Re: Prescription Topic #1BK

Re: Prescription Topic #1BK

Encore Productions Inc./Pelican Records

6/12/1999

Mark,
I've found in my practice that every patient is different and has different
needs. However every patient has expressed 2 exact concerns regarding their
prosthesis; suspension and is it going to be heavy? Being in private
practice, when dealing with medicare I have to establish their functional
levels before I can formulate and Juggle with the advantages vs.
disadvantages of each system to accomidate the proper Rx. In a VA setting
the guidelines are possibly different, however I beleive that if you first
would classify a functional level according to the MCE and follow those
guidelines then your Rx would allow you to use light weight energy storing
feet and other beneficial componentry.

M. Britt Spears CPO

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> From: <Email Address Redacted>
> To: <Email Address Redacted>
> Subject: Prescription Topic #1BK
> Date: Saturday, June 12, 1999 11:36 AM
>
> I am a CP in a VA hospital setting trying to establish and bring
progressive
> prescription criteria to our clinic and several others in our VISN (a
three
> state multi-clinic group) I have a SEVERAL topics in mind but will
introduce
> them one at a time over the next couple of months.
>
> We know that you can give a peg leg to somebody and they can make it
work.
> I am looking for prescriptions that OPTIMIZE a persons ability to
> successfully ambulate.
> I am looking for progressive prosthetists' considered opinions and
experience
> about several topics which I will be posting. I would like your name and,
if
> available, any references you might site for additional justification.
>
> These are my (current) opinions and I am soliciting support as well as a
> difference of opinion.
> I would like to present proposals that reflect more than my PERSONAL
opinion.
>
> Topic #1 BK
> It is my belief that the only time a sach foot should be given is for a
> patient that
> is using a leg to transfer or to ambulate a few steps within the house. I
> question whether you have real plantarflexion with the soft heel, and the
> hard keel does not make for the smoothest rollover.
> If the patient is a bilateral they should have two, not just one, to make
> transferring easier.
>
> If the patient is ambulatory we should, at the very least, give them a
> flexible keel and OPTIMALLY give a foot that has ankle motion.
> I think ankle motion is more important than dynamic response although
both
> would be preferable to the person capable of loading the keel.
>
> A single axis foot which INCLUDES front bumpers can be considered for a
BK
> but multiaxial is preferred.
>
> The first dynamic response feet were the created in response to the
sach
> foot and should be limited to those requiring a zero maintenance foot and
are
> capable of loading the foot.
>
> The more modern dynamic response feet with ankle motion should be the
> preferred foot for most reasonably active people.
>
> We should be using shock pylons on most new ambulating amputees if the
foot
> doesn't incorporate sufficient shock absorption and the patient doesn't
have
> much tissue to pad his limb.
>
> I prescribe like it was for my relative. I would like to establish what
is
> optimal and then factor in patient's compliance, and then cost
limitations.
>
> Thank you for your opinions and help in clarifying my thoughts
> Respectfully,
> Mark Benveniste CP