POST OP DRAFT
Richard Feldman
Description
Collection
Title:
POST OP DRAFT
Creator:
Richard Feldman
Date:
10/22/2018
Text:
Dear List Serv,
In late August 2017, I posted the inquiry below. I apologize for
delivering late to you all the responses that follow due to my inquiry
personal distractions that occurred after my post. I hope you find the
results worthwhile.
Dear list,
I was recently asked by a physician who is part of a large medical
practice to assembly some models of care using initial physical
therapy protocols, prosthetic protocols, and products that will manage
the new amputee until he/she is ready for a preparatory prosthesis;
TF/TT/Upper Extremity. The physician wants to protect the new amputee
from contractures, and muscle atrophy. Simply put she/he wants to
prevent a patients mental and physical debilitation. In my career have
done immediate post op's, and used products such as Flo-tec,
limb-shrinkers, etc., and used my professional care to enhance my
patients' confidence to accept a prosthesis. But I need to update my
resources and document my facts. For example, I was told recently a
local university medical center nearby is using a simple post-op
protective cast applied by the surgeon; I would like to know who the
manufacturer is. In addition, literature must also be given to the
new amputee in multiple languages. Whether you are with an institution,
private practice, small to gargantuan practice I would like to hear
from you so I can it pass this valuable information on.
Thank you all in advance.
Sincerely,
Rick Feldman, cpo
1. Rick, Take a look at this app - exercises developed by
Physiotherapists and Prosthetists
<URL Redacted>
Best! Scott J. Schneider. Chief Future Development Officer & President,
Patient Care – North America
2. Rick, Flo-Tech is still our choice when their post-op products are the
appropriate size. Once in a while, a patient is too large or too small. I
also believe they should be applied by a prosthetist as physicians really
are not skilled in their fitting, use or patient instructions. Rod
O'Connor, cpo
3. Rick, There are a few things that may be helpful. A 2005 JPO article
by Ladenheim, Smith, and Tablada showed a 1 month shorter healing time with
limb protectors. Not sure if it was the protector or the shrinker providing
venous return for faster healing. I typically use Flo-tech repeatedly for
the duration that they are in the hospital and transition them into a
custom removeable rigid dressing. I re-use the Flo-Tech after sterilizing
them unless contaminated. 1988 Article by Moore and Malone on upper
extremity... a 600% increase in the return to work rate when fit with an
arm in 30 days. 92% utilization when fit in 30 days vs. 43% utilization at
the normal fitting time of 4-6 months. From a local non-published research
project, we found 50% pain reduction after TT post-op were fit with mild
shrinkers. The edema likely caused the pain. Tell them to remember that the
mechanism for venous return is no longer present and must be
compensated...It's our norm, not theirs. The VA/DoD document on amputation
guidelines is notably quiet on surgical recommendations. I think that this
is a shortcoming and have issues with intentionally weakening hip abductors
by 30% with the adductor myodesis technique for TF. Tell the doc that if we
need padding, we can add it. Redundant tissue during amputation is merely a
reservoir for problematic volume fluctuations. Jaegers 1995 shows that
there is naturally occurring atrophy in resected muscles that vary from
40-60%. If not properly managed, it is the changed in the patient that
compromise the fit. The fit issues are easy if they are addressed early.
But since 85% of lower extremity amputations are dysvascular in nature, and
a majority of those are due to noncompliant behavior on the part of the
patient, please understand that people often claim to change, but don't.
These people tend to over-utilize hope as a strategy to get better.
Did you know that diabetics have twice the rate of cognitive decline
towards dementia and Alzheimer's as non-diabetics? Neuropathy of the
feet...brain is neuro... the brain doesn't get a pass. This is why there
are so many issues to juggle with amputees. Consider Charcot patients...the
majority of them seem to have some cognitive issue, haven't you noticed? A
doc once said that to me and...wowwww... pretty soon, I saw a trend. With
all these issues, it is the AOTA that identifies prosthetic management in
their scope of practice. There is also a billable code for prosthetic and
orthotic management. There's a meta-analysis of OT intervention with
Medicare demographic. They concluded that it helps. Patient education and
prosthetic management is their job...because a job gets reimbursed. We have
an ethical obligation to make sure that it gets done, but we often end up
getting blamed. The PT can be resistant to the OT encroaching on what they
think is their turf, but... c'mon! Anyway, Rick... I have more if you want
it. I'm sure you got lots from everyone else. Hope this helps!Thomas J.
Cutler, CPO, FAAOP, CPHM Limb.itless, LLC\
4. Hi Rick,
Really interesting and relevant questions and thoughts - I believe you've
hit orthotics/prosthetics and robotics functional restoration and physical
rehabilitation right on the head. Attached is a rather lengthy paper to
this effect.
To save time, you might want to read the introduction, conclusion and page
15, 1ts and 2nd paragraph.
PTs are particularly interested and well trained in clinical neural
correlation modalities, and if you should find this area of physical
rehabilitation interesting, the PT community would be a great place to
start.
Michael Wilson cpo
<URL Redacted>
AND
<URL Redacted>
In late August 2017, I posted the inquiry below. I apologize for
delivering late to you all the responses that follow due to my inquiry
personal distractions that occurred after my post. I hope you find the
results worthwhile.
Dear list,
I was recently asked by a physician who is part of a large medical
practice to assembly some models of care using initial physical
therapy protocols, prosthetic protocols, and products that will manage
the new amputee until he/she is ready for a preparatory prosthesis;
TF/TT/Upper Extremity. The physician wants to protect the new amputee
from contractures, and muscle atrophy. Simply put she/he wants to
prevent a patients mental and physical debilitation. In my career have
done immediate post op's, and used products such as Flo-tec,
limb-shrinkers, etc., and used my professional care to enhance my
patients' confidence to accept a prosthesis. But I need to update my
resources and document my facts. For example, I was told recently a
local university medical center nearby is using a simple post-op
protective cast applied by the surgeon; I would like to know who the
manufacturer is. In addition, literature must also be given to the
new amputee in multiple languages. Whether you are with an institution,
private practice, small to gargantuan practice I would like to hear
from you so I can it pass this valuable information on.
Thank you all in advance.
Sincerely,
Rick Feldman, cpo
1. Rick, Take a look at this app - exercises developed by
Physiotherapists and Prosthetists
<URL Redacted>
Best! Scott J. Schneider. Chief Future Development Officer & President,
Patient Care – North America
2. Rick, Flo-Tech is still our choice when their post-op products are the
appropriate size. Once in a while, a patient is too large or too small. I
also believe they should be applied by a prosthetist as physicians really
are not skilled in their fitting, use or patient instructions. Rod
O'Connor, cpo
3. Rick, There are a few things that may be helpful. A 2005 JPO article
by Ladenheim, Smith, and Tablada showed a 1 month shorter healing time with
limb protectors. Not sure if it was the protector or the shrinker providing
venous return for faster healing. I typically use Flo-tech repeatedly for
the duration that they are in the hospital and transition them into a
custom removeable rigid dressing. I re-use the Flo-Tech after sterilizing
them unless contaminated. 1988 Article by Moore and Malone on upper
extremity... a 600% increase in the return to work rate when fit with an
arm in 30 days. 92% utilization when fit in 30 days vs. 43% utilization at
the normal fitting time of 4-6 months. From a local non-published research
project, we found 50% pain reduction after TT post-op were fit with mild
shrinkers. The edema likely caused the pain. Tell them to remember that the
mechanism for venous return is no longer present and must be
compensated...It's our norm, not theirs. The VA/DoD document on amputation
guidelines is notably quiet on surgical recommendations. I think that this
is a shortcoming and have issues with intentionally weakening hip abductors
by 30% with the adductor myodesis technique for TF. Tell the doc that if we
need padding, we can add it. Redundant tissue during amputation is merely a
reservoir for problematic volume fluctuations. Jaegers 1995 shows that
there is naturally occurring atrophy in resected muscles that vary from
40-60%. If not properly managed, it is the changed in the patient that
compromise the fit. The fit issues are easy if they are addressed early.
But since 85% of lower extremity amputations are dysvascular in nature, and
a majority of those are due to noncompliant behavior on the part of the
patient, please understand that people often claim to change, but don't.
These people tend to over-utilize hope as a strategy to get better.
Did you know that diabetics have twice the rate of cognitive decline
towards dementia and Alzheimer's as non-diabetics? Neuropathy of the
feet...brain is neuro... the brain doesn't get a pass. This is why there
are so many issues to juggle with amputees. Consider Charcot patients...the
majority of them seem to have some cognitive issue, haven't you noticed? A
doc once said that to me and...wowwww... pretty soon, I saw a trend. With
all these issues, it is the AOTA that identifies prosthetic management in
their scope of practice. There is also a billable code for prosthetic and
orthotic management. There's a meta-analysis of OT intervention with
Medicare demographic. They concluded that it helps. Patient education and
prosthetic management is their job...because a job gets reimbursed. We have
an ethical obligation to make sure that it gets done, but we often end up
getting blamed. The PT can be resistant to the OT encroaching on what they
think is their turf, but... c'mon! Anyway, Rick... I have more if you want
it. I'm sure you got lots from everyone else. Hope this helps!Thomas J.
Cutler, CPO, FAAOP, CPHM Limb.itless, LLC\
4. Hi Rick,
Really interesting and relevant questions and thoughts - I believe you've
hit orthotics/prosthetics and robotics functional restoration and physical
rehabilitation right on the head. Attached is a rather lengthy paper to
this effect.
To save time, you might want to read the introduction, conclusion and page
15, 1ts and 2nd paragraph.
PTs are particularly interested and well trained in clinical neural
correlation modalities, and if you should find this area of physical
rehabilitation interesting, the PT community would be a great place to
start.
Michael Wilson cpo
<URL Redacted>
AND
<URL Redacted>
Citation
Richard Feldman, “POST OP DRAFT,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/209190.
