PRAFO Q&A Leaflet by Anatomical Concepts (UK) Ltd

Questions and Answers... PRAFO® Pressure Relief Ankle-Foot Orthosis What is a PRAFO®? The term PRAFO® stands for Pressure Relief Ankle Foot Orthosis - a family of devices manufactured by Anatomical Concepts Inc and developed since 1995.

Do other companies make PRAFO’s? The term PRAFO® is a registered trademark and shouldn’t be used to refer to anything other than our products. The PRAFO® range are patented and trademark registered products because we know that they have beneﬁts that rival products cannot claim. If you compare a rival product side by side with a PRAFO® you will understand this.

What are the main applications? There are actually a broad range of applications and you will find a page later that lists many of them. You will see that these devices are very versatile. In simple terms, the PRAFO® range is perfect for all patients with compromised mobility at risk of pressure sores at the heel. Lack of mobility tends to increase the risk of pressure sores and we all know that the heels and malleoli are vulnerable. Whether a patient is in bed or in a wheelchair, pressure sores at the heel are important to prevent and difficult to treat. These devices ensure ZERO pressure and shear at the heel - eliminating the main cause of ulceration. Research suggests that whenever the risk of pressure sores at the heel is high, it is vital to take ALL pressure, and particularly shear force, off the area. NO device that touches the area can do this.

“Its not what you put on a foot ulcer - its what you take off - eliminate pressure and shear”

The PRAFO® range is particularly impressive because they are the only designs on the market that can serve to protect when a patient is immobile and continue to protect when the rehabilitation process requires mobility. The design ensures that the patient is protected around the vulnerable areas of the foot and heel and will remain so during ambulation. The structure was designed from the outset to allow safe ambulation and still keep vulnerable areas protected. It’s integral walking base gives good stability and security. Many rival products have a detachable foot base that is insecure and puts the patient at risk.

I’ve seen cheaper devices that look similar to yours - why should we use yours? Product cost is always important but make sure that you really compare like - with like. As you know, prescription should be made on the basis of clinical effectiveness. Think about what you actually expect a product to do and then first of all identify products that meet that requirement. The PRAFO® range of products are competitively priced with features that mean you only pay for the benefits you need. Some other devices are certainly cheaper and do not have the same level of mechanical stiffness as our products. Our products have a metal upright section where all other designs are plastic. This ensures that ours has a mechanical stiffness that is vital for effectiveness.

Innovative, clinically eﬀective, healthcare solutions www.anatomicalconcepts.com - info@anatomicalconcepts.com 8-10 Dunrobin Court, Clydebank G81 2QP Scotland t: +44(0)141-952-2323 f:+44(0)141-952-3434

Questions and Answers... This mechanical stiffness is also important when there is a tendency for a deformity/contracture to develop - where the foot/ankle/toes become fixed in a plantarflexed position. This makes the achievement of walking at some later date very difficult. Also if the structure is not stiff enough, even movement of the patient can be enough to flex the device and place pressure on vulnerable tissue areas. What has always been important with the PRAFO® is the ability to eliminate pressure at the heel, have sufficient mechanical stiffness to prevent contracture development, but most of all to allow the patient to be safely mobilised with the device. This allows limited ambulation as part of rehabilitation and ultimately wider-range ambulation whilst remaining protected.

Won’t the metal upright damage the persons other leg? We have never had any episodes of this happening and we have supplied thousands of these devices around the world since 1996. On the other hand, if you use a “plastic” splint, the risk of a patient developing a contracture or pressure ulcer is much greater than with the PRAFO®.

There is a slim bar on the calf section - what is this for? When the device is being worn by a recumbent patient this bar can be positioned medially or laterally to prevent the leg rotating and putting pressure on the malleoli. It’s present if you need it. If you don’t need it, it can be left in the vertical position or easily removed.

What about options? Choices of liner styles? There are quite a few variations of the PRAFO®. There are choices you can make about the style of upright and the liner - both colour and type. The original PRAFO® - the 650 - has a curved metal upright section and can be supplied with different liners or as a “pad & strap” version. The pad and strap version allows bulky wound dressings to be accommodated and can allow superior foot control when the PRAFO® is to be used in walking training and other circumstances when mobility is the primary focus. The range also includes the 650APU and the 650D. The APU version allows precise control of the degree of plantarflexion/dorsiflexion and the 650D version provides both plantarflexion/dorsiflexion and valgus/varus positioning of the foot and ankle.

What about sizes? We have a wide range of Adult products and the key variations are available as Paediatric and infant products. The sizes are adjustable and work for left and right so you have no complex stock holding requirements.

Who uses the PRAFO®? Quite a number of different healthcare professions coordinate the use of the PRAFO® in their organisations. To some extent, who is most involved depends on the application area. When we first started to work with the range in 1996 we primarily worked with orthotists and coordinated the use of the devices in a hospital setting along with Tissue Viability nurses. One of our own specialities has been diabetic foot care and this has often resulted in our working alongside the podiatrist, nurse specialist, orthotist and Innovative, clinically effective, healthcare solutions www.anatomicalconcepts.com - info@anatomicalconcepts.com 8-10 Dunrobin Court, Clydebank G81 2QP Scotland t: +44(0)141-952-2323 f:+44(0)141-952-3434

Questions and Answers... doctor as part of a coordinated care plan. All members of the team need to understand how and why these devices are used and how they ﬁt in with everything else that goes on. As we have broadened the application of the PRAFO into areas such as stroke rehabilitation, the physiotherapists have started to play a leading role. By very early application following a stroke, therapists have realised that the PRAFO can resist contractures developing through abnormal tone and they can take advantage of the devices to get patients standing and moving early in recovery to facilitate the rehab process.

Can you demonstrate what these devices can do? We welcome the opportunity to support you through in-service training and other opportunities. As we use these devices ourselves clinically, we do have “hands-on” experience to share. We will leave you to decide how you might beneﬁt.

Tell me about your company? Established in 1996, Anatomical Concepts (UK) Ltd was founded by clinicians, engineers and business professionals. As part of a group of three companies in related areas of rehabilitation, we are well placed to serve clients with diverse and complex needs. The company designs, develops and distributes innovative and clinically effective healthcare solutions on an international basis. The core products we offer are widely used in rehabilitation - whether in a hospital or home environment. Based in Clydebank Scotland, Anatomical Concepts works with distribution partners throughout Europe and directly with hospitals, other care providers and private individuals. The products and services we offer aim to improve the quality of life of people affected by conditions such as stroke, diabetes, spinal cord injury, arthritis and multiple sclerosis. The company directors work closely with clinicians such as orthotists, surgeons, therapists, podiatrists and nurse specialists to ensure that our products are effective and refined in practice. Cross appointments with University and research organisations have always allowed us to maintain awareness of emerging technologies and concepts. We are represented at conferences and seminars around the world and recognised for our own research and educational expertise.

Where can we buy PRAFOs? Contact us for details. We work with distribution partners across the UK and we can also supply direct depending on the volume and support requirements you have. The range is on the SFD19 contract for NHS supply in Scotland.

References • Munro, WAM (2005) “Orthotic prescription process for the diabetic foot” The Diabetic Foot, Vol. 8, No 2 p72, Summer 2005 • Munro WAM, Jones D, Stang D Benbow S (2005) “Clinical experience of the PRAFO in the management of the diabetic foot” First Prize Poster Presentation, Allied Health Professions Clinical Effectiveness Meeting, Polmont, Scotland • Edmunds, ME; Foster, AVM (2006) “ABC of Wound healing: Diabetic foot ulcers”BMJ 2006;332;407-410 • Munro WAM, Jones D, Stang D (2006) “Clinical Effectiveness of the PRAFO - Diabetic for ulcers” BAPO Magazine, Feb 2006 • Munro, WAM; Stang, D; Jones, D (2007) “Clinical effectiveness of the PRAFO® - Diabetic foot ulcers” Orthopaedie Technik, p114, Feb 2007 • Jones, D; Sealey, R; Munro WAM (2007) “Effective orthotic management and stroke” 1st Prize Orthotic Paper, BAPO Congress, Bolton 2007

For copies of articles and other published papers please contact our office

Questions and Answers Typical Applications

Dermatology

• Diabetes - protection of the neuropathic or ischemic foot • PVD • Multiple sclerosis • Intensive Care Unit CVA – Stoke rehabilitation - contracture management and early mobilisation. • Dermatology • Burns • General Immobility

Use to relieve pressure and protect heels and malleoli with compromised tissue viability due to dermatological conditions.

Diabetes Neuropathic or neuro-ischaemic foot ulcers. Any grade/ classiﬁcation of wound o Lesions on the distal-posterior or medial or lateral border of the calcaneum o Lesions on the medial or lateral malleoli o Lesions extending from distal-posterior margin of calcaneum, over the tendo-achilles area to the distal calf May be used as part of prophylactic therapy for patients at high risk of diabetic foot ulcers

PVD Ischemia involving foot and/or ankle o Lesions on the distal-posterior or medial or lateral border of the calcaneum o Lesions on the medial or lateral malleoli o Lesions extending from distal-posterior margin of calcaneum, over the tendo-achilles area to the distal calf

Multiple sclerosis Prevention and or management of equino-valgus or equino-varus contractures at the foot and ankle

Intensive Care Unit o Management of “at risk” tissue for the prevention of pressure sores at the heels and malleoli. o Immobile patients requiring position control of the foot and ankle.

Burns In the management of burns to control foot and ankle position

General immobility Use to protect the heels and ankles of all patients with compromised mobility at risk of pressure sores in these areas due to poor tissue viability, compromised nutritional status, suppressed level of awareness and general debility.

NOTES Although there are no specific contraindications the following notes apply to the use of the PRAFO®. 1. The PRAFO® is not to be used with open wounds – an appropriate wound dressing must be used. 2. The fitting instructions must be followed and a visual check made to verify that the calcaneal area is positioned and secured within the device to avoid contact with the structure. 3. If gross oedema of the lower limb is present it may be necessary to customise the calf section of the PRAFO® to accommodate the dimensions of the limb. 4. In extreme cases of foot instability it may be necessary to customise the foot bed. 5. Whether the Kodel liner system or the pad & strap system is used, the liner and strap system are for single patient use only. The liner may be laundered using the recommended “white goods” procedure until the resilience and loft are reduced at which point the liner and straps should be replaced. 6. The PRAFO® structure is durable and may be re-used by following specific recommendations on safety checks and cleaning. Linings and soft components are to be removed and treated as medical waste on conclusion of treatment with a single patient. Local protocols for cleaning of the structure may override the manufacturer’s guidance and should be followed.

CVA - Stroke o Use as an evaluation ankle-foot orthosis (AFO) immediately post-stroke and during rehabilitation to restore mobility. o Use as a recumbent foot and ankle positioning system for night time use to resist development of contractures. Innovative, clinically eﬀective, healthcare solutions www.anatomicalconcepts.com - info@anatomicalconcepts.com 8-10 Dunrobin Court, Clydebank G81 2QP Scotland t: +44(0)141-952-2323 f:+44(0)141-952-3434

PRAFO Application Matrix for the 650, 650APU and 650D

Recumbent Prophylaxis

Recumbent Treatment - eg for Pressure Relief & Wound Healing

Recumbent Accommodation or Resist Deformity

Ambulation with Assistance

Gait Tuning

650D

Multiple Sclerosis

650

650D

Cerebral Palsy

550/650

550/650/650D

550D/650D

550/650D

Spinal Cord Injury

650

650 D

650D

650APU/650D

650APU/ 650D

Head/ Neurological Injury

650

650 D

650D

650APU/650D

650APU/ 650D

Stroke

650/650APU

650D

650APU/650D

650APU/ 650D

Diabetes

650

650D

650/650APU

650APU

PVD

650

650D

650/650APU

650APU

Renal

650

650D

ICU

650APU

650D

Burns/Plastic Surgery

650APU

650D

Dermatology

650

650D

650APU

650D

De-rotation

650

650D

Contractures

650D

650

650D

Hip Fractures

650

650D

650APU

650D

Hip Abduction

650

650D

Neuromuscular

Gait Evaluation & Rehabilitation

Medical/ Surgical

Orthopaedic

Osteoarthritis Knee Post-Knee Surgery

ASK -about the V-VAS! ASK -about the KMO!

See Next Page for Product information

Innovative, clinically eďŹ&#x20AC;ective, healthcare solutions www.anatomicalconcepts.com - info@anatomicalconcepts.com 8-10 Dunrobin Court, Clydebank G81 2QP Scotland t: +44(0)141-952-2323 f:+44(0)141-952-3434

PRAFO Range 650

650APU

650D/PS

PRAFO® MAIN PRODUCT RANGE DESCRIPTION

CODE

DESCRIPTION

CODE

ADULT PRAFO® - “Original” PRAFO with Kodel liner

650

ADULT Dual Action PRAFO® with Pad & Strap kit

650D/PS

ADULT PRAFO® - with Black Terry Cloth Liner

650R/T/B

Paediatric PRAFO®

550

ADULT PRAFO® - with Pad & Strap configuration

650PS

Paediatric PRAFO® with Black Terrycloth liner

550R/T/B

ADULT PRAFO® - with heavy duty upright

650HD

Paediatric PRAFO® Dual Action with Black Terrycloth liner

550D/R/T/B

ADULT - Adjustable posterior upright - Green & White Kodel liner

650APU

Infant PRAFO® - with Black Terrycloth liner

450R/T/B

ADULT - Adjustable posterior upright - Black Kodel liner

650APU/B

ADULT - Adjustable posterior upright - Black Terrycloth Liner

650APU/R/T/B

ADULT - Adjustable posterior upright - Pad & Strap

650APU/PS

ADULT Dual Action PRAFO® with Black Terrycloth liner

650D/R/T/B

Enquiry Form Please complete and return to us or phone or email as you please

Anatomical Concepts (UK) Ltd Clydebank Business Park 8-10 Dunrobin Court Clydebank G81 2QP T: 0141-952-2323 F: 0141-952-3434 Email: derek.jones@anatomicalconcepts.com

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