Help with AFO

Help with AFO

John Russell

2/10/2000

Hi
Tue 1/18/00 7:46 AM I sent the following email to the OandP list asking for
help for a mom in Raleigh, North Carolina.

Hi All
We are in California. I have mom that lives in Raleigh, North Carolina, with
teenage daughter, CP, crouch gait, etc. She moved away over a year ago. The
daughter has AR-Wrap AFO's that she has been wearing for about a year and
half. AR-Wrap AFO is a R-Wrap AFO that has articulation. She has had five
AFO's done in the Raleigh areas that are not acceptable, the last one by a
PT doing a DAFO's. The mom called to have me find someone that is an hour
drive from Raleigh, NC that would do an AR-Wrap AFO.
So any independent orthotist that falls into that driving area that would
like to do a project.

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 The following is what I received from practitioners.


John,

I am Winston Salem also I live in Greensboro, which is 1/2 hour closer To
Raleigh then Winston Salem. I am an orthotist with 21-year experience I do
about 95 percent pediatrics. I get almost all of my referrals for Wake
Forest University/Bowman Gray School of Medicine/Baptist Hospital. All I do
is work with hard to brace kids I would be glad to look at what has been
done and let the Family know what I would suggest as far as changes to the
current braces and or new ones. I would not charge for the evaluation.
I will provide my ideals and then it is up to the Family to use then or
return to whom they are currently seeing.

I am an independent facility (I eat Hanger and Nova care for lunch

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John-

I have seen your design and although have only used it several times. I
often use a very very thin inner smo with AFO just seems to work for me I do
all my own modifications footplate style but refuse to use Cascade or other
central fab. I would be willing to listen and see what pt has that works
and what doesn't and go from there. I have been to Billie Cusick's course
and hosted it here. I am quite a ways down the road but would help if your
pt gets desperate

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Hi John,

Without knowing the name of the patient I can't say for sure that we haven't
already seen her. If we have I would like to be able to follow up and fix
the problem. With your advice we might do it better this time. If we haven't
we will gladly take a look via consultation with the patient. XXXXX XXXXX is
a CO working with me who has 23 yrs. in the field and lots of experience
with CP. He is former Director of O&P at Nemours Children's Hospital in
Jacksonville Fla. I have asked him to give you a call.

If we can be of service and you haven't heard from us please give me a call
at your convenience.

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Now here is the reply that I received from the Mom, after I sent her the
e-mails.

Dear John,
Thak you for forwarding the replies you received. I must admit that I am
confused about what to do with them. None of them really sounded willing to
be the intermediary. They seemed to want to do it their way first.
Did I misinterpret?
We had a terrific snowstorm and basically the area shut down for almost 2
weeks. 14 of snow was just more than this southern area could handle. xxx
has the latest version of xxxxx's AFO for us to have fitted and I hope to be
able to try it on her this week. If it doesn't fit, how do you feel about
working with the PT who has done the best casting of her feet here? She
does castings to be sent to Cascade and I think she is an individual who
strives to continue to grow in her profession. Please let me know.

Sincerley,
Mom XXXXX

PS
You should have seen xxxxx sledding in the snow and trying to get her self
back up the snowy hill for another run, a grin from ear to ear and a
determination to get her there.
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This is a two-part question:
Should I go with the Moms feelings and do this with the PT casting?

We are also doing the (It's time to step up to Flexible Stability course).
To tell the truth we have had very poor response so far from the OandP
community regarding this course.
When I get a problem or results that are not favorable I start to ask
questions.
o Is the course price to high?
o Does people not need CEU's
o Does the OandP community think that the R-Wrap AFO is not a valid system?
o Will it take a study before OandP personal can get Drs. to sign RXs?
o Does the Flexible Stability design seem not as strong as the OOS system?
o Is this how the DAFO's got started because OandPers did not want to learn
something new that doesn't follow normal protocol?
o If OandP personal do not want to learn this system, then is it OK to start
teaching therapists how to do it?

This is not to be critical, but a try at understanding the difference
between what clients, and practitioners want. Since we started over seven
years ago on this idea, it certainly has changed my thoughts regarding this
field. The why comes from direct patient input, or I interpreting what the
patient want, and converting it into a tangible object.

The main goal of this is what does the patient want and need, so no replies
being critical of spelling, etc.

That's all for now
John

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