Deliver Cranial Reshaping Helmet

The patient is here today for a followup on his helmet. We checked this device, trimmed it slightly,

added some padding to the posterior distal edge on the occiput to make it more snug. We will see in

back in approximately 2 weeks. At that time, I think that it will be necessary for us to remove some

material.

Static Encephalopathy

This 7-year-old female has no allergies. She is currently taking Depakote and has had no surgeries. She receives physical therapy at school and hipo therapy in town. She is an active ambulator with minimum assistance. She currently has bilateral SAFOs, which she has outgrown. Her toes are over the end and they are too narrow in the forefoot. I heated and relieved these areas today so the she is able to wear these until her new braces are fabricated.

The patient presents with pronated feet bilaterally. Her heels are in valgus, and her forefeet are abducted. She is correctable to neutral bilaterally. Range of motion at her ankles is to 90 degree with knees straight. She has moderate tone with athetosis and no clonus. Her knees and hips are normal. Upon observing her gait, the patient walks externally rotated from the hips bilaterally. Her feet are pronated and she is in a slightly crouched gait. I cast her today for bilateral SAFOs.

Patient Chart Unprocessed - Shoes Undelivered

The patient's wife called today and inquired about the shoes and the status of them, as they had recently been mailed out. Further inquiry into the situation revealed that the chart did not get processed in a timely manor. Therefore, the shoes will not be completed and ready for prefitting until approximately 2 weeks from today's date. I have notified Mrs. _______ of this. She was understanding and I was apologetic. It is my intention that once the shoes are received, the patient come into our office for prefitting. If the shoes fit well, we will rush fabrication of the orthosis for him and see him back rapidly

Definitive Socket Change Delivery - Prosthesis

The patient is in the office today to be fit with her definitive socket change. I also provided to her today her 6 multiply and 6 single ply socks, new ultra-light pyramid and new locking mechanism with 1 locking liner and 1 locking liner without lock. The prosthesis fit very well. We dynamically aligned the patient today utilizing her existing foot and pylon. She walked very well and noted no discomfort. We achieved a 3-ply fit. All bolts and nuts were Lok-Tited and torqued down to manufacturer specifications. I told the patient that she should utilize the prosthesis for 1 month. After that, she should return to the office and we will place a cosmetic cover on her prosthesis. She understands this. She also understands that if there is any difficulty, problems or changes with the new socket, she should return immediately for adjustment.

Unhappy Physical Therapist

The patient received a left AFO with posterior extension in mid-January. The therapist was not happy with this. The brace was not preventing his knee from going into recurvatum. We will remake this brace as a free-ankle AFO with adjustable 90-degree plantarflexion stop. The patient has no change in his medical condition. The parent reports that he has been wearing a solid ankle foot orthosis with posterior extension, but she did not bring it with her today. She reported that he was getting irritation on the heel. I informed her that we could make an adjustment to these if she brought them in while he is waiting for his new brace

The patient presents with a pronated foot on the left. His heel is in valgus and his forefoot is abducted. He has moderate tone and no clonus. Range of motion at his ankle is to 90 degrees with this knee flexed. His knee goes into recurvatum. Upon evaluating his gait, the patient is plantarflexed in swing. He contacts the ground mainly on his toes. He has significant recurvatum and mid to terminal stance. T cast him today, as we could not locate his previous mold.

Fabricate left free-ankle AFO with adjustable 90-degree plantarflexion stop.

Unresolved Brace Bruise - Adjustment

The patient was seen today for an adjustment to his Solid AFOs. The patient has a small red area on the top of the right foot. This area is approximately .5 cm in diameter. It appears to be an irritation from a sock wrinkle. The parent reports that it began as a bruise and has faded to this, but it will not completely resolve. I heated and flared this are. It appeared that the pressure was relieved. The fit was appropriate. The parent will continue to monitor the patient's skin. We will see the patient back as needed for adjustments.

Hip Displasia - Rhino Hip Abduction Brace

Right hip dysplasia. This 7-year-old female has no allergies, is not taking any medications and has had no surgery. I measured her today for a rhino brace. She will fit in a size extra small. I trimmed the foam down to appropriate size. I explained donning, doffing, wear, and care procedures as well as how to assist the patient in sleeping in the brace by propping up her feet and legs with a pillow. We could not release the brace to the patient today due to insurance issues.

Scoop Pads and Supracalcaneal Pads

The patient was seen today for fitting of bilateral AFO-Wraparounds. Proper trimlines and clearances were established. Scoop pads were added posteriorly to decrease the pressure at the back of the calf. Supracalcaneal pads were also added to seat the patient's heel in the brace. The parent was also given inch Aliplast ankle pads to help position the patient's foot. Fit was appropriate. Explained donning, doffing, wear, and care procedures to the parent. They will contact us should they notice any red areas that last longer than 30 to 40 minutes. We will see them back for adjustments as needed.