Re: pre-articulated AFO
Terry Supan
Description
Collection
Title:
Re: pre-articulated AFO
Creator:
Terry Supan
Date:
12/4/2001
Text:
In my opinion, the Arizona AFO is an inappropriate orthosis for the patient
type that Mr. Harvey inquired about. Wonderful for ruptured posterior tendons
and Charcot joints, but not here. Make the orthosis (L1970) with the Tamarack
joints for better hyperextension control when you do articulate it. Instead of
the straps, there are several posterior mounted components that will give you
better control. If you need to control motion after you articulate the AFO you
should use the L2220 add-on code. If you are just providing dorsi assist, use
L2210. With free motion, use L2200.
FYI, the AAOP has asked me to organize an instructional course titled CVA -
Medical, Therapeutic and Orthotic Management for the Annual meeting in March.
Besides myself, it will feature Dr. David Good from Wake Forest Baptist Medical
Center and Cathy Ellis, PT, from the National Rehabilitation Hospital. Both
are specialists in stroke rehabilitation and will be updating us on the latest
in post CVA care.
Prof. Terry J. Supan, CPO, FAAOP
Orthotic Prosthetic Services
Charles wrote:
> Joe,
>
> What we fined, that works very well on CVA patients is the Arizona AFO,
> standard style with combination lace bottom and velcro closer top. With the
> velcro closer at the top, this gives the option of losing the velcro for
> some d/f p/f when needed.
> Chuck Eral
>
> WWW.ArizonaAFO.com
>
> ----- Original Message -----
> From: Joe < <Email Address Redacted> >
> To: < <Email Address Redacted> >
> Sent: Friday, November 30, 2001 8:13 AM
> Subject: [OANDP-L] pre-articulated AFO
>
> > I often get a request by a group of PTs to pre-articulate an AFO without
> > using metal upright/stirrup designs. They feel that metal is a
> > prehistoric method.. The patient is often a week or so post CVA with
> > trace or no ability to P/F or D/F at the ankle, the knee may or may not
> > be involved with extension weakness. The reason for the pre-articulated
> > AFO is a presumed non-coverage by the insurance for a solid AFO now and
> > a articulated later when strength returns. Frankly, I do not have
> > evidence one way or another to argue the point. My facility is not
> > researching the situation. So I blindly go about making a gummy bear
> > designed dorsi assist AFO without cutting the ankle through for
> > articulation. It can be cut later when articulation is warranted but
> > this rarely happens. I'm also not happy with the gummy bear joints as
> > they stretch allowing an unnecessary knee extension moment when the P/F
> > stop is contacted. Once in a while I'm requested to provide a strap
> > posteriorly to arrest D/F so they can have their cake and eat it too.
> > Cosmesis is no better for it as far as I can see. I don't believe that
> > we can bill for this additional strap feature but we are billing for a
> > dorsi assist AFO. One might get their finger tip in the ringer by doing
> > so but in the final analysis the costs may all come out in the wash
> > anyway. I have wondered if some other ankle joint might give me the
> > same features without an unsightly strap or metal uprights necessary for
> > DAAJs that are used in other applications. Any thoughts on this
> > subject are appreciated.
> >
> > Joe Harvey
>
>
type that Mr. Harvey inquired about. Wonderful for ruptured posterior tendons
and Charcot joints, but not here. Make the orthosis (L1970) with the Tamarack
joints for better hyperextension control when you do articulate it. Instead of
the straps, there are several posterior mounted components that will give you
better control. If you need to control motion after you articulate the AFO you
should use the L2220 add-on code. If you are just providing dorsi assist, use
L2210. With free motion, use L2200.
FYI, the AAOP has asked me to organize an instructional course titled CVA -
Medical, Therapeutic and Orthotic Management for the Annual meeting in March.
Besides myself, it will feature Dr. David Good from Wake Forest Baptist Medical
Center and Cathy Ellis, PT, from the National Rehabilitation Hospital. Both
are specialists in stroke rehabilitation and will be updating us on the latest
in post CVA care.
Prof. Terry J. Supan, CPO, FAAOP
Orthotic Prosthetic Services
Charles wrote:
> Joe,
>
> What we fined, that works very well on CVA patients is the Arizona AFO,
> standard style with combination lace bottom and velcro closer top. With the
> velcro closer at the top, this gives the option of losing the velcro for
> some d/f p/f when needed.
> Chuck Eral
>
> WWW.ArizonaAFO.com
>
> ----- Original Message -----
> From: Joe < <Email Address Redacted> >
> To: < <Email Address Redacted> >
> Sent: Friday, November 30, 2001 8:13 AM
> Subject: [OANDP-L] pre-articulated AFO
>
> > I often get a request by a group of PTs to pre-articulate an AFO without
> > using metal upright/stirrup designs. They feel that metal is a
> > prehistoric method.. The patient is often a week or so post CVA with
> > trace or no ability to P/F or D/F at the ankle, the knee may or may not
> > be involved with extension weakness. The reason for the pre-articulated
> > AFO is a presumed non-coverage by the insurance for a solid AFO now and
> > a articulated later when strength returns. Frankly, I do not have
> > evidence one way or another to argue the point. My facility is not
> > researching the situation. So I blindly go about making a gummy bear
> > designed dorsi assist AFO without cutting the ankle through for
> > articulation. It can be cut later when articulation is warranted but
> > this rarely happens. I'm also not happy with the gummy bear joints as
> > they stretch allowing an unnecessary knee extension moment when the P/F
> > stop is contacted. Once in a while I'm requested to provide a strap
> > posteriorly to arrest D/F so they can have their cake and eat it too.
> > Cosmesis is no better for it as far as I can see. I don't believe that
> > we can bill for this additional strap feature but we are billing for a
> > dorsi assist AFO. One might get their finger tip in the ringer by doing
> > so but in the final analysis the costs may all come out in the wash
> > anyway. I have wondered if some other ankle joint might give me the
> > same features without an unsightly strap or metal uprights necessary for
> > DAAJs that are used in other applications. Any thoughts on this
> > subject are appreciated.
> >
> > Joe Harvey
>
>
Citation
Terry Supan, “Re: pre-articulated AFO,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 8, 2024, https://library.drfop.org/items/show/217762.
