August 2023 O&P Almanac

HUMAN AND MACHINE COLLABORATION

FOR A RESET?

With the right mindset, O&P stakeholders have an opportunity to elevate the perception of the profession and build long-term resiliency for their businesses. Industry leaders offer tips for distinguishing O&P from durable medical equipment, aggregating clinical evidence to demonstrate the value of O&P intervention, and garnering professional respect for the important work of O&P professionals.

By MICHAEL COLEMAN

SPECIAL

2023 AOPA

Get set for the Assembly with a look at the events and opportunities planned for the Exhibit Hall.

Learn what the Assembly sponsoring organizations plan to showcase at their booths.

Managing Partial Foot Amputations

• Limb Preservation

• Gait Restoration

• Propulsion with Proximal Stability

Studies have shown destructive forces are distal to the residuum using BlueROCKER thereby preserving the residual foot.

Carbon footplate

SAFO

BlueROCKER

Views From AOPA Leadership

The Initiative That Is Sweeping the Nation: So Every BODY Can Move

Last month marked one year since AOPA, along with our partner organizations—the National Association for the Advancement of Orthotics and Prosthetics (NAAOP), the Amputee Coalition (AC), and the American Academy of Orthotists and Prosthetists (AAOP)—launched the groundbreaking state-based policy and advocacy initiative, So Kids Can Move. What started as a focus on children has successfully expanded, with most states pursuing legislation for all ages. With that, the initiative has been reenvisioned and is now called

So Every BODY Can Move

In 2023, the initiative saw unprecedented engagement and success. Four states—Arkansas (HB 1252), Colorado (HB 1136), Illinois (SB 2195), and New Mexico (HB 131)—joined Maine (LD 1003) in enacting legislation that includes coverage for orthotic and prosthetic care necessary for physical activity for all ages. In addition, five states—Indiana (HB 1433), Massachusetts (HD 4491), Minnesota (HF 3339/SF 3351), New Jersey (SB 3919), and New Hampshire (SB 177)—have joined the movement and introduced legislation in 2023, and more than 20 states are working to bring legislation to their states. At this point, we expect a dozen bills to be introduced in 2024.

For those not familiar with the initiative, So Every BODY Can Move is the only advocacy initiative working to address the healthcare inequity that thousands of individuals living with limb loss and limb difference are unable to afford and access orthotic and prosthetic care that helps them be physically active due to inadequate insurance coverage, with a policy solution rooted in dignity and justice. This is done by empowering state-by-state legislative action, expanding access to this medically necessary care. So Every BODY Can Move is achieved through the establishment of a coalition of advocates in each state. These coalitions are led by individuals living with limb loss and limb difference and/or state O&P associations and are supported by O&P community partners, healthcare professionals, families, and friends who are working together to cultivate systemic solutions that will impact millions of individuals living with limb loss and limb difference for generations to come.

I am proud to say that I am helping lead the efforts in the great state of Minnesota. Our coalition includes the Minnesota Society of Orthotists, Prosthetists, & Pedorthists; Wiggle Your Toes (an amputee nonprofit); our legislators; our lobbyist; and our extended O&P community of facility owners, healthcare professionals, families, and friends. We are working together to move legislation that creates access to O&P care that includes insurance fairness, physical activity equipment, bathing/showering equipment, and nondiscriminatory practices in the provision of care.

AOPA and its initiative partners, NAAOP, AC, and AAOP, help by providing state coalition support with the development of model legislation, strategy, data gathering, and marketing. The support needed proves to be different in each state and depends on legislative priorities. We also provide an opportunity for all state coalition members to share experiences on a monthly lead advocate call. Please know, we are committed to elevating this initiative for all; please reach out so we can help you get started in your state.

So Every BODY Can Move believes that movement is medicine and physical activity is a right, not a privilege. So Every BODY Can Move will have completed its healthcare mission when the discriminatory treatment of people with disabilities ceases to exist and they are given the right to physical, social, and mental wellbeing. 2024 is promising to be another exciting and successful year for So Every BODY

Can Move

Together with our members and industry partners, AOPA continues its work to advance equality, strengthen the O&P profession, and improve the lives of patients we are privileged to serve. To join in this initiative and help inspire a national movement, please contact advocacy@aopanet.org

Very Truly Yours,

Teri Kuffel, JD

Teri Kuffel, JD, is president of AOPA.

Board of Directors

OFFICERS

President

Teri Kuffel, JD

Arise Orthotics & Prosthetics, Spring Lake Park, MN

President-Elect

Mitchell Dobson, CPO, FAAOP Hanger Clinic, Austin, TX

Vice President

Jeffrey M. Brandt, CPO Brandt Ventures, Exton, PA

Immediate Past President

Dave McGill Össur Americas, Foothill Ranch, CA

Treasurer Rick Riley Bakersfield, CA

Executive Director/Secretary

Eve Lee, MBA, CAE AOPA, Alexandria, VA

DIRECTORS

Arlene Gillis, MEd, CP, LPO International Institute of Orthotics and Prosthetics, Tampa, FL

Elizabeth Ginzel, MHA, CPO Össur, Fort Worth, TX

Kimberly Hanson, CPRH Ottobock, Austin, TX

John “Mo” Kenney, CPO, FAAOP Kenney Orthopedics, Lexington, KY

James Kingsley Hanger Clinic, Oakbrook Terrace, IL

Lesleigh Sisson, CFo, CFm Prosthetic Center of Excellence, Las Vegas, NV

Linda Wise Fillauer Companies, Chattanooga, TN

Shane Wurdeman, MSPO, PhD, CP, FAAOP(D)

Research Chair

Hanger Clinic, Houston Medical Center, Houston, TX

A world where orthotic and prosthetic care transforms lives.

AOPA Contacts

Our Mission

AOPA staff and volunteers are committed to our mission of being a trusted partner, advocating for and serving the orthotic and prosthetic community by:

• Fostering relationships with decision makers to ensure equitable access.

• Providing education that promotes professional excellence.

• Supporting research that informs innovative care.

• Advancing equality to strengthen the orthotic and prosthetic profession and improve the lives of patients.

Our Vision

A world where orthotic and prosthetic care transforms lives.

AMERICAN ORTHOTIC & PROSTHETIC ASSOCIATION (AOPA)

330 John Carlyle St., Ste. 200, Alexandria, VA 22314

AOPA Main Number: 571-431-0876 | AOPA Fax: 571-431-0899 | AOPAnet.org

EXECUTIVE OFFICES

Eve Lee, MBA, CAE, executive director, 571-431-0807, elee@AOPAnet.org

Akilah Williams, MBA, SHRM-CP, director of finance and strategic operations, 571-431-0819, awilliams@AOPAnet.org

HEALTH POLICY AND ADVOCACY

Joe McTernan, director of health policy and advocacy, 571-431-0811, jmcternan@AOPAnet.org

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571-431-0854, dbernard@AOPAnet.org

Sam Miller, manager, state and federal advocacy, 571-431-0814, smiller@AOPAnet.org

Susannah Engdahl, PhD, manager, health policy and research, 571-431-0843, sengdahl@AOPAnet.org

MEETINGS & EDUCATION

Tina Carlson, CMP, senior director, education and meetings, 571-431-0808, tcarlson@AOPAnet.org

Kelly O’Neill, CEM, senior manager of meetings and exhibition, 571-431-0852, kelly.oneill@AOPAnet.org

Kristen Bean, digital meetings specialist, 571-431-0876, kbean@AOPAnet.org

MEMBERSHIP & COMMUNICATIONS

Joy Burwell, director of communications and membership, 571-431-0817, jburwell@AOPAnet.org

Betty Leppin, senior manager of member services, 571-431-0810, bleppin@AOPAnet.org

Nicole Ver Kuilen, manager of public engagement, 571-431-0836, nverkuilen@AOPAnet.org

Madison McTernan, coordinator of membership and communications, 571-431-0852, mmcternan@AOPAnet.org

AOPA Bookstore: 571-431-0876

Reimbursement/Coding: 571-431-0833, LCodeSearch.com

O&P ALMANAC

Eve Lee, MBA, CAE, executive director/publisher, 571-431-0807, elee@AOPAnet.org

Josephine Rossi, editor, 703-662-5828, jrossi@contentcommunicators.com

Catherine Marinoff, art director, 786-252-1667, catherine@marinoffdesign.com

Bob Heiman, director of sales, 856-520-9632, bob.rhmedia@comcast.net

Christine Umbrell, editorial/production associate and contributing writer, 703-662-5828, cumbrell@contentcommunicators.com

PUBLISHER EVE LEE, MBA, CAE

EDITORIAL MANAGEMENT CONTENT

COMMUNICATORS LLC

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O&P Almanac (ISSN: 1061-4621) is published monthly, except for combined issues in June/July and November/ December, 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 info@aopanet.org. Yearly subscription rates: $59 domestic, $99 foreign. All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices.

ADDRESS CHANGES

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Copyright © 2023 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 AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials. All letters, press releases, announcements, and articles submitted to the O&P Almanac 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 WITH US

Engage the profession today. Reach AOPA’s membership with more than 10,694 subscribers. Contact Bob Heiman at 856-520-9632 or email bob.rhmedia@comcast.net

Learn more at bit.ly/23AlmanacMediaKit

As a GOLD SPONSOR of the 2023 AOPA National Assembly, we look forward to seeing you in Indianapolis, IN, Sept. 6-9.

Proud Partner of the

Registry (LLPR)

Cailor Fleming is proud to offer new and existing customers a discount on premiums (5-15%) to O&P Providers who participate in the LLPR. Discounts to be applied at renewal or at the beginning of the policy year.

The LLPR is the first quality registry for hospital systems and prosthetic/orthotic practices for creating a collaborative database that focuses on acquired and congenital limb difference, as well as limb preservation, populations.

Happenings

RESEARCH ROUNDUP

High Risk for Neuropathy Among Lower-Limb Amputees With Diabetes

A new study shows that diabetic patients with lower-limb amputation experience diabetic neuropathy more frequently than diabetic patients without amputation. Researchers from JR Tokyo General Hospital in Japan conducted a cross-sectional retrospective study of 27 transtibial and nine transfemoral patients with lower-limb amputation due to diabetes admitted to a rehabilitation center between April 2019 and December 2022. They studied the positive rate of the modified Ipswich Touch Test (mIpTT) as well as physical and orthotic therapy, based on medical records.

Customized Orthosis for Patients With Spinal Cord Injury

A research team in India has developed a multipurpose customized orthosis for use by patients with midcervical spinal cord injury (SCI) to aid in performing activities of daily living. These individuals often experience weakness or paralysis in the flexor muscles and may be unable to perform activities requiring fine motor control, such as eating, brushing, writing, and unlocking doors.

The researchers developed a passive 3D-printed upper-extremity dynamic orthosis to assist spinal cord injury patients. The orthosis is designed with a worm-gear-based mechanism to produce pronation and supination motions of users’ wrists.

Ten patients with cervical SCI tested the orthosis over a four-week period. Researchers studied task completion assessments and QUEST questionnaire responses. Results indicated the orthosis provided an appropriate range of motion, and users indicated ease in performing tasks and quicker task completion times.

“This study helped in defining a new protocol for the rehabilitation of individuals affected by SCI for assistance in their daily activities,” reported the authors. “Future recommendations for healthcare providers and researchers working in rehabilitation would be the incorporation of such multipurpose splinting that makes the life of these individuals less tedious.” The study was published in May in Prosthesis

The researchers found positive mIpTT results in 81% of transtibial subjects and 89% of transfemoral subjects, with no apparent differences in positivity rates by amputation level, gender, or age. The researchers recommended personalized physical therapy and insoles for subjects’ natural feet.

The increased risk of neuropathy among individuals with lowerlimb amputation and diabetes, and possible future ulcers and risk of another amputation, reinforce the need for foot exercises and orthotic therapy for the nonamputated side, according to the researchers. The study was published in June in Cureus

Shorter Cooling Periods for Thermoforming Polypropylene?

An allied health team from Loma Linda University sought to determine whether the 24-hour consolidation time for polypropylene (PP) plastic recommended by the International Committee of the Red Cross could be shortened. Led by David Ojeda Sersun, MSOP, MPT, the team compared plastic expansion or shrinking and heat ratio of PP plastic via cooling periods of six, 12, 18, and 24 hours.

The team made 41 identical plaster models, then applied vacuum at the four different time periods. They found that dimensional stability was not significantly different across the four time groups. “There is so scientific foundation to perform a 24-hour wait before finishing a device,” the authors concluded. Shortening the cooling time “translates to an effective time frame for removing the plastic from the model, saving time and resources, quicker delivery to the patient, and improvement in whole patient care.” The study was published in July in Journal of Prosthetics and Orthotics

Restoring Thermal Sensation for Individuals With Upper-Limb Amputation

With a goal of providing individuals with upper-limb amputation with more natural feeling, a team of Italian and Swiss researchers developed a noninvasive wearable device able to restore thermal sensation. The device delivers thermal stimuli in sensitive areas of the residual limb to elicit thermal phantom sensations.

The researchers tested the device on several individuals with amputation, delivering thermal stimuli to specific regions of skin on subjects’ residual limbs. “These sensations were phenomenologically similar to those on the intact limbs and were stable over time,” reported the researchers, noting that the subjects were able to reliably and consistently detect and discriminate a variety of thermal stimuli.

“The use of a wearable device that provides thermal sensation can increase the sense of embodiment and improve life quality in hand amputees.” The study was published in May in Science

Happenings

DIABETES DOWNLOAD DISEASE RISK RISES

Approximately 529 million people were living with diabetes worldwide in 2021, with a global agestandardization prevalence of 6.1%. More than 20% of individuals aged 65 to 95 were living with diabetes. By 2050, more than 1.31 billion people are projected to have diabetes.

MEDICAL MATTERS

FDA Approves Experimental Gene Therapy for Young DMD Patients

The Food and Drug Administration (FDA) voted to approve the first gene therapy treatment for children with Duchenne muscular dystrophy (DMD) in June. DMD, which primarily affects boys, is a genetic disorder characterized by progressive muscle degeneration and weakness, and many patients benefit from orthoses. FDA rejected a request to make the treatment available to all children with DMD but allowed access for 4- and 5-year-old patients until more evidence is available that the therapy is safe and effective.

The gene used in the therapy, SRP-9001, produces a miniature version of dystrophin, which is lacking in DMD patients. Test subjects who underwent the gene therapy reportedly showed dramatic improvements in mobility; however, some experts say more research is needed to ensure the treatment is responsible and safe.

DATA SECURITY

“Today’s approval addresses an urgent unmet medical need and is an important advancement in the treatment of DMD, a devastating condition with limited treatment options, that leads to a progressive deterioration of an individual’s health over time,” said Peter Marks, MD, PhD, director of the FDA’s Center for Biologics Evaluation and Research. “FDA remains committed to facilitating the development of innovative new therapies to reduce the impact of debilitating diseases and to improve outcomes and quality of life for those affected.”

As a condition of approval, FDA is requiring the developers of the therapy to complete a clinical study to confirm the drug’s clinical benefit. The study will assess whether the therapy improves physical function and mobility in ambulatory DMD patients with a confirmed mutation in the DMD gene.

Hackers Use Generative AI To Attack Healthcare

HISTORICAL O&P

THE BARBIE/ PROSTHETIC CONNECTION

Ruth Handler, co-founder of Mattel and creator of Barbie dolls and a breast cancer survivor, also manufactured and marketed artificial breasts for mastectomy patients. The Nearly Me prosthetic breast debuted in 1976 and was made of liquid silicone enclosed in polyurethane, with a rigid foam backing.

Attackers breached more than 28.5 million healthcare records in 2022, a significant increase from the 21.1 million records breached in 2019, according to a new report from Trustwave SpiderLabs. The researchers found that cybercriminals typically employ a variety of tactics in their breach attempts, including traditional practices such as sending phishing emails, exploiting unknown vulnerabilities, and compromising third-party vendors.

Attackers also leverage newer threat methodologies to breach healthcare organizations, according to the report: generative artificial intelligence (AI), which is a type of AI that can produce various types of content, including text, imagery, audio, and synthetic

MEETING MASHUP Germany To Host OTWorld 2024

OTWorld 2024, an international gathering focusing on the interface between the human body and technology in prosthetics and orthotics, medicine, and therapy, will take place May 14-17 in Leipzig, Germany.

The educational program will cover the core aspects of orthopedic treatment and care. “In Leipzig, we’ll be providing a comprehensive overview of new materials, technologies, research findings, studies, and innovations, in addition to demonstrating numerous types of treatment and care,” said Congress President Ingo Pfefferkorn. “The focus of our lectures

data, as well as deepfakes; and large language models (LLMs), such as ChatGPT. Recent advances in generative AI and LLMs “are setting new benchmarks for what’s possible with healthcare organizations for both adversaries and defenders,” said the report authors. “For healthcare, the risks are further heightened due to the sensitive nature of the data potentially being shared with these tools.”

Ransomware and supply chain exposures also pose threats when securing data, according to the researchers. Read the full report, “Cybersecurity in the Healthcare Industry: Actionable Intelligence for an Active Threat Landscape,” on Trustwave’s website.

and workshops is always on real-life progress in individual care. No matter what participants hope to gain from the congress, they’ll certainly go home with a new perspective on their daily work in treatment and care.”

Pediatric/adolescent and neurological orthopedics will be a central topic at OTWorld 2024. Planned contributions include a talk on orthopedic treatment and care of serious foot deformities in children and adolescents, an update on muscle relaxation techniques for spasticity, and a session on 3D printing in pediatric orthopedics.

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insurance coverage such as VA, Medicare and MedicAid

HCPCS PDAC approved

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See through design that is almost invisible when worn

25% lighter**

18% more dorsi-flexion power**

35% more medio-lateral strength**

Designed for patients with reduced dexterit y and hand mobility such as stroke patients

Unique front suppor t design

Easy rear entry thanks to revolutionary frontal design

Magnetized velcro strap is easily attached with one hand

25% more medio-lateral stability**

L-1951

L-1951

L-1932

O&P ATHLETICS Team Össur Earns 10 Medals in Paris

Team Össur members earned 10 medals at this year’s 2023 World Para Athletics Championships in Paris, including three gold, three silver, and four bronze medals.

Three Team Össur athletes finished top-three in the T64 (BK) women’s long jump event, with Dutch athlete Fleur Jong winning the gold, followed by fellow countrywoman Marlene van Gansewinkel with the silver and Japan’s Maya Nakanishi earning the bronze. Jong also earned gold in the 100-meter run in the T62/64 (BK) category and set a championship record in the qualifying heats.

Canadian Marissa Papaconstantinou, also from Team Össur, took home bronze medals in both the 100-meter T62/64 (BK) and the women’s T64 (BK) 200-meter sprint.

O&P By the Numbers

On the men’s side, Germany’s Markus Rehm earned his sixth back-to-back gold medal in men’s T64 (BK) long jump and a new championship record of 8.49 meters. Denmark’s Daniel Wagner also won a silver medal in the men’s T63 (AK) long jump category. In the men’s T62/64 (BK) 100-meter sprint, Costa Rican athlete Sherman Guity won the silver medal, and Germany’s Felix Streng took the bronze.

“Össur salutes the exceptional achievements of all of the athletes who competed at this year’s World Championships,” said Sveinn Sölvason, president and chief executive officer of Össur. “We remain truly inspired by the members of Team Össur, who are some of the most accomplished para-athletes in the world.”

Are Your Patients Losing Their Medicaid Coverage?

Federal funding to ensure continuous enrollment to Medicaid beneficiaries ended in April. All Medicaid beneficiaries in every state are required to reenroll in the program, which has caused millions of beneficiaries to lose coverage. See the numbers from KFF’s Medicaid Enrollment and Unwinding Tracker, based on data from 41 states and the District of Columbia.

NATIONWIDE DISENROLLMENT REASONS FOR DISENROLLMENT

3,849,000 Medicaid enrollees disenrolled as of August 3 Percentage disenrolled in reporting states

Fleur Jong earned gold medals in the T64 long jump event and the 100-meter sprint.

FABRICATED WITH ACCURACY & PRECISION

At Hersco, we pride ourselves on being on the leading edge of technology. We have mastered the art of accepting scans and 3D printing to bring you precise orthotics every time. Our team works to deliver custom orthotics tailored to each individual’s needs and specifications. We also keep an exact digital record of each patient’s foot orthotics for ease of reproduction.

CUSTOM: FOOT ORTHOTICS • AFO’S • RICHIES

PEOPLE

Maurice Henson has been named the new youth and workforce development director at Amputee Coalition. He will support the advancement of youth and create action plans for youth engagement and workforce development programs.

Henson has spent the past 13 years working with youth. In his new role, he will create long-term action plans for diverse youth engagement and workforce development programs.

Rick Lopez and David L. Evans have been named the two newest district managers for Allard USA.

Lopez, who serves as Southwest district manager, has 25 years of experience with medical-related companies, including Janssen Pharmaceuticals, Codman, Ethicon, J&J, and Megadyne Medical. Evans, who serves as New England district manager, has 20 years’ experience in sales, business development, and territory management and has served in a variety of positions within the healthcare industry.

Noel Neil, JM, CDME, has been named the 2023 Certificant of the Year by the Board of Certification/Accreditation (BOC). The recognition honors a BOC-certified professional for outstanding contributions to their profession, including commitments to service, research, and outreach.

With expertise in the areas of billing, auditing, appeals, and regulatory compliance, Neil serves as vice president of auditing and corporate compliance at ACU-Serve Corp., where he is responsible for maintaining and monitoring the company’s corporate compliance program. He also offers audit defense and policy-specific education and guidance to ACU-Serve’s existing clients, representing multiple suppliers in all types of Medicare audits and appeals.

“I am honored and humbled to be named BOC’s Certificant of the Year,” said Neil, “especially knowing I am the first Certified Durable Medical Equipment Specialist to hold this accolade.”

BUSINESSES

Prosthetic Xpert Consultation has announced its newly funded Dale Berry Orthotics and Prosthetics Endowed Scholarship at Eastern Michigan University (EMU). The annual scholarship will be awarded to a student who is seeking a degree in orthotics and prosthetics and is currently enrolled in EMU’s College of Health and Human Services. An EMU panel will select the scholarship recipient based upon the best 250-word essay submitted on the topic, “How does compliant documentation influence orthotic and prosthetic patient care?”

Funded by the Dale Berry Endowment Fund, the purpose of the scholarship is to educate and prepare future O&P clinicians to produce quality, concise, and compliant clinical documentation. Dale Berry, CP, CP(c), FAAOP, has served 20 years as vice president of clinical operations of a large U.S. O&P provider, keeping his focus balanced between patient care, documentation, compliance, and operational controls. Today, he is owner of Prosthetic Xpert Consultation and offers expertise in prosthetic documentation, compliance, and life cost projections.

“This scholarship will provide a positive impact on the students and an immeasurable impact on the patients they serve in the future,” said Rebecca Spragg, MSPO, CPO, associate professor and program coordinator at EMU. Visit pxcrx.com/about-us for details.

Rick Lopez David L. Evans

Noel Neil, JM, CDME

memset(&iDSA_config, 0, sizeof(IDSA_Config));

iDSA_config.sys_clock = sys_clk;

memset pattern

iDSA_config.filters = m_filters;

iDSA_config.filter_count = 1;

INT32 rc = MCTL_RC_INIT;// return code void * var_data; // pointer to variable data load

m_cmd_send = NULL

m_cmd_send = NULL;

m_num_dofsf(m_dof_cntl)); = 0;

iDSA_config.filter_count = 1;

IDSAInit(&iDSA_config);

m_cmd_send = NULL

/*** Load config

if (VFILE_SUCCESS != (rc = VFile_Var_Read(g_default_config, "MOTOR_MAP", "MOTOR_MAP", &var_data)))

// Motor map if (VFILE_SUCCESS != (rc = VFile_Var_Read(g_default_config,

(row_idx = 0; row_idx < VFILE_DMATRIX_ROWS(var_data);

Initialize motors associated with DOF.

m_cmd_send = NULL

dof_cntl->idx = dof_idx;

Coapt is machine learning.

if (MCTL_SUCCESS != (rc

iDSA_config.filter_count

Initialize output driver module ***/

Initialize motors associated with DOF. (col_idx = 0; col_idx < m_num_dofs; col_idx++)

ADD-ON MYOELECTRIC PATTERN RECOGNITION CONTROLLERS FOR UPPER LIMB PROSTHESES.

iDSA_config.filters

iDSA_config.filter_count

Initialize output driver moduler (MCTL_SUCCESS != (rc = Motor_Out_DAC_Init(m_dof_cntl, m_num_dofs)))

m_cmd_send = NULL;

m_cmd_send = NULL; Load config variables ***/

/*** Load config variables ***/ rc = MCTL_RC_INIT;// return code var_data; // pointer to variable data load

THE TRAILBLAZER OF MACHINE LEARNING IN O&P.

iDSA_config.filter_count = 1;

/*** Load config

m_num_dofs

if (VFILE_SUCCESS != (rc = VFile_Var_Read(g_default_config, "MOTOR_MAP", &var_data)))

CELL_INT32(var_data, row_idx, idx_sys != (emg

(VFILE_SUCCESS != (rc = VFile_Var_Read(g_default_config, "MOTOR_MAP", &var_data)))

memset(&iDSA_config, 0, sizeof(IDSA_Config));

void * var_data;

if (VFILE_SUCCESS != (rc = VFile_Var_Read(g_default_config, "MOTOR_MAP", &var_data)))

dof_speeds.cell = cells;

Initialize motors associated with DOF.

= 0; col_idx < m_num_dofs; col_idx++)

dof_speeds.cols = m_num_dofs;

pattern

INT32 rc = MCTL_RC_INIT;//

void * var_data; // pointer to variable

m_cmd_send = NULL;

/*** Load config

void * var_data; // pointer for (col_idx = 0; col_idx < m_num_dofs;

Initialize motors associated with DOF. pattern

(col_idx = 0; col_idx < m_num_dofs; col_idx++)

(col_idx = 0; col_idx < m_num_dofs; col_idx++)

f(m_dof_cntl));

if (VFILE_SUCCESS != (rc = VFile_Var_Read(g_default_config, return ERROR(rc, Initialize motors associated with DOF.

initialize the internal eDSA module memset(&iDSA_config, 0, sizeof(IDSA_Config));

f(m_dof_cntl));

m_num_dofs = 0;

iDSA_config.sys_clock = sys_clk; iDSA_config.filters = m_filters;

(col_idx = 0; col_idx < m_num_dofs; col_idx++)

Learn more about Coapt, and our vision to create Human-machine interfaces that benefit humans

m_cmd_send

INT32 rc = MCTL_RC_INIT;// return /*** Load config variables if (VFILE_SUCCESS != (rc return ERROR(rc, "VFile_Var_Read");

memset(cells, 0, sizeof(cells));

"MOTOR_MAP", &var_data)))

BY JOE MCTERNAN

Prepare for Change

Understanding the impact of O&P legislative and regulatory events in 2023

The first half of 2023 saw significant developments on the legislative and regulatory fronts for O&P. While the slow developing nature of these processes can be frustrating—it often seems like nothing ever changes— that has not been the case in 2023.

Three significant developments this year may have a significant impact on your business and the O&P profession in general: the introduction of the latest iteration of the Medicare Orthotic and Prosthetic Patient-Centered Care Act, the 2024 final rule for Medicare Advantage plans, and the 2024 Medicare Home Health Agency prospective payment system proposed rule.

This month’s Reimbursement Page takes a closer look at each of these issues and

discusses what may be different as a result of their implementation.

Medicare O&P Patient Centered Care Act

For several years, AOPA’s federal advocacy efforts have been centered around the passage of legislation titled “the Medicare O&P Patient Centered Care Act.”

While the proposed legislation has had varying provisions as AOPA has received feedback from its members regarding what would most benefit their patients, the current version is the simplest, most patient-centric version to date.

The 2023 version of the Medicare O&P Patient-Centered Care Act has been introduced in the House of Representatives (HR 4315) and will be introduced in the

Senate in the near future. This important proposed legislation contains three primary provisions.

Patient Protection From Fraud and Abuse

This provision would prohibit the practice of “drop shipping” custom-fitted and -fabricated orthoses and all prostheses to Medicare beneficiaries.

Under this provision, only off-the-shelf (OTS) orthoses would be allowed to be drop shipped to the patient’s home without any clinical intervention by a provider or supplier. This prohibition would prevent unscrupulous suppliers, who rely on “lead generators” that operate through a model based on late-night advertisements and telemedicine companies, from shipping custom-fitted and -fabricated

orthoses and all prostheses to Medicare beneficiaries without providing necessary clinical care.

Access to O&P Care From Quality Providers

This provision would ensure that patients have access to the full range of orthotic care from their primary O&P practitioner, rather than requiring patients to visit multiple providers in the case where the treating orthotist or prosthetist does not have a competitive bidding contract.

This provision helps ensure efficient and convenient patient care and would treat O&P practitioners similarly to physicians and other practitioners as defined by the Secretary. Because O&P practitioners would be reimbursed according to the adjusted Medicare fee schedule established through the competitive bidding process for OTS orthoses, this provision should not cost the Medicare program any more than it will otherwise spend on OTS orthoses.

Patient Access to Appropriate O&P Care as Their Needs Evolve

This provision would ensure that Medicare beneficiaries have access to custom-fitted and custom-fabricated orthoses when a replacement is necessary due to a change in their condition or clinical needs, an irreparable change in the condition of the orthosis, or excessive cost of repairs.

Currently, Medicare restricts the replacement of orthoses during the “reasonable useful lifetime” of the orthosis. These restrictions currently force Medicare beneficiaries to wait for a period of time, often five years, before they are eligible for Medicare coverage of a replacement orthosis. Section 428 of the Benefit Improvement and Protection Act of 2000 provides for an exception to continuous use and useful lifetime restrictions for prosthetic devices if an ordering physician determines that a replacement device is medically necessary for certain reasons. This provision would extend the exception to custom-fitted and custom-fabricated orthotic devices.

The Medicare O&P Patient-Centered Care Act has unprecedented support, both from AOPA’s partners within the profession and

its allied health partners, including all of the major therapy groups and the majority of members of the ITEM Coalition. AOPA will continue to work closely with our champions in Congress to pass this legislation and create positive impact for your patients and business.

Changes to Medicare Advantage Plans

Medicare Advantage, also known as Medicare Part C, is a program wherein commercial payors partner with CMS to offer health insurance plans to Medicare beneficiaries. Medicare Advantage plans are marketed to Medicare beneficiaries as offering more flexibility, expanded benefits, and reduced out-of-pocket costs when compared to traditional fee-for-service Medicare.

Medicare Advantage is a popular program, but there is always concern that challenges that providers face dealing

with managed care organizations on the commercial side will carry over to Medicare Advantage plans. Medicare Advantage plans are required to offer the same scope of benefits and coverage available through traditional Medicare.

Recently, CMS finalized regulations that establish operating requirements for Medicare Advantage plans operating in calendar year 2024. This is an annual process, but the 2024 final rule will require Medicare Advantage plans to operate much more similarly to the traditional, fee-for-service-based Medicare program. The final regulations represent the most sweeping changes to the operating requirements Medicare Advantage plans must abide by and, in general, will create greater transparency and accountability to Medicare beneficiaries.

Highlights of the final regulations include the following:

• Require Medicare Advantage plans to abide by fee-for-service Medicare coverage rules

• Limit the use of internal Medicare Advantage or proprietary coverage guidelines

• Establish guardrails around the use of prior authorization

• Strengthen medical necessity determinations

• Create new standards for Medicare Advantage reviewers who deny claims.

AOPA will be developing additional resources to help members understand the impact of this final rule and how to effectively communicate with payor partners to ensure that patients are treated fairly and have access to all of the benefits they are eligible to receive.

Medicare Home Health Agency PPS Proposed Rule

On June 30, CMS released its annual proposed rule that will establish 2024 payment rates for the Medicare Home Health Prospective Payment System (PPS). As often is the case, several important, but unrelated, provisions were included in this proposed rule that will have significant impact on O&P providers and the Medicare beneficiaries they serve.

The final regulations represent the most sweeping changes to the operating requirements Medicare Advantage plans must abide by and, in general, will create greater transparency and accountability to Medicare beneficiaries.

The proposed provisions that are relevant for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) include the following:

• The codification and expansion of the Medicare definition of the term “brace” to include powered orthoses and exoskeletons

• Creation of a new benefit category and payment for compression garments used to treat lymphedema

• Changes to the methodology used to calculate Medicare fee schedules based on rates established through competitive bidding

• Modifications to supplier enrollment processes designed to further control Medicare fraud and abuse

• Codification of existing policy regarding documentation requirements for DMEPOS refills.

The proposed provision that will most likely have the greatest impact on the O&P profession is the inclusion of powered orthoses and exoskeletons in the brace benefit category for Medicare coverage and payment purposes. This represents a

reversal of the longstanding CMS position that powered orthoses and exoskeletons should be classified as durable medical equipment as they generate motion across a joint without necessarily supporting a weakened joint or body member.

AOPA has worked closely with its members to communicate the value of including these devices within the O&P

benefit to CMS officials, and the proposed rule represents a significant development that will better classify powered orthoses and exoskeletons under the Medicare orthosis benefit category. AOPA will provide official comments on this proposed rule and will support the classification of powered orthoses and exoskeletons under the Medicare brace benefit category.

2024: A Busy Year

Legislative and regulatory changes in O&P— and healthcare in general—are constantly evolving. AOPA looks forward to seeing the actual impact of the updates discussed above and those that will continue to craft the O&P landscape in the future.

AOPA will continue to advocate for the profession and the patients we serve to ensure continued access to the most clinically appropriate O&P care.

Joe McTernan is director of health policy and advocacy at AOPA. Reach him at jmcternan@AOPAnet.org

The inclusion of powered orthoses and exoskeletons in the brace benefit category would have the greatest impact.

BY CHRISTINE UMBRELL

HUMAN AND MACHINE COLLABORATION

he concept of artificial intelligence, or AI, can be overwhelming, but AI and machine learning, a subset of AI, “are across the border of every single vertical impacting healthcare,”

James F. Jordan, MBA, CHT, a distinguished service professor of healthcare and biotechnology at Carnegie Mellon’s Heinz College Health-

. Machine learning, and the explosion of big data in healthcare, foster innovations in new technologies as well as more efficient and accurate

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processes involving real-time monitoring and decision making, explains Jordan.

Across the medical spectrum, AI has spawned such advances as AI-assisted robotic surgeries, virtual nursing assistants, automated workflow processes, automated scan analyses, and much more. Aspects of AI have infiltrated the O&P profession, too, affecting not only medical devices but also processes and the provision of care.

James F. Jordan, MBA, CHT

What Are AI and ML?

Merriam-Webster defines artificial intelligence and machine learning as follows:

• Artificial Intelligence: A branch of computer science dealing with the simulation of intelligent behavior in computers; the capability of a machine to imitate intelligent human behavior.

Here’s a look at how AI has influenced the orthotics and prosthetics profession, and a peek at what’s coming next.

f Aspects of artificial intelligence (AI) impact the greater healthcare environment—and influence both the provision of O&P care and the devices clinicians fit on their patients.

f Some of the more advanced prosthetic systems leverage machine learning to create personalized and more natural arm movements or smoother, more natural gait during ambulation.

f AI is believed to have significant implications for improving clinical judgment, particularly during prognosis, diagnosis, treatment, and clinician workflow.

• Machine Learning: The process by which a computer is able to improve its own performance (as in analyzing image files) by continuously incorporating new data into an existing statistical model.

f The rapid expansion of O&P-specific data being captured and stored, and the growing use of sensors associated with O&P devices, will enable more informed clinical visits and real-time responses to problems.

f Big changes are coming to O&P research initiatives, with AI advances influencing how investigations are carried out and how information is shared.

How the integration of machine learning, big data, and technological innovations can make you a better clinician

Creating More Advanced Prosthetic Systems

Innovators in the O&P space began using machine learning to design prosthetic and orthotic devices several years ago. One of the earliest examples is Coapt’s Complete Control system, first released in 2013 and designed for use in conjunction with upper-extremity prostheses. The system “leverages the power of machine learning to hyper-personalize the clinical benefit” of the prosthesis, according to Blair Lock, chief executive officer and co-founder of Coapt.

The system features advanced myoelectric pattern recognition for upper-limb prostheses and serves as a “finely tuned neurological decoder that takes signals from the human body and converts them to control commands in real time for robotic hands, wrists, and elbows,” says Lock. The user “teaches” the device what is intuitive to them, making the prosthesis more functional and acclimated to the individual so that their prosthesis becomes “more fluid and less cumbersome,” according to Lock.

Lower-limb devices can also become more advanced and intuitive thanks to AI. For example, the Utah Bionic Leg, a lightweight active prosthesis designed for more natural and efficient gait among individuals with above-knee amputation, was developed after extensive academic research efforts combining robotics, biomechanics, and

AI, according to Tommaso Lenzi, PhD, one of the creators of the leg and director of the HGN Lab for Bionic Engineering at University of Utah. The lab recently a partnered with Ottobock to license the technology behind the leg to bring the technology to more individuals with lower-limb amputations in the future.

The novel prosthesis integrates sophisticated motors, sensors, and control to emulate the biomechanical functionality of the biological knee, ankle, and toe joints, facilitating various ambulatory tasks and day-to-day activities, according to Lenzi. “A distinguishing feature of the Utah Bionic Leg is how it employs AI technology to enable a more intuitive and natural gait for the users,” he says.

“In contrast to other active prostheses, which rely on triggering movements and preprogrammed functions for specific activities like standing up from a seated position or climbing stairs, the Utah Bionic Leg uses a continuous adaptation approach,” Lenzi explains. The leg “adapts the action of its active joints continuously in real time, imitating the natural hip/knee/ankle coordination across different ambulation activities.” That adaptable control approach “enhances the smoothness of the user’s gait,” Lenzi says. “By avoiding these artificial triggering movements, users can more comfortably rely on natural movements during their daily routines. This continuous adaptation approach also prioritizes user safety by minimizing the risk of unintended prosthesis movements.”

Tommaso Lenzi, PhD

An above-knee subject tests the Utah Bionic Leg, walking on an uneven terrain simulator in the HGN Lab for Bionic Engineering at the University of Utah, directed by Tommaso Lenzi, PhD.

Blair Lock

EXPECT MORE

Experience more with QUATTRO, scan now.

Currently, Lenzi’s team is working on a new control approach for active leg prostheses that leverages advanced neural interfaces and AI. “We aim to give users direct, volitional control of the prosthetic leg movements” while focusing on safety and intuitiveness, he says. In the new control approach, “AI plays an important role in interpreting the neural signals from the user’s residual limb and fusing them with the information from the mechanical sensors embedded in the active prosthesis to determine the final behavior of the prosthesis.”

Integrating Big Data Into O&P Practice

For healthcare delivery in general, AI will have significant implications for “improving clinical judgment … with a particular focus on prognosis, diagnosis, treatment, clinician workflow, and expansion of clinical expertise,” according to an article published July in New England Journal of Medicine (NEJM)

We are seeing an exponential increase in the amount of O&P-centered data being collected and stored. Individual facilities are capturing patient demographic information, patient satisfaction surveys, and outcome measurements. On a larger scale, the new national Limb Loss and Preservation Registry has begun capturing data from facilities and hospital systems across the country.

With the advent of sensors and apps associated with many O&P devices, even more information will become available regarding home use of orthotic and prosthetic devices—from hours of wear, to activity levels during wear, to information about pressure points and more, says Lock. Because sensors can be attached to all types of devices, Lock notes that data can be aggregated about lower-tech devices as well as advanced prostheses and orthoses. Accumulating compliance data via sensors will enable more informed clinical visits and provide data to support current wear instructions. “From cranial orthoses to scoliosis braces to orthotic devices, these all could have compliance metrics, plus wear quality, and whether the user is getting the most out of the treatment.”

As more usage and outcomes data becomes available, “multiple sources” will be able to share data that will benefit patients and even facilitate machine learning from new algorithms, says Lock.

“Then we’ll be able to get trends and insights” beyond what’s been seen in the past. “For the first time, we can study things we might not even know we can study yet,” declares Lock.

In addition, new data will support—or perhaps contradict—current O&P standard operating procedures. “We generally have wellunderstood practice guidelines that suggest how long to wear and when to replace devices, among other things,” says Lock. More detailed and advanced data “will tell us whether our assumptions in past clinical evaluations were correct, or not.”

Personalizing Patient Care and Optimizing Documentation Practices

As facilities leverage increasing amounts of data, clinical practice is likely to become more effective and efficient, resulting in improved patient care, says Shane Wurdeman, MSPO, PhD, CP, FAAOP(D), vice president of scientific affairs at Hanger Inc. and a member of AOPA’s Board of Directors.

“Every piece of data, whether it is related to clinical outcomes or digitized processes, provides information that can be used to continue to innovate and improve patient care,” Wurdeman explains. “The challenge has always been decoding the underlying information, and it will no longer be just the larger healthcare systems and companies decoding information; advances in AI will help level the playing field for everyone.”

Rapidly expanding data pools will provide the basis for AI advances, Wurdeman asserts. “While AI will rapidly evolve in the next two to three years, the AI models will need to ‘learn’ from information, and the information is stored in the data,” he says. “The sooner organizations and individuals put processes in place to collect data, the better equipped they will be to ‘teach’ pertinent information to the AI.”

In addition, clinicians will be better informed when fitting patients with advanced devices that send information back to the clinician. “AI and machine learning will help O&P innovation leapfrog tremendously,” according to Wurdeman. “I expect to see devices have self-diagnostic capabilities to alert the care team of imminent device failure before it becomes a negative experience for the patient. Even for simple devices, we will have better awareness of imminent failure based on models constructed from similar devices manufactured through digitized processes, such as 3D printing.

“As a clinician, it is the impact AI will have on patient-care delivery that excites me the most,” adds Wurdeman. “I believe you will see treatment algorithms populated with specific devices that then predict the patient’s outcomes based on the treatment choices.” He anticipates clinicians will be able to instantly inform patients, for example, “about the difference in the predicted outcome related to their scoliosis management if the patient wears the device 20 hours per day versus eight hours per day,” using highly personalized information, “as the models and algorithms account for each unique patient phenotype.”

Shane Wurdeman, MSPO, PhD, FAAOP(D)

The Coapt system leverages machine learning to personalize the clinical benefit of an upper-extremity prosthesis.

Researchers Try Machine Learning to Improve Sensory Feedback, Phantom Limb Pain

Machine learning is playing a key role in the development of neural engineering at several institutions. At the University of Pittsburgh, for example, Associate Professor Lee Fisher, PhD, studies the development of neuroprostheses to restore sensory and motor function after neural damage and amputation—and machine learning has been central to his research. His work at the Rehab Neural Engineering Labs focuses on improving the functionality of prosthetic limbs and reducing phantom limb pain. “We’re using machine learning to narrow the space of parameters that we have to explore,” says Fisher.

“We try and restore sensory feedback from the missing limb,” Fisher explains, to help people do things it would be hard to do without sensory feedback. His team leverages electrical stimulation of the spinal cord to try and generate sensations in the missing hand or the missing foot, and then pairs those sensations with sensors on the prosthetic limb.

For upper-limb studies, “as the prosthetic hand grabs an object, we measure pressure in the fingers of the prosthesis, then we turn the stimulation up appropriately so that the person feels pressure in the missing hand,” he says.

For lower-limb prostheses, “as the foot makes contact with the ground, we have a sensorized insole in the shoe, and as

we measure pressure under the foot, we stimulate so that they feel pressure in their missing foot, and we look to see if we can improve the functionality of the limb,” Fisher says.

Fisher’s team also is trying is to reduce phantom limb pain. He points to a lack of scientific understanding of phantom pain, noting, “it seems like the loss of sensation after amputation plays a role in the development of that pain.” His team is investigating whether that pain is reduced with the restoration of some relevant sensory feedback—and has noted positive results so far.

“Every subject that has participated in our studies, and who came in with phantom limb pain, has reported reductions in pain when they have this sensory restoration,” he says. “It’s still very early days, but these are good initial results.”

Fisher is working on a brand-new study that involves an implantable high-channel count myoelectric recording system to improve hand function in people with transradial amputation. “It’s a device that has 32 channels of myoelectric recording, and it’s fully implantable,” he explains. After implanting the device under the skin in the forearm, leads are implanted into the muscles of the residual limb. “Those are used to record signals from those muscles as a person attempts to move their hand, and we use these to control the prosthesis,” says Fisher.

“For that study, as well as for the sensory feedback studies, we have to build a ‘map’ between the signals that we can record, and whatever the output is,” says Fisher. “So, in the case of sensory feedback, the output is the person’s perception of the sensation and how that relates to the stimulation parameters that we can control,” he says. “For the myoelectric system, it’s [relating] the signals we’re recording from their muscles to the control of the prosthesis.

“For all of these things, one of the approaches you can take is to use machine learning in the middle,” says Fisher. “The idea being, for the sensory feedback study: You stimulate with a variety of different parameters; the person reports what they’re feeling; and then you use machine learning as a way to learn what the relationship is between the stimulation parameters and what they perceive so that you don’t have to test every possible stimulation parameter. You can just test a subset of them, and then fill in the gaps with machine learning.”

For the myoelectric control project, “you have them attempt a variety of different movements,” says Fisher. “And while they’re doing that, you record those signals from the muscles in the residual limb, and then use machine learning to understand how those signals relate to the movements they’re attempting.”

Lee Fisher, PhD

Lenzi also believes that AI will be an integral part of personalizing and customizing prosthetics and orthotics. Patient data from microprocessor-controlled and sensor-embedded devices “will provide the foundation for future devices to more closely fit the different needs of each patient. I expect this AI-powered customization/ personalization of devices will have a big impact on how O&P practitioners think about fitting, alignment, and tuning.”

The NEJM article notes that the use of AI for reimbursements by the overall healthcare industry has become not only “an important tool for stakeholders to monitor one another, but also has been simplifying and reducing difficulty in the patient’s experience with medical payments.” Wurdeman hopes that trend catches on within O&P, and he foresees “great advancements” within O&P clinical documentation in conjunction with AI advances. “This is one of the more challenging elements of patient care and arguably an area that clinicians struggle with the most,” he says.

“The aid of AI in effectively documenting will help to ensure accurate treatment plans with good continuity of care across providers,” Wurdeman says. “I anticipate this accuracy and greater detail will help communication with payors, resulting in a smoother authorization process for all providers.”

Embrace Change—But Be Cautious

The possibilities of how AI will affect the profession seem endless. But it will be important to move slowly—and prioritize patient safety and security, according sources.

“AI has a huge potential to bring many benefits to prosthetics and orthotics. However, we must recognize and discuss potential challenges,” says Lenzi. “Data privacy, ethics, and accessibility are open challenges that the O&P field will need to address as AI becomes more and more prevalent.”

Wurdeman advises O&P professionals to get an AI education to fully understand its capabilities (and weaknesses)—and ensure they don’t unwittingly share protected health information. “It is valuable to remember that there are open and closed AI platforms. The open AI platforms, such as ChatGPT and Google Bard, will take any information that you enter and store it to continue to evolve and advance the models,” he says. “Uploading a document or asking a question that contains patient information is a breach of patient privacy. “

Additionally, “sharing intellectual property or strategic practices through similar means will become part of the underlying information that could subsequently serve as a response to a different person’s inquiry,” Wurdeman says. “Responsible use of these platforms will ensure success without compromise.

“Embracing change can be daunting, but it is a crucial step for growth and sustainability,” he continues. “Every major shift in technology has brought along concerns, but also enormous opportunities, and the facilities that adapt and learn to use these emerging technologies effectively are likely to thrive.”

Rethinking Research and Development

Big changes are coming to O&P research initiatives, with AI advances influencing how investigations are carried out, says Lock. Current O&P research practices involve immense time commitments from both researchers and subjects, which limits the number of study subjects involved and the scope of investigations.

In typical O&P investigations today, “we bring people into the clinic on several occasions, watch them, and video-record” their movement or actions, explains Lock. In the future, “we can do those tests while people are at home, just living their life—and it’ll be better data” because it will offer a more accurate representation of subjects’ daily activities in their home environment. That means investigations could potentially involve a greater number of subjects and require fewer researchers to complete.

Lock also predicts that device manufacturers will collect and clinically share de-identified data so that similar style users of similar ages of a given device will have benchmarks and trends for comparison purposes. Manufacturers that collect data from several facilities that deliver their products will be able to “provide back to facilities best practices with that particular device,” Lock says. “The general excitement and eagerness among many manufacturers are quite high” because “the power of that data will be immense. But we can’t release it until we can do it right,” in a secure and compliant way.

Wurdeman encourages O&P professionals to remember that AI will augment human skill, not replace it. “At the center of what we do is providing care for humans,” he notes. “When an individual has their leg amputated, it won’t be ChatGPT or Google’s AI, Bard, holding their hand and helping them walk again. It will be the programs running on these AI platforms that will help the clinicians providing that personal care to be more effective and efficient in their jobs— ultimately helping improve patient outcomes and goals.”

As use of AI and machine learning becomes more mainstream, Jordan predicts O&P will become less of an art and more of a science. Ensuring the most appropriate fit, for example, will be easier when more information is available, so new technologies will lead to better-fitting prostheses—and less prosthesis abandonment, he says. “It will take some of the ‘art’ out of the space, and give people data. But remember: An artist with more information will be a better artist.”

Jordan encourages clinicians to consider AI as one more tool in the O&P toolbox. “It doesn’t have to be a threat,” he says. AI can be leveraged to brainstorm and give information—the clinician may be able to reference AI or an information database and machine learning “to get to hypotheses quicker.”

“Everyone who is involved in patient care should be exploring and learning everything about AI that they can,” adds Wurdeman, “to position themselves for success as it becomes a more integrated part of our daily lives.”

Christine Umbrell is a contributing writer to O&P Almanac. Reach her at cumbrell@contentcommunicators.com

READY FOR A RESET?

A flexible, positive approach helps businesses not only bounce back from challenges but spring forward

BY MICHAEL COLEMAN

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f O&P facilities should focus on elevating the profession by making clinical and business changes to position O&P clinicians as essential care providers in a modern healthcare environment.

f O&P business leaders should highlight the clinical care and cognitive decision making provided by prosthetists and orthotists as well as positive patient outcomes, rather than extolling the devices they fit on patients.

f Facilities will benefit as their clinicians become savvier at documenting, publishing, and otherwise explaining to healthcare policy makers and payors how much time and skill is required to provide high-quality O&P care.

f O&P stakeholders are pushing for changes to the current device-focused O&P reimbursement system in favor of a system that more closely resembles how physicians are paid for their work. This is particularly important given the growing use of high-tech devices that were created after the L-code system was implemented, including osseointegrated prostheses.

f More facilities are collecting data that demonstrates positive patient outcomes, building an “evidence base” that supports the value of O&P intervention.

f Prosthetists and orthotists should collaborate with O&P clinicians at other facilities and draw inspiration from knowing that O&P is an incredible profession that impacts patients and their families in an extraordinary way.

There’s a lot to worry about these days. Inflation. Recession. Climate change. Political polarization. The list goes on. For business leaders, it can be harder than ever to keep employees—and themselves—engaged, focused on the positive, and working together to accomplish goals.

At AOPA’s leadership conference in Savannah, Georgia, earlier this year, some panels explored the many challenges facing the industry, but one in particular saw distinguished O&P industry leaders more focused on the opportunities that lie ahead by being adaptable and rethinking what it means to offer O&P care in a modern healthcare environment. The discussion touched on the benefits of boosting collaboration and collegiality among professionals, the importance of collecting clinical evidence and sharing it with others, the incentives for documenting clinical time to payors, and the professional respect that accrues when O&P professionals conduct their business more like other practitioners the healthcare field.

The panel also explored ways to distinguish O&P from durable medical equipment, recognizing that the services and care provided by O&P professionals far exceeds that of mere equipment providers—an essential distinction that the industry has been struggling with for years. It’s time, they said, for industry leaders to help prepare their teams to make clinical and business changes to effectuate this shift. If executed with intelligence and savvy, it could have a dramatic and positive impact on the bottom line of O&P practices nationwide.

Focusing on Outcomes

“We, as a profession, frankly, must be defined by the outcomes that we provide, not the products that we deliver,” said Jim Campbell, PhD, CO, FAAOP, senior vice president and chief clinical officer of Hanger and AOPA past president. “If I’m a clinician, if I’m an orthotist or a prosthetist, that’s where my job begins. Some of these philosophical differences are things that we need to think about and embrace.”

Benjamin Clark, CPO, owner of Eastside Orthotics and Prosthetics, agreed. “I’m providing an intervention—I don’t provide products—the product is part of my intervention,” he said. “The intervention looks very different than just a product. It’s education, it’s helping with family support, it’s that follow-up treatment, it starts and stops at multiple places.”

One concrete way to differentiate O&P professionals from those who sell durable medical equipment, is by demonstrating it. That means meticulously documenting the work, according to Doug Smith, MD, a physician and professor in the Department of Orthopedic Surgery and Sports Medicine at the University of Washington

in Seattle, and a member of the AOPA Medical Advisory Board. He practiced orthopedic trauma and helped run the amputation limb salvage service at Harborview Medical Center for nearly three decades. Smith said O&P practitioners are underestimated relative to the expertise and skill they bring to their jobs.

“Most people outside of the O&P profession do not really know the time, intensity, and skill that are involved in how you treat your patients … the cognitive decision making, the hands-on skill of fabrication and alignment, and your skill in educating your patients,” Smith explained.

To shift the mindset of the payors and the public at large from thinking of the profession as, essentially, product dispensers, O&P professionals should study how physicians and other healthcare professionals get paid for their work.

“With physicians and therapists, we have evaluation and management codes, and we have procedure codes,” he explained. “If someone comes in with a hip fracture, I do an evaluation and management, and I bill one code. I bill for the treatment of that hip fracture with another code. Those two codes cover my pre-op evaluation, my decision making for surgery, the surgery, the inpatient care, and coordinating care for three months after I do that surgery.

“And it is independent of whether I use a plate and screw or any arthroplasty,” Smith continued. “It is not tied to a device.”

O&P practices would benefit if their clinicians became savvier at documenting, publishing, and otherwise explaining to healthcare policy makers and payors how much time and skill is required to provide high-quality O&P care. “You really need to educate them about how long it takes, how long you spend with patients and their families,” Smith said. Two ways to do that are documenting in technical journals and having residents or other office staff record and upload highly detailed videos to YouTube, with patient permission in accordance with HIPAA requirements, demonstrating the painstaking and exacting nature of the work.

“You need to get the information out to the world of how complex it is to treat patients,” Smith said. “I think the number of people, whether they’re physicians or therapists, that really get it is very few.”

Kimberly Hoyt, CP, co-founded BioDesign with her husband, Chris Hoyt, CP, and the company merged with Rise P&O in 2022. The couple now runs one of the only civilian osseointegration programs in the United States, providing cutting-edge transcutaneous osseointegration (OI) prosthetic care. The highly complex procedure, which connects the living bone and load bearing implant, offers a new opportunity to help reframe O&P care in the eyes of payors, according to Hoyt.

Doug Smith, MD

Jim Campbell, PhD, CO, FAAOP

WE'VE GOT YOUR BACK

“The difference now is we don’t have what they model the whole L-code system around—a socket,” she said. Because of this, providers working with OI patients are laser-focused on providing high-quality care, which can take more than 30 hours, according to Hoyt.

“We have nothing but a 5999 right now to work with,” she said of the current coding for reimbursement situation for OI. “We have used the philosophy that it is similar to a base code of a prosthesis because … [it] includes all of your time, your measurement, your task and your evaluation, your fabrication, your dynamic and static alignment, and finishing.”

Although OI has been available in other parts of the world for decades, its novelty in the United States means that orthopedic surgeons also are using a miscellaneous code when submitting to payors, according to Hoyt. “We need to prove the power of O&P versus DME, and why our professional service is so important to this group.

“These people are bone anchored to their prosthetic foot, so we need that professional time, and you can’t squeeze us,” Hoyt explained. “If we need to do this in 15 minutes, well, we’re going to put the patient at risk, and if it goes bad, it can get really bad. It’s not stumbling and breaking a prosthetic foot; it’s a trip back to a surgeon.

“We need to do this right, and we need to be compensated for the time involved to keep the patient safe,” Hoyt continued. “And we have an opportunity here to demonstrate that.”

Beyond convincing the payor system to adapt its thinking, O&P leaders may need to manage the outlook and cohesion of internal teams to embrace OI and other new technologies for long-term resiliency. Some certified prosthetists fear osseointegration prosthetic care could chip away at their more traditional business models, despite the fact that OI is applied to fewer than 1% of patients requiring prostheses, almost exclusively those for whom traditional sockets are unhelpful.

“It’s a tool, another tool in a toolbox,” Hoyt explained. “It’s time to recognize that this [technology] is here to stay. I think we need to grasp this opportunity … keep moving forward and embrace the new technology.”

Demonstrating Value and Embracing a Shared Message

Another way to help build a stronger public case for the value of the specialized and exacting work of providing care for O&P patients, and to help colleagues within the profession, is to document and share clinical outcomes.

“Seven years into this, one of the things that’s very, very obvious is that our patients place a tremendous amount of importance on not being told how well they’re doing, but being shown how well they’re doing” using the data Hanger collects, said Campbell.

Campbell says his team has published 32 manuscripts in the past four years. “It’s not about necessarily the data that … myself and others aggregate, and it’s not necessarily about the information we publish,” Campbell said. “It’s how that clinical outcome is being used in the clinic room to modify and change an individual’s care.” The foundation of all that evidence data is based on individual outcome measures, which can be aggregated to detect patterns.

“I think ultimately what we need to talk about is evidence, and developing our own evidence base,” Campbell said. “Find a way of contributing to the development of our evidence base. And I think every clinician in the room, every industry colleague in the room has an opportunity to do that, because ultimately your salvation is going to be your evidence base, not necessarily the technical quality of our product.”

Reframing preconceived notions and simply being more communicative and collegial to one another and allied healthcare professionals goes a long way in elevating the profession and building durable individual practices, according to Clark.

See why using Spinal Technology delivers positive outcomes.

Providence Nocturnal Scoliosis® Orthosis

Full-Time Scoliosis Brace

“In Oregon, and I’m probably sure it’s true in the rest of the country, O&P clinics aren’t very nice to each other,” and some may even discredit others. But he’s come to realize that “that is really doing a huge disservice to us as a whole.”

Eastside Orthotics and Prosthetics focuses primarily on upperlimb prosthetic care, but Clark occasionally receives calls from patients needing a scoliosis brace or other care that might not be in his wheelhouse. He typically refers those potential patients to other practitioners.

“Prosthetics and orthotics [intervention] take a long time, and you’ll probably be going back to that clinic for years, if not the rest of your life, so why not find the place that’s actually economically and physically appropriate to get to? That’s how we’re all going to raise the boats—actually referring our colleagues, not our competitors —when it makes sense for that patient to go there,” he said.

Clark also suggested that clinicians socialize with each other more often. “You’re going to hear ideas you probably haven’t thought of and maybe try different things in your clinic,” he said. “Viewing each other as colleagues and not competitors, irrespective of the size of your practice, is critically important.”

What’s equally critical, in Clark’s estimation? Extending that same collaborative attitude to numerous specialists who are

involved in your patients’ care. “We have a huge amount of time with the patient—more than most of the other care providers. We need to open up the dialogue and say, ‘If you’re seeing this, could you please reach out to me?’”

He offered the example of how he proactively sent his notes to a patient’s physician: “And guess what? The doctor sent me all their notes right back. I don’t have to request medical notes from some of the providers because after they see my patient, they know that I send them my notes and they send me theirs—just shows up in my fax machine.

“Differentiation comes from a change in the narrative: We don’t have competitors, and we’re definitely not vendors,” he said.

When speaking to O&P students, Smith likes to remind them they have committed to an amazing and rewarding profession that is changing dramatically.

“I remind them that they are healthcare professionals and that they should act the part,” Smith said. “Act the part, teach the world what you do, and enjoy what you do. Because it is an amazing, incredible profession, and the way you impact patients and families is superb. And so to be a healthcare provider, act like a healthcare provider, document like a healthcare provider. Look at how your peers document code, and start moving in that direction.”

US Pat. # 8088320 Inventor: Gary G. Bedard

Michael Coleman is a contributing writer to O&P Almanac Reach him at mcoleman@contentcomomunicators.com.

Benjamin Clark, CPO

The Exhibit Hall at the 2023 AOPA National Assembly will showcase all of the latest O&P technologies, products, and services from an international array of manufacturers and innovators. As clinicians, business owners, educators, researchers, manufacturers, and stakeholders from across the O&P spectrum unite Sept. 6-9 in Indianapolis—“the Crossroads of America”—the Exhibit Hall serves as the central meeting ground. Plan to spend several hours navigating the trade show floor, catching up with enterprising O&P professionals, and viewing the latest and greatest in O&P innovation.

Start off your Assembly experience by attending the Welcome to Indy Reception on Wednesday, Sept. 6, from 5:30 to 7:30 p.m. In addition to walking the trade show floor for the first peek at this year’s exhibits, you’ll also experience the “Team Up & Tailgate Exhibitor Contest.” Booths will be decorated in the themes of exhibitors’ favorite sports team—walk the aisles and see if your go-to team is represented, and vote via the mobile app regarding which exhibitors had the most “team spirit”! Plus, members of the Indiana University Wheelchair Adaptive Team will visit the reception and offer attendees the opportunity to try out a chair and shoot some hoops!

Wednesday night also marks the start of the GO! Scavenger Hunt. Make sure to sign up for this exciting event. The hunt will run through Friday at 1 p.m., so you’ll have plenty of time to earn points and possibly win a goodie bag!

Exhibit Hall Hours

Make your way to the Exhibit Hall during breaks throughout the Assembly to meet up with old friends and network with future partners. After the morning general sessions on Thursday and Friday, enjoy a beverage during the networking icebreakers. Grab a cup labelled with the conversation topic you are most interested in—for example, Advocacy, O&P Digital Care, Research, Clinical Care, and more. And be sure to enjoy the famed Happy Hour in the Exhibit Hall on Thursday, Sept. 7, at 5 p.m. This pub crawl-style event will have an interesting turn at every aisle, and you’ll have a chance to partake in the remotecontrol race car challenge.

Don’t Miss These Special Events in the Exhibit Hall

Welcome to Indy Tailgate Party

Wednesday, Sept. 6 5:30 – 7:30 p.m.

Happy Hour in the Exhibit Hall

Thursday, Sept. 7 5 – 6:30 p.m.

Networking Break

Thursday, Sept. 7, & Friday, Sept. 8 9 – 10:30 a.m.

Lunch in the Exhibit Hall

Thursday, Sept. 7, & Friday, Sept. 8 Noon – 2 p.m.

Lunch Service will be via Concession Stands located in the Exhibit Hall. You will receive a Lunch Card to use each day.

With so many special events slated for this year’s AOPA National Assembly, plan to set aside several hours to browse the Exhibit Hall aisles, meet with representatives from exhibiting companies, and interact with thousands of O&P stakeholders from across the world. Keep these O&P Almanac pages handy as you navigate the conference.

MISS A SESSION? CAN’T MAKE IT TO INDIANAPOLIS?

That’s OK—if you miss a session you wanted to attend, or if you cannot travel to Indianapolis for the 2023 AOPA National Assembly, AOPA will bring the education to you—virtually—starting Sept. 20 and ending Nov. 20. Learn on your own schedule!

2023

TITLE SPONSORS

Sponsors preview their exhibits for the AOPA National Assembly

DOUBLE DIAMOND SPONSOR

PLATINUM SPONSOR

Alps South

Booth 601

Area of Specialty: Prosthetics

St. Petersburg, Florida easyliner.com

We’re excited to share our newest and most advanced prosthetic solutions! We have a wide variety of high-quality, innovative product offerings that cater to your patients’ specific needs, from liners and sleeves to the unique BioStep™ prosthetic foot range. Our products offer exceptional comfort, support, and mobility, giving your patients the confidence to tackle their daily activities with ease. We’re confident that our range of prosthetic solutions will not only help your patients experience the best quality of life possible but also help you save on costs and grow your business. Visit Booth 601 to uncover the ALPS Value!

Össur Americas

Booth 301 & 401

Area of Specialty: Prosthetics and bracing and supports Irvine, California ossur.com/en-us

Össur Americas has entered a New Era of possibility with next-generation, simple-to-use orthotic and prosthetic products, providing innovative functionality.

Come visit and chat with our clinical specialists, product champions, and prosthetic and bracing pit crew members to learn how Össur can support your practice, while offering you the tools to create custom patient solutions that will have you racing toward success.

We’ll be demonstrating new bionic and mechanical products like the waterproof Proprio Foot, Power Knee, i-digits 4-site control, and the Pro-Flex family. We can’t wait to see you at the starting line!

GOLD SPONSORS

American Board for Certification in Orthotics, Prosthetics, and Pedorthics

Booth 824

Area of Specialty: Healthcare certification and accreditation

Alexandria, Virginia abcop.org

We are celebrating our 75th anniversary! Attendees can take part in special giveaways, treats, and more as we celebrate this important milestone together. Plus, we are available to answer any questions attendees might have about our programs, including our WhatIsPOP Career Awareness Initiative.

Board of Certification/ Accreditation

Booth 633

Area of Specialty: Credentialing (accreditation and certification)

Owings Mills, Maryland bocusa.org

BOC offers highly valued credentials in the fields of orthotics and prosthetics, including accreditation for O&P practices and certification programs for orthotic and mastectomy fitters. Additionally, BOC certifies 2,000 orthotists, prosthetists, and pedorthists. We believe every aspect of your experience should be meaningful, efficient, and smooth. Our award-winning team of experts is committed to ensuring you are informed and prepared for every step toward achieving credentials for yourself or your business. Visit our booth to learn more about the BOC difference and how we can help with your credentialing needs.

Cailor Fleming Insurance

Booth 507

Area of Specialty: Insurance for the O&P industry

Boardman, Ohio cailorfleming.com

Cailor Fleming has been working with and supporting the O&P community for more than 25 years. Come visit Tom and Don and talk about our new cyber and health insurance policies available to O&P facilities.

Spinal Technology Inc.

Booth 619

Area of Specialty: Custom spinal orthoses

West Yarmouth, Massachusetts spinaltech.com

Spinal Technology Inc. is the global leader in the design and custom fabrication of spinal orthoses, for the stabilization, the immobilization, and the correction of various abnormalities of the spine. Specializing in the treatment of adolescent idiopathic scoliosis, we employ the latest technologies and methods for treating each and every patient. We are “Driving Innovation” around the curve into 2024 with new technology that improves patient compliance.

Stop by Booth 619, try your luck at the prize wheel, or talk to our team and learn how decades of experience and quality products made in the USA will improve your patients’ lives.

SILVER SPONSORS

Allard USA

Booth 337

Area of Specialty: Carbon composite AFOs Rockaway, New Jersey allardusa.com

Assembly attendees should visit Allard USA’s booth because we are excited to introduce our new SmartFAB facility as well as a new product being released in the prosthetic side of our business.

Limb Loss and Preservation Registry

Booth 333

Area of Specialty: Collaborative data hub for those with limb preservation and congenital and acquired limb loss and limb difference

Alexandria, Virginia llpregistry.org

The Limb Loss and Preservation Registry (LLPR) is the first collaborative data hub of its kind that brings together hospitals and O&P practices to serve the acquired and congenital limb difference community. Data from these two resources combined creates longitudinal care records for patients that have never been seen before. Data analytics from the LLPR empower practitioners to mobilize patients by engaging them in managing their own care. Using this powerful tool, healthcare professionals, insurance companies, and patients embark on a new era of personalized care, fueled by comprehensive data transformed into information to propel progress in the O&P industry.

O&P Almanac

Booth 901

Area of Specialty: O&P news and information

Alexandria, Virginia aopanet.org/publications/op-almanac-magazine

AOPA and O&P Almanac staff look forward to connecting with Assembly attendees and learning what’s top-of-mind for today’s O&P professionals. The O&P Almanac booth will feature current and past issues of AOPA’s O&P Almanac magazine. Stop by to pick up a copy and learn about earning continuing education credits by reading.

Stay up to date on the latest AOPA 2023 National Assembly information by visiting aopaassembly.org.

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2023 EXBHITOR DIRECTORY

On the following pages is a look at the companies exhibiting at the 2023 AOPA National Assembly. You’ll find company names, booth numbers, and website information for each exhibitor. Use this guide to get to know this year’s exhibitors and plan your visit to the Exhibit Hall. Visit aopaassembly.org for full exhibitor details.

Acor Orthopaedic LLC

Booth: 733 acor.com

Adapttech

Booth: 1001 adapttech.eu

Aether Biomedical Booth: 927 aetherbiomedical.com

Alternative Prosthetic Services Inc. Booth: 1101 alternativeprosthetics.com

American Academy of Orthotists and Prosthetists

Booth: 833 oandp.org

American Prosthetic Components LLC

Booth: 312 americanprostheticcomponents.com

Amoena

Booth: 924 amoena.com/us-en

Amputee Coalition

Booth: 325 amputee-coalition.org

Anodyne Booth: 729 anodyneshoes.com

Allard USA

SILVER SPONSOR

Booth: 337 allardusa.com

AllClaim by Ottobock

Booth: 801 shop.ottobock.us

DOUBLE DIAMOND SPONSOR

Alps South LLC

Booth: 601 easyliner.com

GOLD SPONSOR

American Board for Certification in Orthotics, Prosthetics, & Pedorthics Booth: 824 abcop.org

American Breast Care Booth: 639 americanbreastcare.com

American Central Fabrication Booth: 1107

u American Limb & Orthopedic Co. Booth: 926 AmericanLimb.com

American Orthotic & Prosthetic Assn. (AOPA) Booth: 901 aopanet.org

Apis Footwear Co.

Booth: 732 emeys.com

Arize by HP

Booth: 635 arizeclinical.com

ARTech Laboratory Inc.

Booth: 738

artechlab-prosthetics.com

Aspen Medical Products

Booth: 110 aspenmp.com

Becker Orthopedic Appliance Co.

Booth: 714 beckerorthopedic.com

Exhibitors as of August 14, 2023

u = New Exhibitor for 2023

Bold = Member of AOPA

AM ORTHOTIC & PROSTHETIC ASSN - NATL ASSEMBLY

INDIANA CONVENTION CENTER - LEVEL 1 - INDIANAPOLIS, IL

u BILLY Footwear

Booth: 119 billyfootwear.com

u Bionic Power Inc.

Booth: 125 bionic-power.com

u BionicM Inc.

Booth: 224 bionicm.com/en

BioSculptor Corp. Booth: 832 biosculptor.com

Blatchford Booth: 715 blatchfordus.com

BLUEWAVE Technologies

Booth: 123 clinic.mybluewave.com

GOLD SPONSOR

Board of Certification/Accreditation (BOC)

Booth: 633 bocusa.org

u Bowman Medical International Booth: 932 bowmanmedicalinternational.com

BrainRobotics

Booth: 327 brainrobotics.com

Bulldog Tools Inc. Booth: 519 bulldogtools.com

GOLD SPONSOR

Cailor Fleming Insurance Booth: 507 cailorfleming.com

Cascade Orthopedic Supply LP Booth: 513 cascade-usa.com

CBS Medical Billing & Consulting LLC Booth: 913 cbsmedicalbilling.com

Click Medical Booth: 113 clickmedical.co

Coapt LLC Booth: 212 coaptengineering.com

College Park Industries Booth: 201 college-park.com

Comb O&P Booth: 919 combscan.com

Comfort Products Inc.

Booth: 500 comfortoandp.com

u Coretech Orthopedics

Booth: 532 coretechortho.com

Coyote Prosthetics & Orthotics Booth: 219 coyote.us

Curbell Plastics Inc. Booth: 329 curbellplastics.com/materials/industries/ orthotics-and-prosthetics

Cypress Adaptive Booth: 104 cypressadaptive.com

Danmar Products Inc. Booth: 928 danmarproducts.com

DAW Industries Inc. Booth: 803 daw-usa.com

DME MAC Medicare Contractors Booth: 1115 cgsmedicare.com

Dr. Comfort, an Enovis Co. Booth: 622 enovis.com

u EastPoint P&O/Advanced3D/GesPodo Booth: 933 adv3dinc.com

Elevate Movement Booth: 1028 elevatemovement.com

Ethnocare Booth: 526 ethnocare.ca

u Fabco Prosthetic Designs Booth: 115 fabcoprostheticdesigns.com

Fabtech Systems

Booth: 1013 fabtechsystems.com

Fillauer Booth: 101 fillauer.com

FIT360 Ltd. Booth: 1117 FIT360Ltd.com

FLO-TECH® Orthotic & Prosthetic Systems Inc. Booth: 1105 1800FLO-TECH.com

Formlabs Booth: 1112 formlabs.com

Friddle’s Orthopedic Appliances Inc. Booth: 124 & 225 friddles.com

Grace Prosthetic Fabrication Inc. Booth: 524 gpfinc.com

Hanger Inc.

Booth: 725 hangerclinic.com

HiTek Fabrication

Booth: 1019 hitekfab.com

HP 3D Printing Booth: 533 hp.com/us-en/printers/3d-printers.html

SpinalStabilization The 7Cs

Impulse Technology

Booth: 222 impulse-technology.com

u Indiana Association of Orthotics and Prosthetics (IAOP)

Booth: 736 linkedin.com/groups/14009035

Infinite Biomedical Technologies

Booth: 109 i-biomed.com

Integrum Inc.

Booth: 422 integrum.se

International Institute of Orthotics and Prosthetics (IIOP)

Booth: 709 iiofoandp.org

Invent Medical USA LLC

Booth: 907 inventmedical.com

JF Enterprises Inc. Booth: 1020 celiaruizusa.com

u Juzo

Booth: 1018 juzousa.com

Kinetic Research Inc.

Booth: 208 kineticresearch.com

KISS Technologies LLC

Booth: 828 kiss-suspension.com

u Landis International Inc. Booth: 1103 info@landisinternational.ca

LaunchPad O&P

Booth: 213 launchpad-op.com

SILVER SPONSOR

u Limb Loss and Preservation Registry Booth: 333 llpregistry.org

Lindhe Xtend Inc.

Booth: 418 lindhextend.com

Lubrizol 3D Printing Solutions Booth: 628 lubrizol.com/3D-Printing/Markets/ Healthcare/Orthotics-and-Prosthetics

Martin Bionics

Booth: 626 martinbionics.com

MD Orthopaedics Booth: 121 mdorthopaedics.com

Mecuris GmbH Booth: 920 mecuris.com/en

Mile High Orthotics Lab Booth: 936 mholabs.com

MONETEK Booth: 1012 monetek.com

u Mosaic Mfg. 3D Printing Booth: 537 mosaicmfg.com

Naked Prosthetics

Booth: 218 npdevices.com

NCOPE Booth: 826 ncope.org

u Neuro Rehab Recovery Booth: 823 neurorehabrecovery.com

New Step Orthotic Lab Inc.

Booth: 900 newsteporthotics.com

u Northwestern University ProstheticsOrthotics Center (NUPOC)

Booth: 108 nupoc.northwestern.edu

u NuTech Synergies LLC

Booth: 1001 nutechsyn.com

Nymbl Systems

Booth: 307 nymbl.healthcare

u O and P Booth: 1032 oandp.com.mx

SILVER SPONSOR

O&P Almanac Booth: 901 aopanet.org

O&P Insight

Booth: 1014 oandpinsight.com

O&P 1 Fabrication-OPOS 1

Booth: 735

Onesource - Bionic Booth: 739 bionicpo.com

OPIE Software

Booth: 813 opiesoftware.com

Orfit Industries America

Booth: 821 orfit.com

OrthoFeet Inc.

Booth: 523 orthofeet.shoes

Silicone Prosthetics to Restore the Original Appearance

Custom fitted for the ultimate patient comfort.

Custom sculpted, in great detail, to the mirror image of the sound extremity.

Traditional prostheses have been fabricated primarily to restore function with little emphasis on the aesthetic appearance. ARTech's natural looking restorations are virtually undetectable.

ARTech silicone prostheses can improve gait and posture, ease lower back pain, relieve pressure on bone spurs and other sensitive areas, protect the tissue from further injury, improve the operation of myoelectric hands, etc.

When a restoration has a natural appearance, sculpted and painted to match the opposite limb, as opposed to the robotic or mannequin look of traditional prostheses, utilization by the patient is maximized.

Orthomerica Products Inc.

Booth: 819 orthomerica.com

Orthotic & Prosthetic Group of America (OPGA)

Booth: 405 opga.com

Orthotic Holdings OHI Booth: 206 ohi.net

u Orthotica Labs Booth: 323 orthotica.com

OssKin Ortho Inc.

Booth: 528 osskin.com

u Pro Armour Booth: 215 pro-armour.com

Pro-Tech Orthopedics Booth: 118 protech-intl.com

PROTEOR Booth: 625 proteorusa.com

u Sanford Health Booth: 424 sanfordhealth.org

u Shining 3D Technology Inc. Booth: 536 shining3d.com

PLATINUM SPONSOR

Össur Americas Inc.

Booth: 301 & 401 ossur.com/en-us

Ottobock

Booth: 701 shop.ottobock.us

Paceline Inc. Booth: 100 paceline.com

Pacific Medical Booth: 1034 topshelfortho.com

PEL LLC Booth: 807 pelservice.com

u Pés Sem Dor Booth: 734 pessemdor.com.br

Point Designs Booth: 107 pointdesignsllc.com

Protosthetics Booth: 534 protosthetics.com

Prudential Billing & Consulting Booth: 319 prudentialbilling.org

PSYONIC Inc. Booth: 114 psyonic.io

PVA Med Booth: 834 pvamed.net

Renia GmbH Booth: 825 renia.com

Roboticom Booth: 1024 roboticom.us

Rodin4D Booth: 427 rodin4d.com/en

Royal Knit Inc. Booth: 321 royalknit.com

Spentys Booth: 1111 spentys.com

GOLD SPONSOR

Spinal Technology Inc. Booth: 619 spinaltech.com

SPS Booth: 501 spsco.com

ST&G USA Corp. Booth: 419 stngco.com

SteeperUSA Booth: 618 steeperusa.com

Steps of Faith Foundation

Booth: 727 stepsoffaithfoundation.org

u Structure

Booth: 435 structure.io

Surestep Booth: 411, 318 surestep.net

Tamarack HTI

Booth: 615 tamarackhti.com

Techmed 3D Inc. Booth: 425 techmed3d.com

The Bremer Group Co. Booth: 439 bremergroup.com

Thermo-Ply Inc. Booth: 827 thermoplygel.com

Thrive Orthopedics

Booth: 433 thriveorthopedics.com

Thuasne USA/Townsend Design

Booth: 313 thuasneusa.com

u Tianjin Tairuibosi Medical Appliance Co. Ltd. Booth: 221 trbsorthosis.com

Tillges Technologies Booth: 923 teamtillges.com/technologies

TriOx Innovations Booth: 837 cleanwithross.com

Turbomed Orthotics Booth: 426 turbomedorthotics.com

Ultraflex Systems Inc. Booth: 122 ultraflexsystems.com

Victoria Hand Project Booth: 111 victoriahandproject.com

Vorum Booth: 719 vorum.com

WillowWood Booth: 207 willowwood.com

Xtremity Booth: 527 xtremity.com

u Xyken/SnugFit Solutions

Booth: 322 xyken.com

Uneven Terrain

How Jackie Bailey, CP, assisted a below-knee patient in navigating the ups and downs of rehabilitation—and the dozens of steps in between

The rehabilitation journey can seem overwhelming for any patient with a new lower-limb amputation. But when that patient lives in a house with 18 stairs just to get to the front door, the situation can seem especially formidable. Fortunately for Nelson Eads, a 61-yearold radio show host who lost his right leg below-the-knee after suffering a diabetic ulcer, he was treated by Jackie Bailey, CP, clinical director at EastPoint Prosthetics & Orthotics. Bailey’s years of clinical experience, and EastPoint’s mobile model of O&P care delivery, helped to guide Eads’ new path to mobility.

Bailey first met Eads in a nursing home following his amputation in 2021. Eads, sole caretaker for an adult daughter with cystic fibrosis, “wanted to get back to work and back to his daughter,” Bailey recalls,

but he was concerned he wouldn’t be able to return to his normal daily activities, and he was less than optimistic about his future. Bailey not only fit him with appropriate componentry to return to an active lifestyle, she also helped him adopt a positive outlook.

Going From Dynamic to Sedentary—and Back

Prior to his amputation, Eads worked fulltime in a rural area as a radio show host and spent his free time with his daughter. Community-minded by nature, he enjoyed riding his motorcycle with a group that rides to raise awareness of different issues, says Bailey. Two years ago, he developed a diabetic ulcer on his foot that wouldn’t heal despite several trips to wound care specialists.

In each issue of O&P Almanac, the Transformations column features the success story of an O&P clinician who has worked with an inspiring or challenging patient. This month, we speak with Jackie Bailey, CP, who helped a patient with diabetes return to his job and caretaking duties after a lower-limb amputation.

Jackie Bailey, CP

Bailey fit Nelson Eads, who underwent lower-limb amputation after suffering from a diabetic ulcer, with a prosthesis that allowed him to easily traverse 18 steps just to get to his front door.

Because he didn’t have any support at home, the amputation came as a shock to Eads. His normally positive and upbeat personality shifted: “He was pretty somber when I met him,” recalls Bailey. Eads worried he wouldn’t be able to return to his responsibilities with his daughter at home or to his well-loved job. The thought of even navigating the steps necessary to enter his house was discouraging.

“It was really tough” during their first couple of appointments, recalls Bailey. She traveled to the nursing home for the meetings to explain how a prosthesis could play an important role in helping him return to his life. He “showed up every day for rehab,” says Bailey. After two weeks of therapy, “a switch flipped” for Eads, and he overcame his mental hurdle; his optimistic personality returned. “He started to own the fact that he would return home.”

Bailey fit Eads with his first prosthesis in December 2021, and she continued to travel to Eads’ locations for his appointments. Unfortunately, Eads’ insurer denied coverage for the advanced foot prosthesis Bailey believed was appropriate; it covered only a basic SACH foot. “That was disheartening because he walks on a lot of different terrains,” as evidenced by the grass and gravelly slopes near his home, “and he needed a more adaptable prosthesis,” she says. Bailey eventually made the basic SACH foot work, combined with a carbon-fiber traditionally laminated socket.

Eads quickly learned to walk using the basic prosthesis and made significant prog ress in his mobility. Soon, he returned to work—a feat in and of itself because his office is on the second story of an old build ing with a narrow 26-step staircase to the second floor.

Even more remarkable, Eads traveled to Hawaii for a work event just six months after receiving his prosthesis. He was able to navigate the beach and complete all of his tasks as a radio host. “Before he left [to go to Hawaii], he was prepared to be in a wheelchair if he had to be—but he found he was able to be fully independent, including getting on and off crowded planes and navigating the airport.”

Lower anterior trim line for sitting comfort

Anatomically side specific

Smooth sockets clean in seconds with antiseptic wipes

Dynamic size variation allows assimilation for actual limb volume reduction

Additional rigid posterior support creates more effective access for attentive wound care & weight distribution.

Corresponding universal frame outer socket (UFOS ) allows the addition of knee & pylon system

Eads appreciated the prosthesis, but he still tired easily while wearing it, and some activities remained difficult using the basic device.

Upgrading—and Speeding Up

Recently, Eads switched insurance companies and has since been fit with a more appropriate device—a multijet-fusion 3D-printed socket made of light, strong materials and a multiaxial dynamic response foot. As an added bonus, the socket features a Beatles logo selected by Eads—a devoted fan of the band. “The new foot is much better for all of the terrains and activities” Eads navigates, Bailey says.

The light weight of the new prosthesis has been a game changer. “The first time he wore it, he immediately took off dancing and jogging in the hallway,” Bailey says. “He told us he feels like he has his leg back—that the prosthesis is part of him.”

To ensure coverage of the more dynamic device once he switched insurers, Bailey and Eads worked closely with his primary care doctor, requesting that he conduct a new evaluation and document—very explicitly—what Eads required to complete his activities of daily living. “They documented how fatigued he got,” as well as the fact

that his skin tissue broke down very easily because he is diabetic. “Collaborating with the doctor” was an essential part of the approval process, she says.

With the new foot, “he has returned to normal life,” says Bailey, and is even tackling activities he had abandoned preamputation, when his foot ulcer became troublesome. Eads has returned to getting up in front of crowds at concerts, and even joining in mosh pits, according to Bailey. “He did not feel strong or able with the old foot, but now he can” engage in his favorite activities as a radio host.

Staying Strong

Bailey’s success in working with Eads is due in part to her dedication to her patients and to the mobile model EastPoint embraces. “We go see patients where they are,” she explains. “When you meet people in their element”—at Eads’ home or at his radio station—“there’s more comfort,” she says. Patients “share more and feel less formal.

“Being able to see the patient’s living environment and determine what they really need to be successful is huge,” says Bailey. “You can see things they didn’t think to tell you.” For example, she experienced

for herself the variable and uneven terrain at his home, and all of the steps required at his home and work. “This enables a collaborative approach to patient care,” says Bailey, and facilitates realistic goal setting.

“First, he returned home, then he began taking care of his daughter and returned to work. Then, new and ‘fun’ goals became possible,” says Bailey.

Bailey says follow-up care is a priority at EastPoint. She and her team helped ensure Eads received physical therapy once he was home.

Today, Eads is completely independent, using his prosthesis without a walker or cane, and he energetically cares for his daughter. He is back to work fulltime and is full steam ahead with his community activities.

He recently rode his motorcycle to lead a funeral motorcade honoring a fellow member who had passed away. With his initial prosthesis, “he hadn’t been able to get the motorcycle started” correctly due to the intense activity it requires. But with his new prosthesis, he is back to riding regularly with his friends. He also is in the process of remodeling his entire house himself. Next up, he hopes to take his daughter to the beach—and to be able to push her wheelchair in the sand.

Bailey’s strong support of Eads has been integral throughout his rehabilitation journey. “I got into this profession to care for patients,” says Bailey. “We want to make sure the whole well-being of the patient is considered. There’s nothing better than finding a patient who’s in a slump, and being able to pull them out of it, and help them return” to mobility.

Today, Eads “has become a bright personality,” says Bailey. “He’s very proud, and he’s breaking down barriers—doing things he didn’t feel he could do, even preamputation.”

PHOTO CREDITS: JACKIE BAILEY, CP

Eads has returned to his favorite activities—including riding his motorcycle—after being fit with a multiaxial dynamic response foot and a 3D-printed socket emblazoned with a Beatles logo.

Add your facility’s name to the growing list of providers that have already joined the LLPR:

American Prosthetic Institute, Ltd.

Arise Orthotics & Prosthetics

Bionic P&O Group

Clark & Associates Orthotics & Prosthetics Inc.

Dynamic by DESIGN

Horton’s Orthotics & Prosthetics

Kenney Orthopedics Prosthetics & Orthotics

Mayo Clinic

Nevada Orthotics & Prosthetics Inc.

Orthocare Innovations LLC

Prosthetic Center of Excellence

Quantum Prosthetics & Orthotics

UAB Medicine

UCHealth Hospital System

Union Orthotics & Prosthetics Inc.

University of Michigan Health

UTHealth Houston System

Victory Orthotics & Prosthetics

Calling all clinical practices!

You’re invited to join the Limb Loss & Preservation Registry (LLPR)

The LLPR is the first national quality database designed and built to generate knowledge about which O&P advances and treatments produce the best outcomes for individuals with limb loss, limb difference, and limb preservation. The LLPR collects and standardizes data from hospitals, providers, and patients over time. This data is used to improve prevention, treatment, and rehabilitation approaches for this population. Join the growing list of O&P providers and hospital systems contributing data to help demonstrate the quality and impact of the care practitioners provide.

Why join?

“A patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure.”

—RICHARD GLIKLICH, MD

Using the data from the LLPR, practitioners, clinical leaders, and operators can:

X Evaluate treatment options and care plans to improve and maximize patient function

X Set meaningful, realistic, and consistent goals and objectives with patients and the care team

X Critically assess the care provided compared to regional and national benchmarks

X Use patient population and social disparities to risk-adjust outcomes.

Participating in clinical registries allows smaller practices to effectively leverage larger volumes of data and requires no additional practitioner time to collect information.

Connecting is easy, secure, cost effective, and sustainable for ALL practice sizes

The registry has partnered with OPIE, OPSolutions, and Nymbl to make exporting data convenient. The LLPR is designated a Federal Risk and Authorization Management Program (FedRAMP) Moderate Impact Level secure database. Providers push their data to the registry—the LLPR does NOT and cannot access a provider’s electronic medical records system.

Currently, there is no cost to join, send data, and receive basic dashboard reports from the registry. Beginning in 2024, subscription plans offering varying levels of benchmarking, progress, and performance will be available for purchase.

For more information, including scheduling a one-hour Q&A with the LLPR team, visit the LLPR website, llpregistry.org, or email info@llpregistry.org.

Richard Gliklich, MD, is the Leffenfeld Professor of Otolaryngology at Harvard Medical School who has done foundational work in healthcare outcomes and analytics. He is senior editor of the landmark publication, Registries for Evaluating Patient Outcomes: A User’s Guide.

HISTORY: 36 years

Enjoying the Ride

Long-time facility owner leverages his knowledge of motocross in fitting patients

Henry Richter, CPO, LPO, took a circuitous route to O&P, with events occurring along the way that pointed him to the career he has loved for more than 40 years. “I was lucky,” he says. “So many things on my path that seemed unrelated ended up leading me to my future in O&P.”

Richter’s first love was professional motocross racing, a serious pursuit during high school and college when he carved out time around classes to train and compete. “At 6 foot 5 inches, I was taller than the average motorcycle racer, so I started modifying motocross gear to fit me,” he says, “and that got me interested in bracing and sports equipment.”

Richter graduated from Louisiana State University–Shreveport with a bachelor’s degree in kinesiology. He was drawn to both O&P and optometry as possible careers but decided to start with O&P, getting a job at Snell’s Limbs and Braces. He never looked back, and Clint Snell, CPO, became one of his mentors and a great friend.

Richter attended an O&P school in White Bear Lake, Minnesota. “It was the best choice of my life,” he recalls. “My dad was being treated at the Mayo Clinic, so I could help him. And Ottobock’s U.S. headquarters was also in Minneapolis. We would go there as a class to learn about components, and I was able to apprentice there in fabrication.” He completed the program in 1984 and moved back to Shreveport with his father.

“My big dream was to go to Australia to work at an ABC-certified facility to satisfy the supervision requirement, but I changed my plans because of my father’s illness,” he says. “I probably never would have gotten so involved in O&P if I hadn’t stayed. I also met my future wife, which was another incentive to stay put.”

Richter’s motocross experience—working with machines—came in handy during his work on upper-extremity cases at Snell’s. “I didn’t realize how rare they were, but my knowledge of cabling and lever systems allowed me to do all the cable work,” he says.

“I was very familiar with those systems, while other prosthetists rarely saw cases that required them.”

Once he left Snell’s, Richter took a job at a Shriners Hospital for three years. In 1987, he opened his own

facility, Certified Limb and Brace, which immediately gained a contract with Shriners.

Today, his facility has 11 employees, including two other certified practitioners as well as fabricators and administrative staff. The facility sees a full range of patients, including military personnel through the Department of Veterans Affairs, pediatric patients, and those who aged out of the Shriners system. Richter continues to specialize in myoelectric upper-extremity prostheses.

One arm of the business is American Central Fabrication, which he opened in 1988. There, Richter makes his technical solutions available to O&P facilities throughout the country. “At the beginning, nothing was standardized among component manufacturers. We were able to fit the different brands together to make the appropriate device for each patient. That was part of what our central fab offered,” he says.

Richter is a strong proponent of new technology, noting that when he first learned the trade, he had to pull wooden sockets. He believes his facility was the first in North America to adopt CAD/CAM, back in 1989. “We are keeping an eye on 3D printing—at this point, I don’t think it is ready for prime time, mainly because of limited materials. But when its capabilities improve, we’ll start using it.”

One of Richter’s patient success stories is racquetball player Chris Coy, whom Richter started treating when Coy was a 4-year-old cancer survivor whose left foot and ankle had been amputated. Coy became a highly successful young racquetball player, competing against able-bodied competitors and winning Sports Illustrated’s inaugural Young Sportsman of the Year award at age 13. He went on to become a five-time junior national champion and a two-time junior doubles world champion.

Richter is looking ahead to further growth, including an expansion that will increase the facility’s physical space to 8,200 square feet. With no plans to retire any time soon, he is still enjoying the ride he embarked on half a century ago.

Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net

FACILITY: Certified Limb and Brace

OWNER: Henry Richter, CPO, LPO

LOCATION: Shreveport, Louisiana

Henry Richter, CPO, LPO

Inspring the next generation of OP&P professionals

Get involved with the OP&P profession’s signature career awareness campaign.

HISTORY: One year

Thumbs Up

New company offers artificial fingers and injury-care devices

Entrepreneur Roderick Bowman founded Bowman Medical International in February 2022. He is a partial owner of other body-powered prosthetic finger companies and has been investing in the industry for decades. Last year, he decided to form his own company and create a new body-powered artificial finger from scratch, the DEX-Thumb.

Bowman has been working with Dan Didrick, who invented the X-Finger. Although Didrick is still an owner of Didrick Medical, which produces the X-Finger, he also serves as a subcontractor to Bowman Medical International, which will license tech from Didrick Medical. The two men plan to form a symbiotic relationship between their two companies and hope to be able to sell each other’s products.

“When we started designing this device 20 years ago, we took a different approach,” Bowman says. “Rather than starting with the basic desire to make an artificial finger bend, we began by compiling a list of problems with all body-powered fingers currently on the market. We then systematically attempted to overcome each challenge.”

He cites one example: grip strength. “It is always easier to open a body-powered finger than a real finger,” he notes. The solution was to include a springloaded automatic locking mechanism. “If any pressure is exerted, the finger locks and stays in place until the pressure is released. Having an automatic locking mechanism changes the game by providing significantly more strength while removing the effort required by the user to exert that force. The thumb moves freely, but when it touches something, it locks. When you lift up, it automatically disengages.”

In addition to the DEX-Thumb, Bowman Medical International offers Premier Series X-Fingers. The thumb can be used alone or with one or more of the X-Fingers, depending on the patient’s need. Bowman points to the dexterity of the DEX-Thumb as a benefit for users. “All of the other artificial thumbs flex down to the pinkie and flex in a single line. We have a patent pending on a rotational hinge that closely mimics the rotational movement of a natural thumb.”

The X-Fingers also are body-powered, made from 3D-printed nylon components that hold their shape

and a stainless-steel substructure for strength. Each finger has a silicone cap that offers tactile grasping capabilities. “When used together, the thumb and fingers are independent of one another but work together,” says Didrick. “You won’t have to think about it.”

In addition to prosthetic fingers, Bowman has developed two new injury-care devices, the Finger-Aid and Thumb-Aid. “These products use an exoskeleton-like shell that partially covers the finger or thumb,” he explains. “The shell connects to our proprietary rotating hinge, which accepts the force when the user grasps and lifts objects, sparing pressure on the injured hand. This allows individuals who have suffered a severe sprain or even received sutures to return to work or enjoy their hobbies immediately without having to give the injured hand a break for a week or longer.”

Bowman and Didrick introduced their new products to the O&P community at the March Annual Meeting and Symposium of the American Academy of Orthotists and Prosthetists and will attend the AOPA National Assembly in early September. In the future, the company will boost its marketing via online advertising, web updates, and collaborations with industry professionals.

Registration with the Food and Drug Administration is in process, and Bowman says he is eyeing the international market. He has applied for the CE Mark to sell the company’s products in the European Union and plans to offer it throughout the world.

For now, Bowman Medical International is a lean company, with only Bowman; his wife, Kassandra, who is chief executive officer; Didrick; and Aara Schuman, who offers administrative help. Staff is available for assembly when needed. When Bowman’s products gain the traction he expects, he is ready and willing to amp up production and staff.

“We hope folks stop by Booth 932 at the upcoming AOPA Assembly,” says Bowman. “We have a lot to show them!”

COMPANY: Bowman Medical International Inc.

OWNERS: Roderick Bowman

LOCATIONS: Mead, Colorado

Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net

Thumb-Aid

Dex-Finger

Dan Didrick, Aara Schuman, Jake Schuman, Kassandra Bowman, and Roderick Bowman

Don’t Miss the Thranhardt Award Presentations at the AOPA National Assembly

Purchase the Updated AOPA Illustrated Guide

The 2023 Illustrated Guide is now available! Purchase this easyto-use digital guide, featuring the Healthcare Common Procedure Coding System codes for orthotics, prosthetics, and shoes. The 2023 Illustrated Guide is a digital product; you will receive a PDF file to view digitally or print on your own.

Prices are for $135 for members and $425 for nonmembers. Contact info@aopanet.org or visit My AOPA Connection for details.

The recipients of the 2023 Howard R. Thranhardt Award will share their impactful research Friday, Sept. 8, at 8 a.m., in conjunction with the 2023 AOPA National Assembly in Indianapolis.

Andreas Kannenberg, MD (GER), PhD, and Shane Wurdeman, MSPO, PhD, CP, FAAOP(D), will present “Microprocessor Stance and Swing Control Orthosis for Patients Dependent on a Knee-AnkleFoot-Orthosis (KAFO) for Walking: A Randomized, Controlled Crossover Trial.” Kannenberg and Wurdeman will share the results of an international, multicenter, randomized controlled crossover trial with 102 subjects comparing the benefits of the C-Brace to those of conventional KAFOs. C-Brace use resulted in significant improvements in balance,

reduction in actual reported falls, and improvements in risk of falling, mobility, function, and quality of life, according to the research team.

Matthew Wernke, PhD, will present “UpperExtremity Myoelectric Interface and Control Methodologies: A Single Blinded Randomized Clinical Trial.” The performance of upperextremity myoelectric prostheses and the satisfaction of their wearers is dependent on the interface and control methodologies chosen. The research was designed to prospectively compare user performance and satisfaction while using different myoelectric interfaces and control methodologies.

The Thranhardt Award, established in 1996 by a gift from J.E. Hanger in memory of Howard R. Thranhardt, CP, has become one of the most distinguished honors in the O&P profession, annually recognizing the strength in clinical research. The work of Kannenberg, Wurdeman, and Wernke “will help improve and further the clinical care provided to the patients our profession is privileged to serve,” says AOPA President Teri Kuffel, JD. “Their presentations are a few of many exciting educational sessions at this year’s National Assembly. We look forward to congratulating and honoring them for these accomplishments.”

O&P PAC Update

The O&P PAC Update provides information on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported. The O&P PAC recently received donations from the following AOPA member*:

Brad Mattear, CPA, LO, CFo

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and Senate and other officials running for office to educate them about the issues, and help elect those individuals who support the orthotic and prosthetic community.

To participate in, support, and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online: bit.ly/aopapac

Andreas Kannenberg, MD (GER), PhD

Shane Wurdeman, MSPO, PhD, CP, FAAOP(D)

Matthew Wernke, PhD

Welcome New AOPA Members

AAA Elite Medical Equipment

811 Van Siclen Avenue Brooklyn, NY 11207 212-518-1416

Aleksander Perelman

Patient-Care Facility

Bisyata Dishmaya Management Services Inc. / dba Teitelbaum Orthotics & Prosthetics

166 Ross Street Brooklyn, NY 11211 718-782-0600

Samuel Teitelbaum, CPed Patient-Care Facility

Brunswick Orthotics & Prosthetics Inc. 3501 Altama Avenue Brunswick, GA 31520 912-261-8117

Shannon Thompson, CPO Patient-Care Facility

Neuro Rehab Recovery 611 S. Fort Harrison Avenue Box 430 Clearwater, FL 33756 813-435-0772

neurorehabrecovery.com

Veronica Viera, MS Supplier Startup

Prosthetic Solutions Inc.

191 San Felipe Road, Ste. M1 Hollister, CA 95023-3036

831-637-0491

prosthetic-solutions.com

Wade Thomas Skardoutos, CP Patient-Care Facility

Shining 3D Technology Inc. 2450 Alvarado Street, #7 San Leandro, CA 94577 415-910-4781

shining3d.com

Connor Burgess Supplier Startup

The officers and directors of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership.

Finding

For Job Seekers:

Job searching is easy with the pane-view job search page. Set up job alerts, upload your resume or create an anonymous career profile that leads employers to you.

For Employers:

Reach 4,500+ O&P professionals through the Job Flash™ email. Ensure high visibility for your open positions through this highly engaging email.

For more information on recruitment options, contact Customer Service at clientserv@communitybrands.com or 727-497-6565

Contact Bob Heiman at bob.rhmedia@comcast.net

CROSS™ Knee Hyperextension Orthosis

CROSS™ Knee Hyperextension is intended for mild to moderate knee hyperextension due to neuromuscular diseases or other injuries. The orthosis can be used alone or together with any Allard AFO when knee hyperextension is present with foot drop. The CROSS™ Knee Orthosis has a preflexed anatomical shape to fit leg contours and be comfortably worn with any Allard AFO.

• Hyperextension resistance easily adjusted

• Easy-to-grasp wide cuff for single-handed donning

• “Donning aid” included for users with limited hand dexterity

• YouTube video fitting: youtube.com/watch?v=9jj6V2Dfbuc

Available in sizes S/M/L/XL. For more information, contact customer service at 888-678-6548 or email info@allardusa.com

Orthotist Required!

Having a component inventory available in your facility, does not make our product OTS. A VertAlign® Spinal Support System is custom fit, requiring the clinical and biomechanical expertise of an orthotist to select the correct front and back shells from the 550 different size, shape, lordosis- and kyphosis-possible configurations. The orthotist’s professional skills are needed to select, adjust, and apply the components that meet the patient’s unique anatomical and spinal support needs. We provide components and product training. You provide clinical judgement and professional skills.

Contact The Bremer Group at 800-4282304 or visit bremergroup.com

For over 10 years, Coapt has been the industry leader in myoelectric Pattern Recognition. Coapt’s system is NOT another myoelectric hand, wrist, or elbow -- it is an add-on brain to enhance and personalize the users’ control of all those prosthetic options.

Coapt’s electronics unit fits neatly inside any arm build and comes with easy-toassemble connectors and hardware. Coapt’s suite of performance applications helps the wearer quickly unlock the power of machinelearning myoelectric control.

Mt. Emey® & FITec® Branded Diabetic Footwear

In the quest for diabetic shoes, it’s important to find a shoe that has features like seamless lining, extra depth, and multiple widths. Mt. Emey® and FITec® branded diabetic footwear have these key attributes, which make them ideal options for those who need accommodation, protection, and support!

Mt. Emey and FITec collection of diabetic shoes are billable under Medicare A code A5500 for Medicare Therapeutic Shoe Bill. All display samples are free of charge delivered to your practice!

For more information, visit apisfootwear.com

Vista Resilience

The Vista Resilience is an autonomous mechanical hydraulic ankle that performs well with any K2 or lower profile K3 foot. The ankle offers a natural mechanical range of motion of 19 degrees, (further increased when combined with your foot of choice). The hydraulic damping for plantarflexion (PF: 15 degrees) and dorsiflexion (DF: 4 degrees) can be independently tuned for perfect balance between stability and mobility, even while ascending/descending slopes and walking on varied terrain. For more information, visit cypressadaptive.com

844.262.7800

Modern and easily adaptable to your myoelectric applications for the benefit of your patients.

Naked Prosthetics

The Original Preflexed Suspension Sleeve

ESP created the Flexi family of suspension sleeves as a comfortable, durable, and cost-effective alternative to traditional suspension sleeves. Preflexed at 43 degrees for maximum comfort and natural unrestricted movement.

For more information, call ESP LLC at 888-932-7377 or visit wearesp.com

Hersco 3D Printing

Hersco is delighted to offer HP’s advanced 3D-printing technology for custom orthotics. 3D printing has unique design capabilities not possible with other methods—reducing landfill waste by 90%! The accuracy of 3D is unparalleled, specs exceed direct-milled polypro, and manual plaster fabrication. Among the benefits: a 90% reduction in landfill waste, many new design possibilities for posting, and the ability to vary thickness and flexibility across the shell. The PA-11 polymer is a biobased renewable material that has been tested and proven in research and industry. Call today, 800-301-8275, for a free sample.

Mecuris Solution Platform

Mecuris is a pioneering software provider for digital orthotics and prosthetics creation. By seamlessly merging traditional craftsmanship with advanced digital tools, Mecuris makes the creation of individual orthopedic devices flexible to fit each clinic and workflow. Our intuitive web-based Mecuris Solution Platform empowers CPOs to optimize workflows, boost efficiency, and enhance patient care. Experience it firsthand with a free trial and visit us at AOPA National Assembly Booth 920.

For more information visit: mecuris.com/aopa or mecuris.com

It’s all about function. We are the manufacturers of durable prosthetic devices specifically for finger and partial-hand amputations. Our aim is to positively impact our wearers’ lives by providing high-quality finger prostheses. We offer four devices: MCPDriver (shown in rose gold), PIPDriver, ThumbDriver, and our newest device, the GripLock Finger. Our devices help to restore length, pinch, grasp, stability, and protection for sensitive residuum. Robust device engineering and their ability to withstand harsh environments help get people back to performing activities of daily living, and back to work. All are available in a dozen color coatings to match our wearers’ preferences and styles. To learn more, visit npdevices.com

EZ Gauntlet™

The EZ Gauntlet™ is specifically designed for easy donning and doffing. This custom ankle gauntlet features a single Dacron® strap to simplify the opening and closing process. The posterior plastic trim is designed to allow a semi-living hinge with greater flexibility. This allows the gauntlet to easily pass over the ankle bones and relax securely into place. The single strap can then be secured with one hand and allows tighter closure for effective ankle stabilization and support.

For more information, visitorthomerica.com

WalkOn

We are excited to announce the latest addition to our WalkOn Family Portfolio—the WalkOn Lateral Jr! The trusted WalkOn Family helps patients walk with greater safety and ease, no matter their age or lifestyle. By introducing the WalkOn Jr, Ottobock is proud to offer the most complete range of carbon ankle foot orthoses on the market.

For more information, visit shop.ottobock.us

GreenLine

As part of our commitment to sustainability, Ottobock is now offering a new line of GreenLine materials: OrthoEpox resin, hardener, and parting agent as well as a phthalate-free hardening powder. This is a milestone for Ottobock and the Materials portfolio as we are combining sustainability, health and safety, and functionality!

For more information, visit shop.ottobock.us

KinnexTM 2.0

The KinnexTM 2.0 microprocessor ankle is designed for real life, without compromise. Featuring 30 degrees total range of motion available in the first step, heel height accommodation from barefoot up to 2-inch heels, a full-length carbon fiber footplate, and the ability the be fully submersed in water, users can confidently participate in their activities of daily living without worry. Kinnex has a patient app available on iOS and Android to save up to 100 shoes and adjust settings to ensure the most comfort regardless of footwear. Trial Kinnex today to stop compromising with your MPA! Visit proteorusa.com

Tillges Technologies Propulsion® Prepreg Partial Foot Prosthesis

The Propulsion® prepreg partial foot prosthesis is engineered by our clinical orthotic and prosthetic practitioners for our own patients, so we’re positive that our dynamic, ultra lightweight, adjustable, and modular designs using cutting-edge carbon-fiber materials will provide your patients with the stability, balance, and energy they need in every step. Propulsion prostheses are built for professionals, by professionals—gain better control and greater comfort. To learn more, visit teamtillges.com or call us at 1-855-4TILTEC.

The Xtern Line: A Step Up for Foot Drop By Turbomed Orthotics

Turbomed has extended its line of AFOs to include three models: Xtern Classic, Summit, and Frontier. The Xterns will allow running, walking, and even hiking as long and far as you want without discomfort. Their unique design acts as an exoskeleton to the impaired limb, keeps the foot at 90 degrees, and provides the user with unparalleled levels of function.

The Xtern Summit is lighter than the Classic, has more dorsiflexion power, and features a see-through design. The Xtern Frontier was designed for patients with reduced hand dexterity and requiring front leg support. Visit turbomedusa.com, and think outside the shoe!

SHARE YOUR UPCOMING EVENT WITH O&P PROFESSIONALS

Contact Bob Heiman at bob.rhmedia@comcast.net

2023

August 1–31

ABC: Application Deadlines, Exams Dates, O&P Conferences, and More! Check out ABC’s Calendar of Events at abcop.org/calendar for the latest dates and event details, so you can plan ahead and be in the know. Questions? Contact us at info@abcop.org or visit abcop.org/contact-us

August 24–26

Texas Society of Orthotic & Prosthetic Professionals Meeting. San Antonio. Visit txsop.org.

September 6–9

AOPA National Assembly. Indianapolis. For more information, visit aopanet.org

October 13–14 (Note Corrected Dates)

PrimeFare Central. Tulsa Renaissance Hotel and Convention Center. In-Person Meeting. Contact Cathie Pruitt at 901-359-3936, pruittprimecare@gmail.com; or Jane Edwards at 901-487-6770, jledwards88@att.net For more information, visit primecareop.com

November 8–10

New Jersey AAOP Annual Meeting. Harran’s Resort, Atlantic City, NJ. Visit njaaop.org

Live and Online/On Demand CEs

The Pedorthic Footcare Association: Diabetic Wound Prevention, Management, and Healing Program. 10-session online education program series. Approved CEs by ABC and BOC, monthly classes are 1.5 hours each. For more information and to register, visit pedorthics.org/page/Diabetic_Series_LMS_List

AOPA Monthly Webinar Series— Now On Demand!

Full-year series: AOPA member $790; Nonmember $1,999 Individual webinar: AOPA member $79: Nonmember $199 Register for the series at My AOPA Connection

Share Your Calendar Event

September 12–15

AOPA National Assembly. Charlotte, NC. For more information, visit aopanet.org

Advertise O&P events for maximum exposure with O&P Almanac Contact Bob Heiman at bob@rhmedia.comcast.net or learn more at bit. ly/23AlmanacMediaKit. Announcement and payment may also be sent to O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711 or emailed to jburwell@AOPAnet.org along with VISA or MasterCard number, cardholder name, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.

State By

State

Expanding Coverage

Each month, State By State features news from O&P professionals about the most important state and local issues affecting their businesses and the patients they serve. This section includes information about medical policy updates, fee schedule adjustments, state association announcements, and more. These reports are accurate at press time, but constantly evolve. For up-to-date information about what is happening in your state, visit the Co-OP at AOPAnet.org/resources/co-op.

Mississippi

Effective May 17, 2023, Mississippi Medicaid’s fee-for-service vendor now allows for the prior authorization request of noncovered orthotic and prosthetic CPT codes when medically necessary for beneficiaries over the age of 21 in special circumstances. AOPA has confirmed that providers in the state have successfully received prior authorization and payment from Medicaid to provide these services.

New York

Assembly Bill 7793, also known as Carter’s Law, mandates health insurance coverage for treatment of congenital conditions. Introduced in mid-June, treatments mandated under Carter’s Law include certain reconstructive, habilitative, and inpatient and outpatient services.

Updates From the Rebranded So Every BODY Can Move Initiative

Initiative Name Change: As 2023 state legislative sessions continue, So Kids Can Move legislation has seen tremendous success across the country. Of the eight bills introduced this year, three have been enacted into law and a fourth is on the way.

The So Kids Can Move initiative was originally intended to expand access to activity-specific O&P devices for children, but the four bills that have been enacted each mandate coverage for enrollees of all ages in stateregulated commercial plans. As a result of these policy wins, the So Kids Can Move partners have decided to rebrand the initiative to So Every BODY Can Move, to fit a more age-inclusive effort.

We’re looking forward to advocating for inclusive, expanded access to physical activity under this new branding in 2023 and beyond!

New Jersey Activity: Senate Bill 3919, introduced in early June with the help of Steve Slawinski, CO, FAAOP, of Boston O&P, mandates coverage of activity-specific orthoses and prostheses, when deemed medically necessary by the patient’s treating physician, for enrollees of all ages in state-regulated commercial plans and public employee plans. Reimbursement for these devices would be set at the Medicare fee schedule.

This joint certificate program will provide you with:

• Basic business acumen

• Practical knowledge to apply immediately to your work

• Techniques for developing better business practices

• How to think about improving your company’s returns

AREAS OF LEARNING

Areas of Learning include:

HEALTHCARE OPERATIONS Learn techniques for planning, design, operation, control, and improvement of the processes needed to operate your business efficiently.

To complete the certificate program, you must register and complete one core course and one elective course from each of the four areas of learning within a four-year period

Certificate in O&P Business Management

Healthcare Operations Healthcare Operations for O&P Professionals

HEALTHCARE MANAGEMENT Increase

knowledge and skills to better manage multiple, individual, and team priorities.

Mastering Medicare

Healthcare Management Healthcare Management for O&P Professionals Ethics and Compliance in O&P

Finance Financial Management for O&P Professionals

Sales and Marketing Sales and Marketing for O&P Professionals

How to Analyze and Negotiate Managed Care Contracts

O&P Marketing Strategies

Know the difference.

With more than 100,000 fittings since 1997, Ottobock set and exceeded the standard for microprocessor knees. In the last 25 years, Ottobock has optimized and built on the groundbreaking technology to create a family of unparalleled MPKs to meet the unique needs of patients and their different lifestyles.

It’s all in the details...

• Intuitive stance

• Stumble recovery

• OPG

• MyModes

X3

C-Leg

Genium

Kenevo