Functional Outcome Levels in Prosthetics
Medicare set up
functional outcome criteria to help limit abuse in the
system. They really did a nice job of thinking it through
for the benefit of all. It is basically what the majority of
practitioners were already using in common sense practice. A
very few were abusing the system by fitting very old and
sick clients with very high functioning prostheses that they
would not be able to use properly even if they were healthy.
Medicare has 5 levels:
0 - non candidate
1 - Sitting and transfers
2 - Household ambulation
3 - Community ambulater, active
4 - High Activity, sports, physical demanding at work
The design considerations
must be appropriate for the amputee and his/her lifestyle.
The activity level, types of activities required and wanted,
climate, height, weight, cosmetic needs, general health,
balance, muscle strength, endurance, the condition and
location of the (leg, residual limb, stump), and many other
factors need to be addressed before components can be
discussed. For example, a common problem with lower
extremity amputations is getting in and out of cars, sports
areas or theaters. Those who require extra attention in this
area may require modifications to solve this problem. For
others it might be the desire to ride a bicycle, play golf,
or cope with the special needs of a work place.
A prosthesis should be designed to meet ones present situation and their future potential.
Children have different needs and solutions to solve than an adult. They are continually growing and usually much more active. They will cycle their prosthesis more times in a given day, meaning more steps, more arm movements, and are not as aware about protecting a prosthesis from abuse (sand, water, hitting it on objects). We also know they will be pushing the functional outcomes to the limit every day.
With new materials, products, components, and designs we are able to meet more and more of these functional needs and outcomes. As you can see many factors play into the design criteria for each patient. That is why each prosthesis is different, to solve the special needs of the individual.