Course Learning Objective:

Video 1 (90 Min.):  Providing Sensory Feedback and Reducing Phantom Limb Pain Using New Medical Technology and the Innovative Surgical Techniques of Targeted Sensory Reinnervation (TSR)

Quiz 1

Video 2 (90 Min.): Adjustable-volume Sockets: Who, What, When, Why, and How to Get Paid

Quiz 2

Acute Versus Delayed Targeted Muscle Reinnervation for Upper Extremity Amputations – Why Wait?

Learning Objective: 

• Managing Major Peripheral Nerves in Forearm Level Amputations with TMR and RPNI—What’s the Best Recipe?
• Bridging Biology and Technology: The Starfish Procedure's Impact on Myoelectric Prostheses
• Responsiveness of PROMIS-9 UE Physical Function to Prosthesis Rehabilitation
• Rethinking the Shoulder Disarticulation Prosthesis: Let's Stop Thinking Outside the Box and Make the Box Bigger
• Prosthesis Receipt Is Associated with Improved Participation and Decreased Pain Following Upper Limb Amputation
• User-Centered Design of a Dashboard to Support Clinicians Treating Upper Limb Myoelectric Prosthesis Wearers

Learning Objective: Conservative management of the diabetic foot includes, of course, diabetic footwear and shoe modifications. Choosing and/or designing the foot orthosis for your diabetic patient is perhaps the easiest way to either help or hurt your patient. 

 In this session, we will examine several different designs, materials and orthosis modifications that may be effectively utilized to prevent or minimize diabetic foot complications - from the bare minimum of a heat-molded prefabricated orthosis to a multi-density custom total contact foot orthosis. We will also discuss the interaction and interface between the orthoses, footwear, and hosiery.

The trend of tuning the stance phase shank to vertical angle of ankle foot orthoses to maximize the impact of the orthosis on a patient's gait has been well established in the literature and in clinical practice. Recent advances of material science illustrate a means to optimize thermoplastic fabrication for a best practice approach. Material options as well as process parameters required for best practice will be reviewed including new data on the flexural modulus differential in thermoplastic sheet materials.

Learning Content: 

• Recognize the impact of extrusion on the physical characteristics of sheet plastic
• Determine the machine direction for extruded plastic sheeting based on sheet dimensions
• Recognize a material science composite alternative to standard extruded thermoplastic sheet stock

INTRODUCTION The denial of a prior authorization directly delays the ability to provide medically necessary care to a patient. The ability to navigate the appeal process in an effective, efficient and timely manner not only benefits the ability to provide clinical care but also has an immediate and direct impact on productivity and profitability to the facility. 

Learning Objective:

• This presentation will provide a simulation of an ALJ trial, the 3rd and for all intents and purposes, the last effective stage within the Medicare System of appeals. 
• The trial simulation will identify key elements of the process and procedure of an ALJ setting, from the viewpoints of the plaintiff (prosthetic provider), defendant (Medicare) and the Adjudication Law Judge.
•  Focus will be on identifying the most common prior errors, omissions, and misconceptions of the ALJ to provide real life examples of effective trial procedures to implement and which ones to avoid.

Expert panel short presentations describing different aspects of Medical Necessity in P&O with a case-study based breakdown at the end and audience Q&A. Medical Necessity reasoning for P&O devices and features is a public funding source (Medicare/Medicaid) requirement and often requested by commercial payers as well. However, many practitioners struggle with how to write medical necessity vs. functional needs or patient desires as reasoning for components or features. The definition of medical necessity is vague enough to require support in interpretation and application. Until passage of the 2018 law that our records are part of the medical record, we were not often required to make robust medical necessity arguments in our clinical notes as we are today. Therefore, more education and support in this area is needed. Likewise, the shift from fee for service to value-based care for custom devices especially, requires a shift from device delivery to provision of healthcare and being part of the healthcare team in all aspects not least of which is communication (records).

Learning Objective: 

The audience will recognize the difference between medical necessity and functional needs or desires

Participants will gain a basic understanding of what type of medical record information can inform medical necessity for an expected health outcome after provision of the prosthesis or orthosis

Participants will learn a method for processing medical information so it can be applied to medical necessity-based reasoning for prosthetic and orthotic care

This lecture presents the biomechanics of partial foot amputations to provide a model to help avoid destructive forces on the residuum while returning gait to near-normal spatial-temporal parameters.

Learning Outcome:

1. Identify potential destructive forces acting on the residual limb and strategies to mitigate them
2. Apply biomechanical principles to optimize prosthetic design and alignment for partial foot amputees

Mobile care is becoming increasingly common in the O&P field. The ideal mobile unit will vary depending on the defined scope of capabilities and local conditions. This presentation will explore the user-centered design process, which offers a framework for designing the mobile O&P lab that will best suit the needs of each care team.

Course Content: 

• Attendees will be able to list the four components of the user-centered design process.
• Attendees will be able to describe the two essential functional qualities identified for the MoPOC mobile O&P lab.
• Define the six essential tasks that were identified for the MoPOC mobile O&P lab.

NIDILRR recently funded a Rehabilitation Engineering Research Center (RERC) for Prosthetics and Orthotics. The funded IDEA Center is focused on improving the interface between the device and human to bolster comfort, function, and health. Here, the IDEA Center team will present our current understanding of pressure effects on the skin, best practices for optimizing pressure distribution, and upcoming innovations including designing devices and the human for the interface.

Learning Objective: 

Insights into Transtibial Prosthetic Socket Design from Expert UK Clinicians’ Digital Records

This presentation introduces a method to compare rectifications made by experienced prosthetists across a range of patient demographics and limb shapes, to improve understanding of socket design strategies. Based upon 163 pairs of limb surface scans and CAD/CAM sockets, socket designs were shown to vary along a spectrum of TSB and PTB principles, with a complex interaction between some rectifications and others showing independence. Such analysis might enable clinicians to leverage design records to support education, peer support for complex case management, and enhance evidence-based socket design.

Digital Health: Remote Visits and Modular Design in a Myoelectric Hand

Explore the cutting-edge advancements in digital health technology that are revolutionizing the field of prosthetics. Discover how remote visits are enhancing patient care and accessibility, while delving into the innovative modular design of the Zeus myoelectric hand, removing the need for loaner hands and empowering individuals with limb differences.

Revolutionizing Prosthetic Care: Smartphone Gait Data for Practical Evidence and Benchmarking

Gait analysis is an invaluable tool in diagnosing and monitoring patients. Until recently, gold-standard gait analysis required sensors and expensive equipment, but a new generation of technologies has made gait analysis accessible to providers in their own clinics. In this session, a panel of clinicians will discuss ways in which a new smartphone-based inertial gait analysis system is being used to equip CPOs with unprecedented data insights!