RESENT: HSubject: WaterLegs Responses 2

RESENT: HSubject: WaterLegs Responses 2

Stephan R Manucharian, CP

9/1/2000

Continuation of responses

7. A few thoughts about your inquiry -

   1. Why not try a lanyard system instead of a shuttle lock system for the
   very reasons you suggested, i.e., it is basically rope that locks into a
   piece of plastic. You can purchase it from Pi Medical or through Ossur. It
   is simple and will not corrode. Furthermore it works well. I have used it
   on a number of swim legs here in Greece - all exo.

   Regarding your other questions, I have forwarded ideas from previous posts
   to the listserv.

   Hope all is well.

   Best regards,

   Jonathan


      >-We use primarily two techniques for swim/shower limbs: the Endoflex
   >thermoplastic system and a hollow exoskeletal technique popularized by
the
   >German's many years ago. We usually bill them as such and seek approval
in
   >addition to the daily use limb, often at a reduced or discounted rate
that
   >we
   >negotiate based on the duplication of an existing positive mold etc. As
far
   >as feet go, USMC has a marginal foot called the Beach Comber which we
have
   >used; there is a swimming foot/fin by the folks who also make the Active
   >Ankle which works well; and we generally utilize any foot we can
waterproof
   >effectively. For AK's we have used the nylon knee unit that is produced by
a
   >
   >small company relatively new to the scene. If you want the name e-mail me
   >back and I'll track it down. Good luck getting Medicare to pay for a
second
   >prosthesis however, in our region that is not possible regardless of
   >functional levels/activities. Hope this helps.
   >Jim Rogers, CPO
   >
    >-Tony Denson has a shower limb which may be OK for both BK and AK amps.
Tony
   >
   >can be reached at <Email Address Redacted> Endolite has a BK shower limb and I
   >believe is working on an AK shower Limb. They are available at
   > <Email Address Redacted>
   >Bob Brown, Sr. CPO, FAAOP
   >
   >-I have had a run of patients requesting a swim leg lately. All have
   >admitted to actually swimming only 2-3 times a year, so I tell them if
they
   >can get their insurance to cover it, I'll do it. I don't think it's
ethical
   >to bill for a swim leg unless I have an amputee who actually uses it
   >regularly (vs 2-3 times in a year). However, I have two alternatives for
   >swim/shower Px.
   >When I was in Harmarville tech school (long, long ago) we made a swim leg
   >using PVC piping, foam, then laminating. The pipe extended from the foot
to
   >a hole in the distal socket and had four extensions running perpendicular
to
   >this piece (open holes in the lamination where the pipe was). Water
filled
   >it so that it didn't float when swimming. It was very rudimentary, but
was
   >an inexpensive alternative and something you could easily do in your lab.
I
   >could explain this further if you're interested. Give me a reply e-mail.
   >Secondly, for shower only Px: When making a new Px, save the check
socket.
   >Have the patient bring in an old Px that they won't use again. Attach the
   >check socket (maybe add some vent holes distally) to the old prosthesis.
It
   >will eventually rust out, but they should be able to get years out of it
for
   >the shower only. You can't bill for this (as far as I know or at least I
   >have never tried), but it's simple to do. The patient paid for the check
   >socket, after all, and it should take only a few minutes to transfer out
the
   >sockets. We do this on occasion. You can add a wedge under the Px heel to
   >simulate heel height. You can even pull plastic over the metal parts to
   >help protect them somewhat. You're not getting paid for it, so putting
too
   >much effort into it seems rather charitable.
   >I am interested in reading your responses to see if others have had any
   >success in getting insurances to pay for this. We have only ever made one
   >true swim leg and it was ordered through a VA clinic. None of my patients
   >have ever pursued it.
   >Good luck to you and I hope this has helped or at least given you some
   >ideas.
   >Joan Cestaro, CP
   >RPI- Winchester VA
   >
   >
   >-i suppose it would be better to use a silicon sleeve with
   >an additional elastic knee support if your patient is going
   >to swim seriously. besides you should use an adjustable
   >ankle part to fix it in about 120 degree for swimming and
   >scuba diving.
   >good luck
   >
   >-Endolite has a new shower leg out that comes with everything except
socket,
   >which if you vacuum form or laminate should be waterproof as well. The
foot
   >has suction cups style bottom for better grip. Call them and they will
fax
   >you the info.
   >Steve Hoover, C.P.

THANKS TO EVERYBODY WHO PARTICIPATED
Stephan R. Manucharian, CP
Orthopedic Arts
Brooklyn Heights, NY


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