Geriatric O&P:
A Booming Field
By Deborah Conn
The baby boomers are way beyond babyhood these days: the first wave is turning 60, and there are plenty more coming up from behind. Much has been written about this imminent influx of older Americans and its impact on Social Security and Medicare, but what about its effect on the O&P industry?
Does the geriatric population have significantly different needs than younger patients? And if so, how are practitioners and manufacturers planning to address those needs?
The answer to the first question is that many seniors do have different needs, or at least, more frequently occurring problems. Some of those problems, such as diabetes and stroke, create conditions that need treatment. Others, such as muscle weakness, affect the way treatment is delivered.
Issues affecting seniors
One of the most prevalent health problems in aging Americans is diabetes, caused primarily by the “obesity epidemic.” According to the American Diabetic Association, 20.9 percent of Americans 60 and over suffer from the disease, leading to a wide range of complications.
Orthomerica Products Inc., based in Orlando, Fla., has observed the effects of the disease in relation to its Charcot boot, a total-contact walking orthosis used with diabetic patients. “We used to produce five a month,” says Clinical Education Manager Dulcey Lima, CO, OTR/L, “but now we are doing 35 a month in response to the rise in diabetic patients.”
Other complications of diabetes in older individuals include stroke and amputation. Dr. John Rush, chief medical officer for Hanger Orthopedic Group, Bethesda, Md., notes that over 60 percent of all amputations occur in those 60 or older.
Obesity also contributes to foot problems in geriatric patients, says Mark Taylor, CPO, FAAOP. Taylor, director of clinical and technical services at the University of Michigan Orthotic and Prosthetic Center in Ann Arbor, Mich. says, “We are seeing the first wave of the baby boom in foot problems. We have three full-time [certified pedorthists] on staff, and they are usually booked up four to six weeks in advance.”
But obesity and diabetes aren’t the only issues. According to the American Heart Association, more than 700,000 people in the United States suffer a stroke every year, and 72 percent of those victims are over 65.
About 5.5 million stroke survivors are alive today, many with physical disabilities, such as foot drop, that require orthotic treatment.
Seniors also have more fragile skin than younger patients. Kevin Carroll, CP, FAAOP, of Hanger Prosthetics & Orthotics in Winter Park, Fla., says, “Geriatric patients have less elasticity in their skin and tissues and are far more susceptible to trauma.”
According to Arthur Shea, CPO, at New England O&P Systems in Worcester, Mass., the challenge is to “create a happy medium between correction and accommodating skin issues and comfort in older patients. If they are diabetic and old, their skin is like paper.”
A lack of muscle strength is another consideration. “A loss of muscle mass and strength means we have to make things more lightweight and more supportive,” says Shea. “Again, we have to figure out how much we can increase function and comfort without overbracing, which has more weight and can be a problem.”
These tradeoffs can be tricky. Seniors have a higher incidence of osteoarthritis, which creates the need for bracing, and osteoporosis, which can lead to compression fractures if too much force is applied. And some seniors have cognitive losses, making it more difficult to provide effective patient education and ensure compliance.
Addressing the issues
Whatever the problems of older patients, they still want a level of care that will enable them to live their lives as fully as possible. Carroll observes, “I’ve been in practice for nearly 30 years. When I started, if you were 60, you were old. Today, it’s not uncommon to see active people in their 90s, with active minds.”
“Older people are aware of their health and are attuned to the importance of exercise and keeping themselves active. It’s exciting to deal with this population of seniors who, even if they lose a foot or leg to disease, don’t see it as their life being over.”
Fortunately, the O&P industry is fully aware that the geriatric segment is growing, and both practitioners and suppliers are preparing for the change. Whether using new, lightweight materials, more comfortable digital scanning systems, or advanced technology to address specific problems, the practitioners and companies described below are making sure that older Americans are well served.
Tender skin, brittle bones
Taylor emphasizes the importance of using materials that accommodate the fragile skin and bones and lack of muscle strength in elderly patients. “We are using composite plastics so that we can provide much lighter devices for older, less active patients,” he says.
Carbon fiber composite, which combines rigidity with ultra-light weight, is used in lower extremity orthoses to provide dynamic response and energy return. Taylor says, “We’re always looking for the next ‘magic’ plastic, one that is even lighter and stronger.”
Raymond Francis, CP, of Ohio Willow Wood in Mount Sterling, Ohio, says his company is continually exploring lightweight, flexible materials for sockets.
"We make liners of different materials,” he notes, “including one that is more flexible and easier for arthritic fingers to stretch on.” Ohio Willow Wood also produces liners that are color coded and clearly labeled to help older patients who might be confused about how to put them on properly.
Orthotic casting can be a highly uncomfortable process for frail seniors. Hanger has developed a data scanning system, called Insignia, to eliminate the casting process for cranial and spinal orthoses, ankle-foot orthoses, and knee-ankle-foot orthoses by using a hand-held laser scanner and motion-tracking device.
The OMEGA® Tracer® CAD System by Ohio Willow Wood also uses optical imagers in its T-RingTM II to capture residual limb shapes for use in creating prostheses. The OMEGA Tracer enables practitioners to greatly reduce the physical strain on geriatric patients commonly associated with the lengthy plaster casting process.
Orthomerica offers the California System of prefabricated orthoses that are lighter, softer, and more comfortable than molded orthoses. Lima says, “We are making orthoses to address new, less-invasive surgical procedures for the spine or for joint replacement.”
“The California Soft Spinal System provides support without the cumbersomeness of custom-molded orthoses. Older patients can tolerate them much more easily. We have created a series of modules that can be mixed and matched to address whatever the patient needs, and they can be fitted quickly, allowing the patient to start rehabilitation right away.”
Mike Martin, orthopedic product manager at Trulife in Jackson, Mich., says his company is preparing for the growth in geriatric patients by exploring new materials and developing new versions of braces for osteoarthritis. “We have been developing osteoarthritis bracing in which forces are applied only when the brace is bearing weight, which makes them more comfortable,” he says.
“Another product, our PTS, or posture training support system, is an innovative biomechanical approach to posture management. There is no abdominal support, and it permits a gradual, progressive approach by adding weight to the device as the patient can tolerate it. This makes it suitable for patients with osteoporosis and arthritis.”
Anatomical Concepts Inc. in Poland, Ohio, manufactures several orthoses that can be used for ambulatory as well as recumbent patients. The PRAFO®, or pressure relief ankle foot orthosis, is used for patients to manage foot drop, contractures and minor knee instabilities.
“It also helps with suspension of the patient’s heel in bed,” says William DeToro, CPO and vice president of operations. “This prevents ulcerations from forming, which is especially important in the diabetic population. Unfortunately, third-party payers fail to recognize that this type of wound-care management is much more cost effective in the long term.”
The V-VAS (Varum-Valgum Adjustable Stress) custom offloading knee orthosis is designed primarily for osteoarthritic patients. It has also been successfully proven in treating non-operative tibial plateau fractures.
The KMO®, or Knee Management Orthosis, is useful for ambulatory and recumbent patients with various muscular or knee joint etiologies. “Because custom-made orthoses are being scrutinized so closely by third-party insurers, and payments are so low, we are moving more into off-the-shelf products,” says DeToro. “They are often modular systems that are easy to use and easy to adjust in the field.”
Kaia Busch, CPO, national director of orthotics for Hanger Orthopedic Group, notes the increase of joint disease in older patients and the development of stance control technology to address it. “This allows patients to ambulate longer with decreased gait deviations,” she says.
“If someone has weakness of the quadricep muscle, a traditional locked knee-ankle-foot orthosis would keep the knee locked. Now we have the technology to stabilize the knee and allow the patient to flex during swing, or non-weight-bearing, phase. The flexibility and fluidity of the gait cycle help decrease locked knee joint deviations, hopefully decreasing secondary degenerative changes.”
Busch anticipates another trend with seniors. “I’m curious to see if we experience orthotic use to help control osteoarthritis,” she says. “Many patients who have had shoulder complications or chronic knee pain depended on pharmaceuticals, specifically Cox-2 inhibitors, which are now off the market. They will have to resort to other ways to relieve pain.”
Busch notes that Hanger practitioners treating older patients tend to work more closely with occupational therapists. “We are working as a team with both [physical and occupational therapists] to help geriatric patients maintain their independence,” she says.
“The important thing with any population,” Lima says, “is to get them up and moving and back to their lives. Many older Americans are still active in the workforce. Devices like our new low-profile hip orthosis, the California Hip, fit under clothing and allow them to go back to work quickly.”
Choose appropriate technology
Ray Francis of Ohio Willow Wood believes that geriatric patients need different types of prostheses than younger amputees.
“Older people want to do different things than younger amputees,” he says. “The geriatric patient is happy to walk, to go to the mall, but doesn’t need to do athletics. I believe there will be a bigger split in design for this type of person, and we’re designing feet and knees specifically for older patients.”
“For example, the knee needs to be more stable. It doesn’t have to move as quickly, but it needs to prevent the person from falling down. For feet, geriatric patients probably won’t be running, but they need a foot that will support their weight as it transitions across the toe. We’re working on providing extremely lightweight feet with some energy return.”
Ossur, whose North American headquarters are located in Aliso Viejo, Calif., takes the opposite view. The company believes that technology has advanced to such a degree in the past two to three years that newer prosthetics have equal application for older amputees and younger, more active individuals.
Ian Fothergill, CPO, clinical project manager at Ossur, says, “Our slogan, ‘Life without limitations,’ applies to people of any age, because today the loss of a limb need not keep you from enjoying your life to the fullest.
“One of the most important lessons we have learned is that elderly and diabetic users are very often under-prescribed, and their mobility and general health improve if they are prescribed appropriately.”
According to Fothergill, enhancements that many view to be intended for higher-activity amputees regularly improve the quality of life of older patients as well.
“If we are clever with our product designs, our system will benefit the whole range of patients,” he says.
“For example, Ossur has invested a lot of our research into developing a foot with bionic technology that uses sensors to accommodate any speed of walking, actively moving the toe out of the way of the floor. Fitted on mature amputees, this bionic foot can enable them to walk farther and reduce the risk of tripping. They don’t have to compensate with hip and knee movements, and it takes less energy for them to move around.
“So this foot may seem to be for the higher-level amputee, but it benefits the geriatric population as well. It can mean the difference between their walking and not walking. Studies show that when seniors are more active, they extend their life expectancy and reduce the risk of other medical problems.”
Ossur is continually looking for opportunities to support studies confirming that such highly sophisticated devices do benefit the geriatric population. “We are moving toward evidence-based medicine, both to benefit the patient and to help justify reimbursement,” says Fothergill.
Innovation for the elderly
One of the most interesting advances in technology that can benefit older adults is myo-orthotics, a term coined by Hanger to describe the merging of orthotic technology with electrical stimulation. “This is a third path,” explaines Dr. Conrad Kufta, director of clinical development for Innovative Neurotronics Inc., Bethesda, Md., a wholly owned Hanger subsidiary.
“Myo-orthotics is not bracing or replacing, but a way to actually restore function that lies dormant in the patient. The benefits are tremendous,” says Kufta. “Getting older people to be independent and mobile has an enormous benefit to their well-being, and walking is especially important.”
Innovative Neurotronics recently received FDA clearance to market the WalkAide, a device designed to counter foot drop in stroke patients and those who suffer from other neurological disorders, including cerebral palsy, spinal cord injury, multiple sclerosis, and brain injury.
Invented by a team at Canada’s University of Alberta, the WalkAide is a small device strapped to the patient’s calf. Its sensors determine at which point in the patient’s gait the foot must be raised and sends electrical signals to the nerve that controls foot and ankle movement. The nerve causes the appropriate muscles to contract, and the patient’s foot lifts off the floor.
“The device can be customized to each patient’s individual gait,” says Kufta. “And it works right away. The patient and the practitioner don’t have to invest a lot of time and frustration in trial and error.”
According to Deanna Fish, CPO, director of clinical support at Innovative Neurotronics, myo-orthotics “opens up a whole new world. For the first time, we are creating change, not just reacting to changes that occur. It’s exciting to see such dramatic and immediate results.”
Hanger is initially distributing the WalkAide through its own facilities and practitioners, but will eventually broaden access beyond the Hanger group.
Take care of business
The upcoming increase in geriatric patients plays a role in business planning as well as technological innovations and clinical care. Hanger’s John Rush says his company has funded studies that compare the number of O&P practitioners in particular regions with the current and projected number of Medicare beneficiaries.
“We make a business case of where to expand our business based on those changes,” he says. “For example, we will concentrate on the Sun Belt states, which have a growing number of retirees, for acquiring and establishing new facilities. We’re also paying attention to the five states that have the lowest ratio of practitioners to Medicare beneficiaries: Arkansas, Mississippi, Kentucky, West Virginia and Alabama.”
Within facilities, practitioners are trying to accommodate an increase in patients by working more efficiently. “The graduation rate of O&P practitioners is approximately the same as the rate of those who are retiring,” says Rush. “Using technology such as Insignia allows us to see more patients with the same number of practitioners.”
Taylor agrees. He says, “Using such technology as computer-aided design allows our practitioners to work faster and smarter.”
Maintain the human connection
The common thread throughout the industry's efforts to accommodate an aging population continues to be a focus on seniors' independence and self-sufficiency. It's important to bring this attitude into the treatment room, according to Taylor.
“I always want to talk to the elderly as individuals, as people who have the right to make decisions. I train my staff to treat our older patients with respect, never to talk around them to caregivers. All patients have their rights.”
New England O&P Systems' Art Shea goes further: “Making a personal connection to the patient, especially the elderly, is very important. Whatever technology we're using, we have to relate to all our patients, no matter what age they are, if we are to be truly successful practitioners.”
Deborah Conn is a freelance writer in Falls Church, Va.
The baby boomers are way beyond babyhood these days: the first wave is turning 60, and there are plenty more coming up from behind. Much has been written about this imminent influx of older Americans and its impact on Social Security and Medicare, but what about its effect on the O&P industry?
Does the geriatric population have significantly different needs than younger patients? And if so, how are practitioners and manufacturers planning to address those needs?
The answer to the first question is that many seniors do have different needs, or at least, more frequently occurring problems. Some of those problems, such as diabetes and stroke, create conditions that need treatment. Others, such as muscle weakness, affect the way treatment is delivered.
Issues affecting seniors
One of the most prevalent health problems in aging Americans is diabetes, caused primarily by the “obesity epidemic.” According to the American Diabetic Association, 20.9 percent of Americans 60 and over suffer from the disease, leading to a wide range of complications.
Orthomerica Products Inc., based in Orlando, Fla., has observed the effects of the disease in relation to its Charcot boot, a total-contact walking orthosis used with diabetic patients. “We used to produce five a month,” says Clinical Education Manager Dulcey Lima, CO, OTR/L, “but now we are doing 35 a month in response to the rise in diabetic patients.”
Other complications of diabetes in older individuals include stroke and amputation. Dr. John Rush, chief medical officer for Hanger Orthopedic Group, Bethesda, Md., notes that over 60 percent of all amputations occur in those 60 or older.
Obesity also contributes to foot problems in geriatric patients, says Mark Taylor, CPO, FAAOP. Taylor, director of clinical and technical services at the University of Michigan Orthotic and Prosthetic Center in Ann Arbor, Mich. says, “We are seeing the first wave of the baby boom in foot problems. We have three full-time [certified pedorthists] on staff, and they are usually booked up four to six weeks in advance.”
But obesity and diabetes aren’t the only issues. According to the American Heart Association, more than 700,000 people in the United States suffer a stroke every year, and 72 percent of those victims are over 65.
About 5.5 million stroke survivors are alive today, many with physical disabilities, such as foot drop, that require orthotic treatment.
Seniors also have more fragile skin than younger patients. Kevin Carroll, CP, FAAOP, of Hanger Prosthetics & Orthotics in Winter Park, Fla., says, “Geriatric patients have less elasticity in their skin and tissues and are far more susceptible to trauma.”
According to Arthur Shea, CPO, at New England O&P Systems in Worcester, Mass., the challenge is to “create a happy medium between correction and accommodating skin issues and comfort in older patients. If they are diabetic and old, their skin is like paper.”
A lack of muscle strength is another consideration. “A loss of muscle mass and strength means we have to make things more lightweight and more supportive,” says Shea. “Again, we have to figure out how much we can increase function and comfort without overbracing, which has more weight and can be a problem.”
These tradeoffs can be tricky. Seniors have a higher incidence of osteoarthritis, which creates the need for bracing, and osteoporosis, which can lead to compression fractures if too much force is applied. And some seniors have cognitive losses, making it more difficult to provide effective patient education and ensure compliance.
Addressing the issues
Whatever the problems of older patients, they still want a level of care that will enable them to live their lives as fully as possible. Carroll observes, “I’ve been in practice for nearly 30 years. When I started, if you were 60, you were old. Today, it’s not uncommon to see active people in their 90s, with active minds.”
“Older people are aware of their health and are attuned to the importance of exercise and keeping themselves active. It’s exciting to deal with this population of seniors who, even if they lose a foot or leg to disease, don’t see it as their life being over.”
Fortunately, the O&P industry is fully aware that the geriatric segment is growing, and both practitioners and suppliers are preparing for the change. Whether using new, lightweight materials, more comfortable digital scanning systems, or advanced technology to address specific problems, the practitioners and companies described below are making sure that older Americans are well served.
Tender skin, brittle bones
Taylor emphasizes the importance of using materials that accommodate the fragile skin and bones and lack of muscle strength in elderly patients. “We are using composite plastics so that we can provide much lighter devices for older, less active patients,” he says.
Carbon fiber composite, which combines rigidity with ultra-light weight, is used in lower extremity orthoses to provide dynamic response and energy return. Taylor says, “We’re always looking for the next ‘magic’ plastic, one that is even lighter and stronger.”
Raymond Francis, CP, of Ohio Willow Wood in Mount Sterling, Ohio, says his company is continually exploring lightweight, flexible materials for sockets.
"We make liners of different materials,” he notes, “including one that is more flexible and easier for arthritic fingers to stretch on.” Ohio Willow Wood also produces liners that are color coded and clearly labeled to help older patients who might be confused about how to put them on properly.
Orthotic casting can be a highly uncomfortable process for frail seniors. Hanger has developed a data scanning system, called Insignia, to eliminate the casting process for cranial and spinal orthoses, ankle-foot orthoses, and knee-ankle-foot orthoses by using a hand-held laser scanner and motion-tracking device.
The OMEGA® Tracer® CAD System by Ohio Willow Wood also uses optical imagers in its T-RingTM II to capture residual limb shapes for use in creating prostheses. The OMEGA Tracer enables practitioners to greatly reduce the physical strain on geriatric patients commonly associated with the lengthy plaster casting process.
Orthomerica offers the California System of prefabricated orthoses that are lighter, softer, and more comfortable than molded orthoses. Lima says, “We are making orthoses to address new, less-invasive surgical procedures for the spine or for joint replacement.”
“The California Soft Spinal System provides support without the cumbersomeness of custom-molded orthoses. Older patients can tolerate them much more easily. We have created a series of modules that can be mixed and matched to address whatever the patient needs, and they can be fitted quickly, allowing the patient to start rehabilitation right away.”
Mike Martin, orthopedic product manager at Trulife in Jackson, Mich., says his company is preparing for the growth in geriatric patients by exploring new materials and developing new versions of braces for osteoarthritis. “We have been developing osteoarthritis bracing in which forces are applied only when the brace is bearing weight, which makes them more comfortable,” he says.
“Another product, our PTS, or posture training support system, is an innovative biomechanical approach to posture management. There is no abdominal support, and it permits a gradual, progressive approach by adding weight to the device as the patient can tolerate it. This makes it suitable for patients with osteoporosis and arthritis.”
Anatomical Concepts Inc. in Poland, Ohio, manufactures several orthoses that can be used for ambulatory as well as recumbent patients. The PRAFO®, or pressure relief ankle foot orthosis, is used for patients to manage foot drop, contractures and minor knee instabilities.
“It also helps with suspension of the patient’s heel in bed,” says William DeToro, CPO and vice president of operations. “This prevents ulcerations from forming, which is especially important in the diabetic population. Unfortunately, third-party payers fail to recognize that this type of wound-care management is much more cost effective in the long term.”
The V-VAS (Varum-Valgum Adjustable Stress) custom offloading knee orthosis is designed primarily for osteoarthritic patients. It has also been successfully proven in treating non-operative tibial plateau fractures.
The KMO®, or Knee Management Orthosis, is useful for ambulatory and recumbent patients with various muscular or knee joint etiologies. “Because custom-made orthoses are being scrutinized so closely by third-party insurers, and payments are so low, we are moving more into off-the-shelf products,” says DeToro. “They are often modular systems that are easy to use and easy to adjust in the field.”
Kaia Busch, CPO, national director of orthotics for Hanger Orthopedic Group, notes the increase of joint disease in older patients and the development of stance control technology to address it. “This allows patients to ambulate longer with decreased gait deviations,” she says.
“If someone has weakness of the quadricep muscle, a traditional locked knee-ankle-foot orthosis would keep the knee locked. Now we have the technology to stabilize the knee and allow the patient to flex during swing, or non-weight-bearing, phase. The flexibility and fluidity of the gait cycle help decrease locked knee joint deviations, hopefully decreasing secondary degenerative changes.”
Busch anticipates another trend with seniors. “I’m curious to see if we experience orthotic use to help control osteoarthritis,” she says. “Many patients who have had shoulder complications or chronic knee pain depended on pharmaceuticals, specifically Cox-2 inhibitors, which are now off the market. They will have to resort to other ways to relieve pain.”
Busch notes that Hanger practitioners treating older patients tend to work more closely with occupational therapists. “We are working as a team with both [physical and occupational therapists] to help geriatric patients maintain their independence,” she says.
“The important thing with any population,” Lima says, “is to get them up and moving and back to their lives. Many older Americans are still active in the workforce. Devices like our new low-profile hip orthosis, the California Hip, fit under clothing and allow them to go back to work quickly.”
Choose appropriate technology
Ray Francis of Ohio Willow Wood believes that geriatric patients need different types of prostheses than younger amputees.
“Older people want to do different things than younger amputees,” he says. “The geriatric patient is happy to walk, to go to the mall, but doesn’t need to do athletics. I believe there will be a bigger split in design for this type of person, and we’re designing feet and knees specifically for older patients.”
“For example, the knee needs to be more stable. It doesn’t have to move as quickly, but it needs to prevent the person from falling down. For feet, geriatric patients probably won’t be running, but they need a foot that will support their weight as it transitions across the toe. We’re working on providing extremely lightweight feet with some energy return.”
Ossur, whose North American headquarters are located in Aliso Viejo, Calif., takes the opposite view. The company believes that technology has advanced to such a degree in the past two to three years that newer prosthetics have equal application for older amputees and younger, more active individuals.
Ian Fothergill, CPO, clinical project manager at Ossur, says, “Our slogan, ‘Life without limitations,’ applies to people of any age, because today the loss of a limb need not keep you from enjoying your life to the fullest.
“One of the most important lessons we have learned is that elderly and diabetic users are very often under-prescribed, and their mobility and general health improve if they are prescribed appropriately.”
According to Fothergill, enhancements that many view to be intended for higher-activity amputees regularly improve the quality of life of older patients as well.
“If we are clever with our product designs, our system will benefit the whole range of patients,” he says.
“For example, Ossur has invested a lot of our research into developing a foot with bionic technology that uses sensors to accommodate any speed of walking, actively moving the toe out of the way of the floor. Fitted on mature amputees, this bionic foot can enable them to walk farther and reduce the risk of tripping. They don’t have to compensate with hip and knee movements, and it takes less energy for them to move around.
“So this foot may seem to be for the higher-level amputee, but it benefits the geriatric population as well. It can mean the difference between their walking and not walking. Studies show that when seniors are more active, they extend their life expectancy and reduce the risk of other medical problems.”
Ossur is continually looking for opportunities to support studies confirming that such highly sophisticated devices do benefit the geriatric population. “We are moving toward evidence-based medicine, both to benefit the patient and to help justify reimbursement,” says Fothergill.
Innovation for the elderly
One of the most interesting advances in technology that can benefit older adults is myo-orthotics, a term coined by Hanger to describe the merging of orthotic technology with electrical stimulation. “This is a third path,” explaines Dr. Conrad Kufta, director of clinical development for Innovative Neurotronics Inc., Bethesda, Md., a wholly owned Hanger subsidiary.
“Myo-orthotics is not bracing or replacing, but a way to actually restore function that lies dormant in the patient. The benefits are tremendous,” says Kufta. “Getting older people to be independent and mobile has an enormous benefit to their well-being, and walking is especially important.”
Innovative Neurotronics recently received FDA clearance to market the WalkAide, a device designed to counter foot drop in stroke patients and those who suffer from other neurological disorders, including cerebral palsy, spinal cord injury, multiple sclerosis, and brain injury.
Invented by a team at Canada’s University of Alberta, the WalkAide is a small device strapped to the patient’s calf. Its sensors determine at which point in the patient’s gait the foot must be raised and sends electrical signals to the nerve that controls foot and ankle movement. The nerve causes the appropriate muscles to contract, and the patient’s foot lifts off the floor.
“The device can be customized to each patient’s individual gait,” says Kufta. “And it works right away. The patient and the practitioner don’t have to invest a lot of time and frustration in trial and error.”
According to Deanna Fish, CPO, director of clinical support at Innovative Neurotronics, myo-orthotics “opens up a whole new world. For the first time, we are creating change, not just reacting to changes that occur. It’s exciting to see such dramatic and immediate results.”
Hanger is initially distributing the WalkAide through its own facilities and practitioners, but will eventually broaden access beyond the Hanger group.
Take care of business
The upcoming increase in geriatric patients plays a role in business planning as well as technological innovations and clinical care. Hanger’s John Rush says his company has funded studies that compare the number of O&P practitioners in particular regions with the current and projected number of Medicare beneficiaries.
“We make a business case of where to expand our business based on those changes,” he says. “For example, we will concentrate on the Sun Belt states, which have a growing number of retirees, for acquiring and establishing new facilities. We’re also paying attention to the five states that have the lowest ratio of practitioners to Medicare beneficiaries: Arkansas, Mississippi, Kentucky, West Virginia and Alabama.”
Within facilities, practitioners are trying to accommodate an increase in patients by working more efficiently. “The graduation rate of O&P practitioners is approximately the same as the rate of those who are retiring,” says Rush. “Using technology such as Insignia allows us to see more patients with the same number of practitioners.”
Taylor agrees. He says, “Using such technology as computer-aided design allows our practitioners to work faster and smarter.”
Maintain the human connection
The common thread throughout the industry's efforts to accommodate an aging population continues to be a focus on seniors' independence and self-sufficiency. It's important to bring this attitude into the treatment room, according to Taylor.
“I always want to talk to the elderly as individuals, as people who have the right to make decisions. I train my staff to treat our older patients with respect, never to talk around them to caregivers. All patients have their rights.”
New England O&P Systems' Art Shea goes further: “Making a personal connection to the patient, especially the elderly, is very important. Whatever technology we're using, we have to relate to all our patients, no matter what age they are, if we are to be truly successful practitioners.”
Deborah Conn is a freelance writer in Falls Church, Va.
