the Trulife brace to be uncomfortable and ill fitting for most people. If you are going to use an off the shelf (which I would only do if the patient is very mild, symmetrical, and flexible) I would take a look at the EmBrace. A custom pectus brace through Protosthetics is what we typically use. If you have questions feel free to reach out to me. Management of this type of deformity is very different from scoliosis and doesn't typically require many x-rays as it is a cosmetic issue involving cartilage.
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Re: pectus carinatum
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Paula Pivko
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5/6/2022
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Dublin Core
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Hello List,
I am trying to locate an orthotist in Nigeria with experience with scoliosis bracing. The niece of a co-worker needs a brace. She was denied a visa to come to the U.S., so my co-worker is now trying to find an orthotist near Port Harcourt, Nigeria. Does anyone have a contact?
Warm regards,
Katie Willison, CPO
Center for Prosthetics & Orthotics
Prisma Health–Upstate
29 N. Academy St., Suite 1148
Greenville, SC 29601
864-371-6751 (office)
864-385-4158 (mobile)
864-371-6752 (fax)
[cid: <Email Address Redacted> ]
Inspire health. Serve with compassion. Be the difference.
[cid: <Email Address Redacted> ]
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Nigeria scoliosis orthotist
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katie willison
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5/16/2022