Michael came to Collier Orthotics because he was having quite a bit of knee pain from arthritis and a torn meniscus, and wasn’t quite ready for knee surgery. Michael speaks about his care journey with Collier Orthotics and Prosthetics, and how they found him an unloader knee brace which allows him to get back to his daily activities with a lot less pain.
James Muelleners, Sacramento, CA
James shared his thoughts with us below.
Q: What’s the most important to you about your experience? A:The ability to work with my schedule and accommodate me in Sacramento instead of the bay area in a timely manner, with quality of care and they wanted to help me.
Q: How did you feel after the first evaluation was complete? A:Very complete! Nick did an amazing job and was very thorough and willing to fight for the brace I needed.
Q: What was most important to you during your time in our care? A:The quality of knowledge and the ability to relate.
Q: Why did you choose our company? A:Quality, speed, knowledge and family
Thank you James, we are glad we could help you get back to your daily activities….pain free!
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.
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.
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.
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.
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.
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.
History of Amputation
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.
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.
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.
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’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.
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.
The 3D Chéneau-Gensingen brace utilizes the latest bracing technology for the best possible outcome:
CAD/CAM is used for the creation of each curve-pattern specific brace for a three-dimensional treatment addressing all three planes
Treats mild, moderate and severe scoliosis
A viable option even for patients with 40°+ curves
Custom fabricated with voids and pressure zones to work in conjunction with Schroth Method Best Practices
Front closing design and less material for more comfortable fit and ease of application
History of the Chéneau Brace Development
Dr. Chéneau was the first brace developer in 1979 in an effort to advance and improve scoliosis bracing an to work in conjunction with the Schroth corrective breathing method developed by Katharina Schroth, and the classification system being developed by Christa Lemert-Scroth. In the 90’s, Dr. Hans-Rudolf Weiss (Christa’s grandson) hosted courses at the clinic demonstrating Dr. Chéneau’s bracing concepts. At the time, braces were still being fabricated from a mold of the patient’s torso through casting. Dr. Weiss went on to develop the ‘Chéneau Light®’ brace. It had a record of improved patient outcomes and reducing the need for scoliosis surgery.
CAD/CAM technology, comfortable design and solo donning.
The newest Chéneau-Gensingen brace design has evolved to a higher standard with the advent of CAD/CAM technology and many years of documenting and researching in-brace results. The unusual features of the brace work to reduce spinal rotation in all three planes. Openings positioned at the spinal concavities and corrective pressure points are plotted with CAD/CAM and fabricated to have a built-in correction effect according to a patient’s individual curve pattern. This exacting fit is much more tolerable for the patient which contributes to improved corrections and happier patient. In addition, most patients will not need assistance after they learn how to don the brace.
Our practitioners trained with Dr. Marc Moramarco, the most experienced Schroth Method practitioner in the United States. In the video, Dr. Marc Moramarco visited Dr. Weiss at his facility in Germany and they discuss the benefits of Cheneau bracing over other bracing methods.
The Schroth physcial therapy method is used in conjunction with brace therapy for best possible outcome.
Collier O&P is committed to having a practitioner available for after hours, weekends, and Holiday services. For our team to serve you effectively and timely please consider the time frames below for our practitioners to provide superior patient care.
1. Early morning orders received by phone before 12:00pm will be serviced from 11:30 to 1:00pm.
2. Orders received by phone after 12:00pm will be serviced by end of business day.
We can fit your patients for any of the following off-the-shelf products with same day service:
Cervical Post-Op Management
Custom TLSO’s: Our team is committed to a 24 hour turn around on TLSO devices.
For us to be successful and meet your expectations, orders are to be called in by 3:00pm. This will allow a 3-hour window to get the patient evaluated, casted/measured and their device manufactured for guaranteed next day delivery. For after hours care please call 510-502-3515.
For osteoarthritis knee pain relief, you need a prescription from your doctor for an unloader-style knee brace. A custom-fitted unloader knee orthosis (brace) has a range of settings to dial in to make the brace as comfortable as possible. Your practitioner should be able to show you how to use the different settings.
An OA brace can relieve bone-on-bone joint pain and slow down the degenerative process. Dynamic OA braces open the joint only when the leg is extended and the most pain relief is needed. No pressure is applied when the leg is bent. With dynamic unloading, these braces are comfortable to wear for extended periods of time.
Treatment with the correct knee brace can relieve most osteoarthritis symptoms:
Pain, after overuse or after long periods of inactivity
Aching and soreness of the joints
Stiffness after periods of rest, swelling of the joints.
Cold weather brings on aches and pains – it is not your imagination. Most common in weight-bearing joints, the pain can settle into your knees, hips and ankles. It is important to remember that stiffness is one of your body’s early warning signs. If the symptoms persist, be sure to check in with your doctor. If stiffness and joint pain persist it might be a sign that you have arthritis, and you want to address the issue as soon as possible with your doctor to prevent further progression.
The Collier-Laurence Orthotic Team works with your doctor and other care providers to find the correct knee orthosis (brace) for your diagnosis. We have these tips for those who might be shopping for an osteoarthritis knee brace:
1) How many patients does the facility see monthly? The busiest clinics tend to have the more experienced practitioners.
2) Look for an orthosis (brace) recommended by your doctor for your specific condition. How many different OA braces do they offer to patients?
a. Pittet style
b. Large styles
c. Valgus / varus
d. Custom / off the shelf
e. Hand Dexterity problems
f. Sports related
3) Do they have a return policy on braces that don’t provide pain relief? Will they provide other options?
4) Your brace can’t help you if you don’t wear it regularly. If your brace is uncomfortable or pinching, contact the provider and they should be able to make adjustments for a better fit.
Unfortunately, there is no cure for arthritis, but there are ways to manage the pain and slow down the progression of arthritis. Although it maybe difficult, staying active is important. Make sure to check with your doctor or physical therapist for appropriate exercises for your condition.
Paul’s journey from orthotic tech to his dream job of helping patients at Laurence and Collier O and P.
Paul was a full time assistant baker and head cake decorator in 2002. The hours were early — he remembers the alarm clock going off at 3am and thinking, is this what I want to do with my life?
In the summer of 2002, I met Bob Jensen and he hired me as an orthotic technician. The work was part time at first – after I finished my day at the bakery I would drive to Laurence Orthopedic and begin my shift modifying and fabricating custom arch supports. My background in art made this a pretty natural transition for me, and I found the job challenging but fun. After a few months, I was hired full time as an orthotic and prosthetic technician and left my job at the bakery.
I would study foot anatomy books and ask questions about everything. I really wanted to understand why I was doing what I was doing, what function did this modification serve? How does this affect how the foot orthotic feels on the patient’s foot?
Over the next few years I worked with the technicians at Laurence, learning how to fabricate AFO’s, knee braces, spine braces and prosthetics of all kinds.
I was constantly learning something new and developing my own techniques for fabricating devices. Our fabrication was pretty efficient in those days but I still thought we could to better, I created a workflow board and job tracking to get the lab more organized. With fabricating knowledge, I started shadowing the clinicians at Laurence helping with patient care. I found this was what I truly loved to do. I took a certified fitter course, took my board certification exam and became a certified orthotic fitter.
I continued to fabricate as well as see patients. Most of my time was spent seeing patients and overseeing fabrication as the lab supervisor. I still wanted more so I went back to college. Nights and weekends were spent going to class and falling asleep with books. I then went on to take my boards in 2008 to become a Certified Orthotic Assistant to further my patient care scope of practice.
At this point my focus was almost all on patient care, casting, fitting and follow up of my patients, going to clinics and assisting in the formulation of design for the devices I was providing. I was seeing a lot of people with ankle and foot dis-function — it is something that is complex and challenging. It is satisfying to me if I can help someone regain a function or reduce some pain with their daily activities.
With a lot of my focus on the foot and ankle I attended the Francis Tuttle Pedorthic Program.
In 2017 I took my board certification and became a Certified Pedorthist. I still like to fabricate but my heart is for helping people by making a small difference in someone’s life and seeing how it affects them is what drives me. I have patients that were once active; hikers, runners and even some marathon runners they have come in, now dragging their foot as they walk, hoping that anything will help. I talk to them about their goals, “What do you want this brace to do for you?” most of the time the answer is walk without stumbling. Some of those people have returned to their active lifestyle, as much as they tell me I’ve helped them it’s gratifying for me to see how much it helps them.
I look forward to working tougher cases in ankle and foot orthotics. I love to teach people what I know, so ultimately having a bigger team to teach and learn from is what I look forward to over the next few years.
You can contact Paul Easterwood at our Oakland Office at 510-658-2062.