FAQ

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Questions about Prosthetics

Q: How do I determine the amount of prosthetic socks I should wear? A: Many amputees wear prosthetic socks over their residual limb. These prosthetic socks come in a variety of thicknesses and materials. They’re many benefits and uses for these socks. They provide cushion, reduce and absorb friction, protect the skin, absorb perspiration, and compensate for shrinkage and/or swelling of the residual limb. As the residual limb matures it will begin to change size and shape. To maintain an appropriate fit of the prosthesis different thicknesses of socks are added to compensate volumetrically for any loss or gain that has occurred. A prosthetic sock thickness and weight is represented with the term “Ply”. As you increase in ply you increase in thickness. Below, is a reference guide to sock ply and their thickness.

1-Ply (White)- all white sock 3-Ply (Green)- all white sock with a green ring around the top end 5-Ply (Blue)- all white sock with a blue ring around the top end

You will receive several socks with your prosthesis. With this supply of socks you will be able to better manage your fit. Every time you put on the prosthesis it is important that you are aware of how many ply you have on. If the socket is loose fitting then add a ply, or if the socket is feeling tight then reduce your fit by a ply. This process may need to be repeated throughout the day as your limb will change volumetrically. It is ideal to have the best fit possible with the least amount of socks. For example, it is preferable to have on one 5-ply sock rather than one 3-ply sock with two 1-ply’s. Understanding prosthetic sock management is key to avoiding skin breakdown and irritation. With the proper fit and follow-up the chances of having a healthier residuum will increase.

Sheaths are also available for the prosthetic wearer. They are used to reduce friction caused by excessive rubbing and help wick away perspiration.

Q: What is a Protective Limb Cover/IPOP? A: A protective limb cover is a flexible plastic shell which is fit immediately post-operative. This device helps to control edema and protect the sensitive surgical site following amputation. The device crosses the knee and reduces the possible incidence of knee flexion contractures. IPOP stands for immediate post operative prosthesis and is a protective limb cover with an attached pylon and foot.

Q: What is the temporary phase of prosthetics? A: The temporary fitting phase is the phase of prosthetics in which the limb is well healed, but remains volumetrically unstable. A shrinker, a compression fitting sock, is then fit to reduce edema. Patients are instructed on wearing schedule to slowly shape their limb to a stable volume. In this phase, the amputee lays the foundation for proper gait mechanics and limb maintenance. Components are selected that match the activity level and functional capability of each patient and helps contribute to patients’ learning and understanding of prosthetic use.

Q: What is the definitive phase of prosthetics? A: Following the temporary phase of prosthetics is the definitive phase. The limb has become more volumetrically stable and the patient is ready to begin definitive care. This involves the careful selection and fitting of the appropriate prosthetic componetry to maximize the functional capabilities of each patient. Proper gait training and limb maintenance are greatly stressed.

Q: Will my residual limb change after surgery? A: The residual limb will undergo a variety of anatomical (physical) changes after surgery. After surgery you will begin to notice a decrease in swelling as the residual limb begins to take shape. As the limb becomes healed and begins to mature and stabilize we can then proceed through the different prosthetic phases.

Q: How long after surgery can I begin to walk on my prosthesis? A: This will vary from patient to patient. However, there are several factors that influence the amount of time one will spend before being able to ambulate. These factors include cause of amputation, time it takes for the residuum to heal, and the integrity of the surgical site. These factors and others will play an important role in determining the time it will take to begin ambulating on a prosthesis.

Q: How do I set-up a free evaluation or consultation in your office? A: To set-up a free evaluation or consultation simply dial (602)222-3032 and the front office staff will assist you in setting a time and a day that is convenient for you. Also, you can click on the contact link associated with this web site, fill out some information, and press send. Front office staff will shortly thereafter be in contact with you.

Q: How do I schedule a visit for peer counseling? A: We offer one-on-one or group peer support. Our amputee patient liaison, Tyler Ritchey, regularly consults and provides support to those who have undergone or are going to undergo surgery. Tyler, who himself is an amputee, can relate to and answer those questions commonly found amongst pre-operative patients. Tyler can be reached by phone or by e-mail. (see peer counseling)

Q: Can my prosthesis get wet? A: We strongly encourage that you keep your prosthesis as dry as possible. Certain componentry will rust and is not meant to get wet. There are however, covers that go over your prosthesis that help prevent water from entering.

Q: What if my orthotic/prosthetic begins to feel uncomfortable, change, or no longer fit? A: The cause for change could be attributed to a variety of factors. First, consult your orthotist/prosthetist concerning the problem. They can help you determine the issue and make the proper adjustments. Do not try to adjust the device yourself, as often this only complicates matters further.

Q: How do I go to school for O&P? A: Under informational links you will find several links of the different schools that offer O&P courses, whether in a certificate program or a bachelors program. The web sites contain all the information you will need for enrollment including prerequisites, start dates, and course information.

Q: What is phantom pain and will it go away? A: Phantom pain is the term used to describe sensations felt by amputees, which may include cramping, tingling, itching, pins-and-needles, stabbing pains, pressure, a sense of fullness (as if the limb was still there, but slightly swollen), and so on. The majority of amputees experience these sensations, however the degree to which it is felt will vary. The phantom sensations are intermittent (they come and go, unpredictably.) New amputees tend to have frequent and intense sensations several times every day, often continuously for a few hours at a time. As the years pass after an amputation, the sensations will generally become less frequent, and less intense, and bouts of pain last for a shorter amount of time. However, despite medical literature that says “both the phantom sensations and pain gradually resolve with time,” many amputees report that the phantom pain never completely disappears.

Questions About Orthotics

Q: What if my orthotic/prosthetic begins to feel uncomfortable, change, or no longer fit? A: The cause for change could be attributed to a variety of factors. First, consult your orthotist/prosthetist concerning the problem. They can help you determine the issue and make the proper adjustments. Do not try to adjust the device yourself, as often this only complicates matters further.

Q: How do I go to school for O&P? A: Under informational links you will find several links of the different schools that offer O&P courses, whether in a certificate program or a bachelors program. The web sites contain all the information you will need for enrollment including prerequisites, start dates, and course information.

Q: How do I set-up a free evaluation or consultation in your office? A: To set-up a free evaluation or consultation simply dial (602)222-3032 and the front office staff will assist you in setting a time and a day that is convenient for you. Also, you can click on the contact link associated with this web site, fill out some information, and press send. Front office staff will shortly thereafter be in contact with you.

Questions About Cranial Banding

Q: What are deformational plagiocephaly, brachycephaly, and scaphocephaly? A: The terms plagiocephaly, brachycephaly, and scaphocephaly refer to the shape of a child’s cranium when viewed from the top. Most caregivers first notice these head shapes during bath time when the child’s hair is wet and the caregiver is looking down at the top of the head. Plagiocephaly refers to an unusual flattening of one side of the occipital bone or back of the head. The child may have one ear which is displaced forward and there may be a prominence on one side of the forehead. A brachycephalic head shape is characterized by a wide and flat head shape when viewed from the top. There is typically uniform flattening of the occipital bone, or back of the head. A scaphocephalic, or dolichocephalic, head shape is characterized by a long and narrow head shape when viewed from the top.

Q: Are these head shapes more common than they used to be? A: There has been a rise in the numbers of deformational head shapes since the 1992 “Back to sleep” campaign. In 1992 the American Academy of Pediatrics recommended that children be put on their backs or sides to prevent Sudden Infant Death Syndrome (SIDS). Although the rate of SIDS has decreased by almost 40% the incidence of positional cranial deformities has become epidemic.

Q: How does a cranial remolding orthosis work? A: All cranial remolding orthotics work on similar principles of redirecting cranial growth to achieve a more symmetrical head shape. This is achieved by maintaining contact on the “high” points of the cranium while creating voids over the “low” points. As the child’s head grows, the growth is directed towards the voided area within the orthosis.

Q: How do I know if my child needs a cranial remolding orthosis? A: There are a number of variables to consider when recommending who is in need of a cranial remolding orthosis. How old is the child, the degree of asymmetry, the area of asymmetry, and cranial circumference percentile to name a few. The most appropriate way to determine if your child is in need of a cranial remolding orthosis is to contact your pediatrician for a referral. Most pediatricians will refer their patient’s to an ABC Certified Orthotist who has experience managing children and their specific orthotic needs.

Q: What is the most appropriate time to begin cranial remolding? A: Although cranial remolding orthoses are appropriate between 3 and 18 months of age, the most appropriate time to begin cranial remolding is between 4 and 7 months of age. This time frame is when the child is growing at the fastest rate and is able maintain head/neck control. Cranial remolding may be recommended following 2 months of repositioning and neck stretching.

Q: Are there different types of cranial remolding orthoses? A: There are numerous types of cranial remolding orthoses that have been approved under the FDA’s 510k certification. All cranial remolding orthoses work on similar principles by redirecting cranial growth to achieve a more symmetrical head shape and appearance. The type of cranial remolding orthoses use by the clinicians at Pongratz Orthotics and Prosthetics are in the Orthomerica StarBand┬« family.

Q: Who refers for cranial remolding orthotics? A: Often times a Pediatrician or Physical Therapist will refer a child to an Orthotist for the evaluation of a cranial remolding orthosis.

Q: How is the impression obtained for a cranial remolding orthosis? A: The clinicians at Pongratz Orthotics and Prosthetics use a plaster hand cast method to obtain the negative impression of a child’s head. The entire process takes 15-20 minutes and is not harmful to the child. Although the process is somewhat messy, the plaster is easily removed from clothing and skin through bathing.

Q: How long will a child typically wear a cranial remolding orthosis? A: Depending on the severity, type of asymmetry, and age of child an orthosis is typically worn 23 hours per day for 2 to 4.5 months.

Q: How often is a child seen for follow-up when wearing a cranial remolding orthosis? A: Depending on the child’s age, severity of head asymmetry and type of asymmetry a child will be seen for follow-up every 10-14 days for the duration of treatment. During follow-up appointments new measurements are taken of the child’s cranium and adjustments are made to the orthosis to accommodate growth and correction.

Q: How is a cranial orthosis cleaned? A: The cranial remolding orthosis that your child has been fit with can be cleaned using a 78-99% rubbing alcohol or with a non-perfumed soap. Wet a soft cloth and wipe out orthosis each time it is removed from the child’s head. Make sure the orthosis is completely dry prior to placing back on the child’s head.

Q: Does insurance cover cranial remolding orthotics? A: Most third party carriers have specific provisions for cranial remolding orthotics. The clinicians and office staff at Pongratz Orthotics and Prosthetics have experience in obtaining authorization through third party carriers. It is important that you contact your insurance company to determine specific provisions, exclusions, and coverage.