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How we help patients after their stroke.

The role of an O&P facility is to provide an orthosis that will aid the patient’s stability and ambulation during the stroke recovery process.

The Orthotist will visit the patient at their care facility and is brought up to speed by the physical therapist and physician with the patient’s diagnosis and outcome goals. We fabricate orthoses for patients with mobility issues who need help with ambulation and rehabilitation at home.

The O&P facility’s job is also to educate the patient and their caregivers on the goals and benefits of using the prescribed device. Follow up appointments with the clinician are very important due to the drastic and sudden changes stroke patients can go through during their rehabilitation process and to check for things such as skin irritation and unusual pain when wearing the device.

Our methodology for patient care.

Following is an example of a post-stroke patient with a diagnosis of foot drop and spasticity.

Fixed Ankle

During the motor skills assessment our team member walks the patient in parallel bars with no shoes or socks, the Orthotist holds the knee and foot to attain what kind of forces need to hold the patient in correct alignment and stabilize their muscle insufficiency. This is determined by the counter forces that we place on the knee and foot. Once we determine how much force is needed to control the patient’s ankle, foot and knee, a decision can be made on what brace will best help the patient walk. 

The team agreed that an ANC (articulated non-cut) AFO (Ankle Foot Orthosis) was the right solution. The function of this brace is to lock the patient’s ankle at the desired position (90 degrees). This helps with toe clearance and to prevent the foot from dragging while walking. It also helps mitigate hyperextension.

Free Ankle

The ANC AFO solution is fairly common for patients graduating from rehabilitation settings but who still need ambulation support to get back to their daily activities. The ANC orthosis we have developed is unique – it can be hinged at the ankle once the patient regains stability and strength. This gives the patient a more natural gait as they transition through their therapy. Essentially it is two braces in one, saving the patient a second co-pay, and saves waiting time during the healing process. For any stroke patient, it is critical to fabricate and fit a brace in a timely fashion to get the patient ambulatory as soon as possible for neuro muscular regeneration and gait training. We put a high importance on getting the patient what they need to continue to improve.

When it is determined what type of orthosis is needed, it is fabricated to specifications. It must help the patient meet therapy goals such as:

  • Toe pick up, ankle stabilization and improved gait
  • Sufficient clearance or relief for the head of the fibula
  • The patient can ambulate safely in the orthosis
  • The Varus/Valgus correction provides the desired support
  • Skin check was satisfactory
  • The range of motion settings meet prescription criteria

When we fit the patient after fabrication we double check:

  • The orthosis conforms to the contours of the body
  • The finished height of the orthosis is appropriate
  • The patient is stable while standing
  • The workmanship of the orthosis is satisfactory
  • The patient can sit and adequately flex knee with orthosis

Follow up from the clinician is a very important step we take due to the drastic and sudden changes these patients can go through during their rehab process. If you would like to speak with one of our practitioners about a specific issue, please send us an email.

Stroke Awareness: Three important milestones.

Why the first 3 hours, the first 3 days, and the first 3 months are significant during stroke recovery.

  • The first 3 hours are vitally important for patient to have critical medical care that will make a difference in their survival rate. Call 911, do not drive self or patient to hospital. Emergency responders can begin medical care as soon as they arrive and while patient is being transported
  • The first 3 days in the hospital gives doctors time for tests and assessments to determine the course of care. Rehab can begin as early as 24 to 48 hours after the stroke while the patient is still under hospital care.
  • The first 3 months are therapeutically important as this is when the brain is most capable of making reconnections through neuroplasticity. This can also be an exhausting time for a stroke survivor and they may need mental health and caregiving support.

Stroke Resources:

In Northern California at the Kaiser Foundation Rehabilitation Center in Vallejo, we work weekly with stroke patients who are completing their intense rehabilitation and preparing to transition home. Read more about their patient and family support.

NAMI: National Alliance on Mental Health

Stroke survivors have a high chance of developing depression and may have other mental health needs. This organization has terrific resources for family and caregivers.

Helping those with limb loss find a prosthetist

Amputees and those with congenital disorders who wear a prosthetic device typically have a long-term relationship with their prosthetist. If you have never worn a prosthesis, we want to provide an outline of what you should expect during your journey.

Are you ready for a prosthesis?

Having a prosthesis can be a lot of work. You need to build strength in your muscles with physical therapy exercises to prepare for your new prosthesis. Having a physical therapist and prosthetist you can communicate with is extremely important for a successful outcome with your prosthetic device.

What is the best way to learn more about getting a prosthesis?

Before you can see a prosthetist, your doctor will need to:

  • Document your current condition
  • Diagnose your K-Level
  • Collaborate among the members of your care team

After your diagnosis, you will want to find a prosthetist to collaborate with on your care team. Your physician will be the one to provide the referral to our facility. The next step is to evaluate which prosthesis will have the fit and function you are looking for.

After the appropriate device has been selected, you will continue your PT while your prosthesis is manufactured. Your prosthetist will fine tune your device and the socket over multiple visits. During the fitting process we will provide education and training so you can get the most out of your new prosthesis.

Step 1: Documenting your current condition

Your doctor will complete an evaluation checklist. This is when you should ask questions. This information will be the basis of the report being sent to your insurance company which ultimately determines the affordability of your prosthetic device.

  • Physical Exam
  • History of Amputation
  • Functional Deficits
  • Functional Level
  • Motivation to use prosthesis
  • Describe the condition of the residual limb
  • Patient’s past experience with prosthesis

If a replacement prosthesis is needed, describe the condition of current prosthesis or component and your recommendation based on your functional level evaluation.

Step 2: Diagnose your K-level

Your doctor will confirm your K-level which determines the type of device your insurance will approve. The K-level is based on your daily activities and current physical condition. it is possible over time that you can graduate to a higher K-Level if you continue to progress in your abilities.

Learn more about K-levels.

Step 3: Team Collaboration = Improved Prosthetic Care

On your first visit, options will be discussed to find the prosthetic configuration that allows you to get back to your daily activities and meet your future goals.

In addition to your doctor, your care team will consist of physical therapists and your prosthetist. Cohesive care during your rehabilitation will help you stay on track with your short and long-term goals to better improve your outcomes.

The team collaboration is a transparent process – the goal is patient education through communication with all members of the team. Collective input creates a clear plan which leads to higher patient satisfaction with improved functional results. After your final fitting, your prosthetic devices will need adjustments over time, so you will likely check in with your prosthetist once or twice a year.

“I believe that providing a prosthesis is just the beginning of my responsibility as a prosthetic provider, I am also involved in the education and follow up care of my patients”, says George. He is always eager to learn new methods and philosophies and share for the benefit of the team as well as the success of the patients’ prosthetic experience.

Read George Villarruel’s Bio here…

Patient Resources

Every patient is unique, physically and psychologically and we have the experience and compassion to guide them through this journey. We have put together a list of resources of organizations and articles to help you and your family members.

Check out our patient and family resources.

Certification Boards

The American Board for Certification in Orthotics, Prosthetics & Pedorthotics (ABC)

abcop.org
info@abcop.org
703-836-7114

The Board of Certification/Accreditation, International (BOC)

bocusa.org

Orthotics and Prosthetics Patient Care – Our offices are open.

Collier Orthotics and Prosthetics in association with Laurence Orthotics and Prosthetics logo

As an essential health care service provider, our offices remain open with a full staff of trained, licensed, bonded and insured practitioners who are ready to provide on-going care for those in need of mobility devices and for in-patient hospital calls 7 days a week, evening and holidays.

Providing Orthotics and Prosthetics care for seniors, pediatric patients, and those with special needs is the heart of what we do.

Our Practitioners and staff can assist those that are in need of orthotic and prosthetic devices to improve or maintain their mobility for all Activities of Daily Living (ADL’s) such as personal care, cooking, walking, exercise, essential transportation to the grocery store and pharmacy, safety, reassurance and especially with those tasks one may have difficulty in accomplishing during this period of Sheltering in Place.

We are here for you. If you need an appointment, please do not hesitate to call. Nothing is more important than the health and safety of our patients and staff. We have taken precautions based on state and federal mandates to provide a safe and comfortable environment for our patients and staff. We follow all social distancing guidelines and ask you to please remain 6 feet from any other patients and staff.

Orthotic and Prosthetic services remain an option to those at risk of mobility and we will do everything in our power to support our patients, staff members and community in every way possible to keep them safe and cared for by continuing services for improved mobility during these times.

Please rest assured that we are monitoring the COVID-19 situation very closely at all our locations.

We will continue to keep our Management, Practitioners, and Office Staff Employees well-informed on a daily basis about the virus and best practices to ensure the health and safety of all of our clients and employees. The following precautions are being taken to combat this changing situation:

  • Limiting the number of people in our facility at any given time. If you require assistance, we ask that you limit caregivers/companions to one support person only for your visit.
  • Reducing patient appointments to comply with social distancing in waiting rooms
  • All patients, caregivers/companions, and staff are required to wear a mask. The mask must remain over your nose and mouth throughout your entire visit to our office.
  • We ask that patient family members remain in vehicle at the time of patient appointment
  • Pediatric patient can be accompanied by an adult during their appointment
  • All patients entering the clinic will sanitize or wash their hands on the way in and out.
  • We will continue to disinfect all equipment and surfaces after each treatment.
  • We will be modifying treatment to accommodate your specific needs.
  • We ask you to help our efforts by staying home if you feel sick or are at risk.

Those defined as at risk are:

· The elderly
· Those with heart or lung disorders
– Diabetes
– Immunocompromised

We are doing our best to take the proper precautions and modifications to meet the needs of our patients under these unusual circumstances. Make sure you are doing your best to protect yourself, and if you have any questions or concerns, please visit www.cdc.gov/coronavirus.

Our compassionate and professional staff and practitioners have been serving the community since 1988 for Collier and 1946 for Laurence. We are committed to offering the same legendary service which we are known for, especially during this unprecedented COVID-19 crisis.

If you have any questions, or are in need of services, please contact us by email below or call 916-979-9729.

Ian McLaughlin: Rising to the Challenges of Post-Stroke Recovery

Ian’s latest achievement: The Rise Paralysis Recovery 5k Wheel & Walk

Ian, what’s most important to you about your experience with Collier?

As a person recovering from multiple serious strokes and complete hemiplegia, I needed to assemble a team of dedicated professionals I can rely on in my recovery effort for their support and expertise. The Collier team is like a family and is an invaluable part of my recovery team. The single most important thing to me is their dependability. I use an AFO to walk and as I recover motor functions over time my orthotic needs constantly are changing. I have been able to work with the Collier team on a regular basis to make the adjustments to my AFO as my needs have changed.

When you think back to your first evaluation with Collier, how did you feel when that was complete?

My initial evaluation with Collier occurred in November 2016 when I was in an acute inpatient rehab facility – only two months post-strokes. I was still cognitively very impaired and not walking very much and I had no idea what my orthotic needs were or what they would ultimately be. Collier orthotist, Dennis “DJ” Johnston, BOCO, CPA, fit me for my AFO (ankle foot orthosis) at that time. I have used the same AFO for three years now with numerous modifications as I become more ambulatory. In 2018, I wore that same AFO when I walked a 5K Turkey Trot in my local community.

If there were things that concern you about the future of your care, what would they be?

My concerns have nothing to do with Collier and their services. I am working very hard to control my post-stroke spasticity that causes me to need to wear an AFO and I hope to not need one someday. My concern is that I will never regain the ability to walk without an assistive device. I know that as I go through the process I will be able to work with the Collier team to fit me with progressively less cumbersome braces as my skills and abilities develop further.

Dennis Johnston, Collier Practitioner

A Board Certified Orthotist, Dennis fits custom orthoses for orthotic patients of all ages.
— Patient Care Specialist
— Specializing in Proprietary R-Wrap™ AFO’s since 2003
— Expert in Spasticity Management

 

Looking for a solution or second opinion? Contact one of our orthotic specialists at 916-979-9729 or contact us with the form below.

Local Orthopedist Volunteers with Operation Rainbow, Healing Patients Around the World

Operation Rainbow provides life-changing medical care to more than 80,000 children and young adults, including more than 18,000 surgeries in 19 developing countries.

Millions around the world live everyday with the pain caused by congenital birth defects and accidents. In the poverty-stricken countries where many of these children live, public healthcare is lacking and families are too poor to address illness or injury as it arises, and they have given thousands of patients the opportunity for a better life.

Generous donors and volunteers are key in helping us change their lives for the better. Last year, Operation Rainbow performed more than 460 free surgeries and treated more than 6,500 other patients for orthopedic and other medical conditions not requiring surgery. The Operation Rainbow team completed 11 medical missions to communities in Honduras, Mexico, Guatemala, Ecuador, Haiti and the West Bank. Part of their mission is to educate local health professionals to encourage medical self-sufficiency.

All team members are volunteers who participate without compensation on their own time. Without the generous donation of supplies from vendors and assistance from friends and family they couldn’t do this work. And there is so much work to do.

You can help educate others about Operation Rainbow by sharing this message, donating or volunteering.

http://Operationrainbow.org

Jon Boone works at Roseville Kaiser orthopedic department as The Senior Orthopedic Technician. He has referred patients to Collier for many years and we have donated orthopedic bracing supplies to the Operation Rainbow since 2009.

“Other than my first mission that was ‘eye opening ‘, the most memorable was our mission to Haiti following the earthquake in 2010. Many children had lost everything… their homes and families and still they would sing songs and help each other as they recovered from injuries. Being able to take my skills and apply it helping those less fortunate makes all the time and expense worthwhile,” says Boone.

Jon’s first mission was to Ecuador in 2009. Since then, he has made 16 missions to Ecuador, Haiti, Dominican Republic, Nicaragua and Mexico. His next mission is to Honduras.

Pediatric Case Study – Cerebral Palsy, Spinal Instability

Patient Challenge:

Sophia’s mother was concerned that Sophia always slouched severely and seemed to be in pain. She also always looked down, and could not make eye contact with those around her.

spinal instability, cerebral palsyCollier Resolution:

Practitioner Brian Lee cast Sophia sitting upright to maintain lumbar and kyphotic curves in the ideal position, and with appropriate scapular adduction and shoulder retraction. Secondarily, the goal was to maintain her cervical spine in extension.

Over the last 6 months, Mom has reported that Sophia seems happier, and is able to look up and see the world around her and, most importantly, make eye contact.

Collier Practitioner Brian Lee, CPO is CCS Paneled and bilingual in Spanish. You can read his bio here.

A community for spinal cord injury survivors

SCI Active Network is a positive network that connects Spinal Cord Injury (SCI) survivors and their families through peer mentoring, and empowers an active lifestyle towards mobility, independence, and a higher quality of life.

Troy is a spinal cord injury survivor and Founder/ CEO of SCI Active Network – a community for spinal cord injury survivors. They welcome survivors AND their families to join and participate so they can network, learn and be supportive of their loved one – and their loved one can connect to those with similar life challenges.

A Collier patient since 2004, Troy received an RGO through Kaiser Rehabilitation in Vallejo. Troy has been using his RGO therapeutically with a walker, as well as at home and during public demonstrations. Troy started mentoring patients and therapists on how RGO’s work, and he saw a real need for peers to connect to share valuable information and encouragement.
Since 2015, Troy has worked to connect, support and encourage SCI survivors to be active in living life. Spinal Cord Injury Active Network has trained peer mentors to visit, speak and teach classes at Northern California Rehabilitation Centers and community events in the Bay Area.
SCI Active Network also hosts over a dozen family-inclusive activities a year at different locations throughout Northern California, plus provide a monthly support network meeting in Solano County, CA.
One of the most important missions for founder Troy Plunkett is the Share-A-Chair program. Donated lightweight wheelchairs are provided to survivors in need to increase their mobility, independence, and quality of life.
Spinal Cord Injury Active Network is a 501(c)(3) organization, and donations are tax-deductible. You can donate, volunteer or participate by visiting their website at sciactivenetwork.org.

Troy Plunkett, sci active network

SCI Active Network
P.O. Box 3434
Vallejo, CA 94590

info@sciactivenetwork.org

Sacramento Region Wheelchair Basketball Program

wheelchair basketball sacramento

Andre Christian, father of a boy who received a prosthetic made by J.R. Brandt at our Sacramento location, reached out to us with an update about his son’s achievements.

Stephen Christian, wheelchair basketball

This photo was taken after Stephen pushed his wheelchair for 15 miles on the American River Bike Trail. Stephen is a Warrior!

“Our son Stephen has been the beneficiary of a prosthetic made by J.R. in your Sacramento facility and was under his care for a couple of years. Last year Stephen joined a wheelchair basketball program and it was truly life changing for him. The friendships, flying to tournaments, discipline from weekly training, learning to overcoming challenges, independence, working as a team and the increase in his confidence was truly remarkable.”

Do you know someone in the greater Sacramento area who wants to experience the many benefits and FUN of our wheelchair basketball program? Please share this post.

Christian Rodriguez with the Sacramento Royals, works to create opportunities for physically challenged persons. The JV Team practices at the Sacramento YMCA (downtown on W), and there is a Recreational Team which competes through the Northern California Recreational League. He can be reached at 916-228-1755 or visit sacroyals.com.

wheelchair basketball sacramento

The Sacramento Royals

We are sharing the Sacramento Royals Wheelchair Basketball Program recruiting flyer, aimed at youth 10-18 years for their JV Team, or high school ages for their Recreational Team. The Sacramento Royals practice at the YMCA on W Street in Sacramento. You can visit their website at sacroyals.com.

Orthotic Patient Case Study – Amyotrophic Lateral Sclerosis (ALS)

Mr. Cutchlow came to see Collier Practitioner Ray Diaz for a pair of new braces, and expressed frustration with his instability due to his Amyotrophic Lateral Sclerosis.

Upon evaluation, Ray noticed the patient had more than just weak inverters/evertors. He also had no plantar flexion and dorsiflexion strength.
Prior to the Phat braces he was using a walking aide, now he’s not. As you can see in the video, his gait is much more stable and his speed improved.

Patient Challenge:

The previous AFOs (Arizona braces) were not picking up his foot, causing him to buckle and fall when ambulating.

Collier Resolution:

Ray introduced the Phat braces to Mr. Cutchlow. These braces will provide the stance control and swing phase, and resolve the weak medial lateral ankle instability. The Arizona braces provided nothing for the absent plantar and dorsiflexion.

The day Mr. Cutchlow came back for delivery of his Phat braces he couldn’t believe the balance, stability, and confidence the braces were giving him.

Mr. Cutchlow has had two follow up visits. The first visit was to see how the braces are working for him. The second visit was a minor adjustment. It feels very rewarding to know Mr. Cutchlow’s goals were achieved and that it also built up his confidence to do more enjoyable things with his grandkids.

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