Short AFO-Posterior Entry & UCB

The patient was seen today for fitting of a right SAFO-PE and a left UCB. All trimlines brought back to appropriate length. Grandparents were instructed in proper donning and doffing as well as placement of the orthoses on the limb. They were told proper wean-in time beginning with 2 hours and increase by 2 hours each day until the patient can were the devices all day long. They were told to monitor the skin for any red marks that persist longer then 30 minutes once the orthoses have been doffed, if there are red marks that persist, they were told to stop using the devices and contact our office. They were told to always wear shoes with these devices. The patient was told to return if there are any problems, or in 3 to 6 months for follow-up

AFO-Free Ankle

The patient was seen today at Central Rehabilitation for fitting of a right AFO-FA. All trimlines brought back to appropriate length. All areas checked for pressure. No excess pressure was found. Grandmother and father were instructed on proper placement of the orthosis on the limb. They were told proper wean and wear time beginning with 2 hours and increase by 2 hours each day. They were told if any red marks persist longer than 30 minutes once the orthosis had been doffed, to stop using the device and contact our office. They did not have appropriate shoe wear today. They were told not to use the device until they purchased shoes. They stated they would do that today and start the patient wearing the device. They were told that if they have any questions or concerns, to contact our office, and if there are any problems, to stop using the device. The patient will be seen on an as needed basis.

Calcaneal Valgus Orthotic

Calcaneal valgus. Orthopedic Surgeon Referral

This 5-year-old female has no known allergies. She is not taking any medications, and she is an active community ambulator. She has not had any surgery, and she has previously worn foot orthotics for the past 3 years according to her father. These were made by another company.

The patient presents as a pronator. She has normal tone and no clonus. Her heels are in valgus and correctable. Her forefeet are abducted bilaterally and correctable. Range of motion at the ankles with the knees flexed is +15 degrees, and with the knees straight it is +10 degrees. I think this child will do well in foot orthotics. I think that they will control the calcaneal valgus very adequately. The casting procedure went well. The parents are aware of what to expect as far as design.

Fabricate bilateral foot orthotics upon receipt of a prescription for the physician and upon insurance authorization.

Bilateral KAFO Braces

The patient was seen today for initial fitting of his bilateral KAFOs. The trimlines were adjusted and several pads were added before the patient was able to stand in them. Also, on the right, his hamstrings are tighter and the joints were readjusted to reflect this. Mom commented that she has not allowing him to wear his previous KAFOs very much because she was waiting for the new ones. I instructed her apply the previous braces on the patient while final changes are being made to the new pair to prevent further tightness. He is not having any difficulty with the previous devices. The overall fit of the new devices was very good. The changes will be noted and made. The patient will be seen in 1 week for final fit and delivery.

UCB Foot Orthotics

The patient was seen today at Race Rehabilitation for fitting of her bilateral UCBs. These were fit. All areas checked for pressure. No pressure was found. The patient stood in the braces and everything looked appropriate. Mom did not have appropriate shoes today. She was instructed in the proper donning, doffing as well as placement of the orthoses on the limb. She was told proper wean and wear time beginning with 2 hours and increase by 2 hours each day. She was told if any red marks persist longer than 30 minutes during the wean-in time, to stop using the devices and contact our office. Mother stated that she will purchase a pair of shoes and start the patient wearing the devices. We will see the patient back as needed.

Left Hemiparesis-Traumatic Brain Injury

Left free-ankle AFO Ankle Brace. Orthopedic Surgeon Referral

Traumatic brain injury and lefthemiparesis.

This 58-year-old male has no known allergies. The medications that he is taking are unknown at this time. He requires maximum assistance when ambulating. He has not had any surgery except after the initial accident, which occurred in 04/2000. He was riding his bike and was hit by a car. His wife was present during this, and she is unclear in regards to what was done. He did not have any fractures from the accident. He is receiving physical, occupational and speech therapy. He has not previously worn a device.

The patient has moderate tone on the left. His clonus is not sustained, and his alignment appears neutral. Range of motion at the ankle is to 90 degrees with the knee bent. This patient is very physically fit. Due to his tone and general strength that he continues to have, I was unable to obtain an accurate assessment of range of motion at ankle with the knee straight. I did not have this patient stand, as he requires maximum assistance to do so. The casting procedure went well. I spoke with his wife regarding the design of the device.

Fabricate left free-ankle brace AFO.

Thoracic Myelomeningeal - AFO Braces

RX:Bilateral solid-ankle AFOs. Orthopedic Surgeon Referral

Diagnosis:Thoracic myelomeningeal paraplegia and equinovarus contractures.

History:LATEX PRECAUTIONS were taken on this 4-year-old male today. He is taking Ditropan and a medication for an infection. He does not ambulate and sits by himself. He has not had surgery since his last visit, and he receives physical therapy at school. His previous devices were bilateral wraparound AFOs. I think that he would benefit more from a solid-ankle system with an anterior panel due to swelling. His feet are very chubby. Mom stated she had difficulty with the wraparound AFOs. She stated they pinched the front portion of his foot.

Evaluation:The patient has a scab and a cut on his left great toe. Mom stated this occurred approximately 1 month ago. It is healing. Range of motion on the left is 90 degrees. On the right, he is tighter, and range of motion is -5 degrees. He presents as a supinator on the right and pronator on the left. He has no clonus on either side. He has moderate tone on the right. He has no tone on the left. The orthotic goal today is to cast him and fit him with devices that will hold his foot in neutral alignment to give him support when he begins to stand.

Fabricate: bilateral solid-ankle AFOs.