Re: Molded to patient model???
John Hatch
Description
Collection
Title:
Re: Molded to patient model???
Creator:
John Hatch
Date:
9/15/1998
Text:
Ron, the problem with the case you presented is not one of methodology
but one of professionalism. A professional can use many different
methods to arrive at a successful solution. The prosthetist that
provided the substandard prosthesis would likely have achieved the same
result if a plaster impression had been taken. A professional can take
a plaster impression, a prefabricated brim or a computer generated check
socket and by diagnosis and modification produce a well fitting
prosthesis. The outcome in the case you cite was not produced because a
computer was used but because the prosthetist failed to do the
diagnosis and modification necessary to produce a usable outcome. The
common misunderstanding of computer aided prosthetics is that the
computer only gets you to the starting point and the professional has to
take it from there. That is why, at least at this stage of the game, we
will not be replaced by a computer or an untrained practitioner with a
computer. The computer is a tool, like any other, that has to be
learned. Some will be adept at using it and some probably never will.
We have been having very good results using computer generated test
sockets. Some AK's that I have casted looked like someone poured
plaster in a bucket, but after modification from my measurements a good
model resulted. Not much difference in a computer generated AK from
measurements. John Hatch, CPO
<Email Address Redacted> wrote:
>
> I was asked last week to consult with an elderly diabetic AKA at the Ohio
> State University prosthetic clinic. This patient had a new but extremely
> poorly fitted prosthesis which she was unable to wear. It was fabricated for
> her by a prosthetist who came out and took some measurements and delivered
> the prosthesis a couple of days later. I explained to her that a cast of her
> residual limb would be required for a socket replacement and she again told me
> that the other prosthetist only took measurements.
> The socket (an attempt at ischial containment) was so poorly designed that the
> I.T. was well above the posterior brim and the socket was internally rotated
> to such an extent that the adductor longus was 2 cm. from it's channel.
> My question is does this constitute fraud using HCFA guidelines? The
> descriptors clearly state molded from patient model. Does CAD by the
> numbers meet these guidelines?
> I know is is becoming common practice for many facilities to order sockets
> (and orthoses) which are measurement based and are not created from either a
> custom impression or virtual casting system. In reality, I have seen some of
> them fit rather well, however, It seems to me that this is not the issue
> What is the feeling of the group? Does a measurement based prosthesis or
> orthosis meet the molded from patient model guidelines? Do we need new L
> Codes for measurement based systems?
> I look forward to your response.
> Ron Kidd, CPO
> American Orthotic & Prosthetic Lab., Inc.
> Columbus, Ohio
but one of professionalism. A professional can use many different
methods to arrive at a successful solution. The prosthetist that
provided the substandard prosthesis would likely have achieved the same
result if a plaster impression had been taken. A professional can take
a plaster impression, a prefabricated brim or a computer generated check
socket and by diagnosis and modification produce a well fitting
prosthesis. The outcome in the case you cite was not produced because a
computer was used but because the prosthetist failed to do the
diagnosis and modification necessary to produce a usable outcome. The
common misunderstanding of computer aided prosthetics is that the
computer only gets you to the starting point and the professional has to
take it from there. That is why, at least at this stage of the game, we
will not be replaced by a computer or an untrained practitioner with a
computer. The computer is a tool, like any other, that has to be
learned. Some will be adept at using it and some probably never will.
We have been having very good results using computer generated test
sockets. Some AK's that I have casted looked like someone poured
plaster in a bucket, but after modification from my measurements a good
model resulted. Not much difference in a computer generated AK from
measurements. John Hatch, CPO
<Email Address Redacted> wrote:
>
> I was asked last week to consult with an elderly diabetic AKA at the Ohio
> State University prosthetic clinic. This patient had a new but extremely
> poorly fitted prosthesis which she was unable to wear. It was fabricated for
> her by a prosthetist who came out and took some measurements and delivered
> the prosthesis a couple of days later. I explained to her that a cast of her
> residual limb would be required for a socket replacement and she again told me
> that the other prosthetist only took measurements.
> The socket (an attempt at ischial containment) was so poorly designed that the
> I.T. was well above the posterior brim and the socket was internally rotated
> to such an extent that the adductor longus was 2 cm. from it's channel.
> My question is does this constitute fraud using HCFA guidelines? The
> descriptors clearly state molded from patient model. Does CAD by the
> numbers meet these guidelines?
> I know is is becoming common practice for many facilities to order sockets
> (and orthoses) which are measurement based and are not created from either a
> custom impression or virtual casting system. In reality, I have seen some of
> them fit rather well, however, It seems to me that this is not the issue
> What is the feeling of the group? Does a measurement based prosthesis or
> orthosis meet the molded from patient model guidelines? Do we need new L
> Codes for measurement based systems?
> I look forward to your response.
> Ron Kidd, CPO
> American Orthotic & Prosthetic Lab., Inc.
> Columbus, Ohio
Citation
John Hatch, “Re: Molded to patient model???,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/210819.
