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Some New Developments in Orthotics
By Judith Philipps Otto At the 2005 co-located meetings of the American Academy of
Orthotists & Prosthetists and the Association of Children's
Prosthetic-Orthotic Clinics (ACPOC), Ammanath Peethambaran, CO,
University of Michigan, and Mark Taylor, CPO, University of
Michigan, described the development of a therapeutic AFO powered by
artificial pneumatic muscles. The lightweight carbon-fiber
orthosis, which provides mechanical assistance during locomotor
training, is powered by two artificial pneumatic muscles that
supply dorsiflexor and plantarflexor torques.
The design is used exclusively to train patients with spinal
cord injuries. They relearn how to walk through repetition of the
motions. As the patient's strength improves, as confirmed by EMG
measurement, the AFO can be regulated and the power can be reduced
accordingly.
Previously such patients have been physically trained in a
time-consuming and labor-intensive process that requires the
participation of three physical therapists working together.
"Now one very low-cost pneumatic-muscled AFO replaces three
physical therapistsa clear cost and efficiency advantage," says
Peethambaran.
CAD/CAM Evolves
CAD/CAM, with its broad range of new orthotic applications, also
continues to be a value not fully appreciated by many. Peethambaran
notes that a majority of the orthotists in the US are still using
traditional plaster-cast methods for cranial remodeling, while only
a small percentage are availing themselves of the advantages of an
electronic system.
"Computer-assisted technology is not at all difficult to use; at
this point the greater problem is affordability," he says. "It will
be many years before the systems are widely available and
affordable."
Although the use of CAD/CAM for spinal systems is greater, says
Peethambaran, there is still a long way to go in this area, as
well.
Don Katz, CO, LO, FAAOP, Texas Scottish Rite Hospital, Dallas,
reports that although Scottish Rite fabricates orthoses in its own
lab, it is still advantageous in some cases to take measurements
which the manufacturer uses to produce a custom orthosis or module,
utilizing CAD/CAM technology
"It can be a timesaver," says Katz, citing the new Charleston
Brace as an example. Previous custom spinal orthoses required the
creation of a bivalve plaster cast in two stages, like the top and
bottom portions of a turtle shella process which took two or three
people to accomplish efficiently. "Today, it is a matter of simply
taking a standing cast, which can easily be done by just one
person, who wraps the patient with a roll of fiberglass that
remains rigid, capturing the patient's shape," Katz explains. By
partnering that standing cast with an X-ray, Charleston can use
CAD/CAM to manufacture a custom-bending orthosis, using
measurements taken from the standing cast. That results in reduced
casting time for the patient, and the orthotist can cast the
patient without additional assistance.
Hanger Prosthetic & Orthotic Inc.'s new Insignia orthotic
CAD system offers advantages of its own.
Kaia Halvorson, CPO, Hanger's vice president of orthotics,
reports that during the last year the program has been introduced
through a carefully segmented release process. The Insignia system
provides complete spinal, cranial, and custom knee measurement
capabilities. "It's been well-structured; each time there is a
release, all procedures and protocols are in place to assure
appropriate outcomes," says Halvorson.
Insignia introduced AFO capabilities in late 2004 and is
currently adding KAFO capabilities.
"One of the nice things about Insignia," says Halvorson, "is
that we can create an actual patient model from our scans, rather
than relying on a library of templates. Another of its great
benefits is that now we have objective data to support all of our
clinical documentation. Before, we only had subjective data. By
creating an exact patient model and being able to compare that
model throughout the progression of treatment, we have the ability
to go through and segmentally look at objective data. Now we can
validate clinical claims and create effective letters of medical
necessity to help gain reimbursement for patients who may have been
denied in the past."
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Hidden Dangers of Orthotic Technology
- June 2005
When we raised the topic of the latest in orthotic technology, the enthusiasm of orthotic professionals was leavened with concern for the hidden dangers to both patients and practitioners utilizing this new technology.
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Table Of Contents - June 2005
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