Prosthetics: Getting the Most Out of What You Pay For Maximizing Functional Potential PRESENTED Jennifer McCarthy, CP Agenda • Understand some of the methods prosthetists use to objectively quantify functional potential of an injured worker • Identify the differences between various prostheses • Understand the importance of the socket design and fit in decreasing the rate of rejection for a prosthesis. • Recognize the impact of physical therapy and occupational therapy on the overall success of the patient with the prosthesis DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Prosthetics Basics DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Limb Loss Statistics • There are nearly 2 million people Amputations living with limb loss in the United States Cancer 1% • Approximately 185,000 amputations occur in the United States each year • In 2009, hospital costs associated with amputation totaled more than $8.3 billion • Between 1996 and 2008, the rate of leg and foot amputations among Vascular Trauma Disease adults with diabetes declined by 45% 65% 54% References: 1. Ziegler‐Graham K, MacKenzie EJ, Ephraim PL, Travison TG, Brookmeyer R. Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050. Archives of Physical Medicine and Rehabilitation2008;89(3):422‐9. 2. Owings M, Kozak LJ, National Center for Health S. Ambulatory and Inpatient Procedures in the United States, 1996. Hyattsville, Md.: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 1998. 3. HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality; 2009. 4. Fisher ES, Goodman DC, Chandra A. Disparities in Health and Health Care among Medicare Beneficiaries: A Brief Report of the Dartmouth Atlas Project. Robert Wood Johnson Foundation2008. 5. Robbins JM, Strauss G, Aron D, Long J, Kuba J, Kaplan Y. Mortality Rates and Diabetic Foot Ulcers. Journal of the American Podiatric Medical Association2008 November 1, 2008;98(6):489‐93. 6. Pandian G, Hamid F, Hammond M. Rehabilitation of the Patient with Peripheral Vascular Disease and Diabetic Foot Problems. In: DeLisa JA, Gans BM, editors. Philadelphia: Lippincott‐Raven; 1998. DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Distribution of Amputations 185,000 amputations per year Annual Amputations – Lower limb = 113,000 – Finger = 61,000 – Other Upper Limb = 11,000 Finger 33% Major limb amputations: 1 to 5 Upper to Lower Lower Limb 61% Other Upper Limb 6% Lower Limb Other Upper Limb Finger Reference: http://www.statisticbrain.com/amputee-statistics/ DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Who Pays? Other 2014 Uninsured 4% 7% • Total Amputations: 209,000 • Total Cost: $28.2 Billion • Does not include: Private 18% – Lost wages – Home modifications – Economic cost of death to Medicare society 58% – Unreimbursed costs Medicaid 13% Medicare Medicaid Private Uninsured Other Reference: https://www.m3meetevents.com/ncvh/Documents/Material/NCVH16/2217_DB_1030_Mary_Yost_16by9_BB.pdf DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Work Related Amputations • The CDC estimates that 3.4 million work- related injuries and illnesses were treated at U.S. hospital emergency departments in 2003 • Estimated 5,100 annual work related amputations reported - The Bureau of Labor Statistics (BLS) • Study found the number of amputations following jobsite accidents in Michigan was nearly two-and-a-half times higher than the official estimate from the U.S. Bureau of Labor Statistics. References: 1. http://www.foxnews.com/story/2006/04/28/cdc-over-3-million-work-related-injuries-and-illnesses-in-us.html 2. https://www.northcarolinaworkerscompensationlawyersblog.com/2016/03/work-related-amputation-results-osha-fine.html 3. http://msutoday.msu.edu/news/2013/federal-figures-miss-most-work-related-amputations/ DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Operation Iraqi Freedom, Operation Enduring Freedom and Operation New Dawn • Total number of amputation to date: approx. 1,650 • Peak number of amputations: June 2011 – July 2011: 78 • 2016: no amputations reported • Less troops, decreased intensity, change in nature of combat and ferocity of attacks Reference: http://taskandpurpose.com/2016-milestone-amputations-military-iraq-afghanistan/ DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Amputation Outcomes • Amputations are life-changing events. • Claimants require a range of healthcare professionals, resources, and support from family and friends to help navigate the path to physical and emotional recovery. • Advances in medical procedures • Physical therapy helps patients return to their standard of life more quickly • Prosthetic limbs have become more comfortable and functional = FUNCTIONAL POSITIVE OUTCOMES! DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Initial Evaluation How does the prosthetist decide which device is appropriate? DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Initial Evaluation DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Health History • Complications from injury • Medications • Medical diagnoses • Previous therapy DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Review of Environment • Home environment • Community environment • Support mechanisms DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Residual Limb Evaluation Length Tissue Shape Other Length Tissue Health Pain and sensitivity Short Bony Conical Volume stability Scars and boney prominences Medium Muscular Cylindrical ROM Long Fleshy Bulbous Environment DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Prosthetist’s Evaluation • Measurements • Current issues/complaints • Past prosthetic devices • Activities prior to amputation • Activities post amputation • Job Description • Describe process • Set expectations DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Outcome Measures What objective tests exist that can help determine functional potential? DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Functional Classification Levels • K0: The patient does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance his or her quality of life or mobility • K1: The patient has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulatory • K2: The patient has the ability or potential for ambulation with the ability to traverse low-level environmental barriers such as curbs, stairs, or uneven surfaces. Typical of the limited community ambulatory • K3: The patient has the ability or potential for ambulation with variable cadence. Typical of the community ambulator who has the ability to traverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion • K4: The patient has the ability or potential for prosthetic ambulation that exceeds basic ambulation skills, exhibiting high-impact, stress, or energy levels. Typical of the prosthetic demands of the child, active adult, or athlete DENTAL | DIAGNOSTICS | EQUIPMENT + DEVICES | HOME HEALTH + COMPLEX CARE | PHYSICAL THERAPY | TRANSPORT + TRANSLATE ©2018 One Call Care Management. All Rights Reserved. Functional Classifications • “Bilateral amputees often cannot be strictly bound by functional level classifications.” • Bilateral amputees still must be assigned a functional level and given the appropriate componentry; however, if there is a well-documented clinical need for components that exceed a bilateral amputee’s functional level classification, the patient may receive components beyond his or her functional level. DENTAL | DIAGNOSTICS