Re: Billing for Tone Reduction (AFO Cook Off Contest)

Re: Billing for Tone Reduction (AFO Cook Off Contest)

Anderson Harold R.

3/2/2001

John,

Sorry I've lost the article but I believe that tone inhibition designs stem
from an article written in the 1950s by a surgeon who looked at responses of
newborn infants to stimulation. Basically that stimulation to the met heads
induces a plantarflexion response, stimulation to the heel induces
dorsiflexion response. His conclusion was that these responses to
stimulation ended at a certain point in the first year of life but that they
did not end in children diagnosed with CP. And they returned after a CVA.
PTs then began working with inducing and reducing these responses in casts
on CP children. I believe the first casts had padding on both sides of the
achilles and wood foot plates with plaster build ups and voids to induce and
reduce these responses.

Having done more TIAFOs, TRAFOs, SMOs, etc than I can admit to, I come to
the same conclusion that we are hearing here on this forum. I get better
control of tone through good alignment. But what do you do about the PTs
and MDs who insist that TRAFOs do work? The fact is, my evidence is
empirical as is theirs. How can I refute them? I see this as one of the
more important studies needed in our field so that we can know how to handle
these situations rather than blanket statements to PTs that they do not know
what they are talking about.

BTW, if AFOs are given the tone inhibiting characteristics that are
expected by the PTs and MDs that we are working with, I believe that we
should be compensated as best possible for the extra effort they do require.


And if Billie or anyone else out there knowledgeable in tone inhibition has
anything to add to or take away from my memory of the TRAFO's origins,
please do so.

Harold Anderson, CO

-----Original Message-----
From: John Russell [mailto:<Email Address Redacted>]
Sent: Friday, March 02, 2001 12:46 AM
To: <Email Address Redacted>
Subject: [OANDP-L] Billing for Tone Reduction (AFO Cook Off Contest)


Hi All and Randy McFarland, CPO John T. Brinkmann, CPO Wil Haines, CPO

I want to add my two cents to this discussion. I feel that we should not
charge for Tone reduction Mods.
It is my feeling that Tone is a bad word, but I still use it to communicate
to OandP professionals about this problem.
Tone reduction is just controlling muscle imbalance comfortably.
Wil wrote>>Billie stated; Tone reduction is best accomplished by
accommodation
I have never heard that stated from Billie, and I would not start talking
for her. In the courses we have taught together (Step up to Flexible
Stability) she has agreed with me that you cast for maximum correction with
the knee at 90 degrees, R1+ pressure, allowing plantarflexion over rotation
deformities.
I think that another urban myth is that there is anything to tone reducing
mods all I got say about that is Prove It.

I propose that orthotists take charge of the research themselves by
beginning to do comparisons studies, etc. One such effort could include
AFO Cook Off Contest, a fun way and a low cost way to see what designs
really work. I thought that this would be best at a national conference.

If persons are interested I could post my idea to the O&P List

That's all for Now

John Russell
3161 Putnam Blvd.
Pleasant Hill, CA. 94523
V-925-943-1119
F-925-943-2493
<Email Address Redacted>