custom range consolidation - prescription braces · 2020. 1. 27. · list price weight limit base...

INNOVATION

Breaking Down the Barriers to Success

Custom AFO Solutions

Learning Objectives

➢ Understand the SpryStep AFO range structure

➢ Learn the unique value proposition of the SpryStepVector and how to communicate it to your customers

➢ Discover the fitting and casting process of the SpryStep Vector

4

Off-The-Shelf AFO Range

SpryStep®

Pediatric

SpryStep®

Flex

SpryStep®

Original

SpryStep®

Plus

SpryStep®

Max

5

Reasons for Escalation to Custom bracing

Improve fit and function

Long term use

High activity goals

Specific functional goals

Triplanar control required

Contractures

Spasticity/tone

Complex biomechanical objectives

Basic Custom AFOs

SpryStep®

Flex

SpryStep®

Original

SpryStep®

Plus

Shape, Pre-tib Shell & MIB Shape & MIB

Advanced Custom AFO

Most

customizable

design

Flagship

AFO

Stiffness

Varus flange

Pretib

MIB

Shape

Off-The-Shelf

Custom BASIC

Custom ADVANCED

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Coding, Weight Limit & Pricing

List price Weight Limit Base Code Add-ons

Basic Custom Range

SpryStep Flex, flat footplate $ 590.00 300 lbs L1940 L2755, L2820

SpryStep Flex, flat footplate, Pretib $ 690.00 300 lbs L1940 + L2340

SpryStep Flex, MIB $ 750.00 350 lbs L1950 + L2280

SpryStep Flex, MIB, Pretib $ 850.00 350 lbs L1950 + L2340 + L2280

SpryStep Original, Flat footplate $ 590.00 300 lbs L1940 L2755, L2820

SpryStep Original, Flat footplate, Pretib $ 690.00 300 lbs L1940 + L2340

SpryStep Original, MIB $ 750.00 350 lbs L1950 + L2280

SpryStep Original, MIB, Pretib $ 850.00 350 lbs L1950 + L2340 + L2280

SpryStep Plus, Flat footplate $ 650.00 250 lbs L1945 L2755

SpryStep Plus, MIB $ 810.00 300 lbs L1945 L2755

Advanced Custom Range

Vector base model $ 750.00 350 lbs L1950 L2755, L2820, L2280

Vector w/ pre-tib shell $ 850.00 350 lbs L1950 L2755, L2820, L2280, L2340

Vector w/ pre-tib shell and varus pad $ 950.00 350 lbs L1950 L2755, L2820, L2280, L2275

Vector w/ varus pad $ 850.00 350 lbs L1950 L2755, L2820, L2280, L2275

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Coding, Weight Limit & Pricing

List price Weight Limit Base Code Add-ons

Basic Custom Range

SpryStep Flex, flat footplate $ 590.00 300 lbs L1940 L2755, L2820

SpryStep Flex, flat footplate, Pretib $ 690.00 300 lbs L1940 + L2340

SpryStep Flex, MIB $ 750.00 350 lbs L1950 + L2280

SpryStep Flex, MIB, Pretib $ 850.00 350 lbs L1950 + L2340 + L2280

SpryStep Original, Flat footplate $ 590.00 300 lbs L1940 L2755, L2820

SpryStep Original, Flat footplate, Pretib $ 690.00 300 lbs L1940 + L2340

SpryStep Original, MIB $ 750.00 350 lbs L1950 + L2280

SpryStep Original, MIB, Pretib $ 850.00 350 lbs L1950 + L2340 + L2280

SpryStep Plus, Flat footplate $ 650.00 250 lbs L1945 L2755

SpryStep Plus, MIB $ 810.00 300 lbs L1945 L2755

Advanced Custom Range

Vector base model $ 750.00 350 lbs L1950 L2755, L2820, L2280

Vector w/ pre-tib shell $ 850.00 350 lbs L1950 L2755, L2820, L2280, L2340

Vector w/ pre-tib shell and varus pad $ 950.00 350 lbs L1950 L2755, L2820, L2280, L2275

Vector w/ varus pad $ 850.00 350 lbs L1950 L2755, L2820, L2280, L2275

13

Coding, Weight Limit & Pricing

List price Weight Limit Base Code Add-ons

Basic Custom Range

SpryStep Flex, flat footplate $ 590.00 300 lbs L1940 L2755, L2820

SpryStep Flex, flat footplate, Pretib $ 690.00 300 lbs L1940 + L2340

SpryStep Flex, MIB $ 750.00 350 lbs L1950 + L2280

SpryStep Flex, MIB, Pretib $ 850.00 350 lbs L1950 + L2340 + L2280

SpryStep Original, Flat footplate $ 590.00 300 lbs L1940 L2755, L2820

SpryStep Original, Flat footplate, Pretib $ 690.00 300 lbs L1940 + L2340

SpryStep Original, MIB $ 750.00 350 lbs L1950 + L2280

SpryStep Original, MIB, Pretib $ 850.00 350 lbs L1950 + L2340 + L2280

SpryStep Plus, Flat footplate $ 650.00 250 lbs L1945 L2755

SpryStep Plus, MIB $ 810.00 300 lbs L1945 L2755

Advanced Custom Range

Vector base model $ 750.00 350 lbs L1950 L2755, L2820, L2280

Vector w/ pre-tib shell $ 850.00 350 lbs L1950 L2755, L2820, L2280, L2340

Vector w/ pre-tib shell and varus pad $ 950.00 350 lbs L1950 L2755, L2820, L2280, L2275

Vector w/ varus pad $ 850.00 350 lbs L1950 L2755, L2820, L2280, L2275

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Competitor Analysis

Phat BraceGood pclinical outcomesLow priceCoding is sketchy

OttobockPoor clinical outcomesLong manufacturing timeAccurate but low reimbursement codingStiffness issues

Propulsion – Tillges TechnoligesExpensiveNicest looking product (after the vector obviously)Questionable coding

Kinetic Research – NoodlePoor cosmesisFab time issues

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How Do You Manage Complex

Pathological Gait?

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Normal Gait has four key functions

Upright stability

Muscle function required to prevent body from falling

“controlled falling”

Stance limb progression

First step initiation, action of the rockers, forward fall of body weight and generation of propulsive forces

Shock absorption

Ankle plantarflexion,

knee flexion and

hip abduction

Energy conservation

Minimise the COM movement and utilise selective muscle control

(Perry & Burnfield 2010)

An Orthoses should impact one or more of the above parameters to be deemed successful

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Example:

➢ Head injury leads to loss of dorsiflexion power –simple foot drop

➢ Patient introduces swing and stance phase compensations (circumduction/vaulting/knee hyperextension)

➢ All of the four components of normal gait are impacted by ‘simple foot drop’

Pathological Gait

Deviation from normal gait impacts one of the

four key functions of

gait

A compensatory gait pattern is

adopted

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Key to a successful Orthotic Outcome

Appropriate stiffness of AFO

Appropriate application of 3-point

force mechanisms

Appropriate skeletal alignment

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Appropriate application of 3-point force mechanisms

Trimlines must be appropriate in order to apply corrective forces

Material used must be stiff enough to apply corrective force

The use of straps to apply corrective forces is viewed as inelegant

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Appropriate skeletal alignment

AFO must: accommodate plantarflexor contractures and hold the patient in their optimal alignment (Shank to vertical angle)

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Appropriate stiffness of AFO

Terminal stance requires high torque

resistance around the ankle joint to prevent

excessive dorsiflexion & provide push off

AFO must be stiff enough to

prevent excessive

motion around the ankle joint

The stiffness is affected by a

variety of factors including height,

weight and stride length

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How does the Vector AFO fit the bill?

ForcePattern

Alignment

Stiffness

Clear casting guidelines and high clinical

skills ensure appropriate alignment

Thuasne USA’s composite expertise

combined with detailed clinical picture

allows to design the AFO with an

appropriate stiffness

Through its base design and options, the

SpryStep Vector addresses a wide range

of biomechanical deficits

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The Orthotic Outcome is the result of a Collaboration

Alignment

Force Pattern

Stiffness

A successful outcome with a superior product like the SpryStep Vector AFO is only possible with good communication between the clinical and fabrication teams.

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SpryStep Vector AFO – Pricing & Coding

The ONLY L1950 PDAC approved custom AFO

PDAC APPROVED L-1950

List Price

• Model 1 = $750

• Model 2 = $850

• Model 3 = $950

• Model 4 = $850

Reimbursement (avg Medicare fee)

• Model 1 = $1466

• Model 2 = $1930

• Model 3 = $2061

• Model 4= $1596

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Indications/Contraindications and Warranty

Indications:

• Designed to address a wide variety of lower limb pathologies

Contraindications:

• Open ulceration of the foot, ankle and lower limb

• Patients weighing under 100lbs

• Patients weighing over 350lbs

• Partial foot amputation more proximal than transmetatarsal

Warranty:

• 1 year on composite structure

• 6 months on soft goods

Warranty limitations:

• Extreme squatting

• Loading a portion of the toe

whilst climbing stairs or uneven

surfaces

• 1

Patient Evaluation

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SpryStep Vector AFO

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Order form: Clinical Information

All essential to ensure appropriate stiffness is selected

1. Manual muscle test

2. Range of motion test

3. Visual gait analysis

4. Activity level

5. Footwear assessment

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Order form: Clinical Information

All essential to ensure appropriate stiffness selected

1. Manual muscle test

2. Range of motion test

3. Visual gait analysis

4. Activity level

5. Footwear assessment

32

Order form: Clinical Information

All essential to ensure appropriate stiffness selected

1. Manual muscle test

2. Range of motion test

3. Visual gait analysis

4. Activity level

5. Footwear assessment

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Order form: AFO Design Options

1. Level of Control

2. Shell Design

3. Inner boot

Dry Wrap Casting Technique

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SpryStep Vector AFO®

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Casting Video

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Dry Casting Tools

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Dry Wrap Casting

Technique Overview

Alignment is critical – represent dynamic midstance alignment

Heel height and contractures must be accommodated

Ensure cast is 2 inches above the fibular head

Remove cast and bench align on the casting platform before shipping

Casting Demonstration

Parameters of a Poor Cast

Forefoot Is Not Flat Calcaneus Is Inverted

Most Common Issues:

• Cast is not rigid • Incorrect heel height • Cut strip in wrong location

Shank Is Reclined What is wrong here?What is wrong here?

Clinical Queries: Cast

Forefoot Is Not Flat Calcaneus Is InvertedShank Is Reclined

All of the following may lead to a delay in fabrication:

• Cast not representative of intended alignment – coronal, sagittal and transverse

• Cast not structurally sound

• Cast does not cover sufficient anatomy

• All queries will prompt a phone call from our technical team

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Clinical Queries: Cast

This cast was crushed during shipping because itwas too flimsy in several areas.

It had to be re-formed (which adds subjectivity) and re-wrapped before being filled.

The picture is taken after re-forming.

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Potential delays in fabrication

Intake process is critical – assess paperwork and cast upon arrival

Any queries found during this process will cause the fabrication to be paused until they are cleared

Fabrication delayed because of:

• Clinical queries1. Order form queries2. Cast queries

• Administrative queries 1. Purchase order missing

Fabrication begins once all queries are cleared

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Clinical Queries: Order Form

Any missing information on the orderform will lead to a delay

Clinical information essential

Asking for deviations from the options available may lead to delays

Writing ‘call me prior to fabrication’ willlead to a delay

AAOP Workshops

Management of Complex Pathological Gait with An Innovative AFO Approach

March 4th – 10.15am – 12.15am, Columbus C&D

March 4th – 3.30pm – 5.30pm, Roosevelt 3A

Will Cox and Fraser Allan