custom range consolidation - prescription braces · 2020. 1. 27. · list price weight limit base...
TRANSCRIPT
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
8
11
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
18
Key to a successful Orthotic Outcome
Appropriate stiffness of AFO
Appropriate application of 3-point
force mechanisms
Appropriate skeletal alignment
19
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
20
Appropriate skeletal alignment
AFO must: accommodate plantarflexor contractures and hold the patient in their optimal alignment (Shank to vertical angle)
21
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
22
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
33
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®
35
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
41
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.
42
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
43
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