Home

Document

1. Revised J uly 2001 Dear Prosthetist Welcome to Motion Control s Third Party Funding Guidelines We have developed the enclosed information to share past experience with you and help you in receiving funding for the Utah Arm ProControl 2 System and ServoPro Controller Please remember that this information is based on samples only and each case should be customized to meet the patient s need If you have any further questions feel free to contact Motion Control s customer service department and we will be happy to answer them In addition suggestions for ways to improve this information are always welcome Call or send us an email at info UtahArm com Contents I Guidelines for Third Party Funding A step by step outline of the procedures you can follow when applying Il Sample Letter Utah Artificial Arm ServoPro A sample format to use when writing to a third party funding agency Ill Pricing Estimates Utah Arm ServoPro ProControl Guidelines for estimating the costs of a myoelectric system IV L Codes A list of L codes to use for billing along with current Utah Medicare reimbursement Actual reimbursement in your state may differ Motion Control Inc a division of Fillauer Inc 2401 South 1070 West Suite B Salt Lake City UT 84119 Ph 801 978 2622 or toll free at 888 696 2767 Fax 801 978 0848 Website www UtahArm com E mail info UtahArm com Page 1 GUIDELINES FOR THIRD PARTY FUNDING
2. Physicians prosthetists or others writing a letter of justification are advised to study the following benefits Those which are appropriate to the specific patient should be stressed to the funding agency A Hand Prehension Motorized powered hand drive allows greater pinch force up to 22lbs force 1 kg Since a motor drives the hand it has the benefits of both voluntary opening and voluntary closing i e the wearer controls the direction and the amount of opening and closing Body powered hands do not allow a user good control of the opening and closing force without significant effort Myoelectric control also allows a wearer to maintain hard or light grip without effort e g when holding an object for a period of time For heavy work situations the myoelectric hand is interchangeable with an electric hook terminal device This allows the patient to have a public hand and a work hand to allow function in almost any situation The electric hook has the possibility of an even greater pinch force of up to 36 Ibs Since power to the hand is controlled by the amount of the amputee s muscle contraction proportional control allows moderation of pinch force and the handling of fragile objects Speed of opening and closing is also controllable Sensitivity of the hand control components for the ProControl below elbow and the Utah Arm above elbow allow operation with just five microvolts of surface EMG significantly less than othe
3. Contents Introduction 1 Overview How to Obtain Preauthorization Steps to Take After Submitting PreA uthorization Justification of a M yoelectric Powered Prosthesis Summary of Benefits Impact on Actual Tasks the Wearer Performs in His Her Daily Life Comparisons with Alternative Products Otto Bock Boston Elbow Hosmer Elbow Other Key Features of the Utah Arm Introduction This paper is intended to give you the information to make a strong case for an appropriate Utah Arm or ProControl candidate Refer also to the accompanying Model Letter for help in composing an effective letter of justification If we can supply any further information please feel free to call or write us at the address at the front of this document Insurance funding of a Utah Artificial Arm prosthesis can and has been obtained in hundreds of cases Nearly all of 800 Utah Arm prostheses fitted have received third party funding However it should be anticipated that insurance providers will want to carefully evaluate this benefit and will expect a well documented proposal Initial and long term costs of myoelectric prostheses are higher than traditional body powered arms Many insurance companies personnel are not familiar with newer technology because of this part of applying for pre authorization is educating the provider about the benefits of myoelectric prostheses Proper strategy is important in a pre authorization request To avoid delays a
4. D Prepare Estimate A complete quotation for delivery of the prosthesis should be prepared by the fitting center The quotation should describe the purpose of all components to be delivered Training follow up extended warranty and any other services should be estimated for the insurance company at this time 2 Steps To Take After Submitting For Pre authorization A Follow Up Contact the insurance company s claims office if a reply is not received within two weeks Ask when a decision can be expected many states require insurance companies to respond within 30 days Record the date of inquiry and the person with whom you spoke If the company promises authorization or makes any other commitments or denials ask for written confirmation Be patient and offer to provide any needed information B Persevere If the claim is denied don t give up Remember this is only their first response not necessarily their last Request a written response detailing the reasons for denial You will then have something specific to answer C Answer Objections Inform the physician and prosthetist should you receive a denial The physician should write a response using the information in this paper to negate their objections Motion Control can also supply reprints of articles from medical journals documenting the benefits of myoelectric prostheses If for instance a claim for a Utah Artificial Arm is rejected as experimental their objection
5. Suite B Salt Lake City UT 84119 1555 www UtahArm com Toll free 1 888 MYO ARMS 696 2767 Phone 1 801 978 2622 FAX 1 801 978 0848 Page 16 RE Guidelines for Estimated Repair Costs for the Utah Arm and ProControl To Whom It May Concern These guidelines coupled with a reasonable inflation estimate can be used to estimate lifetime costs of an electric arm prosthesis Please keep in mind however that arm amputees may have need of other equipment including other prostheses batteries adaptive equipment etc Our estimates include on y the electric arm prosthesis e A four to eight year lifetime should be estimated for the arm components depending upon the extent of usage of the individual arm wearer e Ten percent of the initial cost of the prosthesis should be estimated for yearly maintenance and repair costs Though this is rarely needed we feel it is important to budget for the maximum rather than the minimum e Additional fittings of new sockets may be necessary in addition to the replacements and maintenance estimated in 1 and 2 above because myoelectric prostheses require an intimate fit to function properly The need for refitting should be estimated by the prosthetist based upon the patient s expected weight gain or loss and other factors such as wear and tear particularly on the protective covers for the forearm and hand e New technology may become available for arm prosthesis wearers in the future
6. maximum 25 microvolts using the Myolab Il EMG tester trainer can be produced by contraction of his biceps muscle This muscle also fatigues after approximately five minutes of training and becomes weaker and more uncomfortable to contract The triceps EMG signal is also only moderately strong maximum 35 microvolts but did not fatigue in ten minutes of training With regular biofeedback training performed by a qualified therapist we are optimistic that more muscle strength can be regained ServoPro Candidate We found that only a very low level of EMG maximum 5 microvolts using the Myolab Il EMG testerftrainer can be produced by contraction of his biceps muscle Contraction of this muscle is also very painful for Mr G Therefore we feel his Page 10 maximum potential can only be attained with a harness mounted controller with an externally powered prosthesis Page 11 Recommendation For the above reasons Mr G will not be able to operate a body powered prosthesis as successfully as an externally powered prosthesis We recommend an_externally powered above elbow prosthesis specifically a Utah Arm 2 including an electric hand a Hosmer Synergetic Prehensor or Greifer heavy duty terminal device and an electric wrist rotator We recommend a servo controlled above elbow prosthesis specifically To protect the delicate electronics a silicone protective hand and forearm cover is proposed The cover will enhance the natur
7. a definitive arm consult the chosen fitting center for details 2 Two Y ear Warranty Motion Control is the only manufacturer of prosthetic arm components to offer a two year warranty Consumers can have confidence that Motion Control backs up its products Our commitment to rapid service when repairs are necessary means minimal downtime for the wearer 3 Extended Warranty Option Beyond the initial time period Motion Control offers an optional two years of extended service This plan may be purchased any time within the initial warranty period References 1 Kritter Alfred E Current Concepts Review Myoelectric Prostheses The Journal of Bone amp Joint Surgery Vol 67 A No 4 654 657 1985 2 Millstein G Heger H and Hunter G A Prosthetic use in upper limb amputees a comparison of the body powered and electrically powered prostheses Prosthetic amp Orthotic International 10 27 34 1986 3 Reddy M P Nerve Entrapment Syndromes in the Upper Extremity Contralateral to Amputation Arch Phys Med Rehabil Vol 65 24 26 1984 4 Sears Harold H and Shaperman Julie Proportional Myoelectric Hand Control An Evaluation Amer Journal Phys Med Rehabil Vol 70 No 1 Feb 1991 5 Jacobsen S C Knutti D F Johnson R T and Sears H H Development of the Utah Artificial Arm IEEE Trans on Biomedical Engineering Vol BME 29 No 4 April 1982 Page 9 SAMPLE LETTER Third Party Funding Letter for
8. amputee can operate the Arm Designed for the very high level amputee e g shoulder disarticulation interscapulothorasic or brachial plexus injuries the ServoPro option completely eliminates the electrodes normally required for myoelectric prostheses A very slight pull on a simple harness is all that is needed to control the Utah Arm system For difficult cases the ServoPro controller may be the only option available which can provide functional control of both elbow and hand Relative to body powered cables the excursion and harness force required for ServoPro control is far lower and thus the prosthesis is much more comfortable Compared with harness mounted switches for other electric elbows ServoPro control provides much more functional control because of the proportionality and sensitivity of the controller That is the ServoPro wearer can control the elbow position and the hand force with much better precision than switch control can provide 5 Comparisons With Alternative Components The prosthetist and or physician may wish to present the pros and cons of various options available for a specific patient Following are the key differences between Motion Control components and most alternatives These features of the Utah Arm are especially relevant for high level amputees e Muscle signals are typically weaker with high level patients requiring maximum sensitivity from the electronics in the prosthesis Since hand function is usu
9. fitting as well so that proper use patterns are established We have found that this type of training not only increases the functionality of the patient with the prosthesis but helps to identify any early problems with control and or fit during the important early stages of fitting Background We have fitted over 20 patients with the Utah Artificial Arm with very good results Experience we have gained in fitting externally powered prostheses and careful selection of good candidates for these prostheses have taught us that the advantages far outweigh any disadvantages For Mr G specifically the combination of function comfort appearance and reliability will produce the best prosthetic rehabilitation which can be provided for this patient given his needs and medical condition The Utah Arm has been successfully fitted to over 1400 patients to date It has shown very good reliability and durability and we feel it will be the best choice for Mr G In fact we anticipate considerable problems with fitting any other type of prosthesis for Mr G Others will limit his function and decrease his comfort thus increasing the chance of rejection considerably Documentation etc am enclosing a copy of the prescription by Dr KnowsHis Stuff for Mr G s prosthesis specifying a myoelectric Utah Artificial Arm A copy of Dr Knows His Stuff s letter concerning this prescription is enclosed Also a reprint of the chapter concerning t
10. needed even allowing the same arm socket to be used with both a body powered elbow as well as the Utah Arm when desired Although others have attempted to mimic the Utah Arm s replaceable battery pack batteries are not as easily interchanged by the wearer in the Boston Arm or the Hosmer Elbow see below C Hosmer Elbow The Hosmer also called the NY U Elbow is available with either switch or myoelectric control however with myoelectric elbow control the muscles cannot be used to control the hand The Hosmer Elbow is light but with a myoelectric hand installed the elbow speed is significantly slower than the Utah elbow The Hosmer Elbow unlike the Utah Arm is not designed so that the battery can be easily interchanged by the wearer although there are various battery packs available Freeswing is only possible with the elbow extended so the convenience of relax to extend is not available For high Page 8 level amputees the Homer elbow typically needs to be switch operated giving only one speed operation D Other features of the Utah Arm Motion Control is the leading U S manufacturer of myoelectric components We offer the highest level of service to fitting centers and prosthetic users For added benefit we offer three unique programs 1 Trial Fitting Motion Control will rent components to qualified prosthetic centers This permits a difficult to fit patient to field test a prosthesis at a fraction of the cost of
11. the wearer relaxes the control muscles Perhaps more importantly freeswing is used to extend the elbow without effort Also because reaction forces at the shoulder and socket are lessened the prosthesis is easier to wear while walking Page 4 4 Impact On The Actual Tasks The Wearer Performs In Daily Life A Below Elbow Amputees 1 Increased functionality The letter for pre authorization should mention specific duties which the amputee may be expected to perform that could be enhanced by a myoelectric prosthesis Two handed activities such as handling papers holding a telephone while dialing and carrying papers or briefcases in a normal fashion are all a common office and school tasks In the wearer s workplace tools may be used which require two hands If the patient is a candidate for electric wrist rotation specific situations may exist where using the sound hand to passively rotate the wrist would be awkward or impossible For bilateral amputees or unilateral amputees whose remaining hand is not fully functional or for those in danger of damaging the remaining arm a strong case can be made for providing every available prosthetic function 2 Broader range of Occupations The range of occupations may also be broadened for an amputee who chooses a myoelectric prosthesis For instance wearing a myoelectric hand rather than a body powered hook may significantly enhance the move from blue collar to white collar occupations 3
12. useful features of their prosthesis For example they use it for prepositioning their hand prosthesis even when their other hand or prosthesis is occupied carrying objects or for steering a car 7 Interchangeable batteries Another convenient feature offered by the ProControl which the Otto Bock system does not the ability to interchange between a rechargeable battery and a convenient nine volt battery This allows a ProControl wearer not only to use rechargeable batteries at home or work but also to use a 9 volt battery available at any store selling batteries when traveling Page 7 or camping etc where a recharger is inconvenient The 9 volt battery also operates the hand faster which is another benefit available only with the ProControl B Boston Elbow The Boston Elbow introduced in 1973 was developed by the Liberty Mutual insurance company The most recent version is called the Boston Elbow II The improvements implemented in the Utah Arm 2 will not only give a performance edge over the Boston Elbow but by using more up to date manufacturing in the electronics and connectors throughout the arm the Utah Arm 2 is a much more dependable choice 1 Distal Weight Distribution The Boston Elbow is a few ounces heavier than the Utah Arm but because the battery pack is installed in the forearm it has a heavier distal weight distribution i e it feels significantly heavier to the wearer All prosthetic candidates should be
13. would then interchange the hand for the Synergetic Prehensor or Greifer when repairing fences or shoveling which are common activities for him As stated earlier his ability to operate a body powered prosthesis is severely restricted due to remaining scar tissue The externally powered elbow of the Utah Arm will be important to Mr G since positioning will not require the physical motion of his shoulder Therefore it will provide function of the elbow without discomfort to his remnant limb and axilla area scarring The electric wrist rotation feature will also be useful in his active work situations It is used to position the hand or Greifer in the best gripping position without requiring his sound hand to turn the hand Using his sound hand would be awkward or impossible during two handed tasks such as carrying boards using hand tools holding wires or papers to cut with shears etc All these components are medically necessary for the maximum rehabilitation of this very motivated individual Extensive occupational and physical therapy is essential to a patient s prosthetic success Our center is unique in that we provide prosthetic rehabillitation not just a prosthetic device Occupational therapists associated with our center will provide three weeks of muscle training before fitting and training will continue during and after the fitting Our Page 12 therapists will also provide functional use training during fitting and post
14. If there are any further questions please feel free to contact me directly Y ours truly Mr Ms Able T Fit C P Director of Prosthetics My Oh Lectric Limbs R U s enclosures Page 14 PRICING ESTIMATES FOR A UTAH ARM OR PROCONTROL SYSTEM The pricing of a prosthesis delivered to a patient involves far more than just the components In addition components and services vary from individual to individual and cannot always be predicted therefore exact pricing cannot be given before the patient is evaluated The figures below are intended for use as an estimate only TAN ARM 2 COMPONENTS WRIST ROTATION OPTION Proportional Myoelectric Elbow Unit e Otto Bock Electric Wrist Rotator e Proportional Myoelectric Hand Control e Chin Switch Harness Switch or e EMG Sensors i e EMG Preamplifiers 2 w electrodes Myoelectric Control Option e Adjustable Friction Humeral Rotator e Battery Packs Nickel Metal Hydride 3 Fast Battery Chargers 1 SERVO PRO CONTROLLER 0 PTION Replaces EMG sensors amp electrodes with e Includes 2 year warranty on Motion Control components harness actuated force sensors e Carrying Shipping Case e Operates Elbow Hand or Greifer equivalent to myoelectric control PROCONTROL 2 SYSTEM COMPONENTS e Hand Version Includes proportional myoelectric control for hand alone e Hand and Wrist Version Includes proportional myoelectric control of hand and wrist rotation e Cosmetic Cover caucasian or
15. Increased work envelope Usually the comfort of a myoelectric prosthesis allows a longer wearing period per day Since there are no restrictions from a body powered cable the work envelope may be increased permitting specific tasks to be performed 4 Cosmetic benefits The cosmetic benefits of a myoelectric prosthesis should not be described as merely a nicer looking alternative The more natural appearance lessens the psychological trauma and aids the process of adjustment These are medically necessary benefits not merely cosmetic frills It must be remembered that often the attitudes of the amputee s family greatly affect the adjustment process The family may be more supportive of a natural looking hand than of a less cosmetic prosthesis B Above Elobow Amputees Most of the benefits mentioned above for below elbow amputees also apply to above elbow patients Additionally other considerations exist which will be important to above eloow amputees 1 Function with elbow flexed At the fully flexed position of the elbow complete function of the hand or Greifer is available which is of great benefit to the high level amputee A body powered prosthesis typically does not allow full opening of the terminal device hand or hook when the elbow is flexed above 90 degrees Therefore a myoelectric prosthesis permits more function when the elbow is flexed For example a patient can operate equipment at eye level like a camera or microsco
16. Utah Arm Candidate Changes in specific language for ServoPro controlled Utah Arm are included in italices BlueCross Blue Shield of Utah 1234 State St Salt Lake City UT 84123 Re Mr Robert G Soc Sec 555 33 1234 Your case A007 Dear Mr Chuck In C harge Purpose of letter We are writing to explain the results of our prosthetic evaluation of Mr G and our recommendations for his prosthetic rehabilitation Patient history Mr G was seen in our office on J an 1 1995 He suffered a left above elbow transhumeral amputation after a severe electrical accident at his ranch in April 1994 He is very motivated to return to work on his ranch and to achieve the maximum function he is able to with a prosthesis He has been active in many recreational and social activities and wishes to return to those to the greatest extent possible Especially important to him are square dancing and woodworking Mr G is unmarried at this time Mr G presented with scar tissue covering the end of his remnant limb and left axilla region He remains very tender in that area and cannot tolerate pressure for longer than a few seconds Also due to the scarring his shoulder range of motion appears to be restricted to 20 degrees of flexion and 20 degrees of abduction In addition to the examination of Mr G s skin and shoulder conditions we also performed an EMG evaluation of the remnant muscles in his arm and shoulder We found a moderate EMG
17. al appearance of the prosthesis and contribute to Mr G s willingness to wear the prosthesis in public without feeling conspicuous in business and social occasions The psychological adaptation to limb loss and use of a prosthesis is enhanced with a natural looking prosthesis We feel this is true in Mr G s situation If and when Mr G s physical condition allows it we also recommend a body powered above elbow prosthesis with a hook type terminal device as a back up to the externally powered prosthesis for wet working conditions and especially dusty and dirty environments where dirt could get into the elbow and or hand drive J ustification The functions which Mr G is expected to attain with the Utah Arm prosthesis include excellent control over the opening and closing of the hand Mr G should be able to begin using the prosthesis right away The gripping force of the hand controlled by the Utah Arm has the most sensitive proportional myoelectric control available minimum required EMG signal is 5 microvolts With the ServoPro Controller Mr G will have full gripping force of the hand with only a very slight pull on the harness The Synergetic Prehensor or Greifer heavy duty work hand provides increased grip force and a wider opening These features will prove more adaptable to handling work tools Additionally it allows him to use the prosthesis in situations where the hand cover could be ripped or stained He
18. allows better control of speed and force than a digital controller as demonstrated in surveys of actual wearers 2 The ProControl is more sensitive The Otto Bock digital control is less sensitive than the ProControl and sometimes cannot be operated by patients with weaker muscles Even in the best case greater effort can be expected with the digital controller than for the ProControl or the Utah Arm The hand will usually not run as quickly since it operates only on a 6 volt battery pack as opposed to 12 volts in the Utah Arm and 7 2 14 4 volts in the ProControl system 3 The ProControl is quicker with less effort Otto Bock also makes a Dual Mode Control DMC proportional hand The DMC hand operates only on a 6 volt battery so its speed again is not as quick as the ProControl system operated with batteries ranging from 7 2 to 14 4 volts Also the ProControl is capable of operating with a lower threshold of muscle contraction so the wearer s effort is lower 4 More natural muscle control There are some other very basic but important differences in the control of the Utah Arm and ProControl systems compared with the Otto Bock systems First the Utah systems are operated by the difference between the two control signals much like natural muscles operate This approach provides very delicate and precise control over the hand motion taking advantage of the natural synergy of agonist antagonist muscle pairs If one muscle is st
19. ally of highest priority a sensitive easily operated hand is especially important This is available with a Utah Arm e When muscle myoelectric control is not feasible cable excursion is very limited so controlling the Utah Arm s elbow and hand from only one harness mounted sensor i e the ServoPro controller simplifies the harnessing of a high level prosthesis greatly No other system can operate elbow flexion and extension hand open and close as well as the transfer of function between them all from a single easily controlled sensor in the harness A comparable Boston Elbow fitting would require 3 to 5 control sites depending upon whether switch myoelectric or touch pad control is utilized for eloow hand and switching between elbow and hand e Suspension of a heavy prosthesis also becomes more difficult with high level amputees i e HEAVIER PROSTHESIS MORE DISTAL WEIGHT MORE DIFFICULT SUSPENSION The freeswing feature of the Utah Arm is especially important for these amputees allowing them to extend the elbow by simply relaxing which is not possible with any other electric elbow Page 6 A Otto Bock Below Elbow Prosthesis 1 The Utah Arm has proportional control The Otto bock Orthopedic Industry manufactures a digital electronic controller and a DMC Dual Mode Control proportional controller Digital control indicates that the hand is either on or off with no gradation of speed Naturally proportional control
20. but the increase or decrease in cost this may represent is difficult to estimate at this time For additional information please contact Motion Control at the address or phone number below 1070 West 2401 South Suite B Salt Lake City UT 84119 1555 Phone 888 MYO ARMS FAX 801 978 0848 www UtahArm com E mail info UtahArm com Rev 6 6 03 For the Utah Arm 2 AE and higher levels Suspension choose as appropriate L6672 Harness Base codes includes two batteries and one charger L6682 Test socket AE or ED L6965 Shoulder Disarticulation with myo control L6684 Test socket SD or FQ L6975 Interscapular Thoracic with myo control L6686 Suction socket L7180 Electronic elbow Utah myoelectric L6688 Frame type socket AE or ED L7274 Proportional control 12 v utah L6689 Frame type socket SD L6955 Above Elbow with myo control L6690 Frame type socket FQ L6680 Test socket BE amp WD Add as appropriate L6686 Suction socket L7364 Battery 12 volt utah equiv add one for new arm L6687 Frame type socket BE amp WD L7366 Battery charger 12 volt utah equiv L6692 Silicone Gel Liner L7499 Battery amp charger upgrades from U1 to U2 L8465 Prosthetic shrinker If ServoPro controller is used For Roll on Liners use L7499 Unlisted item ServoPro controller L7499 similar to LE codes K0556 w lock K0557 w o lock and L5671 lock for liner For the ProControl 2 below elbow or hybrid Wrist and Terminal Devices Base codes incl
21. can be refuted by citing experience with over 1 400 fittings since 1981 Send an appeal to the claims manager or the insurance companies specified contact with a copy of the original claim Then call to make certain it was received Ask about appeal procedures and the time involved The appeal will probably be passed to a medical reviewer or committee Be sure this review is conducted with all available information on hand If the first appeal is denied ask again for the denial in writing Also inquire whether another appeal is possible to a higher level person or committee Should you be denied again then answer or ask the physician to answer all objections and resubmit Be patient and persistent Many claims have been authorized after two or more appeals D Lodge a Complaint if necessary If the claim has not been given fair consideration then lodge a complaint with the state insurance commission sometimes known as the Department of Insurance Call their consumer information office and ask for advice about filing a complaint In some states you may be able to request an insurance hearing from the state commission to help settle the appeal If all else fails and you have a legitimate claim it may become necessary to get an attorney s advice the possibility of legal action may be enough to convince the insurance company to pay the claim Page 3 3 J ustification of a Myoelectric Powered Prosthesis Summary of Benefits
22. dark color e Electrodes and Wire Harness necessary for installation M yoelectric Terminal Device Options Body Powered Terminal Device Options For both Utah Artificial Arm and ProControl System Any cable operated Hook e Motion Control Hand For use with the Utah Arm and ProControl Systems Interchangeable with the myoelectric hand e MYOBOCK Greifer Special Version for use if used with the Otto Bock quick disconnect Adaptor with the Utah Arm and ProControl Systems e Synergetic Prehensor Special Version for use with the Utah Arm and ProControl Systems es ETIC SERVICES INCLUDE Prosthetic Evaluation and EMG Evaluation and Training e Check Socket Fabrication Usually includes several versions e Check Socket Fitting Including initial training in use of the prosthesis e Fabrication of Definitive Prosthetic Socket and Harness e Training in Use of the Prosthesis and its control e Fine Tuning of Control Electronics to the Patient e Suspension design fabrication and modifications as needed e Follow up with additional prosthetic care as needed for a period of one year after delivery e Use of evaluation equipment including EMG tester and trainer and spare parts for immediate service as required Including back up complete Utah Artificial Arm or ProControl Page 15 OTHER SERVICES COORDINATED WITH THE FITTING PROCESS e Physical Therapy for Muscle Training and Development Occupational Therapy for proper prosthesis
23. evaluated carefully for weight tolerance regardless of the components For a small individual or someone especially sensitive to prosthetic weight this criteria could override all others making the prosthesis too difficult to actually use regularly 2 Requires additional switch for myoelectric control of hand The Boston Elbow II is capable of switch operation myoelectric control or touch pads installed inside the socket Myoelectric hand control is possible but requires an additional switch in the socket or harness to cause the transfer of function from elbow to hand 3 Requires more effort Since the Boston Elbow does not extend automatically in freeswing like the Utah Arm both muscle signals must be well controlled independently for the wearer to achieve good control over both elbow flexion and extension The freeswing feature of the Utah Arm which uses relax to extend can mean a great deal less effort for a wearer which may translate into more comfort and longer wearing times 4 Higher threshold Another advantage with the Utah Arm is that the threshold for hand control only 5 microvolts is the lowest of any available componentry For maximum flexibility in fitting the prosthetist can also adjust the threshold for each control muscle independently as well as its sensitivity 5 Nonmodular Modular construction pioneered in the Utah Arm is not available in the Boston Elbow Modularity allows rapid field service when
24. he Utah Artificial Arm from the book Comprehensive Management of the Upper Limb Amputee edited by Atkins and Meier is enclosed for your information Request copy from Motion Control Plan of care Once authorization has been received the plan of treatment for Mr G will begin with pre prosthetic training After two weeks as mentioned earlier we will fabricate a temporary prosthesis requiring several check sockets over a period of two weeks Please keep in mind also that much evidence exists to show that the success of prosthetic fitting is directly related to the promptness of the rehabilitation program after amputation Then initial use training for the prosthesis will begin concurrent with completion of the temporary fitting The temporary prosthesis which is fully as functional as the finished device will be used for two months to four months During this time any adjustments to the fit or fine tuning of the electronics are accomplished When Mr G s remnant limb is fully stabilized no further volume changes are occuring and an optimal fit is attained then the final definitive socket will be fabricated and the completed prosthesis delivered to Mr G After delivery we will schedule visits with Mr G every four months Follow up will maximize his rehabilitation Our committment for follow up after delivery of the prosthesis is two years without charge for normal maintenance The manufacturer s warranty is two years f
25. nd increase the likelihood of a favorable reply prepare all materials which justify the claim beforehand Try to anticipate possible questions Once submitted follow up to make sure the request does not get lost in the system 1 How to Obtain Preauthorization An Overview A Evaluate the Candidate The Utah Arm candidate should be evaluated by a knowledgeable certified prosthetist experienced with myoelectric prostheses and a doctor or clinic familiar with modern prosthetics If a referral is needed call Motion Control for a list of authorized centers other certified prosthetist can become qualified by attending a training course offered by Motion Control B Obtain Prescription A prescription must be obtained from a physician for a myoelectric elbow and hand wrist and Griefer if appropriate prosthesis Utah Artificial Arm type Your physician should also write a letter of justification as described in Section 3 stressing that this prosthesis is medically necessary Page 2 C Letter of J ustification A letter of justification must be written to explain the medically necessary rehabilitation benefits of the planned prosthetic care The prescribing physician should write the letter The prosthetist may provide additional information We advise that the benefits of the myoelectric prosthesis be related to the patient s work and personal needs as specifically as possible See Section 4 below for a summary of such benefits
26. on Control manufactured components of the prosthesis Prosthetic services provided may include routine maintenance troubleshooting loan of back up components when required technician time required in replacement or repair and shipping as required Please note that extended service contract coverage does not include repairs for damage incurred outside of normal usage TRIAL FITTING COSTS A trial fitting is used to allow the prosthetist to determine the best components for the patient Initial fitting procedures are performed the client begins training and utilizes the prosthesis in daily activities A trial fitting may last from one to six months and will vary widely depending upon the components used degree of prosthetic difficulty and the status of patient prior to the evaluation Generally the trial fitting will require a fitting fee plus component rental fees per month most of which may be applied towards purchase of the prosthesis should the trial prove successful Trial fittings can also be useful as proof of suitability for insurance reimbursement For further information on the fitting and training procedures recommended by Motion Control please refer to Experience with the Utah Arm Hand and Terminal Device Chapter 18 of Comprehensive Management of the Upper Limb Amputee D J Atkins and R H Meier ed Published by Springer Verlag New York Inc 1989 Motion Control Inc a subsidiary of Fillauer Inc 2401 South 1070 West
27. operation donning and doffing and maximum utilization in ADL s e Follow up on training and evaluation as required for one year GENERAL PRICE GUIDELINES Usual Price UTAH ARTIFICIAL ARM WITH MYOELECTRIC HAND Above Elbow Prosthesis 45 000 55 000 Additional Cost Options Difficult cases e g shoulder disartic brachial plexus injury very short A E skin graft etc 2 500 6 000 Electric Wrist Rotation 3 000 5 000 Extra Terminal Device e g Greifer Synergetic Prehensor 3 000 7 000 Extended Service Package 2 year 6 000 7 000 ServoPro Option 5 000 7 000 Special Cosmetic Silicone Covers for hand and upper arm 6 000 20 000 PROCONTROL SYSTEM Below Elbow Prosthesis Below Elbow Fitting Myoelectric Hand only 13 500 22 000 Below Elbow Fitting Myoelectric Hand and Wrist 15 500 25 000 e Additional Cost Options Difficult cases e g Hybrid Systems for above elbow non standard fabrication skin grafts etc 1 500 6 000 e Extra Terminal Device e g Greifer Synergetic Prehensor 3 000 7 000 e Extended Service Package 2 year 1 300 2 200 Special Cosmetic Silicone Covers for hand and forearm 4 000 20 000 EXTENDED SERVICE PACKAGE As delivered by Motion Control fitting centers the service contract includes equivalent coverage to the initial 2 year Warranty on Motion Control components as well as the prosthetic services required to maintain and repair the Moti
28. pe or grasp food and bring it to the mouth better with a myoelectric arm 2 Prevention of nerve damage Above elbow amputees who actively use a body powered prosthesis are susceptible to nerve damage on their contralateral side This is caused by pressure from the harness and control cable A myoelectric prosthesis can prevent damage from developing or relieve it once it has occurred C Shoulder Disarticulation Forequarter and Brachial Plexus Injured Amputees Page 5 This segment of the unilateral amputee population has lost the most function and thus needs the most restored Body powered prostheses are often difficult uncomfortable and sometimes impossible for amputees of this level to operate The advantages of myoelectric prostheses for above and below elbow cases stated above are not only applicable but of even greater importance for these high level amputees Function of the terminal device at elbow positions above 90 degrees very difficult with body powered arms is even more important Because of the extensive loss suffered by these amputees it is difficult even with a myoelectric prosthesis to regain all function However there are many examples of successful every day prosthesis users among this group Trial fittings can help verify the prescription or guide the Clinical team to the optimal prescription D ServoPro Option A feature exclusive to the Utah Arm called ServoP ro insures that even the highest level
29. r myoelectric systems This means less effort to operate the hand A myoelectric prosthesis unusually permits a greater work envelope for the wearer by eliminating the control cables Since cables need not be pulled across the back the hand may be opened and closed above the head at floor level and even behind the back These are very important comfort and functional benefits over body powered arms B Flexion Extension of the Elbow Above elbow shoulder disarticulation and forequarter amputees can flex and extend the elbow of the Utah Artificial Arm though out a range of 15 to 150 degrees Motorized drive means that elbow motion is achievable without fatiguing muscle effort or movement of other body joints C Comfort Comfort is also increased when cables are eliminated The pull of a body powered arm s control cable creates axillary forces in the contralateral arm It can also cause skin irritation and nerve damage Myoelectric candidates with sufficient residual limb length are often fitted with self suspending suction sockets Amputees consider these sockets to be more comfortable because they eliminate or at least reduce harness loads It must be emphasized that the comfort of the socket has a direct impact on function If the prosthesis is rejected or worn infrequently because of discomfort then it is non functional D Freeswing The Utah Artificial Arm incorporates a feature known as freeswing The elbow swings freely whenever
30. rom our Page 13 receipt of the components Normal warranty follow up presumes of course no extraordinary weight changes and normal use of the prosthesis within the guidelines in the Utah Artificial Arm User s Manual Price of care The price for this complete package of care will be with half the amount paid in advance to allow us to purchase the componentry The balance will be payable upon delivery of the definitive prosthesis Prosthetist Please Place Billable L Code Breakdown Here see attached sheet to choose correct codes If desired we could also structure a Trial Fit which guarantees that the prosthesis satisfies everyone s expectations after a trial period of four months This would require a 40 payment in advance with 30 applicable towards purchase if the trial is successful to the satisfaction of the patient the clinical staff including ourselves and the funding source This program in effect guarantees satisfaction with the prosthesis with risk of only a 40 fraction of the potential cost to pay for our time and rental of the components In the case of Mr G we have so few doubts about his motivation and his abilities to learn to use this prosthesis that we do not necessarily recommend this option in this case Follow up on application We hope to have your written authorization within two weeks so that we can begin this stage of Mr G s rehabilitation as soon as possible for his benefit
31. ronger than the other adjustments in the Utah Arm and ProControl allow the two muscles to be balanced very precisely so the operation of the hand or elbow is also balanced in both directions 5 Utah Arms can be fine tuned to the patient A second key difference is the adjustability of the Utah Arm and ProControl systems which allow the system to be fine tuned to the patient In addition to the sensitivity adjustments for both balance and overall sensitivity of the hand the prosthetist can also adjust the threshold of operation of the hand in both Utah Arm and ProControl This is important so that the prosthetist can raise the threshold to eliminate unwanted motion of the hand from jittery muscles For example many patients muscles tend to contract together especially at low levels of muscle tension In the ProControl and Utah Arm the prosthetist can simply raise the threshold of operation of the hand so the hand does not move unless the wearer intentionally generates a signal 6 Proportional control of hand and wrist The combination of a proportionally controlled hand and wrist in a below elbow prosthesis is also unique to the Utah ProControl System The function of electric wrist is now much more widely used because of the ease of operation in the ProControl system A survey of ProControl wearers using the electric wrist has shown that for those who wish to extend their function to the maximum the electric wrist is one of the most
32. udes 2 batteries and one charger L7261 Wrist Rotator electric L6950 Hybrid AE L7025 Hand myo control L6945 Elbow disarticulation myoelectric L7035 Greifer myo control L6935 Below elbow prosthesis myoelectric L7035 M C Electric Terminal Device ETD L6925 Wrist disarticulation myoelectric L7499 Water Resistant ETD L6882 Microprocessor control upper limb X1 L6890 Glove s production L7274 Proportional control L6895 Glove s custom L6629 Quick disconnect for wrist Add as appropriate uncoded item L7499 Motion Control Flexion Wrist feature L7360 Battery 6 volt OB or equal uncoded item L7499 Short Hand feature L7362 Battery Charger 6 volt OB or equal L7367 Lithium lon Battery 7 2 v replacement L7025 Hand myo control L7368 Lithium lon Battery charger L7035 M C Electric Terminal Device ETD L7499 Water Resistant ETD G Mktg 3rdpind Lcodes 2003 L6882 Microprocessor control X no of TD s L7274 Proportional control

Document

Contents

Download Pdf Manuals

Related Search

Related Contents