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The APOPPS™ & APOPPS-TF™ by FLO-TECH ® O&P Systems, Inc. Robert N. Brown, Sr., CPO, FAAOP CEO/Research, Design & Education Robert N. Brown, Sr., CPO,

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Presentation on theme: "The APOPPS™ & APOPPS-TF™ by FLO-TECH ® O&P Systems, Inc. Robert N. Brown, Sr., CPO, FAAOP CEO/Research, Design & Education Robert N. Brown, Sr., CPO,"— Presentation transcript:

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2 The APOPPS™ & APOPPS-TF™ by FLO-TECH ® O&P Systems, Inc. Robert N. Brown, Sr., CPO, FAAOP CEO/Research, Design & Education Robert N. Brown, Sr., CPO, FAAOP CEO/Research, Design & Education ®

3 Applications in Obesity Setup Setup Selection of Components & Materials Selection of Components & Materials Trouble shooting Trouble shooting

4 APOPPS TM Adjustable PostOperative, Protective & Preparatory System for prosthetic rehabilitation TRANSTIBIAL SYSTEM: TRANSTIBIAL SYSTEM: – The FLO-TECH-TOR™ Protective socket or an early (supervised) ambulatory socket Protective socket or an early (supervised) ambulatory socket – The VCSPS™ Protective, PSRD or Preparatory socket Protective, PSRD or Preparatory socket – The UFOS™ Universal Frame Outer Socket Universal Frame Outer Socket Ambulatory outer socket for both the FLO-TECH-TOR™ and the VCSPS™ Ambulatory outer socket for both the FLO-TECH-TOR™ and the VCSPS™

5 APOPPS- TM TRANSFEMORAL SYSTEM: TRANSFEMORAL SYSTEM: – The INNER SOCKET FLO-TECH-TOR-TF™ (Protective), early (supervised) ambulatory or preparatory socket FLO-TECH-TOR-TF™ (Protective), early (supervised) ambulatory or preparatory socket – The OUTER SOCKET UFOS-TF™ (Universal Frame Outer Socket) UFOS-TF™ (Universal Frame Outer Socket) Ambulatory outer socket Ambulatory outer socket

6 APOPPS TM & APOPPS-TF™ Specifics for Obese Patients Systems In Stock: Systems In Stock: – Transtibial Adult 7” & 9” length Adult 7” & 9” length – Transfemoral Adult 12” length Adult 12” length

7 APOPPS™ & APOPPS-TF™ Sizing The largest TT socket in stock: The largest TT socket in stock: – MPT circumference of 19” to 20” – Distal circumference of 16” to 22” The largest TF socket in stock: The largest TF socket in stock: – Ischial circumference of 30” – Distal circumference of 22” to 28” Longer or larger requires custom system Longer or larger requires custom system

8 CUSTOM ORDERS 131 custom sockets provided 131 custom sockets provided in 2003 in 2003 – An average of nearly 3 custom sockets per week – Allow 3 lab days – Average shipping time 1.05 days If ordered before 12 noon If ordered before 12 noon APOPS-KD™ (Knee Disarticulation) APOPS-KD™ (Knee Disarticulation)

9 Stock BB-d™ Pre-custom Definitive Available in Transtibial & Transfemoral systems Available in Transtibial & Transfemoral systems –Stock –Custom sizes

10 Stock BB-d™ Pre-custom Definitive Adjusts circumferentially at all levels Adjusts circumferentially at all levels AP adjustability at all levels AP adjustability at all levels ML conforms to patient at all levels ML conforms to patient at all levels 5 stock sizes 5 stock sizes 2” carved distal end pad 2” carved distal end pad Custom systems available Custom systems available

11 BB-d™ ORDERS Available in: Available in: – 5 Transtibial & 3 Transfemoral Stock sizes in left & right configurations – Custom sizes – Custom strength Based on weight & activity level Based on weight & activity level – Non-ambulatory (polypropylene inner socket & Polyethylene outer socket) – Up to 500 lbs. (Acrylic resin, carbon & Kevlar inner socket & co-polypropylene outer socket)

12 CUSTOM ORDERS PROVIDED Adult Transtibial sockets & systems Adult Transtibial sockets & systems Adult Transfemoral sockets & systems Adult Transfemoral sockets & systems Adult Knee Disarticulation sockets & systems Adult Knee Disarticulation sockets & systems Adult Symes sockets & systems Adult Symes sockets & systems

13 CUSTOM ORDERS AVAILABLE Toddler, children & youth Transtibial & Transfemoral Toddler, children & youth Transtibial & Transfemoral Toddler, children, youth & Knee Disarticulation & Symes Toddler, children, youth & Knee Disarticulation & Symes Not your every day shapes, sizes and systems for adult, youth, children or toddlers Not your every day shapes, sizes and systems for adult, youth, children or toddlers

14 CUSTOM ORDERS PROVIDED Odd shapes Odd shapes – Extremely long FLO-TECH-TOR  MPT to distal end = 23 ½” MPT to distal end = 23 ½” – plus 1 ½” shrinkage & padding – plus thigh length and trim allowance of 12”  Total one piece forming 37” – Extremely large TF = 45” Ischial circumference

15 Applying the Socket Attachment Plate Bottom portion of UFOS™ MUST be flat Bottom portion of UFOS™ MUST be flat – If not; LIGHTLY sand with a disc sander to remove any protruding plastic AT POINT(S) OF CONTACT ONLY AT POINT(S) OF CONTACT ONLY

16 Other UFOS Trim Permitted Suspension wings (A) on the proximal medial & lateral sides Suspension wings (A) on the proximal medial & lateral sides Proximal posterior (B); if necessary Proximal posterior (B); if necessary NEVER remove material from the distal sides (C) NEVER remove material from the distal sides (C)

17 The Socket Attachment Plate The holes in the socket are oversized intentionally and line up with the holes in the Grace plate & the socket attachment plate The holes in the socket are oversized intentionally and line up with the holes in the Grace plate & the socket attachment plate – If not; carefully drill or cut away any interfering material & smooth as needed

18 Why Over Sized? To p rovide & permit To p rovide & permit – Rotation – 7 o to 10 o – A & P slide – 1/4” – M & L slide – 1/4”

19 COMPONENTS & OBESITY Rating of a complete system is determined by the lowest rated component Rating of a complete system is determined by the lowest rated component The lower the activity level the higher most components are rated The lower the activity level the higher most components are rated – Pylon components rated at 300 lbs with a socket unable to support 300 lbs. plus & an activity level exceeding these limitations negates intended rating

20 EXAMPLE: Foresee – Weight & Activity Levels for Pyramid Systems & Delta Ankle Foresee – Weight & Activity Levels for Pyramid Systems & Delta Ankle – Low activity = 250 lbs – Moderate activity = 220 lbs. – High activity = 185 lbs.

21 COMPONENTS Multiple manufacturers offer choices of: pylon, attachment components & knee units for patients who weigh 275 lbs or less. Multiple manufacturers offer choices of: pylon, attachment components & knee units for patients who weigh 275 lbs or less.

22 COMPONENTS Rated to 300 Lbs. Hosmer Hosmer The W.A.L.K. (Weight Activated Locking Knee) & S.A.F.K (Single Axis Friction Knee) units, Titanium #60794 & #60821 The W.A.L.K. (Weight Activated Locking Knee) & S.A.F.K (Single Axis Friction Knee) units, Titanium #60794 & #60821 The S.A.L.K. (Single Axis Locking Knee) unit #60471 The S.A.L.K. (Single Axis Locking Knee) unit #60471 All Titanium & Stainless Steel pylon and attachment components in the series #60000 All Titanium & Stainless Steel pylon and attachment components in the series #60000

23 COMPONENTS Rated To 300 Lbs. USMC USMC Some Titanium & Stainless Steel pylon and attachment components in the # series Some Titanium & Stainless Steel pylon and attachment components in the # series – Designated by AK and BK respectively The Stainless Steel Knee unit #15226 and the Black Max Knee #P24000 series The Stainless Steel Knee unit #15226 and the Black Max Knee #P24000 series

24 COMPONENTS Rated To 300 Lbs. Ohio Willow Wood Ohio Willow Wood – Magnum Heavy Duty System Functional level 4 = 300 lbs. Functional level 4 = 300 lbs.

25 COMPONENTS Rated to 350 Lbs. USMC USMC Machined Titanium pylon and attachment components in the # series Machined Titanium pylon and attachment components in the # series The Black Max Short Knee & The ProSport ® Titanium Knee in the # series The Black Max Short Knee & The ProSport ® Titanium Knee in the # series

26 COMPONENTS Rated to 350 Lbs. Ohio Willow Wood Ohio Willow Wood – Magnum Heavy Duty System Functional level 1-3 = 350 lbs. Functional level 1-3 = 350 lbs.

27 COMPONENTS Rated to 450 Lbs. IPOS-Bauerfeind IPOS-Bauerfeind – X-tra Series

28 COMPONENTS Rated to 500 Lbs. TiMED (Titanium Specialists in Prosthetics) TiMED (Titanium Specialists in Prosthetics) – BK-500 (does not include foot) GH-610 EX.HD EAR CONNECTOR GH-610 EX.HD EAR CONNECTOR EH-503 TUBE CLAMP 34 mm (requires 2) EH-503 TUBE CLAMP 34 mm (requires 2) A mm CARBON TUBE A mm CARBON TUBE EH-509 EXTRA HD SACH FOOT INSERT EH-509 EXTRA HD SACH FOOT INSERTUSE – HEAVY DUTY SACH FOOT – By Kingsley

29 APOPPS™ Follow Up Concerns Sockets have specific warranties Sockets have specific warranties – Workmanship and initial quality – Thereafter: FLO-TECH-TOR™ 30 days FLO-TECH-TOR™ 30 days VCSPS™ 90 days VCSPS™ 90 days UFOS™ 90 days UFOS™ 90 days FLO-TECH-TOR-TF™ 90 days FLO-TECH-TOR-TF™ 90 days UFOS-TF™ 90 days UFOS-TF™ 90 days

30 Follow Up Concerns Hook and Pile Velcro® on the belts are slipping Hook and Pile Velcro® on the belts are slipping SOLUTIONS: SOLUTIONS: – Set belt to patients specifications & stitch all areas in place You can remove and discard the double sided hook Velcro® You can remove and discard the double sided hook Velcro®

31 Follow Up Concerns Patient seems unstable and one or more sockets demonstrate an unwanted medial-lateral motion Patient seems unstable and one or more sockets demonstrate an unwanted medial-lateral motion SOLUTIONS: SOLUTIONS: – Practitioner may fine tune alignment The toe out and the socket placement over the foot MUST be optimal to minimize unwanted motion The toe out and the socket placement over the foot MUST be optimal to minimize unwanted motion

32 Solutions Continued ALIGNMENT SOLUTIONS: ALIGNMENT SOLUTIONS: – Use equally rated offset components if necessary – Maintain alignment whenever removing or disassembling components – Use pre-custom definitive BB-d if necessary

33 Follow Up Concerns Swelling is causing skin to protrude through the slots on either side of the FLO- TECH-TOR Swelling is causing skin to protrude through the slots on either side of the FLO- TECH-TOR SOLUTIONS: SOLUTIONS: – Elevate the limb as often as is practical – Be sure the proper size is used – Apply a compressive sock, Ace wrap or liner to the residuum before socket application

34 SOLUTIONS Continued: Add a thin polyethylene tongue to the affected area Add a thin polyethylene tongue to the affected area – Attach the tongue to medial and or lateral areas of the posterior section only

35 Follow Up Concerns Socket or system is difficult to don Socket or system is difficult to don SOLUTIONS: SOLUTIONS: – Apply inner socket & tighten straps and Bands – Apply a donning sleeve (nylon or parachute material) over the FLO-TECH-TOR, FLO- TECH-TOR-TF or VCSPS (straps, neoprene and all) AND – Open UFOS™ straps before attempting to insert the inner socket

36 Follow Up Concerns Socket or system is showing signs of stress Socket or system is showing signs of stress SOLUTIONS: SOLUTIONS: – If FLO-TECH-TOR beyond warranty and patient will move to a new socket soon have patient avoid unsupported ambulation until the new socket is ready – If within warranty call for a Return Authorization number and replacement socket

37 Follow Up Concerns Sockets are rotating one inside the other Sockets are rotating one inside the other SOLUTIONS: SOLUTIONS: – Be sure sockets are sized appropriately – Distal sockets are of tri-quad shape to prevent rotation – Call for assistance and possible return of socket or system

38 Follow Up Concerns Patient is slipping up and down inside the socket upon heel contact and toe off Patient is slipping up and down inside the socket upon heel contact and toe off SOLUTIONS: SOLUTIONS: – Most of this motion is designed into the FLO-TECH-TOR to prevent separation of incision upon early weight bearing and

39 SOLUTIONS Continued: – Be sure socks are sized appropriately – Be sure all straps and bands are tightened before the UFOS™ is applied – Be sure the waist belt is secured properly – Application of the Prep Socket (VCSPS™) with other forms of suspension and distal AP closure should eliminate this concern “WHEN THE TIME IS RIGHT”

40 COMMITMENT FLO-TECH ® O&P Systems is here to assist you in any way we can; please call. Our staff can help with most: fitting, follow-up or adjustment issues. FLO-TECH ® O&P Systems is here to assist you in any way we can; please call. Our staff can help with most: fitting, follow-up or adjustment issues. Our Mission is: Our Mission is: To make the benefits of APOPPS™ technology available to all amputees.

41 COMMENTARY Each APOPPS™ or BB-d™ prosthesis has the best opportunity for maximum comfort and success if the selection of components conforms to the patients needs and these components are set up, aligned and maintained in the most effective manner. Each APOPPS™ or BB-d™ prosthesis has the best opportunity for maximum comfort and success if the selection of components conforms to the patients needs and these components are set up, aligned and maintained in the most effective manner.

42 Questions Or Shared Experiences


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