What was a unique innovation you made in your practice?

I had a scoliosis patient of about 6 years old recently, who had an unusual heart condition; if the patient were prone, if you rolled her on her stomach, she would have died. And we needed to make a CTLSO. Most of the time when we make braces through the neck, we do have to [make the patient] prone to get the front and the back of the head molded. And on that particular patient I did a laser CAD mold, which worked out very nicely including the head and neck. 

The sensor either has to be on the head or the neck. In this case, I used clear packing tape to immobilize the head so that both the head and the body could be measured in one session, because if the head were to move, then it would distort [the measurement].

I was able to get this brace made for the patient, who otherwise wouldn’t have been able to have a brace, and it probably improved her quality of life tremendously. 

The doctors I work with love to give me those kinds of challenges. Sometimes I feel like a chef—I’m in the kitchen and I’m working outside of the recipe.
Lawrence D. Lerman, CO, Vice President
Lerman and Son, Orthotics and Prosthetics Inc.
Beverly Hills, Calif.

A few months ago, we [worked on] about five expandable wall sockets for a particular Symes patient. A traditional expandable wall socket doesn’t have anything in between the expandable portion and the socket. [There was] something that was made thirty years ago that actually had foam in between. We tried every foam under the sun trying to fill that space up. What we ended up doing was laminating the expandable wall and pulling plastazote over the socket itself, and then laminating over that, so that it was actually plastazote in between to tighten up the expandable wall.
Josh Millet, CPO
Hanger Prosthetics & Orthotics Inc.
Lafayette, La.

I worked with College Park Industries, and we had a patient, Ronnie, who was a world-class cyclist and a Chopart’s amputee. He would constantly break the toe plate off his prosthesis from the revolutions that he would go through while training. 

Right before he was leaving for the AXA World Ride ‘95, we made him a prosthesis modified from the forefoot of a College Park Foot. 

I [designed] it to be used with existing College Park ankle portions, with an attachment wing as an adapter I could just laminate to the end of the prosthesis, and then I used the fork toe section as the connection toe lever piece shortened due to limited space. This provided an axis that simulates the function of the anatomical forefoot. I forwarded my drawings to College Park and they forwarded me the finished adapter.

I had to modify it slightly and attach it to the custom carbon fiber socket. I cut and trimmed the foot shell and heat-formed it onto the forefoot to protect his cycling shoes.

All Ronnie had to do was replace the rubber durometer bumpers as needed during his trek, as opposed to having to figure out where he could get his prosthesis repaired. 

He’s still on the same prosthesis and wears this for both daily living and competitions. He basically just keeps it lubricated. He’s able to take his prosthesis apart and clean it and keep everything up to date. It’s over a decade old now and only required an epoxy patch to the posterior door recently. 

I have in the past attempted to develop this unique foot with College Park, but they never seemed to be interested in pursuing it any further for our partial foot amputees. I wanted to call it the “Crone Toe” if it was ever developed into an available option.   
Charlie Crone, CP, Clinical Director of Prosthetics
NASCOTT Rehabilitation Services Inc.
Fairfax, Va.

I have a follow-up sheet for every prosthetic patient that I see, that I write on as patients return to me for subsequent appointments. It’s a more formal sheet [than the notes you might write in a file] that I put together to keep track of what kind of changes are going on each time that I see [the patient].
Practitioners can’t remember anything before five minutes ago, so you’ve got to try to do what you can to help remember.

I list different questions on it [like] how many pairs of socks; certain measurements that I take to keep track of if [the limb] is shrinking or gaining in volume; condition of the skin. 

That way I can have something I can show to the insurance company that says, “Well, they’ve been consistently coming in with twelve-ply socks” or “Their measurements have reduced this much since the last time I saw the patient.” 

Sometimes you have to fight tooth and nail to get [someone’s treatment] approved by the insurance company, so [any] documentation you can show [them] helps.
Susan “Subie” Marvin, CP
Orthopedic Motion
Las Vegas, Nev.