Definition: Treatment may take the form of an interim intervention (immediate post-operative prosthesis/orthosis or preparatory prosthesis/orthosis), a definitive prosthesis/orthosis (with or without the use of diagnostic evaluations), adjustment or restoration to an existing prosthesis/orthosis, and/or maintenance of a prosthesis/orthosis. It is customary and necessary for a patient to receive different types of prosthetic/orthotic treatment throughout his / her life.
|1||Interim/Preparatory||The evaluation and treatment involved in providing a prosthesis/orthosis that is utilized for short periods of time (usually less than one year).
Orthotics: Serial casting, post-op stabilization and/or ROM (e.g. Knee/elbow ROM), post traumatic stabilization (e.g. HALO, TLSO), and positional resting orthoses (e.g. dorsiflexion night time AFO’s).
Prosthetics: An Immediate Post-Operative Prosthesis (IPOP) is a temporary socket, typically made of plaster or fiberglass casting material, moulded directly to the involved limb segment and attached to components to provide necessary function.
This procedure allows for treatment with a functional prosthesis soon after surgery, thereby promoting healing, minimizing limb edema, improving the patient’s psychological state and permitting early mobilization.
The use of an IPOP may continue for several days to a few weeks, during which time the quality of tissue control is closely monitored for necessary adjustments. In the case of significant volume reduction, subsequent sockets may have to be applied.
Treatment with an IPOP is frequently followed by treatment with a preparatory prosthesis. A preparatory prosthesis is provided during the early phase of rehabilitation following initial surgery or subsequent revision surgery. The prosthetic socket is moulded over the positive anatomical model and attached to components to allow ambulation.
The goals of the preparatory prosthesis are to mobilize the patient soon after amputation, while accommodating limb healing and changes in residual limb volume. As well, a preparatory prosthesis is a means to establish whether a patient will benefit from a definitive prosthesis.
The use of the preparatory prosthesis may continue for several weeks to a year, during which time the quality of tissue control and prosthetic function are closely monitored for necessary adjustments. Significant changes in residual limb volume may necessitate subsequent preparatory prosthetic sockets. Once limb volume has stabilized, the patient will be prescribed a definitive prosthesis.
|2||Diagnostic||Evaluation of a diagnostic prosthesis/orthosis to assess appropriateness of treatment.
A diagnostic prosthesis/orthosis is moulded over a positive anatomical model. It is used to assess the quality of tissue control for optimal comfort, function and alignment.
The final version of the diagnostic prosthesis/orthosis can serve as a template for the definitive treatment. Modifications to the diagnostic prosthesis/orthosis may be required to optimize comfort and function. Alignment may also be optimized during the evaluation of the diagnostic prosthesis/orthosis.
|3||Definitive||A definitive treatment consists of an interface that has been moulded over the positive anatomical model and is combined with carefully selected components to provide maximum comfort, function and structural integrity for the patient.
This prosthesis/orthosis may or may not be covered with an anatomical restoration, depending on the patient’s preference.
During the patient’s lifetime, individual components of definitive treatment or the entire prosthesis/orthosis will need replacement. It will be necessary to replace either individual prosthetic/orthotic components or the entire prosthesis/orthosis periodically due to changes in physical characteristics of the patient and/or structural failure due to repetitive loading.
|4||Restorative||The evaluation and treatment required to restore and optimize quality of intimacy of strategic surfaces and force systems, function and patient safety. This maintains the maximum benefit of prosthetic/orthotic treatment to ensure normal function.|