3.5/3.5.1 Evaluation, Adjustment, and Restoration of the Prosthesis/Orthosis

3.5      Evaluation, Adjustment, and Restoration of the Prosthesis/Orthosis

Definition: Evaluation of an Interim, Diagnostic or Definitive prosthesis/orthosis to determine efficacy of treatment; may require adjustments to optimize function.

3.5.1    Prosthetic Evaluation, Adjustment, and Restoration

Code             Procedure Description
1 Height/length management Adjust height of prosthesis. This may include adjustments to accommodate physiological growth, change in body weight (including weight gain due to pregnancy), limb volume changes due to medication, change in status of contra lateral limb (joint surgery, progressive deterioration of limb, addition of an orthosis). May include lengthening or shortening endoskeletal pylon or exoskeletal shank, interchanging components and building up height of shoe.
2 Tri-planar alignment management Adjust sagittal/ frontal/ transverse plane alignment of prosthesis. This may include adjustments to accommodate change in footwear, joint range of motion (contracture), muscle strength, joint pain/ instability, areas of socket pressure. May include tilt/shift of socket relative to prosthesis using adjustment screws/ plates, alignment tools/ adaptors or removing and reattaching the prosthetic socket.
3 Strategic surface/ volume management Adjustment to prosthetic socket to optimize intimacy of strategic surface contact on the residual limb. May include application of localized heat to relieve excessive contact, sanding out areas of socket, applying counter pressure pads, full or partial linings to equalize contact or reduce the thickness of the prosthetic socks required, altering trim lines.

Add or remove layers of prosthetic socks to optimize prosthetic comfort, containment within socket and function.

Provide education to patient.

4 Suspension management Adjust to optimize socket suspension.  May include the use of heat to enlarge or reduce suspension areas, adjustment or replacement of straps, belts or sleeves, optimization of the interaction between inner liner and outer socket system, including locking mechanisms, adjustment or repair to suction valve, application of heat, pads or linings.
5 Coordinate maintenance and repair of prosthesis Discuss length of time needed to repair and whether replacement of damaged component is an option.

Discuss associated costs.

Arrange for back-up prosthesis/component while repair is being performed.

Arrange for new components to be ordered or for the repair to be performed either by prosthetic clinic or by manufacturer.

Organize warranty information and funding.

6 Interim component installation In cases of catastrophic component failure, or removal of component to send for warranty service, arrange for installation of suitable interim or service component until repair or replacement is arranged.

Ensure patient comfort, function and patient safety is restored for interim period.

7 Interim component removal Oversee removal of interim component and installation of repaired component.

Ensure patient comfort, function and patient safety is restored.

8 Ongoing maintenance of prosthesis At regular intervals, coordinate necessary technical maintenance of prosthesis, highlighting specific issues reported by patient.

Ensure comfort, function and patient safety is restored.

9 Optimize function of prosthetic components Adjust settings on prosthetic components to optimize function.  Includes knee, ankle joint control settings, myo-electric settings, control harness and cabling for optimum control of upper extremity prosthesis.
10 Remove/reapply finishing Remove and reapply anatomical finishing before and after treatment.
11 Adjustment to anatomical restoration Reshaping of areas of anatomical restoration.

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