How to help your patient find a prosthetist

Choosing a Prosthetist

A Guide for Medical Professionals

Referring a patient to Collier means they will receive ongoing care recommendations as they work towards their rehabilitation goals. After a patient is referred, our job is to evaluate the fit and function of the prosthesis. We can then discuss options that will allow them to find the prosthetic configuration option that will allow them to reach their goals as well as the information their insurance company will require.

Are your amputee patients overwhelmed and frustrated with the process of getting their prosthesis?

Are they currently in a prosthetic socket that is uncomfortable and difficult to wear?

Does your patient feel secure and safe with how their prosthesis functions?

Are they able to use their prosthesis to achieve their goals in life?

If you have a patient that currently has an ill-fitting prosthesis or one with components which do not provide optimal fit or function, they will need a new prescription. New documentation needs to reflect the patient’s current and potential physical condition, their K-level and problem with their current device. Past documentation should be in place for existing patients which speeds up the process.

Document

Evaluation Checklist for Physician

  • 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.

Diagnose

Confirm the K-level. Centers for Medicaid services physician letter.

K1 – Functional Level 1

The patient has the ability or potential to use a prosthesis for transfer or ambulation on level surfaces at fixed cadence.

K2 – Functional Level 2

The patient has the ability or potential for ambulation with the ability to traverse low-level environmental barriers such as curbs, stairs or uneven surfaces. Typical of the limited community ambulator.

K3 – Functional Level 3

The patient has the ability or potential for ambulation with variable cadence. Typical of the community ambulator who has the ability to navigate most environmental barriers and may have vocational, therapeutic or exercise activity that demands prosthetic utilization beyond simple locomotion.

K4 – Functional Level 4

The patient has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high impact, stress or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete.

Collaborate

The Collier prosthetist collaborates with the rehabilitation team, physician(s), therapist, patient and family members to provide improved prosthetic care for each patient. This collaboration will help develop short and long-term goals through their journey to better help them improve their prosthetic progress and outcomes.  During this transparent process with the team, the patient becomes well educated through the thorough communication with all members. Collective input from all team members creates a clear plan for better patient outcomes, which leads to higher patient satisfaction with improved functional results.

Why should you choose a Collier Prosthetist? Patients are our First Priority.

Collier Prosthetic Patient Care — How to Choose a Prosthetist

 

We understand that every patient is unique, physically and psychologically and we have the experience and compassion to guide them through this journey.

We have gathered some resources that might help your patients when they have questions that might be beyond your scope of service.

The Amputee Coalition on preparing your limb for a prosthesis

Upper Limb Loss Questions

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

Collier and Laurence Orthotics Practitioners now Certified to provide the 3D-Cad Cam Chéneau-Gensingen Scoliosis Brace

The Gold Standard of scoliosis bracing is the result of three generations of development.

cheneau-gensingen scoliosisThe 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

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.

Learn more in this Research Study: A Prospective Cohort Study of AIS Patients with 40° and More Treated with a Gensingen Brace (GBW): Preliminary Results

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. As a treatment solution, this brace can be 90% effective for avoiding surgery with full patient compliance. In some cases, patients have been able to partial reimbursement through their insurance.

Our practitioners trained recently with Dr. Marc Moramarco, the most experienced Schroth Method practitioner in the United States.

Cheneau-Gensingen Brace Providers. From left to right: Marc Moramarco, DC; Amy Heller, OTR/L; Brian Lee CPO; Calli Clark, CPO; Ray Diaz, CO.

Dr. Marc Moramarco visited Dr. Weiss at his facility in Germany and they discuss the benefits of Cheneau bracing over other bracing methods in the video below.

The Schroth method. One family, three generations of development.

Learn about the history of the scoliosis therapy and how they set the standards for better scoliosis patient outcomes.

Seeking the Scoliosis Treatment Secret – A Personal Journey

Read about Dr. Moramarco’s healing journey with his daughter after she was diagnosed with scoliosis.

Contact us if you would like to learn more!

Collier Orthotics Hospital On-Call Services

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.

Hospital on-call services for orthotic patients.

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:

  • Spine
  • Hip
  • Knee Orthoses
  • Minerva CTO
  • Cervical Post-Op Management
  • AFO
  • Helmets
  • Fracture 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.

 

Arthritis knee pain flaring up with the change in weather?

An unloader knee brace is specifically designed for treating arthritis knee pain.

Do your bones ache when the weather changes?  Does your osteoarthritis knee pain prevent you from enjoying your daily activities? Studies show that cold, wet weather negatively affects people with rheumatoid and osteoarthritis. 

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.

Osteoarthritis Knee Pain Solutions

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.

 

Additional Reading:

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.

What causes so much pain in my knees?

The stages of Osteoarthritis

Practitioner Paul Easterwood – Certified Orthotic Assistant & Certified Pedorthist

From creative baker to creating orthoses

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.
Collier Family of Companies
Sacramento, Pleasant Hill, Oakland

Now part of the Collier Family – Laurence Orthotics and Prosthetics

Laurence Orthopedic is now associated with Collier Orthotics and Prosthetics.

Laurence Orthopedic was established by Matt Laurence in 1946 and has been providing prosthetic and orthotic patient care services to the Oakland and the East Bay communities for over 70 years.
Laurence Orthopedic specializes in orthotic treatment for scoliosis and clubfoot and state-of-the-art prosthetic services for veterans with limb loss.

Director of Prosthetics George Villarruel talks about the Collier-Laurence transition.

My name is George Villarruel, Director of Prosthetics at Collier-Laurence Orthotics and Prosthetics. I want to speak about the additions-acquisition of Laurence Orthotics and Prosthetics into the Collier Family. This will allow us to service new accounts and to spread our philosophy of compassion and service to the orthotics and prosthetics communities. We feel we can provide excellent service to the pediatric and adult populations in need of an orthotic or prosthetic device.

Continue to our website for help with your orthosis or prosthesis.

Double Upright AFO helps diabetic patient get back on his feet

Practitioner Ray Diaz recently cared for Mr. Harrell, a 50-year-old diabetic. He presented with a very unstable gait and had been previously diagnosed with left foot drop secondary to a stroke and leaving him with left side paralysis. Mr. Harrell would his arms for balance while ambulating, and had experienced a number of falls.

certified orthotist, custom afo

Certified Orthotist Ray Diaz

Ray fabricated a left double upright Ankle Foot Orthosis with extra depth shoes and custom accommodative inserts for Mr. Harrell. The AFO is used to control the instability in his lower limb by maintaining proper alignment and controlling motion and drop foot. The double upright AFO will be attached to the diabetic shoe which allows for edema and protects the diabetic foot from any shear forces. His chronic diabetic neuropathic condition requires extra depth shoes and custom diabetic inserts to accommodate his deformed feet. The AFO will also protect his de-sensitized feet from repetitive stress and irritation – something his current shoes were not providing.

Mr. Harrell has been wearing the double upright AFO for a few weeks now and it has boosted his confidence. He has been very satisfied with the progress he has made toward resuming his normal walking routine.

Mr. Harrell had a few words to describe his patient experience at Collier:

“Ray Diaz treated me with professionalism and was very kind to me. I can walk a lot better! Everything was done in a timely manner and he made me feel at home. I love my new shoes and brace! I am very happy I was referred to Collier.”

Pediatric Case Study: Helping a young patient transition to wearing a prosthesis.

On a recent Monday afternoon, Harmony was meeting with practitioner George Villarruel for her final fitting for the new prosthesis she will wear.

Harmony was born as a congenital right trans radial amputee. Now that she was getting older, her parents wanted to give her an opportunity for bi manual function.

pediatric prosthesis

Laura Kendall (left), Harmony (right) without devices and wearing their prosthesis.

Over about 5 visits, George has been working with Harmony for fittings and preparing her for some of the challenges when adapting to a prosthesis. In fact, George thought it could be helpful to Harmony and her parents to speak with someone who has lived as an amputee since birth. Laura Kendall, a long-time congenital left trans radial patient, came to the office to meet the family. Harmony’s parents were thrilled to connect with someone who really understood their daughter’s challenges – and Laura had such a happy, positive attitude that reinforces with Harmony that life is not about what you don’t have, it is about what you can achieve.

Harmony is eager and excited to use her new prosthesis when it is finished in the next week. You can learn more about Laura’s story here.

 

pediatric practitionereGeorge Villarruel has trained our team in all aspects of care for young patients and their families. His psychology background helps him understand patient care and help our patients heal on the outside and the inside. If you have a question you can contact George here.

 

Pediatric Upper Extremity Prosthesis, A Mother’s Testimonial

When treating pediatric prosthetic patients, working with the family ensures patient success.

Pediatric Upper Extremity Prosthesis

Colin’s Mom expressed her thanks: “It always seemed that George presented a wealth of information regarding the options for my son’s care — with the goal of helping my husband and I decide what would be best for our son as well as practical for our lifestyle.” Maria Haugseth, Sacramento, CA; Colin’s Mom

Colin needed to be fit for his first prosthesis. His long-term treatment plan was developed with his team of caregivers and his mom. Colin was treated by George Villarruel, one of our pediatric and upper extremity prosthetic specialist practitioners. He customized the prosthesis and educated Colin and his mom over a period of about a year during treatment.

Colin’s Mom was with him every step of the way and she deserves a lot of credit for her positive outlook and supportive encouragement. Over the many visits and with a lot of hard work, Colin is now successfully doing more activities with his new arm prosthesis and is not letting anything hold him back.

Colin is ecstatic to be riding his bike!

With the support of his family, and a prosthetic device from Collier O and P, Colin is ready to tackle his next goal.

Our Pediatric Prosthetic Care Specialists

  • Extensive experience working with pediatric patients
  • Veterans are welcome to come for a consultation about problems or challenges with their current prosthesis
  • Our bilingual practitioners can converse with patients in their chosen language

Pediatric Upper Extremity Prosthesis

Our lead prosthetist spent many years with Shriners Hospitals for Children. The volume of patients seen in this inpatient setting established him as a specialist in upper and lower extremity prosthetic care for children and their growing needs. Our philosophy is that we want to treat the family first, and then the patient will have the understanding and guidance they need to be self-reliant.

Collier Orthotics and Prosthetics has offices in Sacramento and the Bay Area Region. Please call 916-979-9729 and we can answer your questions and set an appointment at the location most convenient for you.
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