September/October 2018 O&P News by AOPA

THE ORTHOTIC & PROSTHETIC COMMUNITY NEWS SOURCE

S EPTEM B ER/OC TO BER 2 01 8

C-FAB SOLUTIONS

PG.4

Directory of Central Fabrication Services PG.8

O&P VISIONARY:

Ralph W. Nobbe, CPO

WWW.AOPANET.ORG

PG.27

Mobile Technology: Empowering Prosthesis Wearers To Problem-Solve Socket Fit Issues

Technical Fabrication Contest Winners PG.32

PG.20

Clinical Effectiveness of a Novel Hydrostatic Casting Method for Transfemoral Amputees PG. 22

YOUR CONNECTION TO

EVERYTHING O&P

Regain a Flexible Future with the

ALPS FLEX SLEEVE

Features new kni�ed construc�on with a 30° pre-ﬂexion

Making Lives Better Tel: 727.528.8566 Tel: 800.574.5426

www.easyliner.com

info@easyliner.com

Vol. 27 â&#x20AC;˘ No. 9 | Sept./Oct. 2018

Departments & Columns 30 State by State

32 Tech Tips

COVER STORY

A monthly column dedicated to the most important state and local O&P news.

31 Meetings & Courses

C-FAB SOLUTIONS

Winners from the Technical Fabrication Contest at the AOPA National Assembly.

C-Fab Solutions Outsourcing to central fabrication does not have to be an all-or-nothing endeavor. Learn how c-fab facilities can serve as a useful tool, allowing practitioners and technicians to use their time and skills more efficiently in a patient-care setting. PLUS: See the results of AOPAâ&#x20AC;&#x2122;s survey regarding c-fab habits among O&P facilities. By Renee Lewis, BSE, CO, CPA

C-Fab Directory Explore an alphabetical listing of central fabrication facilities, featuring company names, addresses, contact information, websites, and types of devices fabricated.

27 O&P Visionary Ralph W. Nobbe, CPO, advocates for O&P licensure, prompt pay laws, and clinician volunteerism.

Research & Presentations 20

Mobile Technology: Empowering Prosthesis Wearers To Problem-Solve Socket Fit Issues By Daniel J. Lee, PT, DPT, GCS

Clinical Effectiveness of a Novel Hydrostatic Casting Method for Transfemoral Amputees: Results From the First 64 Patients By Andrea G. Cutti, PhD; Giovanni Osti; Gian Luca Migliore; Dimitri Cardin; Fabio Venturoli; and Gennaro Verni

O&P News | September/October 2018

Why

JoAOin PA?

Editorial Board O&P Practitioners

Randall Alley, CP, BSc, FAAOP

LEARNING

Get a competitive edge with exclusive faceto-face and distance learning opportunities on a variety of topics …plus valuable CEs!

Biodesigns Inc.

Hutnick Rehab Support Services Inc.

Kevin Carroll, MS, CP, FAAOP

Greg Mattson, CTPO

Hanger Clinic

Glenn Garrison, CPO

Hospital for Special Surgery

JoAnne Kanas, PT, CPO, DPT

Pediatric Orthotic and Prosthetic Services, LLC, Shriners International Headquarters

Thomas P. Karolewski, CP, FAAOP Hines VA Hospital

DISCOUNTS

NETWORKING It’s not just who you know, it’s who others know. Networking is powerful.

HAVE A VOICE Gain a say in what happens in government through AOPA’s advocacy efforts.

Increase your purchasing power through members-only discounts on insurance, UPS, workplace apparel, and credit card processing.

Improve documentation with coding, billing, and audit resources and research so you get fairly paid for services while providing excellent patient care.

Jonathan Naft, CPO

Better BUSINESS

Learn more at www.AOPAnet.org/join

O&P News | September/October 2018

Visit www.AOPAnet.org/join

Sue Borondy Endolite

Nabtesco & Proteor in USA

Justina S. Shipley CO, MEd, BOCP, FAAOP

Russell Hornfisher

Shriners Hospital For Children

Eric Shoemaker, MS, CPO

Orthotic Holdings Inc.

Jeffry G. Kingsley

Kingsley Manufacturing

Ability Prosthetics & Orthotics Inc.

Karen Lundquist

Rhonda F. Turner, PhD, JD, (BOCPO, CFm)

Brad Mattear, LO, CPA, CFo

Georgia State University

WITH AOPA

Ability Prosthetics & Orthotics Inc.

Jennifer Fayter

Mark D. Geil, PhD

or email info@aopanet.org.

Debbie Ayres

University of Hartford

Northwestern University Prosthetics-Orthotics Center

Call 571-431-0876

Advanced O&P Solutions

Matthew Parente, MS, PT, CPO

Tufts University School of Medicine

BUILD A

Michael Angelico

Jeffrey M. Brandt, CPO

Hanger Clinic

Steven A. Gard, PhD

JOIN US!

O&P Industry

Robert S. Lin, MEd, CPO, FAAOP

Mark Pitkin, PhD, DSc

Membership has its benefits:

Fabtech Systems LLC

Kempfer P&O

O&P Researchers and Educators

VISIBILITY

Scott Wimberley

American Board for Certification in Orthotics, Prosthetics, and Pedorthics Inc.

American Association of Breast Care Professionals

Let your business stand out and get noticed by peers, patients, and your community. Mobility Saves Lives & Money.

Fabtech Systems LLC

Joel J. Kempfer, CP, FAAOP

Geauga Rehabilitation Engineering

COMPLIANCE

Glenn Hutnick, CPO, CTP, FAAOP

Amputee Coalition Nabtesco & Proteor in USA

Matt Perkins

Coyote Design and Rehab Systems

Don Pierson, CO, CPed Arizona AFO

Brooke Raasch

Össur Americas Inc.

Jon Shreter, CPO

Prosthetic and Orthotic Management Associates Corporation

Michael Sotak

O&P Technicians

PEL

Sarah Clark

Scott Viglianti

O&P 1

WBC Industries

Tony Culver

Lisa Watkins

Grace Prosthetic Fabrication Inc.

WillowWood

Steve Hill, CO, BOCO

MBA, CAE, Board of Certification/Accreditation

Delphi Ortho

Claudia Zacharias

T H E PR E M IE R M E E T I N G F O R O R T H OT I C , P R OST H E T I C , A N D P E D O R T H I C P R O F E SS I O N A L S .

COMPANY NAME /C PAGE 3 Experience all the AOPA National Assembly has to offer while visiting San Diego.

#AOPA2019

Join AOPA next year in San Diego, known for incredible panoramic views. Located in the downtown Marina district, the San Diego Convention Centre has many top attractions within walking distance.

SOUTHERN CALIFORNIA

San Diegoâ&#x20AC;&#x2122;s unbeatable location makes it the perfect gateway providing you with outstanding opportunities for pre- and post-conference travel.

AOPAnet.org

COVER STORY

C-Fab Solutions Tips for utilizing central fabrication in your clinical practice to enhance your operations By Renee Lewis, BSE, CO, CPA

entral fabrication (c-fab) facilities are an excellent resource for fulfilling the custom fabrication needs of orthotic and prosthetic clinicians. Some O&P clinics rely heavily on c-fab facilities as part of their core business model. Others use c-fab as an overflow option when they are unusually busy or have staff on leave or vacation. More and more clinics are exploring how incorporating a c-fab facility into their business model can help keep their overhead costs down while giving practitioners more time to spend directly interfacing with patients and referral sources. Whatever your clinical model, following are a few tips for practitioners and technicians working with a c-fab facility.

It Isnâ&#x20AC;&#x2122;t All or Nothing Every clinic must decide what model best suits its size, patient-care philosophies,

O&P News | September/October 2018

and bottom line. The great news about c-fab is that it isnâ&#x20AC;&#x2122;t an all-or-nothing solution. Most c-fab facilities are ready and able to take on only the steps of the fabrication process with which you require assistance. For example, some clinicians make their own test sockets in house then utilize a c-fab facility for fabrication of the definitive device. Some clinicians use the CAD/CAM capabilities of a c-fab facility to fabricate test sockets, and then they or their in-house technicians fabricate the definitive prosthesis. Others who want to move away from using plaster in their office without letting go of any in-house fabrication use scanning technology to capture and modify the limb or residual limb shape. A c-fab facility can then carve a foam model for the clinic to use in fabrication. If there is even part of the fabrication

COVER STORY

process you feel doesn’t need to be performed in house, there is certainly a c-fab facility that will be able to fulfill your needs.

What’s With All of the Questions? It would be ideal if all work orders took only a few minutes to fill out, and sometimes practitioners try to save time by only including the information they feel the c-fab facility needs. However, if a measurement or question is on that c-fab’s work order, it means the fabrication team feels this information is important in order to create the most accurate device with the best fit and function. You will give the c-fab a better chance of being successful for you if you submit all of the requested measurements and information. You may wonder why a c-fab technician needs measurements when you also send them a cast or scan. Although you have provided an exact model of your patient’s limb or residual limb, appropriate measurements are critical for verification of the model. Most casts are transported without any issues, but a few important measurements will help verify the shape has remained intact during shipping. This verification also is important for digital information such as scanning. While this technology captures the shape of a limb or residual limb, the actual size of the model is subject to some small margin of error in the scanning process. This can be caused by the calibration of the scanner, the skill and experience of the practitioner with the technology, or simply the technology itself. Again, key measurements can help the c-fab team verify the model for complete accuracy before fabricating a custom device. Measurements also can be used to help troubleshoot the cause of an illfitting device. Things can go wrong in the fabrication process, but practitioners who work with growing pediatric patients and adults with fluctuating

shapes also know that a shape that was accurate at the time of casting may not be accurate at the time of fitting. Comparing measurements from a casting appointment to measurements at a fitting appointment helps determine if there was an issue in the fabrication process or if there was a physical change to the patient before the device was fit. All of these measurements and questions may seem to simply take up time in a patient evaluation appointment, but they often will save you time in the long run. Not having all of the necessary information on hand in the beginning can result in extra time needed to call your patient back in for additional evaluations or result in extra time in the fitting of the device if modifications need to be made.

Communicate, Communicate, Communicate Even though c-fab staff members aren’t located in your physical building, they are still on your team—and they are eager to make the best devices for your patients. If you have questions about

anything—from the order form to the process—call or email the c-fab staff and ask. If you have very specific ways you want something fabricated, from components to trimlines, don’t be shy about communicating these specifications to the team. C-fab technicians also are an excellent resource for practitioners designing less common or unique devices. These technicians see devices from a variety of clinics, and they may have just the tip or technique you need to solve a complicated issue. Use your team, and call on their knowledge to help you solve complex issues or utilize new components and technologies. Outsourcing to central fabrication can serve as a useful tool, allowing practitioners and technicians to use their time and skills more efficiently in a patient-care setting. Just like any other tool, using c-fab properly can lead to better outcomes for clinics and their patients. Renee Lewis, BSE, CO, CPA, is director of clinical solutions for Friddle’s Orthopedic Appliances, Inc.

O&P News | September/October 2018

COVER STORY

C-Fab Usage AOPA reached out to more than 100 O&P companies in August with a survey regarding central fabrication habits. A total of 137 companies responded, including 76 complete responses. Below are graphs detailing survey respondentsâ&#x20AC;&#x2122; experiences with central fabrication.

QUESTION 1

QUESTION 2

Does your facility provide central fabrication services?

Have you ever utilizedÂ central fabrication services? 6.7% No

54% No

46% Yes

93.3% Yes

QUESTION 3 Q3:$Do$you$utilize$central$fab$services$for$all$your$fabrication$ needs? Do you utilize central fab services for all your

fabrication needs?

Answered:)59))))Skipped:)78

Yes

O&P News | September/October 2018

COVER STORY

QUESTION 6 QUESTION 4 Q4:$Please$select$the$devices$for$which$you$utilize$central$fab$ services How satisfied Please select the devices for which you utilize

central fab services:

Answered:)56))))Skipped:)81

are you with the company’s work?

Spinal Cranial Lower-Limb Orthoses Lower-Limb Prostheses Upper-Limb Orthoses Upper-Limb Prostheses Other (Please specify)

Extremely Dissatisfied

1.89% Dissatisfied

0% Neutral

5.66% Satisfied

62.26%

Q5:$For$which$of$the$following$reasons$do$you$use$central$Extremely Satisfied QUESTION 5 fabrication$services? 30.19% For which of the following reasons do you use central fabrication services?

Answered:)57))))Skipped:)80

We do not have a technician… We augment our lab workflow… We utilize central fab for unique or specialized devices We only utilize central fab when we are extremely busy Other (Please specify)

O&P News | September/October 2018

DIRECTORY of

CENTRAL FABRICATION FACILITIES

Acme Braceworks LLC 411 NE Baker Road Stuart, FL 34994 (777) 934-6943 www.acmebraceworks.weebly.com Email: acmebraceworks@comcast.net Orthotic Categories: Lower-Limb Metal and Leather, Lower-Limb Leather Corset and Gauntlet, Lower Limb, Stance Control, UpperLimb Elbow, Upper-Limb Wrist, Hand, Finger

ACOR Orthopaedic Inc. 18530 S. Miles Pkwy. Cleveland, OH 44128 (800) 237-2267 www.acor.com Email: info@acor.com Orthotic Categories: Foot Orthoses, Lower-Limb Thermoplastics, Lower-Limb Leather Corset and Gauntlet, Crow Walkers Prosthetic Categories: Lower-Limb Partial Foot

Adaptec Prosthetics LLC 1501 West Campus Drive, Suite J Littleton, CO 80120 (720) 433-1212 www.adaptecprosthetics.com Email: rae@adaptecprosthetics.com Orthotic Categories: Thermoplastics Lower-Limb, Thermoplastics Foot Orthoses Lower-Limb Prosthetic Categories: Below-Knee Endoskeletal, Knee Disarticulation Endoskeletal, Above-Knee Endoskeletal, Partial Hand UpperLimb, Wrist Disarticulation Upper-Limb, BelowElbow Upper-Limb, Above-Elbow Upper-Limb, Below-Elbow Endoskeletal, Elbow Disarticulation Endoskeletal, Above-Elbow Endoskeletal,

Other—Vacuum Sockets Utilizing 5280 Internal Vacuum Systems

Advanced O&P Solutions 8647 W. 95th Street Hickory Hills, IL 60457 (866) 914-2677 www.aopsolutions.com Email: mangelio@aopsolutions.com Orthotic Categories: Cervical, Spinal Metal and Leather, Spinal Thermoplastics, Foot Orthoses, Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, Lower-Limb Leather Corset and Gauntlet, Lower-Limb Laminated Carbon Composite, Lower-Limb Tone Reducing AFOs—Pediatric, Lower-Limb Stance Control, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Knee Orthoses, Upper-Limb Custom Cranial Helmets, Upper-Limb Shoulder, Upper-Limb Elbow, Upper Hand Limb Wrist, Hand, Finger, Other—Protective Face Mask Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Partial Hand, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, UpperLimb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Shoulder Disarticulation, External Power Devices, Other

Alatheia Prosthetics 504 Grants Ferry Road Brandon, MS 39047 (601) 919-3112 www.alatheia.com Email: info@alatheia.com Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Below Knee, LowerLimb Above Knee, Upper-Limb Partial Hand, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, UpperLimb Shoulder Disarticulation, Other—AboveKnee and Below-Knee Covers

Alternative Prosthetic Services Inc. 191 Bennett Street Bridgeport, CT 06605 (203) 367-1212 www.alternativeprosthetics.com

American Central Fabrication 3240 Mabel Street Shreveport, LA 71103 (318) 636-3751 Email: americancenfab@aol.com Prosthetic Categories: Lower-Limb Prostheses, Upper-Limb Prostheses

Amfit Inc. 3611 NE 68th Street Vancouver, WA 98661 (360) 573-9100 www.amfit.com Email: sales@amfit.com Orthotic Categories: Foot Orthoses

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics

O&P News | September/October 2018

Directory of Central Fabrication Facilities

AOD CFAB

Atlanta Prosthetics

Best Made Shoes

12315 Judson Road, #200 San Antonio, TX 78233 (210) 657-8100 www.aodcfab.com Email: info@aodcfab.com

1625 Rock Mountain Blvd. Stone Mountain, GA 30083 (800) 543-7660 www.aibracing.com Email: mhortman@deroyal.com

5143 Liberty Avenue Pittsburgh, PA 15224 (412) 621-9363 www.bestmadeshoes.com Email: footcare@bestmadeshoes.com

Orthotic Categories: Spinal, Lower-Limb Orthoses

Orthotic Categories: Cervical, Spinal Thermoplastics, Spinal Scoliosis—Milwaukee

Orthotic Categories: Foot Orthoses, Custom Shoes

Apis Footwear Co.

Atlantic Rim Brace Mfg. Corp.

Bio-Mechanical Composites Inc.

2239 Tuler Avenue South El Monte, CA 91733 (626) 448-8905 www.apisfootwear.com Email: sales@apisfootwear.com

25 B Progress Avenue Nashua, NH 03062 (603) 886-8130 www.spinalbraces.com Email: sales@spinalbraces.com

2505 McKinley Avenue Des Moines, IA 50321 (515) 554-6132 www.phatbraces.com Email: nchladek@aol.com

Orthotic Categories: Lower-Limb Orthoses

Orthotic Categories: Spinal Thermoplastics, Spinal Scoliosis—Milwaukee, Other—CAD/ CAM Carving, Supplies

Orthotic Categories: Lower-Limb Orthoses

Arizona AFO Inc. 4825 E. Ingram Street Mesa, AZ 85205 (480) 222-1580 www.arizonaafo.com Email: info@arizonaafo.com Orthotic Categories: Foot Orthoses, Lower-Limb Thermoplastics, Lower-Limb Leather Corset and Gauntlet, Crow Walkers Prosthetic Categories: Lower-Limb Partial Foot

ARTech Laboratory Inc. 309 W. Avenue F Midlothian, TX 76065 (888) 755-5501 www.artechlab-prosthetics.com Email: mholt36107@aol.com Orthotic Categories: Upper-Limb Wrist, Hand, Finger, Other

Prosthetic Categories: Other—CAD/CAM Carving, Services, and Supplies

Becker Orthopedic Appliance Co. 635 Executive Drive Troy, MI 48083 (248) 588-7480 www.beckerorthopedic.com Email: cbecker@beckerorthopedic.net Orthotic Categories: Spinal Metal and Leather, Lower-Limb Metal and Leather, LowerLimb Thermoplastics, Lower-Limb Leather Corset and Gauntlet, Lower-Limb Laminated Carbon Composite, Lower-Limb Tone-Reducing AFOs— Pediatric, Lower-Limb Stance Control, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Knee Orthoses, UpperLimb Shoulder, Upper-Limb Elbow, Upper-Limb Wrist, Hand, Finger

Prosthetic Categories: Lower-Limb Prostheses, Lower-Limb Orthoses

Boston Orthotics & Prosthetics 20 Ledin Drive Avon, MA 02322 (800) 262-2235 www.bostonoandp.com Email: customerservice@bostonoandp.com Orthotic Categories: Spinal, Cranial

Cascade Dafo Inc. 1360 Sunset Avenue Ferndale, WA 98248 (800) 848-7332 www.cascadedafo.com Email: bized@dafo.com Orthotic Categories: Lower-Limb ToneReducing AFOs—Pediatric, Knee Orthoses, Upper-Limb Wrist, Hand, Finger

Prosthetic Categories: Other—AboveKnee and Below-Knee Covers for Feet, Toes, Heels, Custom Cosmetic Silicone Restoration Fingers and Hands, Below-Elbow and AboveElbow Passives, Below-Elbow and Above-Elbow Myos and L-limbs, Ears and Noses

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics O&P News | September/October 2018

Directory of Central Fabrication Facilities

Coyote Design

Earthwalk Orthotics LLC

Fabtech Systems LLC

419 N. Curtis Road Boise, ID 83706 (208) 429-0026 www.coyotedesign.com Email: lab@coyotedesign.com

500 Vista Avenue SE Massillon, OH 44646 (330) 837-6569 www.earthwalkorthotics.com Email: brigham.earthwalk@gmail.com

P.O. Box 2248 Everett, WA 98213 (425) 349-9557 www.fabtechsystems.com Email: scott@fabtechsystems.com

Orthotic Categories: Lower-Limb Thermoplastics, Lower-Limb Laminated Carbon Composite, Lower-Limb Tone-Reducing AFOs—Pediatric

Eastern Podiatry Lab Inc.

Orthotic Categories: Lower-Limb Laminated Carbon Composite, Other—PDE Dynamic

Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee

Craft Master LLC 1825 N. Willow Hwy. Lansing, MI 48917 (517) 886-5798 Email: khartman@yahoo.com Orthotic Categories: Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, LowerLimb Leather Corset and Gauntlet, Lower-Limb Tone-Reducing AFOs—Pediatric, Crow Walkers, Reciprocating Gait Orthoses, Upper-Limb Elbow, Upper-Limb Wrist, Hand, Finger

Create O&P 7 Old Military Road Lake Placid, NY 12946 (518) 302-9198 www.createoandp.com Email: info@createoandp.com Prosthetic Categories: Lower Limb, Other—CAD/CAM Services

Custom Composite Mfg. Inc. 21 Palmer Avenue Cranston, RI 02920 (401) 275-2230 www.cc-mfg.com Email: info@cc-mfg.com Orthotic Categories: Lower-Limb Laminated Carbon Composite Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s

1702 5th Street Trenton, NJ 08638 (800) 327-8763 www.eplorthotics.com Email: eastpod@verizon.com Orthotic Categories: Foot Orthoses, Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, Lower-Limb Leather Corset and Gauntlet, Lower-Limb Laminated Carbon Composite, Lower-Limb Tone Reducing AFOs— Pediatric, Lower-Limb Stance Control Prosthetic Categories: Lower-Limb Partial Foot

Elite Orthotics Inc. 705 W. Beaver Street Zelienople, PA 16063 (877) 922-8225 www.eliteorthotics.com Email: eo@zoominternet.net Orthotic Categories: Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, LowerLimb Leather Corset and Gauntlet, Lower-Limb Tone-Reducing AFOs—Pediatric, Lower-Limb Stance Control, Crow Walkers, Knee Orthoses, Other

Epica Applied Technologies 2753 Camino Capistrano, Suite A101 San Clemente, CA 92672 (949) 238-6323 www.epicatech.com Email: sales@epicamed.com Orthotic Categories: Cranial, Spinal, Lower Limb, Other—CAD/CAM

Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Partial Hand, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, UpperLimb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices, Other— PDE Dynamic Partial

Farabloc Development Corp. 3030 Lincoln Avenue, #211 Coquitlam, BC V3B 6B4 Canada (866) 941-4711 www.farabloc.com Email: info@farabloc.com Prosthetic Categories: Upper Limb, Lower Limb, Other—Materials and Lamination Supplies

Freedom Fabrication Inc. 815-B N. Main Street Havana, FL 32333 (850) 539-4194 www.freedomfabrication.com Email: freedomfab@aol.com Orthotic Categories: Foot Orthoses, Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, Lower-Limb Laminated Carbon Composite, Lower-Limb Tone-Reducing AFOs— Pediatric, Lower-Limb Stance Control, Crow Walkers, Reciprocating Gait Orthoses, Knee Orthoses, Upper-Limb Wrist, Hand, Finger, Other

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics

10 O&P News | September/October 2018

Directory of Central Fabrication Facilities

Freedom Innovations LLC

Grace Prosthetic Fabrication Inc.

3 Morgan Irvine, CA 92618 (888) 818-6777 www.freedom-innovations.com Email: info@freedom-innovations.com

7928 Rutillio Court New Port Richey, FL 34653 (727) 842-2265 www.gpfinc.com Email: grace@gpfinc.com

Prosthetic Categories: Post-Operative Prostheses, Pediatric Prostheses, Feet, LowerLimb Electronic Components, Multiple Categories

Orthotic Categories: Cervical, Foot Orthoses, Lower-Limb Metal and Leather, LowerLimb Thermoplastics, Lower-Limb Leather Corset and Gauntlet, Lower-Limb Laminated Carbon Composite, Lower-Limb Tone-Reducing AFOs— Pediatric, Lower-Limb Stance Control, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Custom Shoes, Knee Orthoses, Upper-Limb Shoulder, Upper-Limb Elbow, Upper-Limb Wrist, Hand, Finger

Friddle’s Orthopedic Appliances Inc. 12306 Belton Honea Path Hwy. Honea Path, SC 29654 (864) 369-2328 www.friddles.com Email: c-fab@friddles.com Orthotic Categories: Spinal Thermoplastics, Spinal Scoliosis—Milwaukee, Other—CAD Carving Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Partial Hand, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, UpperLimb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices, Other— CAD Carvings

Glaze Prosthetics Ul.Pradnicka 12 Krakow 30002 Poland +48 501 290 485 www.glazeprosthetics.com Email: hello@glazeprosthetics.com Prosthetic Categories: Upper Limb

Prosthetic Categories: Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Partial Hand, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, Upper-Limb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices, Other—Grace Plate

Grubbs Orthotic & Prosthetic Labs Inc. 3065 Park Circle, Suite 1 Jupiter, FL 33458 (888) 958-5363 www.grubbsoandplabs.com Email: grubbs@aol.com

Endoskeletal Hemipelvectomy, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, Upper-Limb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation

Hanger/ dba Hanger Fabrication Network 5251 Convoy Court San Diego, CA 92111 (858) 292-6045 www.spsnationallabs.com Email: HFN_support@hanger.com Orthotic Categories: Cervical, Foot Orthoses, Lower-Limb Metal and Leather, LowerLimb Thermoplastics, Lower-Limb Leather Corset and Gauntlet, Lower-Limb Laminated Carbon Composite, Lower-Limb Tone Reducing AFOs— Pediatric, Lower-Limb Stance Control, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Custom Shoes, Knee Orthoses, Upper-Limb Shoulder, Upper-Limb Elbow, Upper-Limb Wrist, Hand, Finger Prosthetic Categories: Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Partial Hand, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, Upper-Limb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

Orthotic Categories: Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, LowerLimb Leather Corset and Gauntlet, Lower-Limb Stance Control, Crow Walkers, Knee Orthoses. Upper-Limb Elbow Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below the Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation,

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics O&P News | September/October 2018

Directory of Central Fabrication Facilities

Hanger National Labs – Houston

Hersco Ortho Labs

3260 Willowbend Blvd., Suite 1118A Houston, TX 77054 (281) 824-3210 www.spsnationallabs.com

34-28 Crescent Street Long Island City, NY 11101 (800) 301-8275 www.hersco.com Email: fastorthotics@hersco.com

Orthotic Categories: Cervical, Spinal Metal and Leather, Spinal Thermoplastics, Foot Orthoses, Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, Lower-Limb Leather Corset and Gauntlet, Lower-Limb Tone-Reducing AFOs—Pediatric, Lower-Limb Stance Control, Crow Walkers, Spinal Scoliosis— Milwaukee, Custom Shoes, Knee Orthoses, Upper-Limb Elbow, Upper-Limb Wrist, Hand, Finger, Other

HiTek 222 Turner Blvd. St. Peters, MO 63376 (636) 385-6372 www.hitekmobility.com Email: sbright@hitekmobility.com Orthotic Categories: Spinal, Lower-Limb Orthoses, Upper-Limb Orthoses Prosthetic Categories: Lower-Limb Prostheses, Upper-Limb Prostheses

Hutnick Rehab Support Services Inc. 161 Keyland Court Bohemia, NY 11716 (631) 467-3725 www.thehutnickcenter.com Email: hutnickcfab@optimum.net Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Partial Hand, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, UpperLimb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation

Independent Tech Service LLC 13701 24th Street E., Unit A8 Sumner, WA 98390 (253) 891-1976 www.itsfabrication.com Email: chad@itsfabrication.com Orthotic Categories: Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, LowerLimb Leather Corset and Gauntlet, Lower-Limb Laminated Carbon Composite, Lower-Limb ToneReducing AFOs—Pediatric, Lower-Limb Stance Control, Crow Walkers, Knee Orthoses, UpperLimb Elbow, Upper-Limb Wrist, Hand, Finger Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Upper-Limb Partial Hand, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Other—BOA Closure System

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics

12 O&P News | September/October 2018

Directory of Central Fabrication Facilities

Infinite Biomedical Technologies

Joint Active Systems

Lakeshore Central Fab

8 Market Place, Suite 500 Baltimore, MD 21202 (443) 451-7175 www.i-biomed.com Email: dan@i-biomed.com

2600 S. Raney Street Effingham, IL 62401 (217) 342-3412 www.jointactivesystems.com Email: info@jointactivesystems.com

4605 Detroit Avenue Cleveland, OH 44102 (216) 651-0110 www.lakeshorecfab.com Email: fab@lakeshorecfab.com

Prosthetic Categories: Upper Limb

Orthotic Categories: Foot Orthoses, Knee Orthoses, Upper-Limb Shoulder, Upper-Limb Elbow, Upper-Limb Wrist, Hand, Finger

Orthotic Categories: Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, LowerLimb Leather Corset and Gauntlet

Jim Skardoutos C-Fab Inc. 5765 Winfield Blvd., #7 San Jose, CA 95123 (408) 472-7914 www.limbcraftercfab.com Email: limbcrafter@comcast.net Prosthetic Categories: Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, UpperLimb Partial Hand, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, Upper-Limb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices, Other—Custom Shape Cosmetic and Custom Spray-On Skin

Kinetic Research Inc. 5513 W. Sligh Avenue Tampa, FL 33634 (800) 919-3668 www.kineticresearch.com Email: email@kineticr.com Orthotic Categories: Lower Limb

KLM Lab Inc. 28280 Alta Vista Avenue Valencia, CA 91355 (661) 295-2600 www.klmlabs.com Email: scottmar@klmlabs.com Orthotic Categories: Foot Orthoses

Knee Centre 10733 124th Street Edmonton, AB T5M OH2 Canada (800) 387-5053 www.khager.com Email: nhayday@khager.com Orthotic Categories: Knee Orthoses

L.A. Brace Center 164320 Ventura Blvd., Suite 304 Encino, CA 91436 (818) 570-1611 www.thelabrace.com Email: labrace@thelabrace.com Orthotic Categories: Spinal Scoliosis— Milwaukee, Other—The L.A. Scoliosis Brace

Prosthetic Categories: Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, Upper-Limb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, Other

Life-Like Laboratory 1544 Valwood Pkwy., Ste 104 Carrollton, TX 75006 (972) 620-0203 www.lifelikelab.com Email: info@likelab.com Prosthetic Categories: Lower-Limb Prostheses, Upper-Limb Prostheses

Limb Shed 4402 Valley Hwy. Charlotte, MI 48813 (517) 543-2737 www.limbshed.com Email: limbshed@hotmail.com Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Other

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics O&P News | September/October 2018

Directory of Central Fabrication Facilities

Maramed Orthopedic Systems/ BioSculptor 2480 W. 82nd Street, Unit 1 Hialeah, FL 33016 (305) 823-8300 www.biosculptor.com Email: rholland@biosculptor Orthotic Categories: Spinal Thermoplastics, Foot Orthoses, Lower-Limb Thermoplastics, Lower-Limb Tone-Reducing AFOs—Pediatric, Spinal Scoliosis—Milwaukee, Upper-Limb Custom Cranial Helmets, Upper-Limb Wrist, Hand, Finger, Other—Face Mask Prosthetic Categories: Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, Upper-Limb Shoulder Disarticulation

MedSupply 33333 Dequindre Troy, MI 48083 (248) 597-1038 www.med-supply.com Email: drose@med-supply.com Orthotic Categories: Metal and Leather Lower-Limb, Thermoplastics Lower-Limb Prosthetic Categories: Lower-Limb, Partial Foot Lower-Limb, Syme’s Lower-Limb, Below Knee Lower-Limb, Knee Disarticulation Lower-Limb, Above-Knee Lower-Limb, BelowKnee Endoskeletal, Knee Disarticulation Endoskeletal, Above-Knee Endoskeletal, Below-Elbow Upper-Limb, Above-Elbow Upper-Limb

Mile High Orthotics Lab Inc. 4970 Monaco Street, Unit A (303) 289-1534 www.mholabs.com Email: info@mholabs.com Orthotic Categories: Lower Limb

Mountain View Prosthetics Inc.

Northern Arizona Prosthetics

160 Witter Road Altamont, NY 12009 (518) 872-0374 www.mountainviewprosthetics.com Email: mvprosthetics@yahoo.com

1726 N. Liana Drive Chino Valley, AZ 86323 (928) 583-0707 www.nazprosthetics.com Email: nap@nazprosthetics.com

Orthotic Categories: Foot Orthoses, LowerLimb Metal and Leather, Lower-Limb Thermoplastics, Lower-Limb Laminated Carbon Composite, Lower-Limb Tone-Reducing AFOs—Pediatric, Crow Walkers, Knee Orthoses, Upper-Limb Wrist, Hand, Finger

Prosthetic Categories: Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Partial Hand, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, UpperLimb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

Prosthetic Categories: Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, UpperLimb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices, Other— CAD/CAM Services

National Labs 10524 Euclid Avenue, CB 143 Cleveland, OH 44106 (216) 444-1280 www.spsnationallabs.com Email: HFN_support@hanger.com Orthotic Categories: Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, LowerLimb Leather Corset and Gauntlet, Lower-Limb Laminated Carbon Composite, Lower-Limb ToneReducing AFOs—Pediatric, Lower-Limb Stance Control, Crow Walkers, Knee Orthoses, UpperLimb Elbow, Upper-Limb Wrist, Hand, Finger Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Upper-Limb Partial Hand, Upper-Limb Wrist Disarticulation, UpperLimb Below Elbow, Upper-Limb Above Elbow, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow

OPTEC USA 975 Progress Circle Lawrenceville, GA 30043 (770) 513-7380 www.optecusa.com Email: sales@optecusa.com Orthotic Categories: Spinal, Lower-Limb Orthoses, Upper-Limb Orthoses

Orthomerica Products Inc. 6333 N. Orange Blossom Trail Orlando, FL 32810 (800) 446-6770 www.orthomerica.com Email: custserv@orthomerica.com Orthotic Categories: Cervical, Spinal Metal and Leather, Spinal Thermoplastics, Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, Lower-Limb Leather Corset and Gauntlet, LowerLimb Tone-Reducing AFOs—Pediatric, LowerLimb Stance Control, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Knee Orthoses, Upper-Limb Custom Cranial Helmets, Upper-Limb Shoulder, Upper-Limb Elbow, UpperLimb Wrist, Hand, Finger Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics

14 O&P News | September/October 2018

Directory of Central Fabrication Facilities

Orthotics & Prosthetics One

Ottobock HealthCare Canada

527 Park Lane, Suite 200 Waterloo, IA 50702 (800) 408-3598 www.oandp1.com Email: sclark@oandp1.com

54701 Harvester Road Burlington, Ontario L7L 5N5 Canada (800) 665-3327 www.ottobock.ca Email: steve.wall@ottobock.com

Orthotic Categories: Foot Orthoses, Lower-Limb Thermoplastics, Lower-Limb ToneReducing AFOs—Pediatric, Lower-Limb Stance Control, Crow Walkers, Upper-Limb Elbow, UpperLimb Wrist, Hand, Finger, Other—Face Mask

Orthotic Categories: Spinal Thermoplastics, Lower-Limb Thermoplastics, Lower-Limb Laminated Carbon Composite, Lower-Limb Tone-Reducing AFOs—Pediatric, Lower-Limb Stance Control, Knee Orthoses, Upper-Limb Custom Cranial Helmets, Upper-Limb Shoulder, Upper-Limb Elbow, Upper-Limb Wrist, Hand, Finger, Other

Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, Other— Laminated KAFO

Össur Americas Inc. 7199 S. Conway Road, Suite 100 Orlando, FL 32812 (888) 839-6213 www.ossur.com Orthotic Categories: Knee Orthoses, Multiple Categories Prosthetic Categories: Upper-Limb Electronic Components, Lower-Limb Electronic Components, Multiple Categories

Ottobock 110501 Alterra Pwky, Suite 600 Austin, TX 78758 (800) 328-4058 www.ottobockus.com Email: usa.cumstomerservice@ottobockus.com Orthotic Categories: Soft Goods/ Readyto-Fit Orthoses, Multiple Categories Prosthetic Categories: Upper-Limb Components, Lower-Limb Endoskeletal Components, Suspension Products & Systems, Multiple Categories

Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below the Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Partial Hand, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, UpperLimb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices, Other

Shoulder, Upper-Limb Elbow, Upper-Limb Wrist, Hand, Finger, Other Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Partial Hand, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, UpperLimb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation

Pride Custom Fabrication 22901 Ambassador Blvd. St. Francis, MN 55070 (763) 242-7583 Email: pridecustom@comcast.net

Orthotic Categories: Lower Limb

Premier O&P LLC

Prosthetic Design Inc.

Phits/RS Print 44650 Helm Court Plymouth, MI 48170 (405) 406-1441 www.phitsinsoles.com Email: blake.norquist@rsprint.com

1671 Crane Street, Suite 5 Schenectady, NY 12303 (518) 280-4885 Email: premieroandp@yahoo.com Orthotic Categories: Cervical, Spinal Metal and Leather, Spinal Thermoplastics, Foot Orthoses, Lower-Limb Metal and Leather, LowerLimb Thermoplastics, Lower-Limb Leather Corset and Gauntlet, Lower-Limb Laminated Carbon Composite, Lower-Limb Tone-Reducing AFOs— Pediatric, Lower-Limb Stance Control, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis—Milwaukee, Knee Orthoses, Limb

700 Harco Drive Clayton, OH 45315 (937) 836-1464 www.prostheticdesign.com Email: bcarpenter@prostheticdesign. com Prosthetic Categories: Lower-Limb Below Knee, Lower-Limb Above Knee, Other

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics O&P News | September/October 2018

Directory of Central Fabrication Facilities

Protosthetics

Spinal Solutions Inc.

617 4th Street N., Suite 1 Fargo, ND 58102 (701) 478-2001 www.protosthetics.com Email: sales@protosthetics.com

1971 Old Covington Road Conyers, GA 30013 (800) 922-5155 Email: spinalsolutions@mindspring. com

10633 Summit Street Lenexa, KS 66215 (913) 888-4200 www.sps.nationallabs.com Email: HFN_support@hanger.com

Orthotic Categories: Spinal, Lower-Limb Orthoses, Upper-Limb Orthoses

Orthotic Categories: Cervical, Spinal Thermoplastics, Foot Orthoses, Lower-Limb Thermoplastics, Lower-Limb Leather Corset and Gauntlet, Lower-Limb Laminated Carbon Composite, Crow Walkers, Spinal Scoliosis— Milwaukee, Knee Orthoses, Upper-Limb Shoulder, Other—Carbon Fiber AFO

Orthotic Categories: Cervical, Spinal Thermoplastics, Foot Orthoses, Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, LowerLimb Leather Corset and Gauntlet, Lower-Limb Laminated Carbon Composite, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis— Milwaukee, Knee Orthoses, Upper-Limb Elbow, Upper-Limb Wrist, Hand, Finger, Other

Prosthetic Categories: Lower-Limb Prostheses, Upper-Limb Prostheses

PSL Fabrication 110 W. Industrial Road Fulton, MO 65251 (573) 642-5554 www.pslab.com Email: pslab5@sbcglobal.net Prosthetic Categories: Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Other—CAD/CAM Services

Richey Lab 2335 Seminole Lane, Suite 1000 Charlottesville, VA 22901 (434) 978-1788 www.richeylab.com Email: richeylab@footandankle-usa.com

Silverado Fabricators and Maker Services 1104 E. Pettigrew Street Durham, NC 22704 (984) 439-1821 www.silveradofabricators.com Email: ben.silveradofab@gmail.com Orthotic Categories: Lower-Limb Orthoses, Upper-Limb Orthoses, Thermoplastics Foot Orthoses Lower-Limb, Metal and Leather Lower-Limb, Thermoplastics Lower-Limb, Gauntlet Lower-Limb, Laminated Carbon Composite Lower-Limb, Other

Prosthetic Categories: Lower-Limb Below Knee, Lower-Limb Above Knee

Spinal Technology Inc. 191 Mid Tech Drive West Yarmouth, MA 02673 (800) 253-7868 www.spinaltech.com Email: info@spinaltech.com Orthotic Categories: Cervical, Spinal Thermoplastics, Foot Orthoses, Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, LowerLimb Leather Corset and Gauntlet, Lower-Limb Laminated Carbon Composite, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis— Milwaukee, Knee Orthoses, Upper-Limb Elbow, Upper-Limb Wrist, Hand, Finger, Other

SPS National Labs

Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, Upper-Limb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

Prosthetic Categories: Lower-Limb Prostheses, Lower-Limb, Partial Foot Lower-Limb, Syme’s Lower-Limb, Below-Knee Lower-Limb, Below-Knee Endoskeletal, Above-Knee Endoskeletal, Other Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics

16 O&P News | September/October 2018

Directory of Central Fabrication Facilities

SPS National Labs 121 23rd Avenue SW Rochester, MN 55902 (507) 536-6103 www.sps.nationallabs.com Email: HFN_support@hanger.com Orthotic Categories: Cervical, Spinal Thermoplastics, Foot Orthoses, Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, LowerLimb Leather Corset and Gauntlet, Lower-Limb Laminated Carbon Composite, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis— Milwaukee, Knee Orthoses, Upper-Limb Elbow, Upper-Limb Wrist, Hand, Finger, Other Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, Upper-Limb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

SPS National Labs 4155 E. La Palma Avenue, Suite B-400 Anaheim, CA 92807 (714) 961-2155 www.sps.nationallabs.com Email: HFN_support@hanger.com Orthotic Categories: Cervical, Spinal Thermoplastics, Foot Orthoses, Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, LowerLimb Leather Corset and Gauntlet, Lower-Limb Laminated Carbon Composite, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis— Milwaukee, Knee Orthoses, Upper-Limb Elbow, Upper-Limb Wrist, Hand, Finger, Other

Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, Upper-Limb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

SPS National Labs 9561 Satellite Blvd., Suite 350 Orlando, FL 32837 (678) 455-8852 www.cbb.org Email: HFN_support@hanger.com Orthotic Categories: Cervical, Spinal Thermoplastics, Foot Orthoses, Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, LowerLimb Leather Corset and Gauntlet, Lower-Limb Laminated Carbon Composite, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis— Milwaukee, Knee Orthoses, Upper-Limb Elbow, Upper-Limb Wrist, Hand, Finger, Other Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, Upper-Limb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

SPS National Labs 1119 W. Geneva Drive Tempe, AZ 85282 (480) 894-1755 www.spsnationallabs.com Email: HFN_support@hanger.com Orthotic Categories: Cervical, Spinal Thermoplastics, Foot Orthoses, Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, LowerLimb Leather Corset and Gauntlet, Lower-Limb Laminated Carbon Composite, Crow Walkers, Reciprocating Gait Orthoses, Spinal Scoliosis— Milwaukee, Knee Orthoses, Upper-Limb Elbow, Upper-Limb Wrist, Hand, Finger, Other Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, Upper-Limb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

Directory of Central Fabrication Facilities

Startek Enterprises Inc.

Tillges Technologies

Tower Orthopedic Designs Inc.

4710 Prairie Road Paso Robles, CA 93446 (805) 239-9567 Email: startekcfab@sbcglobal.net

1570 Beam Avenue, Suite 100 Maplewood, MN 55109 (651) 772-2665 www.tcopinc.com Email: mtil@tcopinc.com

300 Alpha Drive Pittsburgh, PA 15238 (412) 599-1111 Email: judyd@towerortho.com

Orthotic Categories: Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, LowerLimb Leather Corset and Gauntlet, Lower-LimbTone Reducing AFOs—Pediatric, Crow Walkers Prosthetic Categories: Lower-Limb Partial Foot, Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Lower-Limb Hip Disarticulation, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, Endoskeletal Hip Disarticulation, Endoskeletal Hemipelvectomy, Upper-Limb Partial Hand, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, UpperLimb Shoulder Disarticulation, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow, Endoskeletal Shoulder Disarticulation, External Power Devices

Stat Diagnostics Inc. / dba NewGen Advanced Orthotics Lab 7740 Trinity Road, Suite 101A Cordova, TN 38018 (901) 756-0257 www.newgenorthotics.com

Orthotic Categories: Lower Limb Prosthetic Categories: Lower Limb

Titan O&P Fabrications 600 Lemens Avenue, Suite 700 Hutto, TX 78634 (844) 678-4826 www.titanopfab.com Email: andrew@titanopfab.com Prosthetic Categories: Lower-Limb, Syme’s Lower-Limb, Below-Knee Lower-Limb, Knee Disarticulation Lower-Limb, Above-Knee Lower-Limb, Below-Knee Endoskeletal, Knee Disarticulation Endoskeletal, Above-Knee Endoskeletal

Top Shelf Orthopedics 1851 E. Paradise Road, Suite A Tracy, CA 95304 (209) 834-1158 www.pacmedical.com Prosthetic Categories: Upper Limb, Lower Limb

Touch Bionics

Surestep 17530 Dugdale Drive South Bend, IN 46635 (877) 462-0711 www.surestep.net Email: info@surestep.net Orthotic Categories: Lower Limb

Tidwell’s Orthotics and Prosthetics LLC

35 Hampden Road Mansfield, MA 02048 (855) 694-5462 www.touchbionics.com Email: wagner@touchbionics.com Prosthetic Categories: Upper-Limb Partial Hand, Upper-Limb Wrist Disarticulation, Upper-Limb Below Elbow, Upper-Limb Above Elbow, Other

Orthotic Categories: Lower-Limb Metal and Leather, Lower-Limb Thermoplastics, LowerLimb Leather Corset and Gauntlet, Lower-Limb Tone-Reducing AFOs—Pediatric, Crow Walkers

Townsend Design / Thuasne USA 4615 Shepard Street Bakersfield, CA 93313 (661) 837-1795 www.townsenddesign.com Email: townsend@townsenddesign. com Orthotic Categories: Lower Limb, Knee Orthoses, Soft Goods/Ready-to-Fit Orthoses: Cervical, Soft Goods/Ready-to-Fit Orthoses, Spinal Orthoses, Multiple Categories

UCO International 225 Larkin Drive, Unit 3 Wheeling, IL 60090 (800) 541-4030 www.ucointernational.com Email: uco@ucointernational.com Orthotic Categories: Foot Orthoses

Voxelcare Online CAD/CAM Systems Avd. Universidad s/r Ed. Quarum III PCE-UMH Elche 03202 Spain +0034965452517 www.voxelcare.com Email: info@voxelcare.com Orthotic Categories: Lower Limb

4450 NW 126th Avenue, Suite 106 Coral Springs, FL 33065 (954) 346-5402 www.tidwellsorthotics.com Email: chris.tidwell@tidwellsorthotics. com

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics

18 O&P News | September/October 2018

Directory of Central Fabrication Facilities

Wacker Orthopedic Inc.

WillowWood

2 Flowerfield, Suite 1B St. James, NY 11780 (631) 686-6802 www.wackerorthopedic.com Email: wackerorthopedic@gmail.com

1760 W. Redwood Depot Lane, Suite 6 Salt Lake City, UT 84104 (740) 869-3377 www.willowwoodco.com Email: lisaw@owwco.com

Orthotic Categories: Lower-Limb Thermoplastics, Lower-Limb Tone-Reducing AFOs—Pediatric, Lower-Limb Stance Control, Crow Walkers, Knee Orthoses, Upper-Limb Elbow, Upper-Limb Wrist, Hand, Finger, Other—Tibial Transformer

WillowWood 15441 Scioto Darby Road P.O. Box 130 Mount Sterling, OH 43143 (740) 869-3377 www.willowwoodco.com Email: chrish@owwco.com Orthotic Categories: Lower-Limb Thermoplastics, Lower-Limb Laminated Carbon Composite Prosthetic Categories: Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, UpperLimb Below Elbow, Upper-Limb Above Elbow, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow

Orthotic Categories: Lower-Limb Thermoplastics, Lower-Limb Laminated Carbon Composite Prosthetic Categories: Lower-Limb Syme’s, Lower-Limb Below Knee, Lower-Limb Knee Disarticulation, Lower-Limb Above Knee, Endoskeletal Below Knee, Endoskeletal Knee Disarticulation, Endoskeletal Above Knee, UpperLimb Below Elbow, Upper-Limb Above Elbow, Endoskeletal Below Elbow, Endoskeletal Elbow Disarticulation, Endoskeletal Above Elbow

Windy City Fabricators 3830 W. Irving Park Road Chicago, IL 60618 (773) 583-4860 www.windycityfabricators.com Email: peter@windycityfabricators. com Orthotic Categories: Lower Limb Prosthetic Categories: Lower Limb

Facilities Accredited by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics O&P News | September/October 2018

Research & Presentations

Mobile Technology: Empowering Prosthesis Wearers To Problem-Solve Socket Fit Issues By Daniel J. Lee, PT, DPT, GCS

The Problem A client is in the early stages of prosthesis wearing. The prosthetist has educated the client on how to selfmanage the residual limb/socket interface, ensured that the fit of the socket is correct, and instructed the client to follow up immediately if the prosthesis is uncomfortable or fitting poorly. Despite best efforts by the prosthetist, the client ultimately is dependent on himself or herself to ensure that he or she is donning, managing volume fluctuations, and achieving a congruent fit of the prosthetic socket on the residual limb when outside of the clinic. The client may find that because of natural changes in the residual limb’s volume throughout the day, he or she may need to add or subtract sock ply or adjust the suspension mechanism to maintain the congruent fit. While the client has been educated on how to perform this function, it is a complex task that requires practice, problemsolving skills, knowledge, and the ability to recognize when the assistance of the prosthetist is needed. While some clients may easily adapt to the process of problem solving the fit of the prosthesis, others will struggle. Some may attempt to solve fit issues without an organized and deliberate approach, which can result in poor suspension or possible skin breakdown. Others may

20 O&P News | September/October 2018

not wear the prosthesis at all and call on the prosthetist instead of performing his or her role in self-management and problem solving, decreasing both the utilization of the prosthesis and the prosthetist’s productivity. In either scenario, the result is antithetical to functionally implementing the prosthesis and can create a barrier to independence.

The Solution A simple-to-use, client-centered mobile application that guides the prosthesis wearer in the problem solving of common prosthetic socket fit issues for most suspension types can help solve the problem. With such a mobile app, the client creates an account, selects his or her level of amputation and suspension type, then navigates the one-press interface to explore solutions to frequently encountered issues experienced with the prosthesis. Major problems are categorized in easy-to-understand terms like, “My prosthesis is fitting loosely,” or, “My prosthesis is fitting too tight.” Under each major problem, individual issues and their corresponding solution sets are presented in a hierarchical and logical order, from simplest to most complex, specific to each suspension type. The client can navigate each issue and, based on a “Yes” or “No” response to the question, be presented with a specific solution to his or her problem.

If the client tries the solution (e.g., adds a one-ply sock) and it works, he or she is presented with a “Problem Solved” screen, and the fit should be comfortable and congruent. If the solution does not meet the client’s needs, he or she will be presented with a finite number of other potential solutions to try before finally being presented with an instructional message to contact a prosthetist as the client is unable to problem-solve the fit issue with the app alone. The app not only empowers the prosthesis wearer to solve problems within his or her control, it also encourages communication with the prosthetist in the case that the client cannot determine a solution on his or her own. It is believed that the app can reduce client frustration, improve communication, and ultimately improve outcomes after an individual receives a prosthesis.

Experiment To understand if this mobile app interface is usable and acceptable to prosthesis wearers, a multiphase testing protocol was performed. First, a paper form of the decision trees was developed and validated. The decision trees provided the content for the mobile app and served as a comparison for the usability and acceptability testing. More on the decision trees can be found in a 2017 Disability &

Research & Presentations

Figure 1 Comparison of usability outcomes in both tools. Technical Efficiency

Effectiveness

250

200

150

100

4 3.5 3

PaperBased

APP

PaperBased

APP

Rating

4.5

Errors

Time (s)

Figure 2 Comparison of acceptability rankings. Note: Lower scores for the “confusing” domain is more desirable.

2.5 2

1.5 1

Rehabilitation publication. Once the decision tree content was established, a cross-platform mobile app was developed with an interface accessible to all age groups. After beta testing the app for functionality, the next phase was to assess usability and acceptability. A total of 30 participants, all lower-limb prosthesis wearers, performed six trials of stepmatched navigation on the app and the paper versions of the decision trees. Usability was measured by two criteria: technical effectiveness (number of errors made while navigating the tool) and efficacy (amount of time spent navigating). Acceptability was determined through Likert-like questions and a semistructured interview.

Results The mobile app was found to be significantly more usable and acceptable when compared to the paper-based decision trees. When using the app to navigate the scenarios, there were fewer errors committed and less time to complete the navigation (see Figure 1). While both tools were found to be highly acceptable, the mobile app version was found to be easier to use, to be less confusing to navigate, and to have a higher overall user experience (see Figure 2).

0.5 0

APP Ease of use

APP

Confusing Acceptability Domains

APP Overall

PB: paper-‐based; APP: mobile application Figure 2. Comparison of acceptability rankings. Note: Lower scores for the “confusing” domain is more desirable.

Qualitative analysis of the semistructured interviews resulted in three themes: 1) The paper-based decision trees were organized. 2) The paper-based decision trees were difficult to navigate. 3) The mobile app was simple to use and navigate.

Significance Obtaining and maintaining a comfortable fit of the prosthesis is a priority of the prosthetist; however, despite best educational interventions, the client may experience issues that require problem solving outside of the clinic. The mobile app is an easy-to-navigate interface for a prosthesis wearer to employ in problem-solving fit issues while being directed to his or her prosthetist in the event a comfortable fit is not achieved. This article is a summary of a manuscript that will be published in an upcoming issue of the Journal of Prosthetics & Orthotics under the title,

“Self-Management Problem-Solving Tools for Lower-Limb Prosthesis Wearers: Evaluating Technical Effectiveness, Efficiency, and Acceptability.” The study was funded by the University of Hartford’s College of Education, Nursing, and Health Professions. Daniel J. Lee, PT, DPT, GCS, is a board-certified clinical specialist in geriatrics through the American Board of Physical Therapy Specialties. He is an assistant professor at the University of Hartford in the Department of Rehabilitation Sciences, where he is dual appointed to both the Doctor of Physical Therapy and Masters of Prosthetics and Orthotics programs. Lee may be contacted at danilee@hartford.edu.

Reference 1. Daniel JL, Veneri DA. Development and Acceptability Testing of Decision Trees for Self-Management of Prosthetic Socket Fit in Adults With Lower-Limb Amputation. Disability and Rehabilitation. 2018; 40(9):1066-1071. DOI: 10.1080/09638288.2017.1286694

O&P News | September/October 2018

Research & Presentations

Introduction The socket is the most important part of a prosthesis.1,2 If the fitting is poor,3 the patient will experience skin breakdown as well as decreased mobility and independence, and will report dissatisfaction and lower perceived quality of life. The negative effects will extend to the service provider in terms of decreased efficiency, chance of reimbursement, and reputation. In particular, the fitting of aboveknee amputees is challenging,4 requiring Figure 1

The first version (2017) of the Romedis Symphonie Aqua System TF. A Venturi pump controls the intake and outtake of water, thanks to the compressed air supply.

22 O&P News | September/October 2018

extensive clinical experience; multiple casts may be needed before a successful fit is acquired. Typically, rectifications are complex, and outcomes depend on the practitioner’s skill.5 To address these issues, the idea of casting based on a physical law applied through a dedicated (hands-off ) system is appealing. Examples of such systems based on Pascal’s principle have been reported in the literature for more than 30 years, referred to as “hydrostatic casting.”6 Their aim is to obtain an

Research & Presentations

even distribution of pressure over the surface of the residual limb exposed to the system, obtaining a comfortable fit with minimal pistoning. Consistency of casting is expected to improve and rectifications to be minimal.7 The limited availability of hydrostatic casting technologies for transfemoral amputees has been a constraining factor for the deployment of this approach beyond case studies. 5 However, in early 2017 we were presented the first version of a commercial solution named Symphonie Aqua System Transfemoral (Romedis, D), which allows the casting of patients while weight bearing on the affected side. With this clinical study we wanted to establish: 1) if the casting procedure was well received by patients, 2) the typical level of pressure applied during casting, 3) the number of casts needed per patient to obtain a successful fitting, 4) if the rectification was simple and consistent among prosthetists, and 5) if the socket based on hydrostatic casting was included in the final prostheses.

Methods System Description

The Symphonie Aqua System used for this study consists of a metallic cylinder (19-inch height, 12-inch diameter) containing a silicone membrane. Between the two, it is possible to intake and outtake water, up to a desired and measurable pressure. A Venturi pump, sitting between the water supply/drain and the cylinder, ensures and accelerates this process (Figure 1). The system is positioned on a height-adjustable lifter. Since residual limb length varies among patients, the internal height of the system can be adjusted with a set of plastic rings and a distal cup. To better fit the residual limb diameter and medialize the patient during casting, a set of half-moonshaped silicone adapters also is provided with the system (Figure 2). Before casting, the prosthetists must complete the steps summarized in Figure 3.

Figure 2

One plastic ring and cup (left). The largest half-moon silicone adapter (right).

Figure 3

Before casting initiation, the prosthetist must complete six steps to prepare the system for the specific patient.

O&P News | September/October 2018

Research & Presentations

To take the cast, the residual limb was first wrapped with wet plaster bandages. Immediately after, the patient inserted the residual limb inside the cylinder and the silicone membrane inflated with water. During water intake, the patient progressively shifted body weight onto the amputated side, until the membrane sustained the patient in full weight bearing (Figure 4). For this study, the water intake was stopped when the patient started to rise, which typically happened when the brim of the membrane was about 1.5 inches in height. The patient was asked to remain in this position

Figure 4

until the plaster hardened, and then the water was pumped out of the cylinder. Finally, the patient removed the residual limb from the cylinder and the prosthetist removed the negative plaster wrap from the residual limb. Study Design

We included transfemoral and kneedisarticulated patients who were able to sustain (at least) a soft distal load, were using a liner, were previous prosthesis users, and were approaching the Prosthetic Center of the Italian Workers’ Compensation Authority (Centro Protesi

Wrapping of the patient residual limb with plaster bandages (left) and image of the patient during casting, when in full weight bearing (right).

INAIL) for socket review. Patients with no tolerance for compression, who had invaginated scars, or who had a flexed stump exceeding 15 degrees were excluded. Four prosthetists also were involved in the study. All prosthetists were specialists in transfemoral casting, with more than 15 years of experience. Their workshop within the Prosthetic Center completes about 800 above-knee fittings per year. In addition, one CAD/CAM technician with experience with MeshLab and Blender software participated. As outcome parameters, for each patient we noted: 1) the patient’s acceptance of the casting procedure, 2) the pressure applied to the residual limb while casting, 3) the number of casts needed to reach a satisfactory fit as perceived by both the patient and prosthetist, and 4), the number of successful deliveries of completed prostheses. Moreover, the rectifications applied by the prosthetists were analyzed by scanning the positive plaster before and after rectification, through a M4D Scanner (Rodin). Quantitative rectification maps were calculated in MeshLab similar to Fatone et al.8 The rectification maps were qualitatively compared, and a CAD procedure was established by agreement among the prosthetists.

Results Sixty-four transfemoral patients (46 ± 13 years old) participated. Fifty-two patients had a medium length residual limb, five short, four long, and three had a knee disarticulation. Fifty-two patients used a Seal-in liner (Össur, IS). For knee disarticulation and short residual limbs, we used Alps liners: Extreme liner AKFR and AKDT (with pink lock), respectively. For half of the patients, the etiology of amputation was traumatic. The procedure was deemed acceptable by all patients. The pressure applied was similar among patients, with an average of 0.22 bar (± 0.046). For 59

24 O&P News | September/October 2018

Research & Presentations

out of 64 patients (92 percent), one cast was sufficient to achieve a satisfactory fitting socket. Four patients were cast twice and one was cast three times to achieve a satisfactory fitting socket. Sixty-two patients (97 percent) have, to date, received the final prosthesis with no issues experienced over a follow-up period of eight to 12 months. Rectifications were minimal (typically smaller than 0.55 inches), focusing on the medial and posterolateral sides. Figure 5 reports the typical rectification map, obtained based on agreement among prosthetists. Two finished sockets are shown in Figure 6. A flexible inner socket is contained within a mediolateral carbon-fiber frame. It is important to note that the Symphonie Aqua System per se does not constrain the shape of the proximal brim. Depending on the physical characteristics of the patient, it is possible to deliver what we might call an ischial-containment-like socket, as well as a subischial socket.

Figure 5

Typical rectification maps. Red indicates material added, while blue indicates material removed.

Figure 6

Example of two complete sockets. Decision on the proximal brim depends on the patient and can range from ischial containment to subischial.

Conclusion Patients were satisfied with the procedure, although it was more challenging for patients with a flexed residual limb due to the inability (at that time) to control the tilt angle of the lifter. The number of re-casts was minimal, and any nondeliveries at the time of writing were due to external factors other than casting. The analysis of the rectification maps was helpful for the prosthetists to quantify their inter-operator reliability and confirmed that rectifications were minimal. Importantly, the Symphonie Aqua System does not constrain the design of the proximal brim, which can range from ischial-containment to subischial. These results suggest that the hydrostatic system applied in this study is a viable way to support prosthetists in completing successful fittings of transfemoral patients. Results will need to be confirmed with standardized longerterm follow-up.

O&P News | September/October 2018

Research & Presentations

As a final remark, in May 2018 Romedis released the Romedis Symphonie Aqua System TF to the public. Since our testing was completed, changes have been made to the system to improve the comfort for patients on their medial side; the size of the cylinder has been reduced, and the half-moon silicone adapters have been eliminated. The new system is already in use at INAIL, and another 70 patients have used the system to date. Exploration of this new system will be the object of a further assessment. Andrea G. Cutti, PhD; Giovanni Osti; Gian Luca Migliore; Dimitri Cardin; Fabio Venturoli; and Gennaro Verni are affiliated with the Prosthetic Center of the Italian Workers’ Compensation Authority (Centro Protesi INAIL) in Vigorso di Budrio, Italy.

References 1. Legro MW, Reiber G, del Aguila M, Ajax MJ, Boone DA, Larsen JA, Smith DG, Sangeorzan B. Issues of Importance Reported by Persons With Lower-Limb Amputations and Prostheses. J Rehabil Res Dev. 1999; 36(3):155-63. PubMed PMID: 10659798. 2. Geil MD. Consistency and Accuracy of Measurement of Lower-Limb Amputee Anthropometrics. J Rehabil Res Dev. 2005; 42(2):131-40. 3. Kahle JT, Klenow TD, Highsmith MJ. Comparative Effectiveness of an Adjustable Transfemoral Prosthetic Interface Accommodating Volume Fluctuation: Case Study. Technol Innov. 2016; 18(2-3):175-183. 4. Muller DM. Transfemoral Amputation: Prosthetic Management. In Atlas of Amputation and Limb Deficiencies, Vol. 2, 4th Ed., AAOS.

5. Buis A, Kamyab M, Hillman S, Murray K, McGarry A. A Preliminary Evaluation of a Hydro-Cast Transfemoral Socket, a Proof of Concept. Pro Ort Open J. 2017; 1:7. 6. Kristinsson O. The ICEROSS Concept: A Discussion of a Philosophy. Prosthet Orthot Int. 1993; 17(1):49-55. PubMed PMID: 8337100. 7. Klasson B. Prosthetic Socket Fit Implications of Basic Engineering Principles. Advanced Prosthetic Science. University of Strathclyde Glasgow. 2006; 56. 8. Fatone S, Johnson WB, Tran L, Tucker K, Mowrer C, Caldwell R. Quantification of Rectifications for the Northwestern University Flexible Subischial Vacuum Socket. Prosthet Orthot Int. 2017; 41(3):251-257.

Make Your First Impressions Count With Customized Polo shirts, Scrub tops, and Lab Coats for your O&P staff

Create an attractive business image, promote your brand, and foster team spirit with AOPA’s new Apparel Program. To order your apparel, go to

iconscrubs.com

AOPA Polo Shirts–Now for Sale Order AOPA polo shirts for your office! The shirts are black with a white AOPA logo. Moisture wick, 100 percent polyester. Rib knit collar, hemmed sleeves, and side vents. The polos are unisex but the sizes are men’s M-2XXL. $25 plus shipping. Order in the bookstore at bit.ly/aopastore.

Enter access code: ICON-AOPA Enter your AOPA member id Create your user profile

AOPA is partnering with Encompass Group, a leading provider of health-care apparel, to offer members special prices on customized polos, scrub tops, and lab coats.

26 O&P News | September/October 2018

POLO TS SHIR

B SCRU TOPS

LAB COAT

O&P Visionary

Ralph W. Nobbe, CPO

Experienced O&P businessman and clinician advocates for O&P licensure, prompt pay laws, and clinician volunteerism

ecently, I received an email request from AOPA Executive Director Tom Fise, JD, with the subject line, “Would you consider?” He was giving me the opportunity to “state my piece” and “wave the wand of change” for O&P. Hmmmm … I was not sure whether I was flattered for being considered or insulted since my certification number is frequently one of the lowest on sign-in sheets and I am now considered an “old timer.” Following a 30-plus-year career as a second-generation O&P practitioner, I have witnessed some dramatic changes in health care and O&P. As I reflect back on my career, I can recall my original entry into the field and very first patient encounter. Up until that patient encounter, I had worked during vacations, after school, and summers for my father, Erwin A. Nobbe, CPO(E). Just like other O&P professionals who grew up in and around the industry, I did some fabrication and “other tasks as may be assigned”—usually to keep me busy and out of trouble. While exploring careers, I was not entirely convinced that O&P was the best choice. My first venture was

participation in an outreach trip organized through the O&P program at Cerritos College. The O&P students travelled to a clinic in Calexico over a three-day weekend under the supervision of Robert Hinchberger, CPO(E). I recall there were five or six of us who made the trip. One of the patients presented into the clinic with a knee-ankle-foot orthosis (KAFO) that badly needed repairs. She was elderly and had travelled quite some distance, spoke no English, and came in with the KAFO under her arm in a wheelchair. I was selected to do the repairs because I had experience using a long arm patcher, knew how to sew leather, and could speak some Spanish. I was able to complete the repairs, then she expressed her gratitude profusely and left—walking out. “OK, that was cool,” I thought. The KAFO patient returned the very next day with her entire family. They had travelled about two hours and brought enough food to feed at least 30 people. They were not satisfied until we had all eaten so much we could not move. My decision was made: I was going into O&P.

Following a 30-plusyear career as a second-generation O&P practitioner, I have witnessed some dramatic changes in health care and O&P.

O&P News | September/October 2018

O&P Visionary

Ralph W. Nobbe, CPO, speaking at the AOPA 2016 National Assembly

Over the years, I have experienced similar instances of grateful patients, parents, and families. I have attended weddings, graduations, and, more recently, funerals. I have no doubt that all orthotists and prosthetists have similar stories to tell. However, with those positive experiences also come the business and administrative frustrations of modern health care. In the early days, life was simple: Patients presented with a prescription and paid, or their insurance paid when they received a bill. As time marched along, a new alphabet soup of acronyms was created: HMOs, PPOs, EPOs, ERISA, HSA, HDHP, and ACOs—as well as third-party financing options. All served to reduce our net reimbursements and increase administrative processing costs. All of the major payors—Medicare, Medicaid, the U.S. Department of Veterans Affairs (VA), and private insurers—engaged in an increasing documentation demand in active pursuit of cost control, limiting fraud and abuse, and reducing “excessive” utilization. We dealt with the Health Insurance

28 O&P News | September/October 2018

Portability and Accountability Act, K levels, outcome measures, prior authorization, recovery audit contractor audits, prepay audits, retrospective denials, and outside third-party reviewers who “recommend” a reduced reimbursement. These documentation demands requested corroborating documentation from physicians and letters of medical necessity. Our own O&P notes held no value because we had a vested interest in the outcome of the claim. O&P was always a ripe target to pick on as a small, referral-based industry with a very high unit cost of service. Against this background of O&P, the following is my “wish-list” for the O&P profession: 1. Licensure would give each individual practitioner standing among the medical community and should be pursued by the professional associations and individual practitioners. 2. Prompt pay laws should be enacted: If a medical service/device is provided, the device has received prior authorization with preservice medical review, and the patient was

eligible on the date of service, that claim should be paid promptly and as agreed, irrespective of the type of insurance. 3. Recoupment and offsetting payment should be stopped. It creates an accounting nightmare for all involved, and all claims should be subject to the prompt pay requirements. 4. Practitioner notes and documentation should be recognized. A licensed, credentialed practitioner should be able to document patientspecific needs for a given device following physician prescription/ referral. Physician countersignature of the “orthotic/prosthetic treatment plan” should provide adequate documentation and would place our service delivery requirements on par with other referral-based providers of medical care. 5. Payment for O&P services by all paying agents, most specifically Medicare, VA, and Medicaid, should only be made to accredited facilities with appropriately credentialed staff. 6. The O&P industry’s alphabet soup of representative groups leads to lots of confusion. The industry numbers are simply too small to have so many entities with slightly differing messages. Patients will be best served with unified messaging delivered in a consistent manner. 7. Participation should be a priority. Every practitioner, as part of their mandatory continuing education, should serve a defined number of hours in a volunteer capacity within the industry organizations. Serve on a committee, do a presentation, go visit your legislators, meet with other associations. Attend the AOPA Policy Forum. The O&P industry has an easy story to tell. Go tell it. Ralph W. Nobbe, CPO, is president of Nobbe Orthopedics Inc. in Santa Barbara, California.

AOPA Celebrates Health-Care Compliance & Ethics Week November 4-10, 2018

HE SAVE T

DATE

10 NOV. 4-

2018

Save the Date!

Health-Care Compliance & Ethics Week Make plans to join your AOPA member colleagues in celebrating Health-Care Compliance and Ethics Week (HCEW), November 4-10. In its first year celebrating HCEW, AOPA energized more than 500 members of our community to participate in seminars, educate staff, and share their focus on ethical behavior with their patients and community. AOPA is organizing resources, education, prizes, and more to help your organization participate. With a week-long celebration of compliance and ethics, you have a great opportunity to introduce and reinforce your chosen themes. Your plans will rely in part on your organizationâ&#x20AC;&#x2122;s specific needs, but some basic goals may include:

AWARENESS of the Code of Conduct,

relevant laws/regulations, and other reporting methods, the organizationâ&#x20AC;&#x2122;s compliance and ethics staff, etc.

RECOGNITION of training completion,

compliance and ethics successes, etc.

REINFORCEMENT of a culture of compliance for which your organization strives.

AOPA has developed several free tools and resources to assist you. Visit our dedicated web page for tools, resources and more:

bit.ly/AOPAEthics

STATE NEWS

State by State

A recap from the AOPA State Reps meeting at the 2018 AOPA National Assembly in Vancouver

Each month, we talk to O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This column features information about medical policy updates, fee schedule adjustments, state association announcements, and more.

Multiple State Alert Blue Cross Blue Shield (BCBS) Illinois, BCBS Montana, BCBS New Mexico, BCBS Oklahoma, BCBS Texas, and Health Care Service Corp. (HCSC) issued a draft policy that would limit access to microprocessor-controlled prosthetic technology. AOPA, as well as many other O&P organizations, including the O&P Alliance, issued comments on the draft policy, which was removed from the BCBS website on Monday, Oct. 1, 2018. AOPA’s comments are available for review on the AOPA Co-OP, and AOPA will continue to monitor this issue. Arizona Several O&P providers in Arizona are exploring the possibility of expanding the scope of practice for orthotists and prosthetists in the state. The expanded scope of practice would include the ability to bill for Current Procedural Terminology (CPT) codes, specifically the four codes designated for prosthetic and orthotic training.

30 O&P News | September/October 2018

During the summer AOPA Board of Directors meeting, AOPA Executive Director Tom Fise, JD, recommended that AOPA develop a long-term plan to give serious consideration to expanding O&P’s scope of practice to include more patient-care services, billed through CPT codes. Certified orthotists and prosthetists are the only primary care providers who do not bill both CPT and Health-Care Common Procedure Coding System codes, according to Fise.

Arkansas Members from Arkansas reported concerns about Medicaid work requirements and the entry of new managed-care organizations beginning Jan. 1, 2019. Many of the states with work requirements have exclusions for individuals with disabilities, but Arkansas has not yet released its criteria. California The California Orthotic and Prosthetic Association continues to push for increases to the MediCal fee schedule and is now working with a health economist to build its case. Massachusetts AOPA members in Massachusetts reported a MassHealth (Massachusetts Medicaid) proposal, 101 CR 334.00: Payment Rates for Prostheses, Prosthetic Devices, and Orthotic Devices, which would cut the fee schedule for some O&P codes by as much as 17 percent. A public hearing was held on Aug. 17, 2018, for which AOPA submitted written testimony. Several

O&P organizations also attended the hearing to present testimony in person. As a result of the feedback received during the public hearing, MassHealth has delayed implementation, pending further review. O&P providers continue to monitor the situation but have concerns that the proposed cuts may still go through due to the lack of detailed descriptions and documentation of time allotments associated with the provision of orthotic and prosthetic care. MassHealth has requested additional information with respect to the amount of time it takes to provide the services associated with the global payment of the L codes with proposed fee schedule cuts.

Minnesota AOPA members in Minnesota report a successful transition under the new licensure law, which went into effect Jan. 1, 2018. The law was intended primarily for patient protection purposes. Minnesota planned to hold a vote on moving forward with pursuing the introduction of insurance fairness in the state in 2019 during its state meeting, held in conjunction with the Northern Plains Chapter Meeting, October 4-5. EDITOR'S NOTE: To submit an update for publication, please email awhite@aopanet.org. For up-to-date information about what’s happening in O&P in your state, visit the AOPA Co-OP and join the conversation in the AOPA Google+ Community.

CALENDAR & CLASSIFIEDS

Meetings & Courses

2018 NOVEMBER 4-10

2019 JANUARY 4-6

Health-Care Compliance & Ethics Week. AOPA is celebrating

AOPA 2019 Leadership Conference. The Scott, Scottsdale,

Health-Care Compliance & Ethics

AZ. For more information, email

Week and is providing resources

Ryan Gleeson at rgleeson@

to help members celebrate. Learn

AOPAnet.org.

more at bit.ly/aopaethics.

MARCH 13 Advanced Beneficiary Notice: Get To Know the ABN Form. Register online at bit.ly/

Shoes, External Breast Prostheses, Surgical Dressings, and Other Policies. Register online at bit.ly/

2019webinars. For more

2019webinars. For more inform-

information, email Ryan Gleeson

ation, email Ryan Gleeson at

at rgleeson@AOPAnet.org.

rgleeson@AOPAnet.org.

PRACTICE SALES & APPRAISALS

WANTED!

JANUARY 9 Understanding the Knee Orthoses Policy. Register online

A few good businesses for sale.

at bit.ly/2019webinars. For more information, email Ryan Gleeson at

NOVEMBER 12-13 Mastering Medicare: Essential Coding & Billing Techniques. Las Vegas. Register online at

Lloyds Capital Inc. has sold over 150 practices in the last 26 years.

rgleeson@AOPAnet.org.

FEBRUARY 13

bit.ly/2018billing. For more

Patient Outcomes: Best Practices & How To Use Them. Register

information, email Ryan Gleeson

online at bit.ly/2019webinars. For

at rgleeson@AOPAnet.org.

more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

If you want to sell your business or just need to know its worth, please contact me in confidence. Barry Smith Telephone: (O) 323-722-4880 â&#x20AC;˘ (C) 213-379-2397 e-mail: loyds@ix.netcom.com

NOVEMBER 14 AOPA Webinar: Evaluating Your Compliance Plan & Procedures: How To Audit Your Practice. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

DECEMBER 12 AOPA Webinar: New Codes, Medicare Changes, & Updates. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson

APRIL 10

Publisher Thomas F. Fise, JD Advertising Sales RH Media LLC Editorial Services Content Communicators LLC Design & Production Marinoff Design LLC Printing Sheridan SUBSCRIBE O&P News (ISSN: 1060-3220) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email ymazur@AOPAnet.org. EMAIL ADDRESS CHANGES To update your subscription email address, contact 571/431-0876, fax 571/431-0899, or email ymazur@ AOPAnet.org.

Copyright ÂŠ 2018 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of the publisher, nor does the publisher necessarily endorse products shown in O&P News. The O&P News is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P News may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted. ADVERTISE Reach out to the O&P profession and more than 13,500 subscribers. Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

at rgleeson@AOPAnet.org.

O&P News | September/October 2018

TECH TIPS

AOPA Announces Winners of National Assembly Technical Fabrication Contest FIRST PLACE

he Technical Fabrication Contest at the 2018 AOPA National Assembly, which took place in Vancouver in September, featured a timed competition on the Exhibit Hall show floor. Participants were asked to properly assemble an articulating ankle-foot orthosis (AFO) or simple below-knee prosthesis. A judge recorded the time from start to finish, with participants able to record up to three times on each device. The best time was chosen as the final time submission. Any ties resulted in a “time-off ” to determine the winner. Two winners were selected from each category (student, technician, and practitioner). Six first-place winners with the lowest fabrication times each received a $500 prize. Six runnerups with the second-best times each received $200.

TECHNICAL FABRICATION CONTEST SPONSORS

32 O&P News | September/October 2018

SECOND PLACE

PRIZE CATEGORY

PRIZE

WINNER

PROPERLY ASSEMBLING

AN ARTICULATING AFO FIRST PLACE

Technician

$500 Prize

Ramen Landon, MPO, CP, CTPO

FIRST PLACE

Student

$500 Prize

Robert Hinks

FIRST PLACE

Practitioner

$500 Prize

Anton Kruglov, CPO

SECOND PLACE

Technician

$200 Prize

Desmond Cook

SECOND PLACE

Student

$200 Prize

Wesley Fong

SECOND PLACE

Practitioner

$200 Prize

Koji Duncan

PROPERLY ASSEMBLING

A SIMPLE BELOW-KNEE PROSTHESIS FIRST PLACE

Technician

$500 Prize

Ramen Landon, MPO, CP, CTPO

FIRST PLACE

Student

$500 Prize

Mackingley Burrell

FIRST PLACE

Practitioner

$500 Prize

Loren Schubert, MSc, CP(C)

SECOND PLACE

Technician

$200 Prize

Desmond Cook

SECOND PLACE

Student

$200 Prize

Molly Jeffers

SECOND PLACE

Practitioner

$200 Prize

Tony Ward, CPO

Realize the facts. O&P care improves quality of life and is cost effective! Learn more at MobilitySaves.org. The Study that Started MobilitySaves.org A major study, comparing patients using prosthetics versus patients without prosthetics had these findings: • They will experience greater independence. • They can increase their physical therapy and become less bed-bound. • They will have fewer emergency room admissions and acute care hospital admissions. • They will have lower or comparable Medicare costs than patients who need, but do not receive, these services. Share this significant news by using the educational tools provided at MobilitySaves.org. Mobility Saves Lives And Money!

The Results Lower Limb Prosthetics Prosthetic patients experienced better quality of life and increased independence compared to patients who did not receive the prosthesis at essentially no additional cost to Medicare (or other payers).

O&P CARE IS A SAVER, NOT AN EXPENSE TO INSURERS! Visit MobilitySaves.org. Follow us on social media! “Search Mobility Saves” on Facebook, Twitter, and LinkedIn

www.bocusa.org

EARN CREDITS AT YOUR OWN PACE www.AOPAnetonline.org/aopaversity

100+ TOP-QUALITY ORTHOTIC, PROSTHETIC, AND PEDORTHIC EDUCATION COURSES.

EARN SCIENTIFIC, BUSINESS, AND PEDORTHIC CE CREDITS BY STUDYING THE COURSE MATERIAL AND PASSING THE QUIZ.

ACCESS YOUR PERSONAL ACCOUNT, VIEW VIDEOS, PRINT CERTIFICATES, OR REVIEW CE CREDIT HISTORY 24/7.

Learn & Earn TOP QUALITY

orthotic, prosthetic, and pedorthic education and CE credits from the organization that knows O&P.

Itâ&#x20AC;&#x2122;s as easy as 1-2-3 1. Set up your free personal online account 2. Choose your education and study 3. Take the quiz and print your certificate Membership has its benefits:

BUILD A

Better BUSINESS WITH AOPA

Learn more at www.AOPAnet.org/join

Start earning your credits today!

Visit www.aopanetonline.org/aopaversity.

September/October 2018 O&P News

Articles inside

Tech Tips

State by State

O&P Visionary: Ralph W. Nobbe, CPO

Clinical Effectiveness of a Novel Hydrostatic Casting Method for Transfemoral Amputees: Results From the First 64 Patients

Mobile Technology: Empowering Prosthesis Wearers To Problem-Solve Socket Fit Issues

Directory of Central Fabrication Facilities

Cover Story: C-Fab Solutions