Sample Prosthetic Needs Analysis

Sample Prosthetic Needs Analysis
Prosthetic Needs Analysis For: {AMPUTEE NAME}

The purpose of this analysis is to project the prosthetic needs of {NAME} with the object of returning him to the closest possible degree of normalcy. This report also includes the use of specialty prosthetic devices, soft goods and maintenance.

{NAME} is a thirty-five-year-old male who became a left-knee disarticulation amputee in September of 1998. he is currently being fitted with his permanent prosthesis at Prosthetic Orthotic Laboratories and a new prescription has not been offered as of the date of this report. {NAME} has an unusual residual limb. He has a deep distal invagination that has caused a lot of problems with his preparatory limb. In addition, his current prosthetist related that {NAME} suffers from heterotropic bone mass growth in his quadriceps and hamstring muscles. This is highly unusual but not unheard of when head trauma occurs. This bone mass growth in the muscles reduces the muscle elasticity, restricting range of motion at the hip. It also creates fitting problems since the loading of soft tissue inside of the prosthesis is complicated due to the presence of bone growth inside the muscle. The consensus was that further revision surgery is probably indicated.

{NAME} was employed with IBM as an engineer and has since returned to work in his previous position. He can only wear his preparatory prosthesis for short periods of time and utilizes crutches for his mobility. He has had an active lifestyle prior to his amputation. He played high school sports – football and track – as well as enjoyed bicycling, running and various other activities. His current residual limb status diminishes his activities with a prosthesis. However, this situation should improve with time and possibly future surgical considerations. {NAME}’s current prosthetic situation rates him as a K-2 ambulator; however, his age, motivation and continued improvement suggest that he will progress to K-3 or K-4 rapidly. The K ratings are Medicare’s standard of activity level: K-1 is non-ambulatory and progresses to K-4, which is child or recreationally active adult.

My experience as a prosthetist/amputee has led me to divide a person’s prosthetic life expectancy into three phases: initial, stable and geriatric. The initial phase represents {NAME}’s time of most rapid change in the size and shape of his residual limb. Due to the high probability of revision surgery and the subsequent need to “start all over again” following surgery, I believe that this initial phase will last five years. This phase requires the most frequent prosthetic replacement rate with changes necessary yearly. The second phase is the stable phase. This represents the time period when {NAME} maintains a more active lifestyle and his residual limb has stabilized, allowing his prosthetic replacement rate to spread to once per four years. The final phase of his prosthetic life expectancy is the geriatric phase, which represents the time of his life when his activity level has diminished and his prosthetic needs have decreased. During the geriatric phase, his replacement rate increases to every six years.

I have also projected three types of prostheses for {NAME} that I feel would return him to his highest degree of normalcy (1). His walking prosthesis would be his everyday leg, providing function and cosmesis for work and general home life. The backup prosthesis is designed to be utilized as a spare limb whenever his walking prosthesis is being repaired or refinished (these procedures can sometimes take weeks). The third type of prosthesis that is projected is a shower/water prosthesis, designed for use in the shower or in other water activities.

His current walking prosthesis will be replaced every year for the first five years during the initial phase. There are four years left in this phase, ending at age 39. He will replace his walking prosthesis every four years during his stable phase, which is projected for 26 years and will end at age 65. His final phase, the geriatric phase, will project replacements every six years until his projected end of life at age 75.9 (2).

{NAME}’s backup prosthesis will consist of a viable foot/knee mechanism from his previous prostheses, fitted with a new, well-fitting socket. The replacement rates are the same as the walking prosthesis except that during the initial phase, at least half of the old prostheses would suffice as backup prosthetics.

I have also projected a shower/water prosthesis for {NAME}, which is designed to provide safety in the shower and tub as well as allow {NAME} to participate in water activities without fear of damaging expensive knee/foot components. An added necessity for this prosthesis is the increased stability that a peg device gives during snow and ice conditions – a necessity in cold climates. The replacement rate is every two years during the initial phase, every six years during the stable phase, and every eight years during the geriatric phase.

Soft goods and maintenance bills for {NAME}’s prosthesis would be estimated at $2,400 per year. This was calculated by utilizing 8 hours of maintenance time at $100/hour and adding $1,400/year to cover the cost of additional liners, socks, knee maintenance and refinishings.

This projection is based upon replacing the entire prosthesis in various yearly increments. In reality, sockets and feet are often changed at different times, so this projection represents averages during each phase. The information, cost projections and replacement rates were derived from review of records, phone interviews and personal experience. I reserve the right to review and alter my report based on any new evidence that may be presented.

Respectfully submitted,

Richard L. Riley, C.P.