Telerehabilitation - Edge

MAY 2016 oandp.
com/edge
ACROSS THE STATE OR

AROUND THE WORLD:
TELEREHABILITATION
P 24
BUILDING RELATIONSHIPS P 32
PROVIDING EVIDENCE-BASED CARE IN
LOW-, MIDDLE-INCOME COUNTRIES P 38
CANADIAN PIONEERS IN PROSTHETIC
OUTCOME MEASURES P 46
Cutting-edge information for the prosthetics, orthotics, pedorthics, and allied healthcare professions.
ALPS ENCP
SKIN RELIEVER
Features ALPS EasyGel
Replaces socks
High elasticity
Reduces shearing and abrasions
Softens and soothes skin
Tel: 1-727-528-8566 Fax: 1-727-528-8862

www.easyliner.com info@easyliner.com
Vol 15, No 5 // May 2016
Photograph by ROMP volunteer Paula Cavanaugh, courtesy of ROMP.
Contents
38
46
54
Viewpoint ........................................................................................ 4
Making Connections, Gaining Perspectives
Calendar ........................................................................................... 6
Industry Review ........................................................................... 14
Bionic Fingertip Provides Tactile Sensations
Professors Team Up to Design a Better Prosthetic Arm
32
24
UNB Students Creating Golf Prosthesis
Sprinters With Left-leg Prostheses at a Disadvantage
Australian Engineer Trialing Provision of Low-cost Prosthetic Legs

ABC Seeking Board Nominations
Across the State or Around

the World: Telerehabilitation
Technologies Cover the Distance
3D-printed Myo-hand Tested in Ecuador
BOC Wins Fifth Stevie Award in Four Years

PrimeFare West Exploring New Locations
By Miki Fairley
32
In Memoriam: Henry Gardner, CPO (Retired)

COPC Announces Leadership Changes
Building Relationships
ssur Acquires Touch Bionics
Academy Meeting: Something Bold, Something New
By Laura Fonda Hochnadel
38
On Topic ........................................................................................ 62
Providing Evidence-based Care

in Low-, Middle-income Countries
Pitfalls of Waiving Patient Balances
Advertisers Index ....................................................................... 65

Showcase ...................................................................................... 66
By John T. Brinkmann, MA, CPO/L, FAAOP
46
Classifieds ..................................................................................... 70
Deathe and Miller: Canadian

Pioneers in Prosthetic Outcome
Measures
Perspective ................................................................................... 80
Empowering Local Providers to Provide Prosthetics in Less-resourced

Countries
By Phil Stevens, MEd, CPO, FAAOP
54
Academy Society Spotlight:

Standing Postural Changes
While Wearing a Lumbar Sacral
Orthosis With Varying Degrees
of Lordosis
By Jon Peurach, BSc, and Sun Hae Jang, MSc, CO, FAAOP
MAY 2016
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Viewpoint
Making Connections, Gaining Perspectives
Vol 15, No 5 // May 2016
Too often, technology intended to connect us seems

to do the opposite as we spend more time engaging
with electronic devices than with the humans who
operate them. But, with the physical distance between
healthcare colleaguesand sometimes patientsand
people in need of specialty services in rural areas with
limited ability to travel, technology that divides us can
be used to bring people closer together, enhancing quality patient care
across the state or around the globe.
As Miki Fairley explores in this issues cover feature about telerehabilitation and its potential within O&P (pg. 24), teleconferencing and remote
programming features of devices can be used as an adjunct to physical
encounters, not as a substitute for them. O&P professionals and occupational and physical therapists may use telerehabilitation to enhance services
to patients and share knowledge with colleagues too distant for in-person
interaction. While use within the broader rehabilitation spectrum is fairly
well established, this article shows O&P is beginning to use this technology
to add another layer of service without losing that important personal
connection of face-to-face care.
Building Relationships (pg. 32) stresses the importance of making longterm connections with local governments, practitioners, and communities
when participating in O&P humanitarian projects. We spoke with several
well-established, U. S.-based O&P organizations to gain insight into the
relationships that help them provide ongoing care to patients within the lessresourced communities they serve. These individuals say that in addition to
finding the key stakeholders, building a connection with them, and gaining
an understanding of the local culture, it is imperative to train in-country staff
to sustain ongoing services when U.S. volunteers return home.
Phil Stevens, MEd, CPO, FAAOP, provides an overview of the prosthetic
outcome measures work of two researchers hailing from our neighbor to the
north (pg. 46). Despite the thousands of miles that separate them, Canadians
A. Barry Deathe, MD, FRCP(C), and William C. Miller, MSc, PhD, OT,
have collaborated to, notably, develop the L Test of Functional Mobility
and pioneer the use of the Activities-specific Balance Confidence Scale for
individuals with lower-limb loss.
So, returning to my reflections on modern technology, I hope this issue
will spur you to look at creative ways that you can reach beyond the surface
of that electronic contact to make connections and further perspectives.
Congratulations to Joann Marx, CPO, FAAOP, Northport VA Medical
Center, New York; Debbie Hall, Progressive Prosthetic & Orthopedic Services,
Virginia; and Alexis Gagliardotto, Florida, who each won an Amazon Fire in
the The O&P EDGE/Amplitude drawing at the Annual Meeting & Scientific
Symposium of the American Academy of Orthotists and Prosthetists.
Contact us
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Kit Frank
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Sun Hae Jang
Jon Peurach
Phil Stevens
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MAY 2016
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Calendar
Calendar ads are published in print once a month and within 24 hours of order confirmation on
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No additional charge for Internet placement during the months your ad runs in print!
L
O
U
I
S
I
A
N
A
LAOP 2016
June 24 & 25, 2016 | Nashville
LOUISIANA ASSOCIATION OF ORTHOTIST & PROSTHETIST STATE MEETING
This years state meeting will be held

in Baton Rouge, Louisianas capital city.
Whether youre visiting a riverboat casino
or enjoying some of the local fare, theres
always something going on in Baton Rouge.
June 2 4
Location: Renaissance Baton Rouge

7000 Bluebonnet Blvd., Baton Rouge, LA 70810
Telephone: 225.215.7000 Fax: 225.761.9110
Registration: www.laop.org
Speakers Contact: Justi Shipley at jshipley@gmail.com
Vendors Contact: Jennifer Ingraham at jingraham@spsco.com
ANNUA
L
18TH
May
PrimeFare
BOC: Examinations. BOC offers year-round testing for all

exams and no application deadlines. Apply and test when ready
and receive instant results for multiple-choice and clinical-simulation exams.
Apply now at http://my.bocusa.org
REGIONAL SCIENTIFIC
PrimeFare East 2016 Offers
SYMPOSIUM
a Scientific Symposium with
Hands-On Exposure for
Maximum Learning Experiences
May
CFS: ABC/BOC/NCOPE-approved fitter and CE classes

near you! Baton Rouge, LA; Philadelphia, PA; Las Vegas,
NV; Memphis, TN; Dallas, TX; Houston, TX; El Paso, TX; Birmingham, AL;
Atlanta, GA; New York, NY, area; and Tulsa, OK. Private fitter classes at your
location too! Contact 918.266.3678; www.cfslearningstore.com
May 3-6
THANK YOU TO ALL OUR SPONSORS:

The O&P EDGE
Spinal Technology, Inc.
ALPS
Fillauer
Cailor Fleming
Comfort Products
Bulldog Tools
WillowWood
Janisse Orthotic Effects
American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC)

The Board of Certification/Accreditation (BOC)
OTWorld 2016: International Trade Show and

World Congress, Leipzig, Germany. Contact
info@ot-world.com
Contact PrimeCare for details or registration:
1-888-388-5243 www.primecareop.com
May 9-14
ABC: Written and Written Simulation Certification Exams.
ABC certification exams will be administered for orthotists,
prosthetists, pedorthists, orthotic fitters, mastectomy fitters,
therapeutic shoe fitters, and orthotic and prosthetic assistants and
technicians in 250 locations nationwide. Contact 703.836.7114;
certification@abcop.org; www.abcop.org/certification
May 17-20
ssur: Orthotic Fitter Course, San Antonio, TX. Entry-level

prerequisite program for ABC (CFo) and BOC (COF)
testing. This 32-hour course covers patient care, assessment, treatment
planning, follow-up, and practice management. Contact 949.382.3755;
https://ossurofcsanantonio2016.eventbrite.com
May 11-13
New York State Chapter of AAOP: Annual Meeting, Albany
Marriott. Contact www.nysaaop.org
May 18-19
May 16-17
May 19-20
NORA: Introduction to Materials and the Interim Shoe,

Salem, NH. 4 CEUs for day 1 (p.m.); 8 CEUs for day 2 (all
day). Contact www.nora-shoe.com/Nora_USA_Events_News.Nora#ABC
NORA: Introduction to Materials and Making an Insole,

MAY 2016
EAST
Orthomerica: Whole Limb Solutions Seminar, Dallas,

TX. Earn 14 CEUs and increase your referral sources as a
certified OWLS practitioner by attending this ABCaccredited seminar. Tuition is $495; each attendee receives a $200 coupon.
Register today as seating is limited. Contact www.orthomerica.com/education
www.oandp.com/edge
Calendar
Expand Your Skills with a Leader in O&P Education!
Allard USA:
Your O&P Partner in Education!
Register Now for Certification or Continuing

Education Courses at St. Petersburg College.
Partner with Allard, who sells O&P products ONLY to O&P,

to provide your referral sources with a variety of education
programs (CEUs).
Grow your business through referral sources
Build team relationships between PTs and O&P
Join our mission - Support for Better Life!
Orthotic Fitter: 5/1314/2016

Mastectomy Fitter: 5/20/2016
Other continuing education courses are available. For more information,
visit www.spcollege.edu/orthotics-ceu or call 727-302-6614.
Contact your District Manager, email education@allardusa.com,

call 888-678-6548 x1208 or visit www.allardusa.com
The HOPE Careers Consortium is funded by a grant awarded by

the U.S. Department of Labors Employment and Training Administration.
July 11-16
ABC: Written and Written Simulation Certification Exams. ABC
certification exams will be administered for orthotists, prosthetists,
pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe
fitters, and orthotic and prosthetic assistants and technicians in
250 locations nationwide. Contact 703.836.7114; certification@
abcop.org; www.abcop.org/certification
*Upcoming courses are subject to availability.
June

June 1
July 29-30
ABC: Orthotic Clinical Patient Management (CPM) Exam,
Caruth Health Education Center, St. Petersburg College, Pinellas
Park, FL. Contact 703.836.7114; certification@abcop.org;
www.abcop.org/certification
ABC: Practitioner Residency Completion Deadline for July and

August Exams. All practitioner candidates have an additional 30
days after the application deadline to complete their residency.
Contact certification@abcop.org; www.abcop.org/certification;
703.836.7714
August
June 9-10
MOPA: Michigan Continuing Education Meeting, DoubleTree by Hilton
Hotel Bay City-Riverfront. Now offering pedorthic continuing education
credits. Contact 517.784.1142; www.mopa.info

June 23-24
August 1
June 24-25
August 11-12
Orthomerica: Whole Limb Solutions Seminar, Newark,

NJ. Earn 14 CEUs and increase your referral sources as a
certified OWLS practitioner by attending this ABCaccredited seminar. Tuition is $495; each attendee receives a $200 coupon.
Orthomerica: Whole Limb Solutions Seminar,

Milwaukee, WI. Earn 14 CEUs and increase your referral
sources as a certified OWLS practitioner by attending this
ABC-accredited seminar. Tuition is $495; each attendee receives a $200 coupon.
PrimeCare: PrimeFare East Regional Scientific Symposium

2016, Renaissance Nashville Hotel & Convention Center, TN.
Contact Jane Edwards, 888.388.5243; jledwards88@att.net;
www.primecareop.com
July
August 12-13
Texas Chapter of the American Academy of Orthotists and
Prosthetists: Annual Meeting, Grand Hyatt San Antonio on the
Riverwalk. Contact Leslie Gray, secretary-treasurer@txaaop.org;
214.648.1006; www.txaaop.org

July 1
August 16-18
ABC: Application Deadline for Certification Exams. Applications

must be received by July 1 for individuals seeking to take the
September written and written simulation exams. Contact
703.836.7114; certification@abcop.org; www.abcop.org/
certification
Virginia Orthotic & Prosthetic Association: Annual

Meeting & Scientific Session, Hyatt Regency Reston.
Contact vopainfo@gmail.com; www.vopainfo.com
September
July 6-8
AABCP: Mastectomy Summit & Expo 2016,

Dallas, TX. Open to all mastectomy fitters,
students, and breast health providers, and
mastectomy products, brands, educators, organizations, manufacturers,
and stakeholders. Vendor/exhibitor registration now open. Contact
800.892.1683; social@aabcp.org; www.aabcp.org
MAY 2016
ABC: Practitioner Residency Completion Deadline for September

Exams. All practitioner candidates have an additional 30 days after
the application deadline to complete their residency. Contact
certification@abcop.org; www.abcop.org/certification;
703.836.7714
www.oandp.com/edge
Calendar
September 12-13
NORA: Introduction to Materials and Footwear
Modification, Salem, NH. 4 CEUs for day 1 (p.m.); 8 CEUs
for day 2 (all day). Contact www.nora-shoe.com/Nora_USA_Events_News.
Nora#ABC
November 3-5
Midwest Chapter of the American Academy: Annual Meeting
& Scientific Sessions, Hyatt Rosemont, 6350 North River Road,
Rosemont, IL (near OHare Airport). Contact mwcaaop@gmail.
com; www.mwcaaop.org
September 14-15
NORA: Introduction to Materials and Making Orthotics,
November 4-6
Pedorthic Footcare Association: 57th Annual Symposium
and Exhibition, Renaissance Atlanta Waverly Hotel,
GA. Contact Jeremy Long, 229.389.3440; j.long@pedorthics.org;
www.pedorthics.org
October

and receive instant results for multiple-choice and clinical-simulation
exams. Apply now at http://my.bocusa.org
November 9-11
The New Jersey Chapter of AAOP: 22nd Annual Continuing
Education Seminar, Harrahs Resort Atlantic City. Contact Lisa
Lindenberg, 973.609.2263; director@njaaop.org; www.njaaop.com
October 6-8
December
Tennessee Society of Orthotics & Prosthetics: Annual

Meeting & Scientific Sessions, Embassy Suites Nashville
Airport. Contact tsopstaff@gmail.com; www.tennsop.org

November
2017
March 1-4, 2017

Academy: 43rd Annual Meeting & Scientific Symposium, Hyatt
Regency, Chicago, IL. Contact Diane Ragusa, 202.380.3663 x208;
dragusa@oandp.org; www.oandp.org
MASTER OF SCIENCE
PROSTHETICS AND ORTHOTICS
THE ONLY CAAHEP-ACCREDITED TRANSITIONAL MASTERS PROGRAM IN THE NATION.
Designed to accommodate the busy schedules of working professionals.

Our faculty of internationally renowned researchers, clinicians, and
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ELEVATE YOUR CAREER AND TAKE A LEADERSHIP ROLE IN ADVANCING THE P&O PROFESSION.
OUR TRANSITIONAL PROGRAM OFFERS
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Applications are due on July 1 for the fall semester
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Eligibility requirements apply.
hartford.edu/tmspo
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MAY 2016
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860.768.4599
www.oandp.com/edge
YOU ARE INVITED

O S S U R . C O M / A C A D E M Y
1C2EUs
Running & Mobility Clinics
TOPP Workshops
Running and mobility clinics teach basic and

intermediate running techniques to improve
patient mobilit y. All mobilit y levels are
encouraged to participate in these free, exciting
and fun events.
An interactive workshop designed to educate

physical therapists on how to employ selected
functional outcome measures to enhance
amputee rehabilitation and maximize prosthetic
performance.
May 21
June 5
July 11
August 20
September 17
September 24
October 22
Portland, OR
New York, NY
Greensboro, NC
Pittsburgh, PA
Vancouver, CANADA
San Francisco, CA
San Diego, CA
4
CEUs
Reimbursement
Success for Prosthetics
Learn the fundamentals and best practices for

billing prosthetics, including how to minimize
reimbursement risk and the time spent on
non-clinical activities, read and understand
medical coverage policies, draft letters of
medical necessity, and navigate the appeals
process.
April 27 Orlando, FL
August 17 Orlando, FL
December 6 Orlando, FL
April 6-7
April 21-22
April 26-27
May 4-5
June 22-23
September 28-29
October 5-6
Raleigh, NC
Newark, DE
Ottawa, CANADA
Las Vegas, NV
Johnson City, TN
Indianapolis, IN
Minneapolis, MN
Science of
Elevated Vacuum
Learn the benefits of elevated vacuum technology,

how to cast, fabricate and troubleshoot a good
f itting TT/TF socket, and which liners and
components work best with these advanced
techniques.
April 28-29
June 16-17
August 18-19
October 20-21
December 7-8
Orlando, FL
Orlando, FL
Orlando, FL
Orlando, FL
Orlando, FL
1CE7Us
CENDUINsG
PE
ssur Womens
Leadership Initiative
Conference 2016
Achieving Optimal
Outcomes in Physical
Therapy I
Join us for a first-class education and networking

event at ssurs Orlando facility. This 3-day
conference will focus on issues relevant to female
O&P practitioners and leadership development.
CEUs will be offered and topics will include
leadership, career, and product development.
From post-op to prosthetic fitting, this 2-day

course covers the continuum of care, including
patient management skills and proper training
with prosthetic components to expand the
physical therapists knowledge of lower extremity
prosthetics.
September 15-17
Orlando, FL
April 22-23
October 7-8
Orlando, FL
Orlando, FL
*FPTA Approved for 17 CEUs and through ProCert for 11 CEUs.
Additional course oerings available. Dates and locations subject to change.

Please visit ossur.com/academy or contact oapa@ossur.com for the most up-to-date information and registration.
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Industry Review
Bionic Fingertip Provides Tactile Sensations
Dennis Aabo Srensen was able to feel
smoothness and roughness in real time
with a prosthetic fingertip that was
surgically connected to the nerves in
strength. Micera and his colleagues

also developed that technology.
In this latest development, Srensen
is said to be the first person in the
world to recognize texture using
a bionic fingertip
connected to
electrodes that
were surgically implanted
in his residual
limb. Nerves in
Srensens arm
were wired to an
artificial fingertip equipped
with sensors.
A machine
controlled the
movement of the
fingertip over
different pieces of
plastic engraved
with smooth or
rough patterns.
As the fingertip
Sensors in the fingertip generate an electrical signal by moving across the textured
surface. Photograph by Hillary Sanctuary, courtesy of EPFL.
moved across the
textured plastic,
his left upper arm. The technology
the sensors generated an electrical
to deliver this tactile information
signal. This signal was translated into a
was developed by Silvestro Micera,
series of electrical spikes, imitating the
PhD, and his team at cole Polytechlanguage of the nervous system, and
nique Fdrale de Lausanne (EPFL),
then delivered to the nerves. He was
Switzerland, and Scuola Superiore
able to distinguish between rough and
SantAnna (SSSA), Pisa, Italy, together
smooth surfaces 96 percent of the time,
with Calogero Oddo, PhD, and his
and the bionic fingertip attained a level
team at SSSA. The results, published
of touch resolution superior to that he
March 8 in eLife, provide new avenues
experienced in the 2013 experiment.
for developing bionic prostheses with
The stimulation felt almost like
sensory feedback.
what I would feel with my hand, said
Srensen, who is from Denmark,
Srensen. I felt the texture sensations
lost his left hand in a fireworks-related
at the tip of the index finger of my
accident 11 years ago. In 2013, he had
phantom hand.
electrodes surgically implanted into the
This same experiment to test coarseulnar and median nerves of his residual
ness was performed on a cohort of
limb. He then was fit with a bionic
able-bodied individuals; the tactile
hand that allowed him to achieve realinformation was delivered nonsurgitime bidirectional sensory feedback,
cally through fine needles that were
which enabled him to distinguish
temporarily attached to the arms
shapes, softness of objects, and grip
median nerve through the skin. This
MAY 2016
14
www.oandp.com/edge
O&P Separated from

DME in Uniform Glossary
of Medical Terms
The Centers for Medicare and Medicaid
Services (CMS) announced that enhancements have been made to the Summary of
Benefits and Coverage (SBC) template and
Uniform Glossary of Medical Terms, also
known as the Glossary of Health Coverage
and Medical Terms. Included in the revised
glossary is a definition of the term orthotics and prosthetics that is separate from
durable medical equipment (DME). This
document, which was established through
provisions of the Affordable Care Act, is
intended to provide guidance to private
insurance companies when defining and
establishing coverage for essential health
benefits.
The glossary offers the following definition of orthotics and prosthetics:
Leg, arm, back and neck braces, artificial
legs, arms, and eyes, and external breast
prostheses after a mastectomy. These
services include: adjustment, repairs, and
replacements required because of breakage, wear, loss, or a change in the patients
physical condition.
To access the glossary, visit www.healthcare.gov/
sbc-glossary.
cohort was able to distinguish roughness in textures 77 percent of the

time, demonstrating that the needles
relay the information about texture in
much the same way as the implanted
electrodes, which gives scientists new
protocols for improving touch resolution in prostheses.
Further, the team sought to determine whether the touch information
from the bionic fingertip resembles the
feeling of touch from a real finger. The
brain-wave activity in the test cohort
was compared to brain scans collected
by an EEG cap on the subjects head,
revealing that analogous regions in the
brain were activated.
Editors note: This story was adapted from materials
provided by cole Polytechnique Fdrale de Lausanne.
Professors Team Up to Design a Better Prosthetic Arm

Professors at San Francisco State
University (SF State) have teamed up to
develop a prosthetic arm that better
understands and interprets the EMG
signals necessary for elaborate arm,
wrist, hand, and finger movements.
The project is spearheaded by
Zhang and Okada. Photograph courtesy of SF State.
Kazunori Okada, PhD, an associate

professor of computer science, and
Xiaorong Zhang, PhD, an assistant
professor of engineering.
Todays EMG control technology,
which is based on single-channel EMG
recordings on multiple muscles, can
only recognize simple static motions,

such as hand open or closed, due to
the lack of meaningful neuromuscular information that can be captured.
Yet the complexity of arms and hands
requires that multiple muscles fire at
varied intensities and often in a set
sequence to perform
basic tasks.
Coming up with a
good replacement for
a lost arm is difficult,
said Okada. There are
still muscles and nerves
at the end of the arm,
but how they coordinate together is very
complex and reading
their signals is not an
easy thing.
Existing design only
allows a few simple
motions, like opening or closing a
hand, Zhang said. These are static
motions. But if you were to grab a glass
of water and drink it, thats a sequence
of motions that is continuous and
dynamic.
To solve the challenge of allowing
more complex movements, the project

will build on Zhangs concept that
envisions a grid of signal readers
capable of capturing richer neural
information across both space and
time. She and Okada will begin their
research by capturing EMG signals
from subjects using electrode grids
and analyzing how effective they are
in representing the proportional and
dynamic muscle activities of hand
gestures. As the signals are collected, a
computer program will be built to not
just read and interpret them but also to
test solutions, learn from mistakes, and
adapt. Zhang will also develop a highperformance, real-time computing
system to address the computational
challenges of applying grid sensing to
real-time prosthetic control.
Okada and Zhang acknowledged that
a finished product is likely a long way in
the future. For now, they are focused on
collecting data and building computer
software that analyzes that data and
points them toward a solution.
provided by San Francisco State University.
UNB Students Creating Golf Prosthesis

Students at the University of New Brunswick (UNB), Fredericton, Canada, are creating
a golf prosthesis to help people with upper-limb amputations. Such devices exist for people
with transradial amputations, but this is intended for people with transhumeral amputations.
The project has been in process for five years, with previous groups putting their own
touches on the design.
Now, mechanical engineering students Trevor Scott and Lucas Pupek are adding their names
to the list of students who have participated in the research, design, and creation of the device,
which must recreate the motions of an elbow joint without actually using a hinge.
You lose degrees of freedom when you lose the elbow, Scott said. Youve got to be able
to have that range of motion back, which is what were attempting to do with this device.
Scott and Pupek have been making adjustments to satisfy the client, Bob Radocy, founder
of TRS Prosthetics, Boulder, Colorado. Edmund Biden, BScE, DPhil, the professor overseeing
its progress, said this could be the final iteration of the device. Our clientwants to make
Pupek and Scott with the 3D-printed mold of their device. Photograph
courtesy of UNB.
the shape smoother and more organic looking, Biden said. We have work to do but I think
were close.
The groups working on the device have also been communicating with UNBs Institute of Biomedical Engineering, which will be testing the device.
Editors note: This story was adapted from materials provided by the University of New Brunswick.
MAY 2016
15
www.oandp.com/edge
Industry Review
// Research
Sprinters With Left-leg Prostheses at a Disadvantage

A study conducted at the University of
Colorado Boulder (CU-Boulder) shows
that when rounding curves, Paralympic
sprinters with left transtibial prostheses
who sprinted in the inside lane of an
indoor track ran about 4 percent slower
than athletes with right transtibial
prostheses. Based on that, the researchers estimated a 0.2 second difference in
an outdoor 200-meter race.
Participants included 11 Paralympic
sprinters from the United States and
Germany who use transtibial prostheses, as well as six sprinters without
amputations. The Paralympic sprinters
wore their own customized carbon
fiber running blades. All participants
were timed and filmed running on
a straight section of an indoor oval
track, running on the curve counterclockwise (standard protocol for
track and field races), and running
the curve clockwise. The study was
published March 15 in the Journal of
Experimental Biology.
All participants
ran slower on curves
compared with straight
running, but with different kinematics. The
able-bodied cohort
ran 1.9 percent slower
clockwise compared
with counterclockwise,
and reduced stride
length and frequency in
both curve directions
compared with straight
running. Sprinters with
an amputation ran 3.9
percent slower with
their affected leg on the
inside of the curve compared with the outside of the curve,
and also reduced stride length in both
curve-running directions, but reduced
their stride frequency only on curves
with the affected leg on the inside.
The research indicates the performance of Paralympic sprinters was
impaired by their reduced

ability to generate enough
force with their left-leg
prostheses while running
counterclockwise on the
inside of a track curve,
said CU-Boulder research
associate Paolo Taboga,
PhD, chief study author.
The athletes had a shorter
stride frequency and longer contact time between
the blade and the track
surface, and were not able
to compensate by using
more rapid leg-swing
times, he said. Taboga
suggested that to make
Paralympic sprint races more fair, the
sprinters with left lower-limb amputations running on a curve should be
allowed to run in the outside lanes.
provided by the University of Colorado Boulder.
Australian Engineer Trialing Provision of Low-cost Prosthetic Legs

Professor Peter Lee, BEng, PhD, deputy head in the Department
of Mechanical Engineering at the University of Melbourne, Australia,
is leading a trial to provide low-cost prosthetic limbs to patients in the
developing world. His team is using the PCAST system, which uses a
portable unit to create a customized socket without the need for specialist
technicians. The patients residual limb is first wrapped with plaster and
placed inside the PCAST unit. The unit then uses water pressure to create
a custom socket shape that will allow the prosthesis to bear the patients
weight comfortably.
The initial motivation for the project was the high number of amputees
in Cambodia and Vietnam, which are affected by landmines, said Lee,
who is working on the PCAST project trial with the Vietnamese Training
Centre for Orthopaedic Technologists, Hanoi. In these situations, groups
such as the International Committee of the Red Cross have to solve the
problem using appropriate technology that is also low in cost.
Lee said the PCAST technology is not aimed at replacing prosthetists.
This is about solving some of the problems that are unique in developing countries where there are too many amputees and not enough
professionals working in the field. Our philosophy is that if you use the
PCAST to treat the majority of patients, this leaves the prosthetist more
time to focus on those complex cases that require more specialized
expertise.
Lee fits a patient. Photograph courtesy of the Melbourne School of Engineering, the University
Editors note: This story was adapted from materials provided by the University of
Melbourne, Australia.
of Melbourne.
MAY 2016
16
www.oandp.com/edge
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Industry Review
ABC Seeking Board
Nominations
The American Board for Certification in
Orthotics, Prosthetics and Pedorthics
(ABC) is seeking nominees for its board
of directors. The
open positions are
for director and
public member
director. Each
position entails
a four-year commitment beginning
December 1. The
deadline for submitting nominations
is June 1.
The selected directors will be voting
members of the board and will
participate in overseeing general
management of the organizations
affairs, including policy development,
governance, and budgetary matters.
Nominees for the director position
must be ABC-certified professionals
and must have a record of volunteer
involvement with ABC. Nominees
for the public member director
position must represent the interests
of consumers, O&P patients, and other
public groups. Ideal candidates will
have some experience related to the
O&P profession.
For more information or to submit a nomination,
contact Steve Fletcher, CPO/L, at sfletcher@abcop.org
or 703.836.7114, x216.
// Associations & Humanitarian
3D-printed Myo-hand Tested in Ecuador

The Range of Motion Project
(ROMP) arranged for several of the
patients it serves in Ecuador to test
a low-cost, 3D-printed myoelectriccontrolled hand with sensory feedback. The device, called the Psyonic
Hand, allows the user to form
different hand grasps and offers a
sense of touch and pressure.
The current field trial arranged for
people with upper-limb amputations to participate in clinical tests
and provide direct user feedback.
Psyonic engineers used ROMPs onsite 3D-printer lab to fabricate and
make immediate improvements to
the products design.
An Ecuadorian subject tests the Psyonic hand. Photograph courtesy of ROMP.
BOC Wins Fifth Stevie Award in Four Years

The Board of Certification/Accreditation (BOC) was awarded a bronze Stevie Award for ecommerce customer service in the Customer Service & Contact Center Achievement category in
recognition of its innovative customer service support and social media
efforts. Winners were announced at an awards ceremony held March 4
in Las Vegas. The Stevie Awards for business, created in 2002, honor and
generate public recognition of the achievements and positive contributions of organizations and professionals. BOC has won five of the awards since 2013.
One example of BOCs innovation involved using SocialToaster, a social media amplification
platform, e-mail communications, and sign the petition artwork on company e-mail signatures
to obtain signatures on the We the People petition requesting that the White House rescind the
Draft Medicare Local Coverage Determination for Lower Limb Prostheses.
BOC competed for the award against more than 2,100 nominations, including those from
large corporations.
PrimeFare West Exploring New Locations

PrimeFare West was held
again this year at the
Denver Marriott City
Center, from March
18-19. While the meeting attendees and exhibitors reported a positive
experience, attendance from the local
area was less robust than normal, possibly due to the snowstorm that rolled
in just in time for the meeting.
All three tracksprosthetics,
orthotics, and pedorthicswere well
attended by the practitioners who
were on site, with one

attendee reporting that
he had traveled from
Maine to attend due
to the strength of the
programs educational
content, particularly the
prosthetics offerings.
Unlike in the eastern part of the
country, where attendees prefer the
consistency of attending meetings in
the same city year after year, PrimeCare Orthotics & Prosthetics Network,
Germantown, Tennessee, the organizers
MAY 2016
18
www.oandp.com/edge
of PrimeFare, have found that the same

does not hold true in the west, where
a downward trend in local attendees is
experienced over time. This trend was
the rationale for moving PrimeFare
West from Salt Lake City to Denver in
2013. Thus, PrimeCare management is
evaluating various western cities and
locations, with an eye toward rotating
the meeting venue among three different locales beginning in 2018, in order
to better meet the needs of attendees
throughout the area.
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Industry Review
// Business & People
IN MEMORIAM: HENRY GARDNER, CPO (RETIRED)

Henry F. Gardner, CPO (retired), a World War II veteran and pioneer
in the development of prosthetic devices, passed away March 28.
He was 96. A founder and the fourth president of the American
Academy of Orthotists and Prosthetists, Gardner was also the first
person to be certified internationally, according to his obituary.
Gardner was born April 9, 1919, in Stephenson, Michigan. He
joined the U.S. Army Transport Service, Marine Division, after
graduating from high school. A 1942 graduate of the Marine
Officer Academy, he served as an engineering officer on board the
H-11 in the Pacific and the E.B. Alexander in the North Atlantic.
After World War II, he joined the U.S. Department of Veterans Administration (VA) Prosthetics
Center, New York, as a prosthetics technician and graduated from New York University (NYU) with
a degree in biomechanics.
As a technical assistant to the director of the state VA, Gardner coordinated a research and
development program with the National Academy of Sciences; NYU; the University of California,
Los Angeles; and Northwestern University, and developed and patented numerous prosthetic
devices and advanced prosthetic designs, including contributing to endoskeleton design. He
traveled worldwide to lecture and teach those new techniques, often with the U.S. Department of
State, the World Health Organization, and the United Nations.
Upon retirement, Gardner moved to Upstate New York, where he enjoyed walking in the
woods, bird watching, and hunting, and became an expert and avid fly fisherman who handcrafted his own rods and flies.
He is survived by his wife, Jean Gardner; a son, Henry Jr., daughter-in-law, and grandson; a
brother, sister, and several stepchildren, grandchildren, and great-grandchildren.
COPC Announces Leadership Changes

The Center for Orthotic & Prosthetic Care (COPC), with headquarters in Durham, North Carolina, and
Louisville, Kentucky, announced that
David R. Sickles, CPO, CPed, chief operations officer and managing partner
of COPC of North Carolina has been
Sickles
named president. He will oversee the
management of more than 125 employees
and be responsible for quality patient care,
company growth, efficiencies of

systems, and further development
and expansion of COPC services
throughout North Carolina, New York,
and Pennsylvania.
Martin Persson, CPA, MBA, has been
appointed chief financial officer of
COPC of North Carolina. He has extensive accounting experience, including positions
in the medical industry.
ssur Acquires Touch Bionics

ssur, Reykjavik, Iceland, acquired Touch Bionics, Livingston, Scotland, on April 11, for 27.5
million (US $39 million) on a debt- and cash-free basis. The acquisition was
financed through existing loan facilities. With this acquisition, ssur enters
into the upper-limb prosthetic market.
Touch Bionics has over 120 employees with operations in Scotland,
Germany, and the United States. In 2015, total sales were 15 million (US
$21 million) with adjusted earnings before interest, taxes, depreciation, and
amortization (EBITDA) of 900,000 (US $1.3 million). Synergies between the
operations of ssur and Touch Bionics are expected to be achieved over the next two to three years,
ultimately increasing the EBITDA margin of Touch Bionics to a level similar to ssurs. The acquisition
will not have an impact on the financial guidance provided for the full year.
BUSINESS BRIEFS
COAPT LICENSES PURDUES
IMPLANTABLE TECHNOLOGY
Coapt, Chicago, has licensed implantable
technology from Purdue Universitys
technology transfer program, Purdue
Research Foundation, West Lafayette,
Indiana. The implantable electrodes,
developed by Purdue University
researchers, read electrical signals from
underneath the skin. With the license
to this technology, Coapt will work to
advance prosthetic limb control for
individuals with upper-limb amputations.
CPO ACQUIRES INDIANA PRACTICE
CPO Services, dba Comprehensive
Prosthetics & Orthotics (CPO),
headquartered in Peoria, Illinois, has
acquired the Center for Orthotics and
Prosthetics Excellence (COPE), located
at 759 45th Street, Suite 102, Munster,
Indiana, and 9615 Keilman Street, Suite
200, St. John, Indiana. The acquisition was
effective March 3.
OPIE SIGNS OTTOBOCK AS INTEGRATED
SUPPLIER
OPIE Software, Gainesville, Florida,
announced that the North American
region of Ottobock, Austin, Texas, has
become an integrated supplier.
REX BIONICS SIGNS AGREEMENT WITH
U.S. ARMY
Rex Bionics, London, England, and
Auckland, New Zealand, has agreed to the
terms of a Material Transfer Agreement
with the U.S. Army Medical Research
and Materiel Command, which is the
prologue of a design modification
program to the REX robotic mobility aid
that will allow its use for early ambulation
of patients with lower-limb loss. Through
the proposed modification of the harness
system within the REX device, service
members with limb loss could benefit
from being upright while awaiting
prosthetic fitting.
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Industry Review
// Conference
Academy Meeting: Something Bold, Something New
MAY 2016
22
www.oandp.com/edge
Highsmith (right) presented Charles W. Kuffel (left)

with the Distinguished Practitioner Award for his
many years of practice and work advocating for those
with limb loss and limb impairments in both his
home state of Minnesota and at the federal level.
credits with professional development

sessions, instructional courses and
symposia presentations, free paper
and poster presentations, demonstrations and discussions of clinical and
practice management techniques
and issues, manufacturer workshops,
and product preview presentations.
American Board for Certification
in Orthotics, Prosthetics and Pedorthics certifees had the chance to earn
up to 37.5 credits, while Board of
Certification/Accreditation certificants
had the chance to earn up to 39.5
credits and pedorthists could earn up
to 11.75 Category I credits.
Of particular note was the session
3D Printing and the Future of O&P.
A large audience assembled to hear the
latest on this controversial topic. The
Thematic Poster Session, the first of
its kind at an Academy Annual Meeting, was a hit. The town hall forum
approach to this session encouraged
questions to be directed to and from
anyone attending the session, including the presenter, moderators, and
audience members, which led to lively
debates and discussions. Moderators
helped to initiate the conversation but
encouraged the discussion to grow
beyond the specific scope of any single
presentation to encompass a broad
area.
The Academys 43rd Annual Meeting
& Scientific Symposium is scheduled
for March 1-4, 2017, in Chicago.
Photographs courtesy of the Academy.
colleagues for the generous donation of

their time and talent over the year that
aided many of the Academys accomplishments. Academy Awards were
bestowed on industry leaders, including
Charles Michael Mike Schuch, CPO,
FAAOP, FISPO (1955-2015), who
received the Titus-Ferguson Award
posthumously for his years of contributions to O&P research and practice,
and service to the Academy. Other
honorees included Tim Dennis, CO, for
clinical commitment; Ryan Caldwell,
CP/L, FAAOP, for clinical creativity;
Highsmith for research; and Sara Peterson, MBA, CPO, FAAOP, and Steven
Stolberg, CP, as outstanding educators.
Senator Charles Grassley (R-IA), and
Billie J. Randolph, PT, PhD, ATC (Colonel, U.S. Army, Retired),
received honorary membership awards for their
work that is closely allied
with O&P.
The 2016 class of
Academy Fellows were
inducted during the
opening ceremonies, as
was the inaugural class
The designation Fellow With Distinction, the newest designation program,
of the Academy Fellows
recognizes the pursuit of the highest standards of care and the remarkable
With Distinction.
commitment to promoting the wide exchange and dissemination of
knowledge in the O&P profession. The 2016 class of Academy Fellows With
Thursday morning
Distinction include, from left: Pat Prigge, John Rheinstein, Michelle J. Hall,
featured
presentations by
Stephanie D. Langdon, and Kevin M. Carroll. Not pictured are Christopher Lake
the
Thranhardt
Lecture
and Christopher Robinson.
winners. Michelle Hall,
MS, CPO, FAAOP(D),
presented Margins of
Stability in Children
With Cerebral Palsy
Diplegia: Barefoot vs.
AFO Comparison, and
Joan Sanders, PhD, presented Effect of Daily
Limb Volume Changes
and Volume Accommodation on Activity and
Self-Reported OutThe designation Fellow of the Academy is a signature recognition of
comes.
professional achievement. The 2016 class of Academy Fellows includes, from
Thursday through Satleft: Kyle A. Sherk, Jared A. Howell, Michael P. Madden, Matthew A. Parente, Sun
urday offerings included
Hae (Sunny) Jang, Ellie Boomer, Cara M. Negri, Julian A. Wells, and Michael
Carroll. Not pictured are Kristin J. Carnahan, Adam Edmonds, Erin OBrien,
the opportunity to earn
Brittany L. Stresing, Santiago Munoz, Rick Miller, and Leslie Gray.
continuing education
ore than 1,700 O&P professionals participated in the

42nd Annual Meeting &
Scientific Symposium of the
American Academy of Orthotists and
Prosthetists (the Academy). It took
place March 9-12 in Orlando, Florida,
and something bold
and something new was
on the menu.
The new flavors were apparent with
the launch of the Academys new logo,
the first phase of its corporate rebranding effort. Academy President Jason
Highsmith, PT, DPT, PhD, CP, FAAOP,
addressed attendees at Wednesday evenings opening session; he thanked his
Across the State or
dvances in telecommunication
technologies such
as videoconferencing, smartphones, tablets, Wi-Fi, and
broadband, along with
e-mail and POTS (plain
old telephone service),
are propelling the use of
telemedicine in the United
States and internationally.
Many experts regard telemedicine, or telehealth
these terms are often used
interchangeably, with
telerehabilitation being a
MAY 2016
subsetas a highly effective complement, not a

replacement, for personal,
hands-on patient care in a
clinical setting. Telemedicine is generally integrated
into healthcare information
services and care delivery
rather than offered as
a stand-alone service.
Although occupational,
physical, and speech/
cognitive therapy have
been a longstanding part
of telerehabilitation,
O&P is now beginning
to consider its potential.
24
www.oandp.com/edge
Telemedicines
Advantages and
Barriers
Several recent studies

about the use of telemedicine reveal lower costs and
equal or better outcomes
in various medical areas,
along with high patient
satisfaction. Other advantages include the following:
l Reduced travel time
and costs for patients
and caregiversespecially advantageous for
patients with medical
conditions that make
ld
Aro
or
h
e
t
W
d
n
Telerehabilitation
Technologies
Cover the Distance
travel difficult
Less time off work for
patients and caregivers
l Ready access to specialty
care and multidisciplinary team care in
remote areas
l Access for clinicians
to specialists through
professional-to-professional consultations
l Remote monitoring of
vital signs
l Fast transmission of
images and diagnostic
test results
l More convenient access
l
to continuing education
for health professionals
although there have been

some advances that reduce
these difficulties. The barriers include the following
considerations:
l Difficulties involved in
licensure and credentialing requirements in
multiple states or internationally for telemedicine
providers
l Vague, inconsistent
legalities involving telemedicine that increase
providers liability
concerns
l Reimbursement issues
According to an article
in the International
Journal of Environmental
Research and Public
Health, December 2013
(Crossing the Telemedicine Chasm: Have the U.S.
Barriers to Widespread
Adoption of Telemedicine Been Significantly
Reduced? by Cynthia
LeRouge and Monica J.
Garfield), there are also
barriers to adoption,
MAY 2016
By Miki Fairley
25
www.oandp.com/edge
Unclear return on investment for healthcare

organizations
l Lack of broadband
infrastructure in many
areas, specifically highdemand video and storeand-forward services
l Technology security
issues to protect patient
information
l Shortage of telemedicine
specialty providers and
provider reluctance to
use telemedicine technologies
l
ACROSS THE STATE OR AROUND THE WORLD
Telerehabilitation in O&P
This feature looks at how some U.S.

organizations are using telerehabilitation in O&P, which clinicians and
practices may be able to incorporate for
the benefit of their own patient care.
VA Telerehabilitation Care
Forges Ahead
The U.S. Department of Veterans
Affairs (VA) operates one of the largest
and most comprehensive healthcare
systems in the world. Among its facilities are 150 large medical centers and
about 800 community-based outpatient
clinics (CBOCs) nationwide where
veterans can receive primary care closer
to home.
VA Telehealth Services Acting
Deputy Chief Consultant John Peters
notes that more than 677,000 veterans
accessed VA care through telehealth in
fiscal year 2015. Of these, 282,000 used
videoconferencing for live interaction
with their VA healthcare specialists.
About 98 percent of these videoconferences were between a veteran at a
CBOC and a specialist at the medical
center; about 6,300 videoconferences
were from the veterans own home to
the medical center. For video telehealth, the VA is just now dipping its
toe in the water in going beyond brickand-mortar VA facilities to veterans at
home, Peters says.
Tele-amputation Care
Covers the Bases
Three types of telehealth clinics operate

under the umbrella of the VA Amputation System of Care (ASoC), according
to Rehabilitation Planning Specialist
Cindy Poorman, MSPT:
an interdisciplinary
team with the telehealth
amputation clinic, a
prosthetist support clinic,
and a telehealth support
group for veterans with
amputations.
The interdisciplinary
teams within the VA telehealth amputation clinics
include a physician, an
amputation rehabilitation
coordinator, a prosthetist,
and an occupational or
physical therapist (OT or
PT) depending on need.
A telepresenter, usually a
nurse or PT, accompanies
the veteran at the veterans site. The clinic
provides initial evaluations for a prosthesis and follow-up prosthetic checkouts.
Facilities providing tele-amputation
clinics have increased from two facilities in 2008 to 36, Poorman says. In
the last four years, episodes of care have
increased on average by 50 percent each
yearits growing very quickly.
The prosthetist support clinic provides prosthetic support from the main
VA center when the amputation team
at the veterans local VA clinic doesnt
have an in-house prosthetist. Services
include developing prosthetic prescriptions and new prosthesis checkouts.
The telehealth support group for
veterans with amputations involves
multiple sites connected through
videoconferencing where veterans
with amputations can interact and
receive support and education from one
anotheran opportunity they might
not have otherwise. Currently this program is running at the James J. Peters
VA Medical Center, Bronx, New York;
the VA Palo Alto Health Care System,
Palo Alto, California; and the James
MAY 2016
26
www.oandp.com/edge
A. Haley Veterans Hospital, Tampa,

Florida. This program has been really
successful, and we anticipate expanding
it even further, Poorman says.
A clinical video telehealth pilot project allowing the amputation care team
at the VA Eastern Colorado Health
Care System, Denver, to videoconference with a private prosthetic facility
in Colorado Springs, Colorado, to do
prosthetic checkouts is under way,
Poorman says. This eliminates the
need for veterans to return to the large
VA facility; they can be seen closer
to home at their private prosthetists
facility, she explains.
Occupational Therapy via

Telehealth
We have been providing occupational therapy telehealth services since

2010, says VA Occupational Therapy
Discipline Lead Deborah Voydetich,
OTR/L, SCLV. Last year we had more
than 1,200 telehealth patient visits,
mostly in the community-based outpatient clinics. For instance, a veteran
with impairments who is receiving
care at a CBOC may participate in a
telehealth visit with a physician and
an OT at the main medical facility.
The therapist may educate the veteran
about how to compensate for some of
his or her impairments. For instance,
the therapist might suggest a different
way of dressing, how to use different
adaptive devices, such as a shoehorn,
sock aid, or a dressing stick, or how to
modify the home to make it safer.
Home visits via telehealth are an
emerging area, Voydetich says. We
want to expand in this area because
it definitely makes sense to provide
services in the veterans home and help
them maximize their independence in
their own environment.
Were also looking into videoconferencing into the home for veterans with
amputations, Poorman adds. Were
thinking about follow-up for wound
care, home assessment, safety assessment, and how well the prosthesis is
fitting.
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Veteran, Provider Satisfaction
Patient satisfaction with videoconferencing in general is 94 percent,

although in-home videoconferencing is
a small percentage, Peters says. Setting
up the video connection between
the care team at the facility and the
veteran at home is the hardest part,
since besides requiring a username and
password, the video has to be encrypted
to protect privacy. But once were connected, the providers, the veterans, and
the caregivers are all enthusiastic about
it, he adds.
One of the things we hear from our
veterans is that they appreciate not
having to travel as fardecreased travel
is really important to them, Poorman
says.
Besides veteran satisfaction, there
is also provider satisfaction, because
many of our providers are learning new
techniques and new skills through the
telehealth visits, Poorman continues.
For instance, a smaller facility may only
have one PT on staff. So, that physical therapist is learning a great deal
through the specialty team at the medical center.
When they are with patients in the

field, ssurs clinical specialists use
interconnectivity with the research
and development (R&D) team to help
with diagnostics and troubleshooting
via the Internet, Pratt explains. For
instance, with the POWER KNEE,
engineers can tap into the clinical
specialists computer remotely by
using ssurs proprietary software and
International Manufacturers:
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ssur
ssur utilizes several telecommunication technologies, such as FaceTime,
Skype, and other Internet features,
for a variety of needs involving its
more complex products, generally the
RHEO KNEE and POWER KNEE,
according to Justin Pratt, CP, director
of ssur Academy, prosthetics. ssur
Americas is based in Foothill Ranch,
California; the parent company is headquartered in Reykjavik, Iceland.
Situations vary from patient-specific
challenges, gait anomalies, provider
experience with the device technology,
etc., Pratt notes. We have used a variety of methods in an effort to see and
understand the situation so we can recommend the appropriate adjustments
and provide education and support.
observe the devices behavior. These

situations most often involve a patient
with a hip disarticulation or bilateral
transfemoral amputations and often
are related to the range of motion
(ROM) the user can accomplish.
Their amputation level, experience,
and any training they may have would
all influence the changes in parameters
within the bionic knee programming.
ssurs clinical specialists may also
assist by sharing a FaceTime video
from their home office with the remote
local prosthetist.
One of our greatest assets at ssur
is that everyone desires to push the
envelope and find new ways to service
MAY 2016
28
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our clinical customers and end users,

Pratt says. We often exchange these
ideas and methods with our counterparts in ssur offices around the globe
so we can all improve our clinical and
technical support.
Ottobock
Although Ottobocks Cooperative
Care consulting service, headquartered
in Austin, Texas, usually involves an
in-person meeting with a prosthetist
and patient, FaceTime or WebEx
videoconferencing technology is used
to follow up with the practitioner and
patient, explains Byron Backus, CP,
senior lower limb clinical specialist for
prosthetics.
Telerehabilitation via mobile devices
has been indispensable for Backus. I
have assisted practitioners with aligning a prosthesis, programming one of
our MPKs [microprocessor knees],
adjusting the hydraulics on a hip joint,
or all of the above together, as well
as programming a DynamicArm or
Michelangelo hand. I have used WebEx
and FaceTime while sitting at my desk
at the office, sitting in a hotel, and
even while sitting in an airport. Once,
when traveling, he says he had several
text messages and phone calls from a
practitioner seeking help with a Helix
hip fitting. As Backus left the plane,
he noticed a sign for free Wi-Fi at the
airport. SoI sent the practitioner
an e-mail with a WebEx invitation and
within five minutes I was virtually in
his office seeing his patient walking. I
was able to check the alignment of the
prosthesis, suggest some minor alignment changes, and walk the practitioner
through the programming of the knee
and adjustments to the hip joint. The
patient did very well. Backus also has
used these technologies to coach practitioners and patients in gait training.
WebEx has been useful for remote
education, such as providing more
in-depth information through sharing
a presentation or other documentation. Some technical support staff use
remote access software to log into a
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practitioners computer to troubleshoot software issues or help install

Ottobock software, he adds.
Touch Bionics
High-tech upper-limb prostheses such
as the i-limb from Touch Bionics, headquartered in Livingston, Scotland, with
a U.S. office in Hilliard, Ohio, require
intense user training. After the fitting
and initial training, users often require
additional education, therapy, and support. Due to the relatively small number
of people with upper-limb loss, many
prosthetists and OTs are not highly
experienced in treating this population.
For Touch Bionics staff prosthetists
and OTs, obtaining licenses in multiple
states to interact directly with users is
impractical.
Given these two situations, Touch
Bionics is using telehealth technologies
to provide education, training, troubleshooting, and support to the patients
local prosthetist and OT.
Through GoToMeeting or other
videoconferencing software, Touch
Bionics prosthetist Nathan Wagner,
CPO/L, OTR/L, and Lynsay Whelan,
OTR/L, director, remote training and
occupational therapy, can interact with
local clinicians and patients in real time.
Through the companys biosim software, Wagner and Whelan can remotely
access the i-limb.
The hand itself connects to the local
clinicians computer via Bluetooth
and can be connected to our program
and transmitted to GoToMeeting so
everyone can see what the muscles are
doing, Wagner explains. The i-limb has
two electrode sites for control, although
there is a version with one-site control
strategy. With two electrode sites,
sometimes the user may think their
system isnt working when in reality
they may be having trouble firing the
muscles and separating out signals.
If both muscles are firing at the same
time, the hand doesnt know whether to
open or close. So, often just by cueing
the local occupational therapist and the

user, we can help them get better signals
for better function.
We also work with the occupational
therapist and the patient on what they
want the hand to do, for instance,
handling eating utensils, dressing, and
other activities, Whelan says. We can
share what weve learned over time to
help them figure out how to best do
these activities, since the prosthesis user
may have to do them differently.
From the local prosthetists perspective, we are assisting them to create a
better outcome for the i-limb wearer,
Whelan adds. Even though we dont
charge for the service, the local prosthetist and therapist are excited when
there is a good outcome, and are more
apt to use our products again.
DynamicBracingSolutions
Marmaduke Loke, CPO, owner of
DynamicBracingSolutions (DBS),
Carlsbad, California, and Jean-Paul
Nielsen (since retired), developed a
unique triplanar bracing concept to
improve function of patients with
neuromuscular disorders such as
post-polio syndrome, Charcot-MarieTooth disease, and muscular dystrophy.
Telecommunication technologies that
include FaceTime, Skype, and videos
transmitted via e-mail have helped DBS
clinicians successfully assess, train, and
follow up with international patients,
Loke says.
International patients generally send
a video to help clinicians assess gait and
other factors. Candidates for the bracing solutions follow specific instructions to create their videos and are
asked to provide any pertinent medical
documentation they have. We may ask
them to see their doctor, PT, or orthotist to provide information regarding
manual muscle testing, contractures,
ROM, etc., Loke says.
Loke looks for as many details as
possible in the videos. For improving
balance and efficiency, all structural and
MAY 2016
30
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functional deficits must be recognized

and a strategy developed to realign each
bone with triplanar management. We
need to fully understand the cause and
effect of each compensatory movement
pattern and how to solve them.
After being fit with and trained on the
use of the orthosis and the accompanying exercise program, Loke encourages
international patients to send follow-up
videos; he also uses Skype and direct
phone calls when needed.
I often give the remote international
clients a kit of extra screws, bushings,
SACH heels, [and] pads, and will
provide instructions, Loke adds. He
encourages return visits when possible
to check and improve alignment and fit.
Remote troubleshooting often
involves helping the patient utilize more
efficient movement and more natural
walking patterns, which must be
practiced repeatedly to fully optimize
the functional improvement potential
of the orthosis. Our bracing solution
enables clients to move the pelvis in the
correct pattern to stop the trunk and
head from moving side to side when
they compensate.
Its Come a Long Way
Telemedicine has come a long way since

a visionary cover appeared on Radio
News magazine in 1924. Radio was just
beginning to become part of American
life, and the first experimental television
broadcast was still a few years away. The
cover portrayed a radio doctor linked
to a patient via sound and a live picture,
anticipating modern videoconferencing. As the complexities of the technology have caught up with the vision,
several experts affirm that telemedicine,
including telerehabilitation, will continue to grow, unlocking its potential
for better patient care. O&P EDGE
Miki Fairley is a freelance writer based in southwest
Colorado. She can be contacted via e-mail at
miki.fairley@gmail.com.
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An O&P student from Northwestern University

Prosthetics-Orthotics Center works with a patient
in ROMPs Zacapa, Guatemala, clinic.
MAY 2016
32
Photograph by ROMP volunteer Paula
Cavanaugh, courtesy of ROMP.

www.oandp.com/edge
RELATIONSHIPS
By Laura Fonda Hochnadel
When a large-scale disaster strikes,
help from around the world often arrives in droves. Such was the case with the catastrophic earthquake
that struck Haiti in January 2010. While O&P nongovernmental organizations (NGOs) had already been
working in-country, efforts were amplified. The need for O&P care at such times is urgent. But, the need
for O&P care in less-resourced countries is always prevalent, if not urgent. Fortunately, multiple O&P
NGOsroom doesnt permit us to mention them allhave found niches in which to operate
and provide continuity of care. Their work underscores the importance of
building relationships with in-country healthcare providers
and governments.
Network,
Network, Network
The thing that really has made the big

difference in our ability to continue
providing services has to be the relationships and the connection we have
with the people in Belize, says Robert
Kistenberg, MPH, CP/L, FAAOP,
cofounder of Prosthetic Hope International (PHI) and its sister organization,
Prosthetic Hope Belize (PHB), which
provide O&P care in Belize. Because
if you want to go down to any developing country and provide services, you
have to have a really good support network, and the key is finding out what
they need. The need in Belize was easy
to determine, he says, as there were no
prosthetic services when he arrived.
Kistenberg first traveled to Belize
in 1995 as part of a mission trip to
provide prosthetic care. For the next
few years, he and a handful of friends
returned annually to carry on that
work before PHI (formerly Sonrie
Ministries) was formally established
in 2000. He and volunteers operating through PHI/PHB have been

going to Belize at least biannually ever
since. Volunteer teams include O&P
students, practitioners, technicians,
and administrative workers. In 2002,
PHI/PHB received grant funding and
purchased a building in Orange Walk
Town. There have been bumps and
roadblocks associated with property
ownership and operating a clinic long
distanceincluding the logistics of
stocking the facility, paying utility
bills, having tools stolen, and organizations hesitancy to partner with PHI/
PHB. Yet the care Kistenberg and his
staff provide is always welcome, and
with new systems and new in-country
staff in place, he feels the clinic has
turned a page for the better.
I really feel like we are at a position
MAY 2016
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now that we have made great

connections with stakeholders
from the national health insurance, to
the ministry of health, to the hospital systems, and the other support
networks, as well as the parents and
patients, Kistenberg says.
Dino Scanio, CO, clinical director and founder of the Florida O&P
Outreach Team (FOOT) Foundation concurs about the value of
strong networks. FOOT Foundation
was organized nine years ago and
the majority of its efforts have been
focused on providing O&P care to
children in Guatemala. It took about a
year to really develop the network, the
foundation, the understanding of the
governmental policy in Guatemala, he
says. You have to have your relationships strong and solid to be successful.
Word of mouth traveled quickly, and
the highest levels of government found
out about the foundations work; he
and his colleagues then received an
invitation to the government palace.
ROMP provides continuity of care, which

is especially important for pediatric
cases, as children outgrow their devices
and need more frequent replacements
than do adults.
Photograph by ROMP volunteer Paula
Cavanaugh, courtesy of ROMP.ROMP.
From a Closet
to a Clinic
This was not only an honor and

privilege but also an opportunity to
discuss how the government can support our efforts. It was a remarkable
chance to build a strong friendship
with a common goal to improve lives,
because friendships like this can make
a difference.
FOOT Foundation operates an
ongoing clinic at the Hospital Infantil de Infectologa y Rehabilitacin in
Guatemala City, and when Scanio
travels there he is accompanied by a
core group of three practitioners and a
technician.
However, its not always easy to make
those connections, cautions Jon Batzdorff, CPO, founder of ProsthetiKa.
He was among a group of volunteers
who traveled to Ukraine for the first
time last April to provide prosthetic
care, rehabilitation, and prosthetic
training. It is a large country with a
large population, and with that comes
a large bureaucracy and associated
frustrations. Basically, within the
government level in a country where
corruption is rampant, change happens
when there is some kind of financial
incentive for the bureaucrats who are
responsible for making the change, he
says. We are actually working
with the government ministries.
We are getting some cooperation
from the government, but its slow and

laborious.
Batzdorff says it is necessary to find
the champions of the cause and work
with them. Sometimes those champions are practitioners, and sometimes
those champions are patients and the
communities that serve them. The
motivation and inspiration goes from
the bottom up, he says.
Batzdorff s experience in this area
is significant. Although 2015 marked
ProsthetiKas first trip to Ukraine,
the NGO has been operating since
2004, providing care in Mexico, India,
Bolivia, and elsewhere. He emphasizes
that involving local people in the country in which you are working not only
forms relationships but shows respect
for the people and the community.
PHI/PHB involves local stakeholders by partnering with the Belizean
healthcare system, Kistenberg says. At
least once a year, or whenever I go into
the country, I will sit down and meet
with the medical director and hospital
administrator so they know what is
going on with the clinic, what we are
doing, and what our plans are. These
individuals have a good idea of the
O&P care that is needed in the country and can get word out to satellite
hospitals, which will, in turn, get word
out to patients.
MAY 2016
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The Range of Motion Project

(ROMP) was established in
Zacapa, Guatemala, in 2005.
The location was chosen based
on a perceived need in the
community for O&P services,
says Patrick Mathay, the NGOs
executive director. The clinic
itself started in basically an unused
storage closet [in a hospital] that they
put a pizza oven and some tools into
and started just making limbs. In
2007, the Loren J. Mallon Centro de
Rehabilitacion, a full-service O&P
clinic and fabrication facility, was
constructed; it is now staffed by local
practitionerstwo prosthetists, two
technicians, an administrator, and a
clinical hygienist. (ROMP also has a
mobile O&P lab that services medical partners in Western Guatemala
and Chiapas, Mexico, and a research
facility in Quito, Ecuador, where the
NGO provides financing for medical
partners that provide O&P care.)
ROMP is increasing efforts to
formalize its work with the existing
healthcare system, Mathay explains.
[W]e are increasingly eager to integrate our services with the broader
healthcare system so that we can avoid
redundancies and really work for the
patient, so that they can get the best
outcomes possible. For example,
ROMP is able to provide physical
therapy (PT) to its patients through a
partnership with Universidad Mariano
Galvez de Guatemala, Guatemala City.
Guatemalan PT students work in the
ROMP facility six months per year,
while patients living in the capital are
referred to the university campus.
Delivering a prosthesis isbut a
means by which we achieve our true
objectivefull patient rehabilitation.
BUILDING RELATIONSHIPS
Partnerships like this are a small but
important step in creating that kind of
value for our patients, Mathay says.
ROMP has also formed relationships
with masters-level O&P programs at
Northwestern University ProstheticsOrthotics Center and Baylor College
of Medicine. The students travel to
Guatemala to gain experience working
in a developing country, and the Guatemalan staff can get access to some of
the latest techniques or latest schools
of thought in O&P, Mathay says.
Sustainability
English: self-sustaining
Spanish: autosostenible
Ukrainian: samoobespechyvatsya
No matter how you say it, it means
the same thing: the ability to maintain
oneself or itself by independent effort.
Each of these NGOs stress sustainabilityensuring that the clinics carry
on year-round with local staff and,
for the most part, that devices can be
fabricated or repaired in-country with
locally available materials.
We work with a local practitioner
at the hospital, Julio Duarte, who has
been with us since day one, Scanio
says.
When Scanio is home in Florida, he

and Duarte communicate via e-mail
and Skype so the clinics work continues without him. The local staff work
within their skillsets, Scanio says, and
seek help from him and FOOT Foundation for more difficult patient cases.
ProsthetiKas humanitarian ventures
include education as the primary
aspect, Batzdorff says. If we were
going to measure our success primarily by the number of patients that we
fit, then we would just tell the people
who are inexperienced to get out of
the way and just do the fittings [ourselves], he says. This is the opposite
of that.
The importance of providing O&P
training to in-country healthcare
workers is underscored by the nature
of limb loss: Its a permanent state,
requiring lifelong prosthetic care. So
when a prosthesis breaks, the patient
must have an accessible clinic to make
repairs, Mathay says.
Never underestimate the local practitioners ability to improvise, Scanio
adds. Ive literally seen [local practitioners] hand-whittle metal sheets to
make joints. They know what to do to
sustain their level of living.
While the goal of self-sustainability is commendable, there
are barriers to implementation,
one of which is always funding, Kistenberg says. In Belize,
health insurance does not
cover O&P, so those people
who do have savings must
spend their money on hospital bills and rehabilitation,
leaving nothing for a prosthesis. How would the
environment in Belize
or in any developing
country be able to cover
the cost of providing
services? he ponders.
In view of this
financial barrier, PHI/
Lema has been receiving prosthetic
care from FOOT Foundation for over five
years. This photo was taken when she first
came to the clinic.
Photograph courtesy of FOOT Foundation.
MAY 2016
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www.oandp.com/edge
PHB, FOOT Foundation, ProsthetiKa,

and ROMP operate on a humanitarian sliding scale. This means that some
patients get their care for free, and
what others pay may not cover the
total cost of the device and care. Those
who can afford to pay for care from a
local practitioner in private practice
are guided that way.
Why Do It?
As our interviewees attest, their NGOs

require hard work, demand long hours,
and are fueled by passion. They must
take time away from their jobs and
families. So why do it? There are a
variety of answers: Its about the patient
relationshipsseeing children grow up
and advance through their prosthetic
options, international practitioner relationships and information exchange,
and because the need is there.
I felt when I first went there and got
the clinic that I made a commitment
to the country and to the people that
we would try to solve this problem that
they had no services, Kistenberg says.
I still have that same commitment.
He also claims stubbornness and being
unwilling to accept failure as driving
forces.
Theres a great connection when
people in prosthetics, prosthetists,
get together from different countries,
Batzdorff says. I think that they find
that theres a lot that can be shared
even with the language barrier, and
part of that is the passion and dedication and understanding.
There is nothing greater than to see
a dad walk in carrying his child, who
has no legs below the knee, and that
child gets up and walks or stands for
the first time, Scanio says. [P]assion
and helping humanity will motivate
you to push beyond your personal
limits and that will inspire you to bust
your ass to make it happen. At the
end of the day, you will be rewarded
by smiles and tears of joy by those you
have helped, and thats why I do it.
O&P EDGE
Laura Fonda Hochnadel can be reached at

laura@opedge.com.
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Providing
evidence-based care
in low-, middle-income countries
By John T. Brinkmann, MA, CPO/L, FAAOP
Photographs courtesy of Gail Palethorpe/Shutterstock.com.
MAY 2016
38
www.oandp.com/edge
everal years ago

I attended a
meeting where a
young practitioner reported
on a medical
service trip
(MST) involving prosthetic care in a low-income
country (LIC) that lacked such services. Many features of the industrialized worlds infrastructure,
such as transportation, housing,
plumbing, etc., were not readily
available in the area served by that
venture. As the presenter reported
on the details of the trip, it became
apparent that little thought had
been given to the long-term sustainability of the services provided.
For example, at the most basic
level, the components provided
were not suitable for the patients
living conditions.
A discussion with the speaker
following the presentation confirmed that she had no prior
experience with that type of project
and had not informed herself
by reading literature or speaking with other prosthetists who
had provided services in a similar
situation. The trip had been a
one-time undertaking, providing
exactly the same types of prostheses that would have been provided
to patients in the United States,
and there were no plans to provide
follow-up care.
P&O Services in
Low-, Middle-income
Countries (LMICs)
When implementing evidencebased medicine, a practitioner

combines clinical experience, the
values and needs of the patient,
and the best available research evidence to make the most appropriate care decisions for the patient.
Practitioners participating in
charitable activities have a professional responsibility to integrate
those same considerations into
their services. However, research
evidence related to humanitarian
efforts is limited.
Harkins et al. summarize their
2013 review of P&O services in
LICs by saying that the lack of and
quality of available research made
efficacy of methods used to provide
services in low-income countries
difficult to determine.1 They also
report that a substantial body of
research is needed to prove the
efficacy of the methods of service
provision; maximise the effective
methods; and to develop evidencebased, sustainable services.
[M]ore specific data are necessary
to create effective prosthetic and
orthotic services.1 Ikeda et al.s two
scoping reviews on the provision of
P&O services in resource-limited
environments (RLEs) published
in 2014 provide thorough descriptions of considerations for success
and research and outcomes.2,3
While these articles provide a
helpful evidence base of available
literature and outcomes reported
by P&O service providers working in RLEs, they conclude that
their research highlights the need
for standard, valid, and reliable
methods of data collection and
reporting.2,3
Lessons From
Surgical Literature
While surgical and P&O services

differ in many obvious ways,
reviewing research related to
surgical MSTs can provide helpful perspective on P&O efforts in
similar contexts. Several systematic
reviews of articles related to surgical MSTs have been completed in
recent years and can be used to
promote professionalism in P&O
MSTs.
Models for providing medical
services to LMICs involve either
self-contained operations (e.g. hospital ships), established local facilities that are staffed and supplied
in part by high-income countries
(HICs), or ad hoc trips in which
personnel and supplies from HICs
are brought in to provide services
on a short-term basis. Short-term
MAY 2016
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missions can span from one week

to two months. Shrime et al.
reviewed articles related to MSTs to
determine the effectiveness of each
of these platforms for delivering
medical assistance in LMICs.4 They
report that self-contained temporary platforms and specialized
surgical centers appear to provide
more effective and cost-effective
care than short-term surgical mission trips, except when no other
delivery platform exists, concluding that the short-term temporary
surgical missions role should be
limited to areas and conditions for
which no other surgical delivery
platform is available.4
This recommendation is made
regarding MSTs that focus on
medical conditions with obvious
potential for surgical resolution.
Ongoing, local, and sustainable
services are even more important
when providing P&O care, since
the disability is ongoing and the
intervention requires adjustment
and repairs over time. In these
cases, short-term, ad hoc P&O
MSTs may be even less effective
than their surgical counterparts.
In 2012, Martiniuk et al. published a review of articles to determine advantages and disadvantages
of medical missions.5 They report
that only 5 percent of articles they
reviewed included theoretical or
conceptual analysis, and that there
was little quantitative data to analyse.5 The authors advise organizations and individuals participating
in MSTs to adopt a more precise
approach to mission planning,
implementation, and reporting.5
The 2015 review by Caldron et al.
focused on empirical studies on the
social, economic, and diplomatic
aspects of short-term medical missions (STMMs), and the authors
report that scant analyses exist in
the current literature wherein normative concepts of volunteerism,
altruism, and philanthropy is
applied specifically to the praxis
of STMMs.6 This research
demonstrates that the difficulty
Seven Sins of
Humanitarian
Medicine
1 LEAVING A MESS BEHIND
2 FAILING TO MATCH
TECHNOLOGY TO LOCAL
NEEDS AND ABILITIES
3 FAILING TO COOPERATE
WITH AND HELP OTHER
NONGOVERNMENTAL
ORGANIZATIONS (NGOS),
AND ACCEPT HELP FROM
MILITARY ORGANIZATIONS
4 FAILING TO HAVE A
FOLLOW-UP PLAN
of implementing evidence-based
practice is not unique to P&O.
5 ALLOWING POLITICS,
A Systematic Review of
Empirical Evidence
TRAINING, OR OTHER
DISTRACTING GOALS TO
TRUMP SERVICE, WHILE
REPRESENTING THE MISSION
AS SERVICE
6 GOING WHERE WE ARE

NOT WANTED, OR NEEDED,
AND/OR BEING POOR GUESTS
7 DOING THE RIGHT THING

FOR THE WRONG REASON
Adapted from Welling et al.9
Multiple researchers report that

the available literature on MSTs
has been primarily descriptive and
presented little objective evidence
of cost effectiveness or patient
outcomes. Most notably, in 2015,
Sykes published a review of articles
that included empirical results
of intentional data collection in
areas including treatment interventions, costs, cost effectiveness,
quality assessment, or surveys of
perspectives of involved parties.7
He found 67 such studies published
from 1993-2013, which accounted
for only 6 percent of the articles
published on the topic in that
timeframe.7 The majority of the 67
articles (80 percent) reported on
surgical MSTs.7
Sykes classified the articles based
on their study designs, and found
that almost half employed a retrospective study design or simple
MAY 2016
40
www.oandp.com/edge
descriptive statistics to report their

findings, with nearly all representing low-level quality evidence.7
Thirteen percent were quality
improvement or quality assurance
projects, and 10 percent involved
surveys of individuals who volunteered on MSTs and organizations
that operated them.7
Output Versus Outcomes
While there is an increased emphasis on collecting outcomes data on

medical services provided in HICs,
this is not a priority during most
MSTs. Sykes concludes that most
MSTs report outputs rather than
outcomes, a criterion that falls
short of the measures used to identify high-quality evidence-based
medicine.7
Nearly three-quarters (74 percent)
of the articles Sykes reviewed did
not report on outcomes or limited
those reports to outcomes within
seven days of the service provided.7
Since these were reports primarily
of surgical MSTs, the focus was on
the immediate outcomes of the
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PROVIDING CARE
surgical procedure or other aspects
of the mission, and not on long-term
effects of the treatment. Sykes reports
that most of the publications lack
significant data collection and information about changes in quality of life
resulting from medical interventions.7
Intention Versus Impact
The desire to help others is a common

reason for choosing a medical profession, and volunteering for an MST
may spring from genuine altruism.
MSTs are complex and multifaceted
undertakings, with many opportunities for good intentions to result in
poor outcomes. Eddy Fuentes, CPO,
provides valuable insight into one such
unintended negative consequence in
his article The Effect of Good Missions Overseas.8 Concerns about the
negative effects of well-intentioned but
poorly implemented charitable efforts
resulted in the development of the
International Society for Prosthetics
and Orthotics (ISPO) Code of Conduct for Humanitarian Organizations,

which can be accessed at www.usispo.
org/code.asp.
Martiniuk et al. report that very few
of the articles they reviewed discussed the ethics, policies, standards,
or evaluations of short-term medical
missions.5 These are important topics
to discuss prior to, during, and following an MST and should be a standard
part of volunteer recruitment and
training. Caldron et al. point out that
participants in MSTs may assume that
because these missions are charitable
and altruistic they are valid in their
own right, and therefore the collection of objective outcomes data is not
mandated.6 Sykes asserts, however, that
delivering care without understanding
the impact or the outcome of that
care presents ethical challenges.
[T]here should be no assumed ethical
immunity solely based on the altruistic nature of these efforts.7 He adds
that to measure quality, organizations

should incorporate outcomes evaluations in their activities.
Which Outcomes?
Collecting outcomes data during MSTs

may be perceived as unnecessary by
U.S. practitioners, since the relatively
recent (and by no means universal)
practice of collecting this data can be
closely tied to reimbursement pressure.
The freedom from the financial and
administrative pressures of everyday
practice is one of the appeals of MSTs,
so it is understandable that the collection of outcomes data is not a high priority. Additionally, surgical procedures
represent a much greater risk than
most P&O interventions, and the often
immediate and obvious beneficial
impact of P&O services may appear
to obviate the need for outcomes
measurement in LMICs. However,
measurements of the treatments direct
effect on the patients function is only
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PROVIDING CARE
Modern
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Control
one aspect of outcomes

measurement. There are
many ways to measure the
impact of a particular medical service, and P&O MST
organizers can and should
use a variety of different
measures to demonstrate
their effectiveness. Martiniuk et al. suggest that MST
reports should include the
number of people treated,
follow-up needed and how
this will occur, cost per
beneficiary, training of local
counterparts conducted,
and challenges faced.5
Sykes recommends that
organizations collect patient
demographics including
socioeconomic status, the
availability of regular care in
the patients communities,
and the MSTs cost of delivering care.7 He reports that
outcomes in the literature
he reviewed involved the
impact on the volunteer, on
the patient relative to cost,
and on the local health care
providers.7
The literature reviews by
Ikeda et al., mentioned earlier, reported that outcomes
collected as part of P&O
provision in RLEs included
durability, cost, satisfaction, use/nonuse of device,
amount of utilization,
walking speed, discomfort,
pain, fit, misalignment,
capacity for service provision, number of devices
produced or delivered, and
number of graduates from
training programs.
[M]easurements of inclusion, participation, or [quality of life] were rare.2,3
Organizers of P&O MSTs
should be familiar with
ISPOs protocol and assessment, as well as benchmarks
developed by researchers
and clinicians providing
services in RLEs. Evaluating
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MAY 2016
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and reporting on all of these

factors using valid methods
will improve the level of service provided on MSTs.
Conclusion
Providing care in any

context without adequate
training and preparation
is irresponsible, and the
majority of P&O practitioners participating in
MSTs are doing so more
responsibly than the efforts
described in the scenario
at the beginning of this
article. Those considering
participating in charitable
efforts have a professional
and ethical responsibility to
develop a coherent philosophy and inform themselves
of the unique challenges of
providing care in LMICs,
including being familiar
with the P&O literature on
this topic and the output of
national and international
organizations that have
been providing this type of
service for many years.
P&O-focused articles and
reviews such as those by
Ikeda et al. and Harkin et al.
should inform the development of outcomes programs
by MST organizers. The best
available research evidence
may be limited, but as
MST organizers adopt and
expand an evidence-based
approach to their activities, the level of credibility
and professionalism will
increase. O&P EDGE
John Brinkmann, MA, CPO/L, FAAOP, is
an assistant professor at Northwestern
University Prosthetics-Orthotics Center.
He has more than 20 years of experience treating a wide variety of patients.
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Deathe and Miller:
CANADIAN PIONEERS
IN PROSTHETIC
OUTCOME MEASURES
By Phil Stevens, MEd, CPO, FAAOP
pparently unaffected by the 2,300 miles that

separate their physical locations, physiatrist
A. Barry Deathe, MD, FRCP(C), of London, Ontario,
Canada, and researcher William C. Miller,
MSc, PhD, OT, of Vancouver, British Columbia,
Canada, have collaborated for more than a decade to contribute

to the development and validation of clinically relevant outcome
measures in rehabilitation for people with amputations. While an
exhaustive review of their academic contributions is beyond the
scope of this article, their work with the L Test of Functional Mobility
(L Test) and the Activities-specific Balance Confidence (ABC) Scale
warrant detailed review.
MAY 2016
46
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y,
t
i
l
i
b
ty
a
i
t
l
i
un ob
o
cc ic m
a
re thet
a
hc ros
t
l
ea g p nd.
h
f
in ma
y
o
f
i
ate uant n de
i
lim f q
y
c
l
rn m o sing
e
od anis rea
m
c
h
n
i
e
c
h
e
s
t
i
m
In
a
L Test: Initial Development
One of the goals of rehabilitation

following amputation is to enable
patients to return to mobility, or regain
the ability to walk and change body
positions when needed. When mobility is restored, activities such as transfers, level-ground walking, turns, and
household ambulation can be routinely
performed. In the modern climate of
healthcare accountability, a mechanism of quantifying prosthetic mobility is increasingly in demand.
In a 2005 publication, Deathe and
Miller describe the evolution of just
such a measure within a clinical setting.1 In their Regional Amputee Program, they were using the Timed Up
and Go (TUG) test and two-minute
walk test (2MWT) to assess prosthetic
mobility. However, they were finding
neither test to be fully conducive to
their needs. The TUG test was simply
too easy for younger individuals
and many of the fit, elderly patients,
leading to an observed ceiling effect.
The longer 2MWT was difficult to
administer due to the requirement

of a 20 meter long hallway free of
distractions. In the authors words,
[O]ur need was to find or develop a
test that could be easily and quickly
administered concurrent with each
patient visit that assisted with determining ability to walk with prosthetic
devices.1
Recognizing the value of including
transfer skills in addition to ambulation, the authors wanted to preserve
that element of the TUG test in a more
demanding test. The authors describe
the evolution of their solution as follows: Observations of a patients gait
during clinics showed that we usually
asked the patient to get up and walk
out of the room, turn and go down the
hall, then return to the room and sit
down. This walking path, representing
an L configuration, required turns
to both the right and left. Standardizing the distance (3m x 7m) led to
the development of a potentially more
demanding, yet practical, modification of the TUG that we have titled the
MAY 2016
47
www.oandp.com/edge
L Test of Functional Mobility (L Test).1

To validate the new instrument, a
convenience sample of 102 subjects
who were attending regular clinic
appointments during a six-month
treatment window was studied. This
included the performance of a number
of walking teststhe L Test, 2MWT,
TUG test, and ten-meter walk test
(10MWT)during two testing sessions, conducted by two separate raters and broken up by the completion
of several self-report questionnaires.
The L Test was performed three times
during each session to assess any
potential learning affect, and willing
subjects returned two weeks after that
initial study protocol to perform the L
Test series a second time.
Ninety-three of the subjects who
began the study protocols completed all
of the tests, defining the original study
cohort. Of these, 27 returned for the
retest protocols, comprising a secondary cohort. The primary cohort was
predominantly male (78 percent) with
transtibial amputations (74 percent)
CANADIAN PIONEERS IN PROSTHETIC OUTCOME MEASURES
interventions, and returned to

and traumatic amputation
the clinic where a second L Test
etiologies (60 percent). However,
MEAN TIME TO
COMPLETE
was performed.
transfemoral amputations (26
(in
seconds)
Of the 33 patients included in
percent) and vascular amputathe
study, the most commonly
tion etiologies (40 percent) were
Amputation level
identified problems were a poor
also well represented.2
Transtibial
29.5
prosthetic fit (33 percent), residWithin the primary cohort, the
ual limb problems (30 percent),
average completion time for the
Transfemoral
41.7
and residual limb shrinkage (15
initial L Test was 32.6 seconds,
Amputation
etiology
percent). Of these subjects, 64
a time that did not change
percent required a new socket.
substantially with the second
Traumatic
26.4
Other interventions included
performance (32.9 seconds).
Vascular
42
modification to an existing
The normative data according to
prosthesis (9 percent) and the
amputation etiologies and levels,
Walking aid used
prescription of medication (9
along with age and walking aid
No
25.5
percent). Upon their return to
considerations, are shown in
the clinic, in addition to retaking
Table 1.
Yes
43.3
the L Test, subjects were asked,
The most intuitive clinometric
Age
Since we last saw you, have you
consideration to most readers is
experienced any change in your
reliability. Performance on this
<55
25.4
ability to get up and walk with
test appears to be fairly consis55
39.7
your prosthesis? Not surpristent across multiple iterations
ingly, the vast majority (82 perand different test administrators.
cent) said they had. They were
However, other validation values Table 1. Mean performance values for the L Test according to amputation
levels and etiologies, the need for a walking aid, and age. Adapted from
then asked if this ability had
were also observed. For examDeathe and Miller.1
improved or gotten worse, and
ple, as expected, performance
rated the amount of change on
on the L Test correlated very
but the test added 90 degree turns to
a seven-point Likert scale (0 =
strongly with performance on
both the left and rightan activity that
almost the same and 6 = a very great
the TUG test and during the 10MWT.
can be challenging to some patients
deal better/worse). The authors then
Similarly, a strong negative correlawith transfemoral amputations. The
set out to determine the relationship
tion was observed with the 2MWT,
net result was a measure with a
between changes in reported abilities
meaning patients with lower L Test
reduced ceiling effect relative to its
and L Test performance.
performance values covered greater
predecessor, the TUG test.1
Encouragingly, the L Test appeared
distances during the 2MWT.1
sensitive enough to capture the
The end result of this initial effort
L Test: Sensitivity
changes experienced by most of
was the introduction of a more
to Change
the patients who had required and
demanding version of the TUG test
The utility, reliability, and validity of
received major prosthetic intervenwith high clinical utility (that is, easily
the L Test are evidenced in its initial
tions. The mean performance score
performed in most clinical environpublication. The answer to the more
decreased by an average of 6 seconds
ments). This utility is also consistent
nuanced question, how sensitive the L
following the intervention (46 to
with the concept of face validity,
Test
is
to
change,
would
take
another
40 seconds). Even among the four
meaning that the instrument meadecade to reach publication.2 This
patients who reported a decrease in
sures prosthetic mobility in a fashion
trial began with a carefully selected
prosthetic ability, an average improvethat captures the real needs of most
cohort of patients who were attending
ment of 4.5 seconds was observed.
patients, such as getting up from a
the South Western Ontario Amputee
As hypothesized, those who reported
chair in the living room, exiting the
Program, all of whom were identigreater amounts of improvement
room into the hallway to retrieve
fied by their physiatrists as requirdemonstrated greater average reducsomething from the kitchen, and
ing
a
major
intervention
such
as
a
tions on the L Test of 13.5 seconds
returning to a sitting position in the
new socket or referral for additional
than those reporting more measured
living room.
therapy. These patients performed
improvements, 3.5 seconds.2
Compared to the TUG test, not only
the L Test at the time of those deterwas the distance traveled more than
In addition, the authors ultimately
minations, received the indicated
tripled, from 6 meters to 20 meters,
assert that the minimal clinically
MAY 2016
48
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FACTORS
important difference for the L Test was 4.5 seconds, meaning

that an improvement of 4.5 seconds best distinguishes those
patients who experience greater or more measured levels of
improvements through their prosthetic interventions.2
Age
Balance Confidence
Just as Deathe and Miller were concerned about measuring

limitations in prosthetic mobility, they were interested in better
understanding potential barriers to prosthetic mobility. To do so,
they examined the concept of fear of falling in terms of balance
confidence. Based on Albert Banduras theory of self-efficacy,
that confidence is at least as important to predicting and changing behavior as the presence of the appropriate skill level, balance
confidence can be summarized as an individuals belief that he or
she can perform a given activity or action without losing balance
or sustaining a fall.
In contrast to attempts to quantify fear of falling, assessing
balance confidence is measured over a continuum of activities
from easy to more difficult, allowing a more refined assessment
of where limitations might be present. Additionally, inquiries
regarding a persons degree of confidence in performing a given
activity are less threatening than asking about his or her fears.3
In one of their early studies on balance confidence, Miller and
Deathe administered the ABC Scale to a convenience sample of
435 individuals with lower-limb amputations who were attending one of two outpatient limb-loss clinics in Ontario. While
Miller and Deathe did not develop the ABC Scale, which was
originally created for use in the able-bodied geriatric community, they were the first to publish research about using the selfreport instrument for those with limb loss. The ABC Scale is a
16-item survey that asks participants to rate their confidence in
their ability to perform tasks in a number of different commonly
encountered situations and environments without losing their
balance or becoming unsteady. A score of 100 represents full
balance confidence.
Analysis of their observations confirms several expected
relationships along with some surprises (Table 2). Older patients
tend to report lower balance confidence, as do women. Perhaps
less intuitive, advanced education and increased income were
associated with higher balance confidence scores. Higher scores,
predictably, were associated with increased prosthetic experience, nonvascular amputation etiologies, and those who did not
use assistive devices during indoor ambulation.
The presence of a fall in the past 12 months did not appear
to affect ABC scores and those who sustained injuries in a fall
reported only modestly reduced ABC values compared to those
who had not. By contrast, those who admitted a fear of falling
reported substantially lower ABC scores. Perceived general health
values were also closely related with reported ABC scores.3
While such values are helpful in describing the relationships
between a number of presentation variables and balance
Table 2. Average ABC scores according to a number of sociodemographic, amputationrelated, health-related, and psychologic factors. Extracted from Miller et al.3
MAY 2016
MEAN ABC SCORE
50
23-55 years
75
56-70 years
64
71 years
53
Gender
Male
68
Female
54
Education
<grade 12
57
grade 12
73
Income
$0-$19,999
57
$20,000-$39,999
63
$40,000
74
Years since amputation

0-3
56
4-13
61
14
74
Amputation cause
Vascular
54
Nonvascular
75
Mobility device used indoors

No
78
Yes
45
Fall in the past 12 months

No
65
Yes
63
Fall injury
No
65
Yes
58
Fear of falling
No
77
Yes
49
Perceived health
Excellent
86
Very good
73
Good
63
Fair
52
Poor
43
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confidence, additional work was

required to affirm the reliability and
validity of the measure among people
with amputations and was subsequently published.4 Reliability was
verified by asking a sample of patients
to complete the ABC Scale on two
separate occasions, four weeks apart.
Convergent validity was verified by
comparing ABC scores to physical performance measures mentioned earlier.
A positive correlation was found, as
expected, between higher ABC scores
and 2MWT distances. Similarly, a negative correlation was found between
higher ABC scores and reduced times
to complete the TUG test.4
Discriminative validity was confirmed by the ability of the ABC scores
to discriminate with regard to average
prosthetic wearing times, stair climbing ability, and reported walking
distances (Table 3).
FACTORS
through the ABC Scale, the last Deathe

and Miller contribution this article
addresses is an effort to determine
to what extent these two variables
might predict the actual utilization
of a lower-limb prosthesis. As the
authors state, Acknowledging that
learning a new skill, such as prosthetic
ambulation, largely relies on having
the appropriate physical attributes,
whether the individual uses the new
skill or not also involves on having the
self-efficacy or confidence to perform
targeted activities.5
To test this relationship, one more
convenience sample from Ontario
was assembled. The researchers
recorded the L Test and ABC scores of
those individuals at the time of their
discharge from the inpatient rehabilitation that followed their amputations, and then again at one and
three months post-discharge. At the
AVERAGE ABC SCORES
Wearing time
values on those two outcome measures

at the time of discharge predicted 64
percent of the observed variance in
prosthetic utilization during social
activity. These two variables were
better predictors of such activity than
were age, gender, amputation level, or
reliance on walking aids.5
Conclusion
As the requirements for the objective

assessment of patient outcomes continue to gain traction in the healthcare
community, the O&P profession is
indebted to the efforts of this Canadian
duo. Their efforts to produce an accurate assessment of prosthetic mobility
and validate an existing measure of
balance confidence among patients
with lower-limb amputations have
yielded two straightforward outcome
measuresthe L Test and the ABC
Scalethat can be easily included in
prosthetic rehabilitation to document
both mobility and self-efficacy while
also predicting prosthetic utilization.
O&P EDGE
<84 hours/week
46
84-104.9 hours/week
64
Phil Stevens, MEd, CPO, FAAOP, is in clinical practice

with Hanger Clinic, Salt Lake City. He can be
reached at philmstevens@hotmail.com.
78
References
105 hours/wee
Stair climbing
Unable
32
With help
56
Independent
82
Reported walking distance

<1 block
42
1 block
62
Unlimited
83
Table 3. ABC scores were able to discriminate with regard to average prosthetic wearing times, stair climbing ability,
and reported walking distances. Extracted from Miller et al.4
Combination
With prosthetic mobility measured

and characterized through the L Test
and balance confidence recorded
three-month follow-up appointment,

prosthetic utilization was measured.5
Using regression analyses, they
determined that patient performance
MAY 2016
52
www.oandp.com/edge
1. Deathe, A. B., and W. C. Miller. 2005. The L Test

of functional mobility: Measurement properties
of a modified version of the timed up & go test
designed for people with lower-limb amputations.
Physical Therapy 85 (7):626-35.
2. Rushton, P. W., W. C. Miller, and A. B. Deathe. 2015.
Minimal clinically important difference of the L Test
for individuals with lower limb amputations: A pilot
study. Prosthetics and Orthotics International 39
(6):470-6.
3. Miller, W. C., M. Speechley, and A. B. Deathe. 2002.
Balance confidence among people with lower-limb
amputations. Physical Therapy 82 (9):856-65.
4. Miller, W. C., A. B. Deathe, and M. Speechley. 2003.
Psychometric properties of the Activities-specific
Balance Confidence Scale among individuals with
a lower-limb amputation. Archives of Physical
Medicine and Rehabilitation 84:656-61.
5. Miller, W. C., and A. B. Deathe. 2011. The influence
of balance confidence on social activity after
discharge from prosthetic rehabilitation for first
lower limb amputation. Prosthetics and Orthotics
International 35 (4):379-85.
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SOCIETY SPOTLIGHT
Standing Postural Changes While

Wearing a Lumbar Sacral Orthosis
With Varying Degrees of Lordosis
By Jon Peurach, BSc, and Sun Hae Jang, MSc, CO, FAAOP
Introduction
orthoses with varying degrees of lumbar lordosis.

There have been few studies
examining how the degree of lumbar
lordosis for an LSO affects patients
standing sagittal posture.1 Sagittal
spinal posture is an important consideration in the course of treatment
with spinal orthoses, as it has been
demonstrated that the spine attempts
to compensate for changes and
imbalances.3-6 Negative effects may be
associated with not
maintaining sagitIN TREATING CASES OF THE SAME DIAGNOSIS,
tal spinal balance,
and it is directly
THE RECOMMENDATION FOR THE DEGREE
related to many
disorders including
OF LUMBAR LORDOSIS WITH WHICH
degenerative spinal
disorders, pain, disAN ORTHOSIS IS DESIGNED OFTEN DIFFERS.
ability, and healthrelated quality of
4,7,8
many of the protocols for the optimal
life. However, the optimal degree
degree of lumbar lordosis for a specific
of lumbar lordosis, as well as sagittal
orthotic intervention were developed
spinal balance, has not been meayears ago. In treating cases of the same
sured or discussed in orthotic studies
diagnosis, the recommendation for the
and thus does not appear to have been
degree of lumbar lordosis with which
adequately considered as an impor1,2
an orthosis is designed often differs.
tant aspect of treatment. In addition,
Furthermore, there is insufficient
the extent to which an individual
literature comparing the difference in
is able to compensate for a change
effectiveness and clinical outcomes of
in lumbar lordosis has not yet been
Lumbar sacral orthoses (LSOs) are
commonly prescribed treatment
devices for spinal disorders such as
low back pain. Typically, the goal of an
LSO is to unload vertebrae by providing compression on the abdominal area
or to limit undesirable motion during
the healing period.1,2 The amount of
lumbar lordosis recommended for LSO
designs varies depending on diagnosis
and patient presentation. However,
MAY 2016
54
www.oandp.com/edge
Image 1. Photograph of the subject standing in

an orthosis, with the number of pixels shown to
the projected plumb line.
defined. Nor has the correlation been

established between a change of lumbar
lordosis in-orthosis and the resulting
changes of thoracic kyphosis.
SOCIETY SPOTLIGHT
SOCIETY SPOTLIGHT
Image 2. Three positive plaster

torso models at 30, 15, and 5
degrees of lumbar lordosis.
Purpose
This study was conducted to determine if the amount of lumbar lordosis

in an LSO design alters standing
posture. Measurements of the degree
of lumbar lordosis, thoracic kyphosis, and sagittal spinal balance were
taken while the subject wore each of
the three different orthoses that were
fabricated with 30, 15, and 5 degrees
of lumbar lordosis, respectively. In
Image 3. Vacuum forming the LSOs.
addition, the subjects pain level was

recorded when wearing each orthosis
as was her baseline pain level with no
orthosis.
Methods
The single subject, a 27-year-old

woman, has low back pain with no formal diagnosis. She was casted and fit for
three custom-fabricated LSOs made in
30, 15, and 5 degrees of lumbar lordosis.
Data collection involved measuring
changes in alignment patterns and taking photographs to analyze the patients
sagittal posture while she was wearing
each of the orthoses. Lumbar lordosis
and thoracic kyphosis were measured
using a flexible curve ruler, while C7
decompensation was measured using a
laser plumb line tool (Image 1, pg. 54).

Six trials were conducted for each of the
four conditions (in-orthosis for each
of the three designs, and no orthosis)
while maintaining the same lower-limb
alignment. A verbal numeric pain rating scale was recorded during each trial.
Fiberglass bandage was used to
take an impression of the subjects
torso. A positive model of her torso
was then made from plaster of paris
(Image 2). Each positive model, after
modification, was measured with
a flexible ruler to ensure the exact
desired degree of lumbar lordosis was
obtained. Plaster was added to the
posterior aspect of the lumbar portion of the model to reach the desired
degree of lumbar lordosis, and plaster
Condition
(Lumbar lordosis
built into LSO)
Actual Lordosis
Kyphosis
No orthosis
44 4.6
28 3.1
30 degrees
34.7 4.1
22.2 4.2
15 degrees
29.7 2.3
14.7 3.3
5 degrees
24 1.8
15.2 2.7
Table 1. Actual measured lumbar lordosis without an orthosis and in each orthosis.
MAY 2016
56
www.oandp.com/edge
SOCIETY SPOTLIGHT
SOCIETY SPOTLIGHT
was removed from the anterior of the

abdomen and the gluteus maximus
area (Image 2, pg. 56). The LSOs were
vacuum formed over the three models and trimmed according to usual
fabrication protocols (Image 3, pg. 56).
Unlined Surlyn was used because of its
transparency.
Results
The subjects lumbar lordosis with no

orthosis was measured at a mean of
30
25
Kyphosis
Figure 1.
The
relationship
between
actual
measured
lumbar
lordosis
and thoracic
kyphosis in
each orthosis
and without
an orthosis.
(Table 1, pg. 56). The decrease in

thoracic kyphosis and decrease in
lumbar lordosis are correlated (r = 0.8)
(Figure 1). The average distance of C7
to the line of gravity (LOG) plumb
line was 7cm with no orthosis, 5cm
in the 30 degree orthosis, 5.4cm in
the 15 degree orthosis, and 2.5cm in
the 5 degree orthosis. The average
distance of S1 to the LOG plumb line
was 5.7cm with no orthosis, 8.7cm
in the 30 degree orthosis, 8.6cm in
the 15 degree orthosis, and 9.2cm in
the 5 degree orthosis (Table 2). The
pain scale was consistently reported
at level 3 for the no orthosis, 30
degree, and 15 degree conditions, and
increased to level 5 and level 6 at the
fourth and sixth trials of the 5 degree
LSO, respectively (Table 3).
44 degrees ( 4.6). Her mean lumbar

lordosis in the orthoses made in 30,
15, and 5 degrees of lumbar lordosis
was 34.7 degrees ( 4.1), 29.7 degrees
( 2.3), and 24 degrees ( 1.8),
respectively (Table 1, pg. 56).
The mean thoracic kyphosis was
28 degrees ( 3.1) in no orthosis,
22.2 degrees ( 4.2) in the 30 degree
orthosis, 14.7 degrees ( 3.3) in the
15 degree orthosis, and 15.2 ( 2.7)
degrees in the 5 degree orthosis
20
15
10
5
Discussion and Conclusion
0
0
10
20
30
40
The actual measured lumbar lordosis of the subject was significantly

greater than the lumbar lordosis built
into each LSO condition. As lumbar
lordosis was decreased, a decrease
in thoracic kyphosis was observed
up to the 15 degree LSO. As lumbar
lordosis decreased, a change in C7
and S1 positions relative to the LOG
was also observed. When compared
to baseline, the largest change in C7
anterior displacement relative to the
LOG plumb line was seen in the 5
degree LSO condition. S1 moved further posterior to the LOG plumb line
to the same degree in each orthosis
50
Lordosis
Condition
C7 Distance to LOG
(cm)
S1 Distance to LOG
(cm)
No orthosis
5.7
30 degrees
8.7
15 degrees
5.4
8.6
5 degrees
2.5
9.2
Table 2. Distance (cm) from spinal markers to C7 plumb line measured on photographs.
Numeric Pain Rating Scale (1-10)

Condition
Rating
Trial 1
Trial 2
Trial 3
Trial 4
Trial 5
Trial 6
No orthosis
30 degrees
15 degrees
5 degrees
Table 3. Level of pain reported during each trial using the numeric pain rating scale.
MAY 2016
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www.oandp.com/edge
Table 1. Actual measured lumbar lordosis in each orthosis and without an orthosis.
SOCIETY SPOTLIGHT
SOCIETY SPOTLIGHT
compared to baseline. It was also shown

that the sagittal spine became more flattened and the pelvis was tilted more
posteriorly as the lumbar lordosis in the
orthoses was decreased. Similar results
have been shown in previous studies,
where a reduction in lumbar lordosis also
reduced thoracic kyphosis or was accompanied by an anterior displacement in
center of mass.5,9 The subjects pain level
was relatively constant, including in the
baseline condition. However, in the 5
degree LSO, the pain was decreased initially and then increased sharply as the
number of trials increased. This may be
due to the long period of time the orthoImage 4. The three completed LSOs built to 30, 15, and 5 degrees of lumbar lordosis.
ses were donned, since the 5 degree LSO
was the last of the three conditions. However, previous studies have shown eviThe subject also showed a relatively high degree of
dence of the importance of lumbar lordosis in treating low
lumbar lordosis (44 4.6) with no orthosis (Table 1,
back pain as it can reduce intradiscal pressure.9
pg. 56). Although this is still within normative values
for lumbar lordosis, each condition afforded less
lumbar lordosis than the subjects natural curvature and
may explain why full correction was not achieved.2,10
Furthermore, a relatively flexible plastic was used and the
degree of deformation of the material was not measured.
Even though this was a small sample size, clinicians may
want to be mindful that the actual change of the patients
lumbar lordosis may be less than anticipated. Future
research could be done to directly test the efficacy of an
orthosis in decreasing lumbar lordosis. Additionally,
further research may be able to validate the correlation
between a reduction of lumbar lordosis and the resulting
thoracic kyphosis. O&P EDGE
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NRG Morton Toe Plates
Jon Peurach, BSc, recently graduated from the Master of Science in Orthotics
and Prosthetics (ORPR) program at Eastern Michigan University (EMU) and
completed this study as his capstone project. He also attended Grand Valley
State University to obtain a BSc in movement science. Peurach is a member of
the Student Resident Committee of the American Academy of Orthotists and
Prosthetists.
Sun Hae Jang, MSc, CO, FAAOP, is an assistant professor in EMUs ORPR program,
a research scientist at Gillette Childrens Specialty Healthcare, and a doctoral
candidate in biomedical engineering at the University of Strathclyde, Glasgow,
Scotland. Jang has also been serving as chair of the Spinal Orthotics Society of
the American Academy of Orthotists and Prosthetists, and working as an orthotist
for more than 15 years.
3535 Route 66, Bldg. #4

Neptune, NJ 07753-2625
800-342-2602
(732) 918-8115
Fax: (732) 918-1131
jmsplastics.com
Academy Society Spotlight is a presentation of clinical content by the Societies

of the American Academy of Orthotists and Prosthetists in partnership with
The O&P EDGE.
References are available online at www.oandp.com.
MAY 2016
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2016 marks our 25th year as

a leader in Custom Orthotic &
Prosthetic fabrication. We'd like to
thank all of our loyal practitioners
that have helped us grow over
the years.
We work for you, the practitioner.
Your service is our priority.
As we've done for the past 25 years,
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800 253 7868
Thank you for 25 years of growth.
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West Yarmouth, MA 02673
spinaltech.com
1991
2016
Dedicated to supporting the O&P industry since 1991.
On Topic
Pitfalls of Waiving Patient Balances
By Erin Cammarata
any O&P practitioners will tell you that they decided to

enter this profession to help people, rather than to make
money. Were business owners who often think with
our hearts. One of the ways I see our professions empathetic
business practices is through waiving patients account balances.
There are some occasions when it is appropriate to waive a

patients coinsurance or deductible. This article, however,
focuses on those times it is not appropriate to do so and
why it may be detrimental to your company financially and
from a compliance standpoint.
When you waive a patients deductible and/or coinsurance,
you are devaluing the services you provide. For example,
if you delivered a device for which your contracted rate is
$1,000 and the insurance carrier reimburses 80 percent, then

waiving the patients $200 balance puts a discounted value
of $800 on that service. From the payers point of view, your
contracted rate should then be $800 since that is what you
are accepting as full payment. Furthermore, of that $800,
the carrier should and will only pay 80 percent. Your $1,000
service was just devalued to $640. Can your practice afford
this devaluation?
Continually waiving patient balances without attempting
to collect them is a violation of insurance contracts, can
be grounds for contract termination, and can result in the
insurers refusal to pay the claim. The insurer could also sue
the provider for fraud. Violations of contracts with private
insurers may be viewed as fraud under the Health Insurance
Portability and Accountability Act. Therefore, know the details
of each insurance contract prior to waiving deductibles and/
or coinsurance. Can your practice risk losing its in-network
provider status?
Collecting patient balances can be burdensome to your
administrative staff as well as to your patients. However, incorporating some common practices can lessen the burden,
increase your revenues, and keep your business compliant
with your insurance contracts. First, make patients aware of
their balances prior to delivery; this allows patients to make
an educated decision about whether or not they can afford
the devices. Second, patient balances should be collected
at the time of delivery because the chance of collecting the
copay and/or deductible decreases by 15-20 percent as soon
as the patient leaves your office. Third, offer payment plans
for patients who cannot afford to pay their entire deductibles and/or coinsurance amounts up front. When a patient
truly cannot afford to pay anything toward his or her
device, enact your financial hardship policy. Follow your
policy, complete the documentation required, and keep a
record of this waiver in the patients chart.
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On Topic
Instituting these additional tips can
create clear direction for your administrative staff when they are talking to
patients about their financial responsibilities:
1. Verify and reverify patients
insurance. This may seem
obvious but I cant tell you
how many times we see that
this simple step does not
get completed. The patients
insurance and the procedure
codes must be verified to correctly
inform the patient of his or her
financial responsibility.
2. Have a written patient
collections policy. Once the
insurance is verified and you
know the patients financial
responsibility, exercise your
patient collections process.
Y Create a payment plan policy.
Have a form that outlines three
payment plan options that the

ing the account to collections or
patient can choose from and
writing off the balance.
sign. Keep a copy of that payI challenge you to reexamine your
ment plan agreement in the
patient-responsibility accounts
patients chart.
receivables and assess how much of
Y Create a financial hardship
your revenue is lost due to uncollected
policy. A formal policy must be
patient balances. O&P EDGE
instituted that applies to all your
Erin Cammarata is president and owner of CBS
patients and ensures you are not
Medical Billing and Consulting. While every
arbitrarily picking and choosing
attempt has been made to ensure accuracy, The
which accounts to write off. A
O&P EDGE is not responsible for errors. For more
financial hardship policy should
information, contact erin@oandp-solutions.com.
be utilized for patients
who have proof of a true
financial burden. Proof
can be copies of W-2
forms, pay stubs, tax
returns, etc.
Y Create a write-off policy.
Have written procedures
Read association and industry news as it happens.
that outline how many
Visit our website, www.oandp.com/edge, for the
statements will be sent to
latest, most thorough, cutting-edge information.
the patient prior to send-
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Advertisers Index
For information, please circle the red reply number on the enclosed Free Product Information Card.
Ability Dynamics.................................. pg IFC, 66 ....................246
Freedom Innovations.......................... pg 69, IBC .....................68
www.abilitydynamics.com // hsanger@abilitydynamics.com
www.freedom-innovations.com // info@freedom-innovations.com
Allard USA ............................................. pg 5, 8, 68 ...................153
Hersco Ortho Labs ............................... pg 9..............................225
www.allardusa.com // info@allardusa.com
www.hersco.com // fastorthotics@hersco.com
ALPS ....................................................... pg 1, 66 .......................167
JMS Plastics Supply Inc ...................... pg 60 ...........................232
www.easyliner.com // info@easyliner.com
www.jmsplastics.com // sales@jmsplastics.com
Amfit Inc................................................ pg 59, 69.......................40
LAOP ...................................................... pg 6................................63
www.amfit.com // info@amfit.com
www.laop.org // debneybrown@iopla.com
Apex Foot Health Industries .............. pg 17, 53, 68 ..............193
Martin Bionics Innovations................ pg 7, 69 .........................88
www.apexfoot.com // aorder@apexfoot.com
www.martinbionics.com // jay@martinbionics.com
Apis Footwear Co ................................. pg 62, 69.....................121
MEDEX International........................... pg 55, 66.....................252
MSPO Program.................................... pg 10 ...........................129
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Ottobock ......................................... pg 79............................3

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PrimeCare O&P Network .................... pg 6..............................101
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SPC- St. Petersburg College ............... pg 8..............................200
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Spinal Technology ............................... pg 61 .............................28
800.253.7868
www.spinaltech.com // info@spinaltech.com
405.850.2069
TechMed 3D.......................................... pg 66 ...........................267

418.836.8100
www.techmed3d.com // info@techmed3d.com
The University of Hartford
860.768.4599
www.bignwideshoes.com // apisfootwear@earthlink.net
888.886.2420
www.medexinternational.com // info@medexinternational.com
www.hartford.edu/tmspo // mspo@hartford.edu
Aspen Medical Products ..................... pg 29, 69.....................201
medi USA (Orthotics) ....................... pg 41........................234
Tidwells Orthotics ............................... pg 57, 66.......................30
www.aspenmp.com // custserv@aspenmp.com
888.937.2747
800.633.6334
954.346.5402
www.mediusa.com // info@mediusa.com
www.tidwellsorthotics.com // chris.tidwell@tidwellsorthotics.com
Becker Orthopedic ............................... pg 19, 68.....................112
medi USA (Prosthetics) ....................... pg 68 ...........................196
Touch Bionics........................................ pg 67, BC.....................138
800.295.2776
855. MY iLimb
www.beckerorthopedic.com // mail@beckerorthopedic.net
800.633.6334
www.mediusa.com // info@mediusa.com
www.touchbionics.com // info@touchbionics.com
Coapt ..................................................... pg 44 .............................70
MIH International LLC/M-Brace ......... pg 35, 66.....................100
TRS Prosthetics ..................................... pg 42 .............................80
866.374.4050
800.279.1865
www.coaptengineering.com // info@coaptengineering.com
www.m-brace.com // sales@m-brace.com
www.trsprosthetics.com // jennifer-trs@att.net
College Park Industries ...................... pg 31, 67.......................32
Nabtesco & Proteor in USA ................. pg 23, 67.....................161
WillowWood......................................... pg 49, 67.........................1
www.college-park.com // info@college-park.com
www.nabtesco-proteor-usa.com // info@nabtescoproteor-usa.com
www.willowwoodco.com // customerservice@owwco.com
Coyote Design ...................................... pg 21, 67.........................7
Nora Systems ....................................... pg 43 ...........................181
www.coyotedesign.com // info@coyotedesign.com
www.nora-shoe.com // jonathan.fogg@nora.com
Curbell Plastics .................................... pg 67 ...........................229
OPIE Software....................................... pg 37, 63.......................15
opesales@curbellplastics.com // opecontact@curbellplastics.com
www.oandp.com/opie // info@oandp.com
DJO Global............................................ pg 27, 68.....................192
OPTEC .................................................... pg 12-13 .......................23
www.djoglobal.com/exosfreemotion // customercare@djoglobal.com
www.optecusa.com // sales@optecusa.com
Endolite................................................. pg 3, 66 .........................58
Orthomerica ......................................... pg 45, 69.......................69
www.endolite.com // info@endolite.com
www.orthomerica.com // custserv@orthomerica.com
Ferrier Coupler ..................................... pg 64 .............................25
ssur ..................................................... pg 11, 51, 68 ..................2
www.ferrier.coupler.com // sales@coupler.com
www.ossur.com // ossurusa@ossur.com
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MAY 2016
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the Structure Sensor, 3DsizeME
iPad app, and MSoft software
for the most compact, versatile,
and affordable scanning solution.
With the new color detection
feature, you can now use colored
positioning targets to identify
anatomical landmarks or to
automatically align the 3D form. With pay-per-scan licensing,
this solution has never been more flexible and accessible. Central
fabrication facilities can customize the app to their own colors and
logo and include their PDF order forms so clinicians from all over the
world can instantly send orders from an iPad.
Tidwells Charcot Restraint Orthotic Walker is

available in standard black with a removable
Plastazote insert, a full interface lining,
standard rocker sole, and DACRON back
straps attached with copper rivets.
Tidwells Orthotics is offering the CROW with
a turnaround of 5-7 days at an incredible price.
TechMed 3D 855.832.4633
www.techmed3d.com
Tidwells Orthotics 877.346.5402

www.tidwellsorthotics.com
Comfort and Stability
ALPS Thinner Seamless Suspension Sleeve
OA Knee Brace #46
Formulated with the ALPS GripGel, the new SFB seamless suspension
sleeve provides superior comfort with a single-piece construction.
The SFB sleeve features a new, black knitted fabric that allows the
user excellent freedom of knee flexion. This new sleeve seals with
the skin without restricting circulation, while the GripGel sticks
to the patients skin without
causing shear forces. With a
thinner profile of 2mm, the
SFB is an ideal choice for those
concerned about bulk.
The #46 knee brace brings your comfort to a new level with its
elegant and light design. This brace alleviates knee pain by reducing
the weight on the medial or lateral compartment by using the threepoint pressure system. It is composed of
two aluminum-reinforced semirigid straps
that surround the distal region (above the
knee) and the proximal region (below the
knee). These straps are to be custom molded
to allow for optimal torsion support. Learn
more and check out our other products and
product lines on our website.
MIH International 866.374.4050

www.m-brace.com
ALPS 800.574.5426
www.easyliner.com
Adventure Starts Here
Endolite Introduces Breathable Liner Technology for

Drier Skin and Socket Security
Extraordinary adventures begin with the new ultralow-profile RUSH

ROVER! With a clearance just over two inches, even patients with the
most extreme low or high clearance will benefit from the dynamic
toe-off and superior energy return of the ROVER.
Capable. Strong. Comfortable. From rocky trailheads to the
sidewalks of a concrete jungle, patients can navigate even the most
demanding terrain with ease. RUSH ROVERthe world is yours; go
live it! Now available in sizes 22-30cm. Visit www.rushfoot.com for
more information.
The Silcare Breathe silicone liner allows moisture to escape. Unique

moisture management results in drier skin, helps reduce the damaging
effects of friction, and improves comfort and control.
Features and benefits include:
Y Stretch zones: Seamless technology
provides bidirectional stretch,
improving comfort and contouring,
and reducing shear force as it flexes.
Y Laser-drilled perforations: Optimally
sized pores distributed uniformly along the length and distal end
of the liner permit the escape of air and moisture.
Y Tendresse finish: A lower coefficient of friction than standard
silicone reduces shear stress on the skin.
Endolite 800.548.3534
www.endolite.com
Ability Dynamics 855.450.7300

www.rushfoot.com
MAY 2016
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Apple Watch Now Compatible

with i-limb from Touch Bionics
New OdysseyK3 Hydraulic Foot
Introducing the next step in the Odyssey line

of hydraulic feet from College Park.
SHOWCASE
The OdysseyK3 utilizes the

patented curved hydraulic ankle
plus a higher-frequency carbon
fiber foot base for increased
dynamic response. The robust
ankle housing with angular
positioning was designed for
moderate-impact users who are able to
balance without assistance. The combination
of smooth hydraulics and a dynamic foot base
brings exceptional performance during activities like aggressive city
walking or multi-terrain hiking. See it in action at www.youtube.com/
collegeparkind.
Y Tap the screen for quick grips

Y Change selected quick grips using the my i-limb app
Y Compatible with all i-limb hands manufactured after June 2013
College Park Industries 800.728.7950

www.college-park.com
Touch Bionics 855.MYiLimb

www.touchbionics.com
Symphony Knee
Thick PETG Sheet
Harmony Between Security and Fluidity.
Try "-thick PETG sheet

when " is not enough!
PETG is a transparent
plastic material that is most
commonly used for check
sockets, face guards, and
other applications where
clarity and deep draw
forming are required.
The Symphony is a six-bar polycentric knee

designed for patients who need both safety and
dynamics. It orchestrates the phases of the gait cycle
to offer a harmonious solution among security,
comfort, and fluidity.
The p-MRS system detects different gait phases
and adapts stability. At heel strike, the system
locks the knee and then cushions heel strike using
a stance flexion dampening feature. The selective
lock function enables the patient to lock the knee
manually whenever security is needed. At pre-swing
phase, the Symphony unlocks for an effortless switch
to swing phase.
Nabtesco & Proteor in USA 855.517.4414

www.nabtesco-proteor-usa.com
Curbell O&P | One Source 888.858.0911

www.curbellplastics.com/oandp
Coyote Composite Braid
Regulate Heat and Reduce Sweat

with Alpha SmartTemp Liner
Our proprietary braid was designed to be used in equivalent amounts

to carbon. Coyote Composite is more flexible than carbon (we consider
this to be an advantage), but if you need to match the rigidity of a
carbon socket, use additional layers of stockinette and/or carbon tape.
Y Extremely durable
Y
Y Resistant to cracking
Y
Y Less itch than carbon
Y Noncarcinogenic and
Y
nontoxic
Y
WillowWoods Alpha
SmartTemp Liner brings
temperature control to
prosthetic liners with Outlast,
the original heat-management
technology developed for
NASA. The liner absorbs heat
generated by the users residual
limb (as illustrated) and reduces sweating and the amount of moisture
within a liner. When skin temperature drops, stored heat is recycled
back to the limb to prevent chilling. Comfort is achieved when the
skin and the liner temperatures are balanced.
Alpha SmartTemp Liners are available for transtibial and
transfemoral use and retrofit with Alpha Hybrid and Silicone Liners.
Strong and lightweight

Finishes smooth, with superior
resin saturation
Unique dampening characteristics
Less expensive
Coyote Design 208.429.0026

www.coyotedesign.com
WillowWood 800.848.4930
www.willowwoodco.com
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The Future of Ankle Bracing is Here
SHOWCASE
3D-LITE LSO XTRA: Customize Your OTS LSO!
A custom-fit brace in just 30 minutes.
Breathable and lightweight, yet rigid and

custom moldable! Boost patient compliance
with a comfortable back support that delivers
the stability your patient needs. The 3D-LITE
LSO XTRA is designed to accommodate
the healing process by applying adjustable
compression and incorporating removable
polyethylene anterior inserts and a 3D-LITE
custom-moldable back panel that can be
reheated and remolded.
The patient can easily slip his or her hands into the hand loops
sewn onto both anterior panels for simplified donning and doffing.
Five sizes fit from 23" to 55" waists. PDAC letter available for
L-0631. Contact us to learn more!
Introducing the first prefabricated AFO that can be fully customized

and formed to the patient to provide functional stabilization of the
ankle-foot complex and address bony abnormalities, chronic instability,
and post-trauma rehabilitation.
The Exos Free Motion Ankle presents a
new orthopedic choice with a treatment option
that is moldable, reformable, removable, and
adjustable. This leading-edge treatment uses
revolutionary technology, allowing a clinician
to custom fit a brace within 30 minutes
minimizing time and cost while providing
immediate results for the patient.
TM
Allard USA 888.678.6548

www.allardusa.com
DJO 760.727.1280
www.djoglobal.com
RHEO KNEE 3Stability and Dynamics

Whatever the Weather
The K is Silent. The Style Is Loud and Clear.

New Knits for spring from Apex.
RHEO KNEE 3 delivers both confidenceboosting stability and a dynamic

experience for users who want to return
to everyday activity. While other leading
microprocessor knees still use traditional
hydraulic solutions, only RHEO KNEE 3
features the highly responsive magnetorheologic (MR)
fluid technology, popularized by the aerospace, defense,
and automotive industries.
This proven MR fluid makes it possible for RHEO
KNEE 3 to shift almost instantaneously from the high
resistance required for stability in stance phase to the low
resistance needed for a dynamic, free swing phase. Request
a demo today at www.ossur.com/rheoknee3.
The Apex FitLite

Collectionthe Mens
Bolt and the Womens
Breezeare the ultimate
in eye-catching, vibrant
knit athletics. Featuring
consummate style, superior
comfort, and industryleading construction,
each pair is meticulously
crafted with the highest quality materials and designed for agility and
ultimate durability.
For our new catalog or to place an order, call or visit our website.
ssur 800.233.6263
www.ossur.com
Apex Foot Health Industries 800.252.2739

www.apexfoot.com
Camber Axis Hinge
medi USA Introduces the 4Seal TFS Liner
The Camber Axis Hinge provides an adjustable

range-of-motion ankle joint with anatomical
axis alignment that can be used in thermoplastic
orthoses. Equipped with seven different colorcoded range-of-motion keys, the Camber Axis
Hinge eliminates the need for posterior stop
mechanisms. The Camber Axis Hinge is available
in three sizes with a new, optional black noncorrosive finish.
For more information about the Camber Axis
Hinge and other Becker products, please contact
our customer service department or visit our
website.
U.S. Patent No. 5,542,774
The new medi 4Seal TFS Liner combines a revolutionary

sealing technology with a unique self-gliding surface,
providing extraordinary suspension, comfort, and ease of
use for those with transfemoral amputations.
Y Now available in conical version
Y Integrated seals for easy inversion and a highly
secure fit
Y Easy Glide PLUS outer surfaceno donning aids
or sprays required
Y Excellent tissue control due to a highly
effective, full-length matrix
Y Optimal radial stretch for greater comfort
Y Simple to use gel-grip spacer socks for easy application (available
separately)
medi USA 800.633.6334
www.mediusa.com
Becker Orthopedic 800.521.2192

www.beckerorthopedic.com
MAY 2016
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Mt. Emey Accommodative Custom

Foot Orthotics
Introducing the Fuzion Family of Orthoses
Our accommodative foot orthotics are

specially designed for patients with
foot deformities. We offer a variety of
materials for foot conditions such as
neuropathy, Charcot foot, edema, or
amputation; or conditions resulting from
health issues like obesity, diabetes, sports
injuries, or heart conditions. Custommade foot orthotics provide support and
relief wherever necessary. Apis provides you with a free 3D camera to
eliminate impressions or castingnow its just a push of a button. Fulfill
all of your pedorthic needs under one roof. Call our friendly customer
service representatives for more information or free samples.
Benefits include:
Y Proprietary, heat-adjustable plastic makes
patient management much easier (versus
traditional orthoses)
Y New treatment options for patients
historically not candidates for orthotic
intervention and management
Y Fuzions compression design holds the patient in a secure,
comfortable position while assisting with spasticity management.
Y Accommodates volume changes
Apis Footwear Co. 888.937.2747

www.apisfootwear.com
Orthomerica 877.737.8444
www.orthomerica.com
Socket-less Socket Transfemoral
Peak Scoliosis Bracing System
No more static socket shape.

No more hard ischial seat. No more loss of suction.
Winner of the 2015 Spine Technology Award.

This innovative new concept in bracing
from Aspen is the only brace specifically
designed for adults with scoliosis.
Weve reinvented sockets from the

ground up. Using our NASA-based
hammock-fit technology, the Socketless Socket truly conforms to the
user, providing a custom-fit socket
every time you put it on.
Fitting a socket is now microadjustable in real-time, eliminating
the antiquated casting, modification,
and iterative test socket fitting
methods from the past.
View the free Socket-less Socket training at MartinBionics.com.
It has been shown to:

Y Significantly reduce pain
Y Increase mobility
Y Promote better posture
Y Improve the quality of life
Martin Bionics 844.624.6642

www.martinbionics.com
Aspen Medical Products 800.295.2776

www.aspenmp.com
Maximum Shock Value

With the New Freedom Agilix
Free Shipping and Replacement Box!

A5513-approved custom
diabetic insoles through
Amfit FootPrinter are custom
orthotics made easyno
hassle, no equipment. Foam
box processing for diabetic
insoles starts at three pairs for
$77 or single pairs at $46.50.
Shipping both ways is included
in the price. Harness the
power of 3D scanning for your
patients with a patented foam box to minimize errors. Choose bi-lam,
tri-lam, toe filler, or Charcot foot styles. Offer your patients a true
custom solution for their foot orthotic needscall today to get started!
The Freedom Agilix is a multiaxial, shockabsorbing, flexible foot system designed

to manage loading impacts, reduce socket
shear forces, and improve comfort while
walking on nearly any terrain. The ultralightweight design offers low-impact K3
ambulators shockingly comfortable
performance at a value like no
other. Learn more about the
Agilix on our website.
Amfit Inc. 800.356.3668

www.amfit.com
Freedom Innovations 888.818.6777

www.freedom-innovations.com
MAY 2016
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SHOWCASE
Patients experience greater fit, function, and freedom with

Orthomericas new Fuzion line of custom orthoses. The Fuzions
design and materials ensure greater patient compliance for a variety of
challenging clinical indications. Available for select adult and pediatric
patients.
CLASSIFIEDS
Classified ads are published in print once a month, and receive premium
placement online at www.oandp.com/classifieds during the month(s) the
ad runs in print. Immediate online placement is available for an additional
fee. Rates are calculated per word and must be pre-paid by credit card.
Free four-color logo!
For more information or to place an ad, please contact
Alyssa Lechuga at 303.255.0843 or alyssa@opedge.com.
2016 Classified Rates
50 words or fewer ...................................... $220

51-75 words ................................................ $275
76-120 words.............................................. $350
121-150 words ........................................... $475
151-200 words ........................................... $600
201-250 words ........................................... $725
1/4 page...................................................... $725
1/2 page...................................................... $925
Online only rate ...........................................$95
Scan the QR code to view our online classified ads.
Add-Ons:
Blind ad fee: +$30
Bulleted ad: +20%
US PACIFIC
CPO
Tri-Cities, Washington
Ce tified
st etist O t
Established in 1987, Pacific Medical Prosthetics and Orthotics has

become a tenured company in the industry for patient care products
and services. With the heart of the company dedicated to helping
and serving others, we are currently seeking a certified prosthetist/
orthotist who is a seasoned practitioner with clinical experience
and expertise in outpatient and inpatient settings, organization and
maintenance of an O&P facility, fabrication, fitting, and a willingness
to work within a dynamic team. This position is an excellent
opportunity for a self-driven, motivated candidate who has an
entrepreneurial spirit that is focused on market growth. Competitive
salary, benefits, and profit sharing are offered based on experience.
tist
Shriners Hospitals for Children Honolulu, which treats pediatric

and young adult orthopedic patients throughout Hawaii and the
Pacific Basin, has a rare and gratifying opportunity to work with
a wide variety of patients at our new centrally located facility. A
minimum of five years of experience, including in pediatrics, is
required, and occasional travel should be expected. Relocation is
available.
Contact:
Shriners Hospitals for Children

Attn: Human Resources
1310 Punahou Street
Honolulu, HI 96826
E-mail: dito@shrinenet.org
Contact:
Fax: 209.834.0690
E-mail: careers@pacmedical.com
O&P TECHNOLOGY PROGRAMS

SPOKANE FALLS COMMUNITY COLLEGE
C O CO
Ready for WorkO&P Technicians
Four spectacular seasons, outdoor adventure, and a thriving career

await you in southern Oregon. Spectrum Orthotics & Prosthetics is
seeking a knowledgeable, certified CPO or CO to join our rehabilitation
team. Spectrum O&P is an ABC-accredited, independently owned
company with 12 facilities spanning southern Oregon and northern
California. We provide a competitive salary based on experience; a
medical, dental, and retirement plan; and a relocation allowance. Lets
work together to make a difference for our future. All inquiries will
remain confidential.
The O&P Technology Program at Spokane Falls Community

College has graduates ready to enter the O&P workforce as
entry-level technicians. SFCC graduates are skilled in metal
bending, thermoforming, laminating, and sewing. They are
competent in alignment, transfer, plaster, and leatherwork
procedures. Students are knowledgeable in anatomy and O&P
terminology, and possess many other desirable professional
characteristics, including good communication skills, reliability,
and responsibility. SFCC offers the only orthotic-prosthetic
technology program in the western United States with training
in a 9,000 sq. ft. lab. Training for each discipline includes three
quarters of study and lab work plus one quarter of student
internship in an O&P practice. The internship experience
provides a potential employer the opportunity to evaluate a
student without obligation.
Contact:
Spectrum Orthotics & Prosthetics

Phone: 541.955.9678
Fax: 541.471.4909
www.spectrumoandp.com
Visit our website for more information

www.spokanefalls.edu/oandp or call 509.533.3231
to discover how our board-eligible graduates
can benefit your organization.
Scan the
QR Code
to see
more job
openings
This ad was 100 percent funded by a grant awarded by the U.S. Department
of Labors Employment and Training Administration.
MAY 2016
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US PACIFIC
A CPO search is currently under way in our unique corner of the

world. The candidates vital characteristics are enthusiasm for mobility
and a voracious drive to continue improving his or her skillset. The
candidate must be a quick learner with the innate and insane ability
to seek solutions to problems (rather than adding to them) and enjoy
being busy. Actions speak louder than wordsquit reading and start
doing.
Work and Play in Alaska!

ABC CPO positions open.
We are offering a relocation allowance, a sign-on bonus, a salary

commensurate with experience, and benefits. The CPO will work with
a variety of patients and a great support staff. We are seeking outgoing,
bright, and energetic practitioners who are passionate about patient
care. Applicants must have a bachelors or masters degree in O&P.
Contact, with cover letter and resum:

E-mail: wil@alchemyak.com
Contact:
Marsha Foy
E-mail: mfoy@northo.com
CERTIFIED ORTHOTIST
CERTIFIED ORTHOTIST/ PROSTHETIST
/ PROSTHETIST
A unique opportunity to be a part of a rapidly
A unique opportunity to be a part
expanding, multi-center department.
of a rapidly expanding,
multi-center department.
Department of Orthopaedic Surgery
Functional
Title:
Orthotist-Prosthetist
Department
of Orthopaedic
Surgery
Functional Title:
Orthotist-Prosthetist
- Some prior experience providing direct patient care in an

The University of California, San Francisco division of Prosthetics
The
University Surgery
of California,
San Francisco
division
of Prosthetics
orthotic
and prosthetic
facility
and Orthotics in the Department of
Orthopaedic
is
and Orthotics
in the
Department of Orthopaedic
Surgery
is seeking
- Demonstrated
skills,
knowledge and abilities essential to
seeking applicants interested in a dynamic
clinician
position.
applicants interested in a dynamic clinician
position.
successful
performance of duties in a patient care setting
excellent
and interpersonal
Incumbent will have the opportunity
to workwill
as ahave
full-time
Incumbent
the opportunity to- Demonstrated
work as full-time
cliniciancommunication
in
skills Center at Zuckerberg
clinician in the newly remodeled Orthotic
and
ProstheticOrthotic
Center and Prosthetic
the newly
remodeled
at Zuckerberg San Francisco General
Zuckerberg
San
SanHospital.
Francisco
General Hospital.
Zuckerberg San Francisco General
Francisco General Hospital is a Level
1
trauma
hospital
and
as
Hospital is a Level 1 trauma hospital and
as one ofqualifications:
the largest county
Preferred
one of the largest county hospitals,hospitals,
it is the heart
of the
it is the
heartcity.
of the city. Candidate
will beofresponsible
for
- Knowledge
disease processes
and associated orthotic/
Candidate will be responsible for providing
providing patient
patient care
care for
for aa broad range
of orthotic
and prosthetic
prosthetic
intervention
broad range of orthotic and prosthetic
related
medical
diagnoses
related
medical
diagnoses
in both inpatient
andwith
outpatient
care
- Familiarity
current treatment
modalities, materials and
in both inpatient and outpatient care
settings.
a clinician,
settings.
As aAsclinician,
there will be opportunity
to techniques
also be a part of
fabrication
there will be opportunity to also beother
a part
of other
outside
clinics
outside
clinics
in skilled
and rehabilitation
locations.
Additionally,
- Ability to
work efficiently,
and effectively
in skilled and rehabilitation locations.
Additionally,
candidate
will
candidate will work closely with members of other departments such
work closely with members of other
such
as ortho
asdepartments
ortho surgeons,
neuro
and vascularMedical
specialists,
physical
therapists,
benefits
and
pension plan are included. Salary will be
surgeons, neuro and vascular specialists,
physical
therapists,
podiatrists, physiatrists and social workers
to lay out a treatment
planqualifications and experience.
commensurate
to applicants
podiatrists, physiatrists and social workers
to optimum
lay out a functional
treatmentoutcome for patients.
to achieve
plan to achieve optimum functional outcome for patients.
UC San Francisco seeks candidates whose experience, teaching,
Required qualifications:
or community
service has prepared them to contribute
- Specialists appointed at the junior rankresearch,
must possess
a baccalaureate
to our commitment to diversity and excellence. The University
Required qualifications:
degree (or equivalent degree)
of California is an Equal Opportunity/Affirmative Action
- Specialists appointed at the junior rank must possess a
- Specialists appointed at the Assistant or Associate rank must
Employer. All qualified applicants will receive consideration for
baccalaureate degree (or equivalent degree)
possess a masters degree (or equivalent degree)
employment without regard to race, color, religion, sex, sexual
- Specialists appointed at the Assistant or Associate rank must
- Specialists
appointed at the full rank
must possess
terminalnational origin, disability, age or
orientation,
genderaidentity,
possess a masters degree (or equivalent
degree)
degree
(or
equivalent
degree)
protected veteran status.
- Specialists appointed at the full rank must possess a terminal
degree (or equivalent degree) - ABC Certified Orthotist/Prosthetist
Please
applycare
online
CV at: http://apptrkr.com/781063
- ABC Certified Orthotist/Prosthetist
- Some prior experience providing direct
patient
in anwith
orthotic
and prosthetic facility
- Demonstrated skills, knowledge and abilities essential to successful
performance of duties
71 www.oandp.com/edge
MAY 2016
in a patient care setting
CLASSIFIEDS
Work in a State-of-the-Awesome Practice
CLASSIFIEDS
US PACIFIC
US CENTRAL
CO C O
a d- li i le
a titi ne
Ce tified e
A well-established, private practice in sunny eastern Washington

is moving to accommodate growth. We are looking for a certified
orthotist, certified prosthetist/orthotist, or board-eligible practitioner
who is also eligible for state licensure. Experience in pediatrics is a
plus. We provide a competitive salary, health insurance, and a 401k.
American Central Fabrication is a busy, diverse, and leading-edge

company fabricating for CLB, next door, and other fine O&P facilities
around the country. Weve had 29 years of success and continue to
evolve and stay fresh.
Shreveport, Louisiana, is a city of moderate size, with an
abundance of wildlife, sports, waterways, casinos, and good school
choices. Our facility is modern, safe, clean, and well stocked.
Our candidate is an ABC-certified technician with at least
five years of experience. Upper-limb fabrication and CAD/CAM
experience is a plus. A generous salary and benefits are included,
based on experience.
Contact:
Tri-Cities Orthotics and Prosthetics

E-mail: tcarswell@tri-citiesoandp.com
US MOUNTAIN
C l
ni ian
Contact:
ad C
an
Theresa Quinn
American Central Fabrication
Fax: 318.636.3746
E-mail: americancenfab@aol.com
ee in CO C O
A well-established, independent patient care company is seeking

a motivated and knowledgeable ABC-certified CO/CPO for our
growing locations. At least three years of experience in patient
management is preferred, and the ability to maintain and grow
referral source relationships is requested of all applicants. A
competitive salary and benefits are offered based on experience. Join
us in beautiful Colorado!
C O C
Want to build a rewarding career while doing what you do best? A
reputable company in Texas is seeking dependable CPOs or CPs.
There are multiple office locations and an immediate opening for a
Spanish speaker in Laredo.
Quality patient care and employee satisfaction are always our
top priorities. Major incentives include a very competitive salary;
continuing education; relocation assistance; and medical, dental, and
vision insurance. The company is open to additional incentive requests
for the right candidate. All applicants will be kept in strict confidence.
Contact, in the strictest of confidence:

Reference Ad # 0401
Fax: 303.255.0844
E-mail: classifieds@opedge.com
Contact:
CPed and Technician
Phone: 210.949.0011
Fax: 210.949.0050
E-mail: assi.sara@txprostheticcenter.com
www.txprostheticcenter.com
A well-established, privately owned practice in Montana is seeking a

CPed and a technician. We are a growing practice needing motivated
practitioners and technicians. Compensation will be based on
experience and skill. We offer a retirement package that includes a
401k, profit sharing, educational fees and dues, as well as PTO.
Send resum to:
Fax: 406.585.1438
E-mail: peggy@tsopmt.com
Ce tified
st etist O t
CPOs
Openings and excellent opportunities are available for independent,
motivated, ABC-certified practitioners at a well-established, multiplelocation O&P practice in Illinois. The ideal candidate will be certified
by ABC and must be eligible for Illinois licensure. Our fast-paced,
energetic atmosphere is a rewarding place to establish a great career.
We offer a very competitive salary and benefits commensurate
with experience. If you have what it takes to be part of a successful
and well-organized team, then we would love to speak with you.
Management experience is a plus.
tist
We are seeking a certified prosthetist/orthotist who is motivated to

provide exceptional patient care and works well with team members
to provide positive outcomes. We desire a like-minded, hardworking,
positive individual who is dedicated to quality and care and is ready
for any challenge. Dedication to the profession, outcomes, excellence,
and teamwork with the entire staff are essential characteristics needed
to fulfill this position.
Contact:
Recruitment Manager
CPO Services Inc.
741 West Main Street
Peoria, IL 61606
Fax: 888.663.6322
E-mail: hr@cpousa.com
Contact:
Reference Ad # 0200
Fax: 303.255.0844
E-mail: classifieds@opedge.com
MAY 2016
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US CENTRAL
CLASSIFIEDS
A CC
C O
We are looking for a seasoned, energetic, and motivated practitioner

who possesses strong clinical skills and experience in inpatient and
outpatient settings. Candidates must be able to market services
to potential referral sources. Responsibilities include patient care,
documentation, fittings/adjustments, and interdisciplinary communication reflecting leadership and integrity. Shreveport, Louisiana, is
a moderate-size city with an abundance of wildlife, sports, waterways,
casinos, and good school choices. Our facility is modern, safe, clean,
and well stocked. We offer a competitive salary commensurate with
experience and ability, and excellent medical benefits for you and
your family.
Orthotist
Raleigh Orthopaedic Clinic is seeking a board-certified orthotist
who will be responsible for measurement, fabrication, delivery, and
maintenance of orthoses that are prescribed by a physician. We
are committed to being the orthopaedic provider of choice for our
community by delivering high-quality, personalized care to our
patients through our experience and dedication.
Qualified candidates must be able to establish and maintain
effective working relationships with coworkers, physicians, and
patients; communicate effectively orally and in writing; and work with
minimal instruction or supervision. Prosthetics certification is highly
desirable. Interested candidates can apply directly at the Careers link
on our website.
Contact:
Theresa
Fax: 318.636.3746
E-mail: certlimbandbrace@aol.com
Visit:
www.raleighortho.com
Prosthetic Technician
Restorative Health Services
Cent al
We have an immediate opening in Murfreesboro, Tennessee, for a

prosthetic technician who has good hand skills. The job is very labor
intensive and requires the employee to stand for a full eight-hour
workday. Major duties include fabricating, fitting, maintaining, and
repairing prosthetic limbs made with carbon, silicone, and plastic,
and other prosthetic devices according to practitioner specifications.
The lab manager will guide prosthetic device repair. Candidates
must be detail oriented; good at operating machinery such as saws,
carvers, power tools, and welders; and self-starters with strong
communication skills and exceptional technical skills. We offer a
great salary and benefits.
assa
setts a ilit
ee s CO C O
We are seeking an enthusiastic practitioner who can work independently. Pediatric experience is preferred. Full benefits package offered, including 100 percent employer-paid family health insurance.
A competitive salary is dependent on experience and training, with a
profit-sharing option.
Contact:
Karen Lynch, CPO

E-mail: klynch@sunrisepando.com
Contact:
Lauren Vaughn
Restorative Health Services
E-mail: lvaughn@rhs-tn.com
US EASTERN
A C-Ce tified C Os
Virginias largest O&P provider has an immediate opening for

two ABC-certified prosthetist/orthotists or orthotists. This is your
chance for a career with a dynamic company offering state-of-theart technology and the support of an in-house fabrication facility.
Applicants must possess a team-building philosophy and excellent
communication and time management skills, and be detail oriented
in his or her work. A very competitive compensation package,
commensurate with experience, includes salary, health and vacation
benefits, a 401k, and continuing education.
C O CO
Southwest Virginia
A well-established, multi-office, ABC-certified O&P company
is looking for a certified practitioner with excellent orthotic and
prosthetic skills to provide comprehensive treatment for patients.
Excel offers a competitive salary, bonus opportunity, and full benefits
package. Salary to be determined by experience.
Contact:
Charles Coulter, O&P Coordinator

4338 Williamson Road
Roanoke, VA 24012
E-mail: ccoulter@virginiaprosthetics.com
www.virginiaprosthetics.com
Contact:
E-mail: sethwalters@excel-prosthetics.com
MAY 2016
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CLASSIFIEDS
US EASTERN
Orthotic Fitter or Pedorthist

Central Florida
C O
Our growing company is seeking a Florida-licensed (or licensureeligible) orthotic fitter or a certified pedorthist. We are seeking a
motivated individual with strong clinical skills to help continue our
growth by providing assistance at our patient-centered care facility.
Primary duties include providing comprehensive orthotic care while
working with other members of the clinical team. We are seeking
a compassionate individual who possesses the following skills:
analytical, clinical, problem-solving, interpersonal communication,
and detail orientated. The candidate must be a team player and
support the companys vision, mission, and values. We offer
competitive wages based on experience.
OC O
Louisville, Kentucky
At Center for Orthotic & Prosthetic Care (COPC) our staff
of orthotic and prosthetic professionals is committed to our
mission of providing the highest level of patient care possible.
COPC is a private partnership that enjoys the privilege and
challenge of serving in leading and renowned medical centers in
Kentucky, Indiana, North Carolina, New York, and Pennsylvania.
Due to an opening at one of our patient care facilities in
Louisville, Kentucky, we are seeking a CPO or Kentuckylicensed BOCPO who has a minimum of five years of clinical
experience. Candidates must possess excellent communication,
organizational, and interpersonal skills, and the demonstrated
ability to provide the highest quality patient care. This position
offers a competitive salary, relocation assistance, and excellent
benefits that include medical, dental and disability insurance; a
401k; certification and licensure fee; and continuing education
expenses. If you meet the requirements and have an interest,
please submit your resum.
Contact:
Fax: 863.937.9199
E-mail: sandy@integritypando.com
www.integritypando.com
Contact, in confidence:
CPO or CP (Board-Eligible Considered)
Fax: 502.451.5354
E-mail: dkoch@centeropcare.com
Washington DC and Northern Virginia
Infinite Technologies O&P seeks an experienced CPO or CP to join

our team. Located in the metro area, we have three offices that serve
DC, Maryland, and Virginia. The ideal candidate should possess
good communication and organizational skills. Advancement
opportunities are available. We offer a competitive salary, based on
experience, and benefits.
Contact:
CPO or CO
Amy Braunschweiger
E-mail: amy@infinitetech.org
Are you a self-motivated leader looking to take control of your career?

Our privately owned, well-established O&P company is looking for
an experienced CPO or CO with a Florida license for immediate
placement in our Davie, Florida, facility. Before you apply, ask yourself
if you have the following prerequisites: excellent communication and
organizational skills; a commitment to providing the highest quality
patient care; the ability to manage and assist in fabrication; experience
in pediatric O&P, and with scoliosis bracing and cranial remolding; and
experience with the OPIE management system.
If you answered yes to all of these qualifications, then you are just
one step away from embarking on a journey that includes a six-figure
salary, relocation assistance, and excellent benefits that include a
health plan and 401k.
A C-Ce tified
An excellent opportunity is available for an independent, motivated,

ABC-certified practitioner at a well-established, ABC-certified O&P
practice with multiple locations in New York and Vermont. Clinical
Prosthetics & Orthotics is seeking an ambitious, self-motivated,
driven CPO who is willing to take charge and manage a satellite office.
The CPO must be autonomous and able to market and evolve the
business while maintaining a strong patient load. We will offer a partial
ownership arrangement to the right individual. Salary to be determined
by experience. A strong bonus plan and full benefits package are
available.
Send resum to:
Melisa Chang
Dynamic Orthopedics Inc.
6555 Nova Drive, Suite 306
Davie, FL 33317
Phone: 954.303.6999
Fax: 954.424.1884
E-mail: melisa@dynamicorthopedics.com
www.dynamicorthopedics.com
MAY 2016
a titi ne
Contact:
E-mail: alb@clinicalpando.com
74
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US EASTERN
C O
Coastal Prosthetics and Orthotics is in search of a certified CPO or

CO. We are a well-established, ABC-certified facility that has been
serving southeastern Virginia for 15 years. Strengths in pediatrics,
communication, and computer skills are a must. Candidates must also
demonstrate good rapport with patients and coworkers, and must be
able to service the local hospitals and in-office patients.
OC O
Eastern North Carolina

AOP O&P, a 20-year-old established facility, is seeking a goaloriented practitioner. Exceptional pay and a benefits package is
available for the right candidate. Enjoy a quality of life with great
weather, sports, and access to the East Coasts best beaches. Must
be organized, motivated, and energetic, and must possess leadership
qualities. All applications will be held in strict confidence.
Contact:
Fax: 757.892.5303
E-mail: steve@coastalpando.com
Contact:
AOP Orthotics & Prosthetics

835 Johns Hopkins Drive, Suite B
Greenville, NC 27834
Fax: 252.752.5424
E-mail: brian@aopoandp.com
Orthotic Assistant
A well-established, privately owned, multi-office practice in middle
Georgia is looking for an ABC- or BOC-certified orthotic assistant.
We are looking for a hardworking, self-motivated individual with
strong clinical skills to help continue our growth. We offer a great
compensation and benefits package.
Contact:
Looking to Relocate to the Carolinas or Georgia?
E-mail: amandamccorkle@orthoproservices.net
Advanced Prosthetics has CPO, CP, CO, assistant, and orthotic fitter
positions available immediately. We are also seeking a Georgialicensed practitioner. If you are compassionate and patient care is
top priority, we are looking for you. Consider joining our team as
we thrive on making a difference. A competitive salary and benefits
package are offered.
Contact:
English and Spanish Speaking CPO or LPO

O
e
t l ida O fi e
Human Resources
E-mail: carol@advancedpro.biz
A certified, well-established, reputable, multi-office O&P facility in

the Pittsburgh area is seeking an energetic and motivated pedorthist
who is licensed in Pennsylvania or eligible for state licensure. The
candidate should be skillful, hardworking, organized, and able to
provide services to and for pediatric, adult, and geriatric patients. We
offer a competitive salary with benefits.
We are a growing practice with established offices throughout Florida

looking to add to our family. We are looking for a bilingual CPO
or LPO, or board-eligible Prosthetist/Orthotist to serve our south
Florida patients. Ideal candidates will:
Y Have a minimum of two years of experience, excellent
communication and time-management skills, and exceptional
bedside manners
Y Have the ability to do clinical patient evaluations, castings and
measurements, and fitting of prosthetic and orthotic devices
Y Like the option of seeing patients in the office or meeting new
people in our mobile O&P platform
Y Value the multitude of vendor options we provide to our
practitioners
The compensation package will be commensurate with experience,
and includes a competitive salary, auto allowance, health and vacation
benefits, a 401k, and bonuses. If this sounds like something you want
to be a part of, then let us know. We may be your destination!
Michael Serenari, CO/L

E-mail: michaelserenari@gmail.com
E-mail: overcome@opcenters.com
www.opcenters.com
Ce tified and
and O t ti
i ensed ed t ist
st eti e ni ian
Pittsburgh, Pennsylvania
Contact:
Contact:
MAY 2016
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CLASSIFIEDS
CPO or CO
US EASTERN
CLASSIFIEDS
LA TORRE
ORTHOPEDIC LABORATORY
PROSTHETICS ORTHOTICS
SINCE 1920
A C-Ce tified CO C O
CPO, CO, Board-Eligible Orthotist,

and Orthotic Fitter
Celebrating 95 years of reputable, quality O&P care in the beautiful

four seasons of Upstate New Yorks Albany Capital District, we are a
well-established, multi-office practice with an exciting opportunity for
the right individual. We are seeking an ABC-certified CO or CPO with
a minimum of three years of experience to become an integral member
of our orthotics department. The ideal orthotist will also be proficient
in pediatrics and custom spinal systems. Diverse pediatric to geriatric
patient care is provided in our office as well as at local clinics and
hospitals. Highly experienced, on-site technical support staff solidifies
your quality outcomes in an enjoyable environment. Salary and
compensation package includes flexibility, health benefits, a matching
401k, and performance bonuses. Lastly, we firmly believe in the
importance of investing in your continued professional development
and education. Annual ABC dues and CEUs are provided.
Central Pennsylvania
(Williamsport, Shamokin Dam, and Wilkes-Barre)
Are you a motivated self-starter who wants to put patients first and
be part of a growing team? Our expanding company is looking for
a CPO, CO, or board-eligible orthotist. We are also looking for an
orthotic fitter. Hardworking, self-motivated candidates should possess
strong clinical skills, a strong work ethic, and a true team approach
to providing the highest standards of care for our patients. The
fitter will work closely with our practitioners to meet patient needs;
however, the individual must also be able to work independently.
Strong candidates will be ABC certified. Only those with the ability
to manage varying as well as scheduled tasks should apply. Salary and
compensation package includes health benefits, a matching 401k, and
performance bonuses.
Contact:
Timothy P. Lacy, CP
La Torre Orthopedic Laboratory
Latham, NY
Phone: 518.786.8655
E-mail: latorre.orthopedic.laboratory@gmail.com
Contact:
Dave Sickles, CPO, CPed, COO

Phone: 919.475.5592
E-mail: dsickles@centeropcare.com
CPOs, LPOs Needed

s
t
e s l ida O fi e
Ce tified
tist
Westcoast Brace & Limb cares for patients throughout the beautiful
Tampa Bay region where, for more than 40 years, we have set new
standards of orthotic and prosthetic care by focusing on the needs of
the whole patient, as well as on the device we are providing.
We are seeking an experienced, self-motivated, licensable CPO
with five years of experience in both prosthetics and orthotics to
contribute to a progressive, fast-paced, multifacility, career-oriented
team. Applicants should be well-rounded and proficient in traditional
prosthetic and orthotic systems as well as with advanced technology
and complex treatment plans.
We offer a competitive salary and benefits package, including
health insurance, a 401k, and disability benefits. We also believe
strongly in the importance of investing in continued professional
development and education.
We are a growing practice with established offices throughout Florida

looking to add to our family. We are looking for CPOs, LPOs, or
board-eligible Prosthetists/Orthotists for our Fort Myers office who:
Y Have a minimum of two years of experience, excellent
communication and time-management skills, and an
exceptional bedside manner
Y Have the ability to conduct clinical patient evaluations, castings
and measurements, and fitting of prosthetic and orthotic
devices
Y Like the option of seeing patients in the office or meeting new
people in our mobile O&P platform
Y Value the multitude of vendor options we provide to our
practitioners
and includes a competitive salary; auto allowance; health, dental,
vision, long-term disability, and life insurance; and vacation benefits,
as well as a 401k and bonuses. If this sounds like something you want
to be a part of, then let us know. We may be your destination!
Contact:
Bridget Augustine, CPO

Westcoast Brace & Limb
5311 East Fletcher Avenue
Tampa, FL 33617
Phone: 813.985.5000
Fax: 813.985.4499
E-mail: bridget.augustine@wcbl.com
Contact:
E-mail: overcome@opcenters.com
www.opcenters.com
MAY 2016
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US EASTERN
New England Orthotic and Prosthetic Systems (NEOPS), a premier

provider of state-of-the-art orthotic and prosthetic patient care
products and services in the eastern United States, is hiring
an eligible CPO to meet its rapidly expanding business in the
Queens/Boroughs area of New York. Candidates must be highly
motivated team players and possess excellent customer service,
communication, and technical skills.
Are you a certified prosthetist and/or orthotist with excellent clinical

skills? An established and expanding O&P company serving patients
in Bucks County/Philadelphia for more than 25 years is seeking
CPOs, CPs, or COs for all aspects of O&P patient care. Candidates
must be detail oriented, knowledgeable of insurance requirements,
and possess strong communication and marketing skills. Our
suburban patient care facility includes an on-site, fully staffed
fabrication shop.
Contact:
E-mail: careers@neops.com
Contact:
E-mail: ltioandphr@yahoo.com
Ae
O&P Technician
Chattanooga, Tennessee
a CO
in t e C a l tte A ea
We are looking for a certified and licensed orthotist in the Charlotte,

North Carolina, area. We require a minimum of two years of
experience; excellent communication and time management skills;
exceptional bedside manners; and the ability to perform clinical patient
evaluations, casting, measurement, and fitting of all orthotic devices.
and includes a competitive salary; auto allowance; health, dental,
vision, life, and long-term disability insurance; paid time off; a 401k,
and bonuses.
Looking for a rewarding career in a well-established, multi-office

facility? Come to Chattanooga, Tennessee, listed among National
Geographics Next 50 Great Adventure Towns. Were looking for
an orthotic and prosthetic technician to work, live, and play in this
affordable, beautiful, walkable city. A competitive salary and benefits
package is offered. Relocation available. Must be eligible to work in
the United States.
Contact:
Contact:
Southeastern Orthotics & Prosthetics

Fax: 423.698.0568
E-mail: gary@southeasternoandp.com
E-mail: mforte@opcenters.com
www.opcenters.com
CPO
Pedorthist
Victory, a privately owned, multi-office O&P company in East

Tennessee, is looking for a knowledgeable, self-motivated, Tennesseelicensed (or licensure-eligible), ABC-certified CPO. The candidate
must be proficient in documentation and in traditional and advanced
prosthetic systems, and must appreciate rapid growth and a processdriven practice. Victory offers a competitive salary, a benefits package,
paid continuing education, and more. Victory is located at the base
of the Appalachian Mountains where hiking, camping, snow skiing,
rafting, fishing, and other outdoor activities are only minutes away.
This areas cost of living is 12.6% lower than the U.S. average, which
allows more freedom to do the things in which you are interested. If
being valued as an employee, being well compensated and rewarded
for your efforts, and being part of a dynamic team are important to
you, then this may be the opportunity you seek.
Reach is a growing, privately owned, multi-office practice in Newport

News, the Tidewater region of Virginia. The area offers an array of
indoor and outdoor recreational and historical opportunities, as well
as a reasonable cost of living.
We are looking for an individual with a commitment to the
orthotic and prosthetic industry and two years of experience. Must be
ABC certified. We provide a competitive salary and benefits package
and a comfortable practice environment. We understand industry
challenges and see them as opportunities to set ourselves apart.
Contact us if you are interested in making a positive change or have
questions about the practice.
Contact:
Reach Orthotic & Prosthetic Services

Phone: 757.595.9800
E-mail: info@reachops.com
Contact:
E-mail: jason@victoryop.com
MAY 2016
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CLASSIFIEDS
CPO
Now Hiring CPOs, CPs, and COs

to Join Our Growing Team
US EASTERN
CLASSIFIEDS
CO C O and Ce tified O t ti itte

Needed to Join Our Practice
Ce tified O t
Our multifacility practice based in Long Island and New York, New
York, is in need of several experienced practitioners. Each practitioner
must have a minimum of three years of clinical experience. Our
practice offers competitive salaries based on experience; medical,
dental, and life insurance; and company-paid 401k and continuing
education credits.
tist
Synergy Orthopedics is a rapidly growing third-party biller of

orthopedic bracing and rehabilitation products that is focused on
serving patients and physicians in Pennsylvania, New Jersey, and
Delaware. Synergy has an immediate full-time opening for a smart,
detail-oriented, personable, and preferably experienced certified
orthotist or apprentice orthotist to support our orthopedic account
in New Jersey and eastern Pennsylvania. This individual will be
expected to work closely with physicians, physician assistants, nurses,
and orthopedic office staff to provide enhanced patient care through
custom orthopedic bracing. Synergy needs someone who is clinically
oriented, is very organized, and has a hands-on approach to patient
care, as well as strong interpersonal skills, a team-oriented attitude, a
flexible schedule, and the drive for career advancement.
Our office is located in Plymouth Meeting, Pennsylvania; however,
we have openings in orthopedic accounts in New Jersey and
Pennsylvania. This will be a field-oriented position.
Contact confidentially,
with resum and salary requirements:
Fax: 631.253.0989
R C
OR
Lloyds Capital Inc.

Lloyds is currently selling or valuing O&P businesses from coast to
coast. In the last 25 years, Lloyds has sold more than 150 businesses
and valued an additional 300 more.
lease contact, in confidence:
Barry Smith
Phone (office): 323.722.4880
Phone (cell): 213.379.2397
E-mail: loyds@ix.netcom.com
Visit:
www.synergyortho.com
US MULTIPLE LOCATIONS
Join the clinical team

dedicated to treating infants
with plagiocephaly.
Now hiring full and part-time
Orthotists to support company growth
Orange, CA
Miami, FL
W. Houston, TX
San Diego, CA
Orlando, FL
Annandale, VA
Boca Raton, FL
Hackensack, NJ
Milwaukee, WI
BEFORE
To learn more
Visit cranitaltech.com/careers or
contact Nathan Lawson at 480.403.6338
or nlawson@cranialtech.com.
AFTER
We dont just reshape heads. We reshape lives.
MAY 2016
78
What I like about

working at Cranial
Technologies is the joy
I feel daily when I see
a babys head shape
improve.
- Christell B., CPO, Clinician
www.oandp.com/edge
Its almost
here
Dynamic Vacuum
System
Bridging the gap between
valve and Harmony systems
Dynamic - Pump
activates with each step
Vacuum - Enhanced fit

and function
www.ottobockus.com
www.ottobock.ca
System - Easy fabrication,

no certification required
Perspective
Empowering Local Providers to Provide Prosthetics
in Less-resourced Countries
By Robert Frank, CPO(E), and Kit Frank, OTR
ow do you provide prosthetics to patients in the developing world?

Affordability and empowerment of local providers are the keys to
sustainability. We have a long-running experiment in the northern
highlands of Ecuador attempting to do just that.
Patients in Ecuador often leave the hospital after an amputation without knowledge
of prosthetics, access to a provider, or even information about how to care for their
residual limbs. Unfortunately, many physicians there find that prostheses are just not
available for their patients.
We opened a clinic in Ibarra in 2008 as part of a Rotary International project,
financed by the provincial government, that provided free prostheses using donated,
high-quality components. Worn-out exoskeletal prostheses were replaced with modern
systems, individuals received their first prostheses after waiting many years, and young
children took their first steps. But we saw immediately that the project was too dependent on foreigners and began intensive training efforts with physical therapy graduates,
who took over operating the project.
The government funding ended in 2012, and the project quickly went broke. We then
instituted a system in which patients paid a sliding fee, depending on the prostheses
and their financial situations. We did not know if the strategy would work, but it was
so successful that it attracted unwanted interference. As Rotarians ourselves, we were
dismayed when local Rotarians took over and decreased employee pay and control,
increased costs to patients, and decreased accounting transparency. A downward spiral
quickly ensued.
After eight years, we and all the employees left that group, leaving behind the equipment, funds, and components. We began again, this time setting up a small, private
enterprise to fabricate prostheses, working alongside a nongovernmental organization
that accepts recycled components and donates them directly to the patients. We have a
secure model for the employees who are now owners. They are well connected to our
large network of volunteer professionals and donor organizations.
We have been asked to consult in Ecuador on setting up other prosthetic projects,
but the inquiries often focus more on equipment than on the people needed to provide
services. Our advice for aspiring projects: The equipment is the easy part. You must
connect to a source of components, usually recycled or available at low cost. Most
importantly, you must find or develop a strong, local team of providers and be willing
to train them, pay them fairly, and provide professional support for them.
Over the years, professionals from all over the world have volunteered and have given
our local prosthetists a well-rounded experience. The learning travels both waysthe
caseload is so varied and challenging (most patients walk many miles a day on mountainous terrain) that many volunteers come away with new knowledge. You must adapt
to working with the components on hand, and to amputations done without regard for
future prosthetic use. And as you adapt to being part of the community, you may be
invited to visit your patients farm on top of a mountain, receive hand-carved gifts, and
learn to play the charango. O&P EDGE
Robert Frank, CPO(E), and Kit Frank, OTR, have been volunteering with the rehabilitation community in Ecuador for
more than 25 years. They can be reached at bobkitfrank@gmail.com or at www.protesisimbabura.com.
MAY 2016
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Editorial Advisory Board

Randall Alley, BSc, CP/L, CFT
biodesigns inc.
Gary Bedard, CO, FAAOP
Becker Orthopedic
Kevin Carroll, MS, CP, FAAOP
Hanger Clinic
Dennis Clark, CPO
OPGA
Robert Gailey, PhD, PT
Advanced Rehabilitation Therapy Inc.
Edward Haddon, MEd, CO
Century College
Chris Hovorka, MS, CPO/L, FAAOP
Georgia Institute of Technology
Patty Johnson
Ron Sonntag Public Relations
Samus Kennedy, BEng (Mech), CPed
Hersco Ortho Labs
Chris Lake, CPO/L, FAAOP
Lake Prosthetics and Research
Charles E. Levy, MD
North FL/South GA Veterans Health System
Karl Lindborg, CPO
Intersect Orthotic and Prosthetic Services
Karen Lundquist
Ottobock
Angela Montgomery, CPO
Horizon Posthetics
Edward S. Neumann, PhD, PE, CP
University of Nevada, Las Vegas
Paul E. Prusakowski, CPO/L, FAAOP
O&P Digital Technologies
John Rheinstein, CP, FAAOP
Hanger Clinic
Blount Swain
Ability Dynamics
Tony Wickman, CTPO
Freedom Fabrication
Why I
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MODERATE
HIGH
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confidence my Pli 3 will respond to my daily activities.
Jack Green ~ San Diego, CA
Both weatherproof and FULLY SUBMERSIBLE.

Lightweight design requires minimal energy.
The most responsive stumble and fall protection.
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even if its taking small short steps or pivoting in confined spaces.
Streamlined, intuitive set up makes the Pli 3 MPC knee even
easier for prosthetists.
To learn more, call your Freedom representative at 888-818-6777

or visit www.freedom-innovations.com/ Plie-3
2016 Freedom Innovations, LLC. All rights reserved. Made in the USA.
#freedominnovations #plieknee
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A prosthesis I can
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technology that touches lives

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MAY 2016 oandp.

ACROSS THE STATE OR

Tel: 1-727-528-8566 Fax: 1-727-528-8862

Vol 15, No 5 // May 2016

Photograph by ROMP volunteer Paula Cavanaugh, courtesy of ROMP.

Making Connections, Gaining Perspectives

Industry Review ........................................................................... 14

Bionic Fingertip Provides Tactile Sensations

Professors Team Up to Design a Better Prosthetic Arm

UNB Students Creating Golf Prosthesis

Sprinters With Left-leg Prostheses at a Disadvantage

Australian Engineer Trialing Provision of Low-cost Prosthetic Legs

Across the State or Around

3D-printed Myo-hand Tested in Ecuador

BOC Wins Fifth Stevie Award in Four Years

In Memoriam: Henry Gardner, CPO (Retired)

ssur Acquires Touch Bionics

Academy Meeting: Something Bold, Something New

By Laura Fonda Hochnadel

Providing Evidence-based Care

Pitfalls of Waiving Patient Balances

Advertisers Index ....................................................................... 65

By John T. Brinkmann, MA, CPO/L, FAAOP

Deathe and Miller: Canadian

Empowering Local Providers to Provide Prosthetics in Less-resourced

By Phil Stevens, MEd, CPO, FAAOP

Academy Society Spotlight:

The worlds first fully

Linx utilizes an integrated

Making Connections, Gaining Perspectives

Vol 15, No 5 // May 2016

Too often, technology intended to connect us seems

Reproduction, or commercial, advertising, promotional, or

Periodical postage paid at Denver, CO.

Follow oandpedge on Twitter

Individuals may e-mail address changes to info@opedge.com.

Same Great 2.0 Features

Smooth, sleek surface allows pant legs

Classic natural pattern blends in

Sophisticated matte black finish

June 24 & 25, 2016 | Nashville

LOUISIANA ASSOCIATION OF ORTHOTIST & PROSTHETIST STATE MEETING

This years state meeting will be held

Location: Renaissance Baton Rouge

BOC: Examinations. BOC offers year-round testing for all

CFS: ABC/BOC/NCOPE-approved fitter and CE classes

THANK YOU TO ALL OUR SPONSORS:

American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC)

OTWorld 2016: International Trade Show and

Contact PrimeCare for details or registration:

ssur: Orthotic Fitter Course, San Antonio, TX. Entry-level

NORA: Introduction to Materials and the Interim Shoe,

NORA: Introduction to Materials and Making an Insole,

Orthomerica: Whole Limb Solutions Seminar, Dallas,

Your O&P Partner in Education!

Register Now for Certification or Continuing

Partner with Allard, who sells O&P products ONLY to O&P,

Orthotic Fitter: 5/1314/2016

Contact your District Manager, email education@allardusa.com,

The HOPE Careers Consortium is funded by a grant awarded by

*Upcoming courses are subject to availability.

BOC: Examinations. BOC offers year-round testing for all

ABC: Practitioner Residency Completion Deadline for July and

BOC: Examinations. BOC offers year-round testing for all