Restorative Care

To: Doctors, Restorative Nurses, PT's, OTR's.

I would like to propose that we form a coordinated Team to manage patient that are at risk of contractures. I strongly believe in early intervention as the most appropriate care for clients who have very special needs and concerns. Together we can set a standard that would be the envy of others in the care for seniors. It is my hope that all others will follow in the future. I believe that if we share information on what is working from each of our respective professions, we can accomplish our goals.

I believe that as a Team we can make a tremendous difference in long term management of contractures. Working together as a team we will be able to work with the most challenging clients . I know that most chronic contractures can be prevented when treated in time. Often we are asked to evaluate a patient when it is too late to make much of a difference.

I strongly believe in the most appropriate care. Many times that does not mean that it is easy. As professionals we need to do what is appropriate. This means that the most appropriate nursing care, physical therapy, occupational therapy, and the most appropriate orthotic or prosthetic service must be in place. Early intervention by an organized Team will have remarkable results when compared to clients or other facilities who do not have a complete Team in place.

As an Orthotist and Prosthetist, I often find we are called in to consult or evaluate after all other measures have failed. This may limit what service we can provide to the patient. This also sets us up for a much higher degree of failure. As a practitioner, I prefer to work with other professionals, like yourselves, who truly have the patient in mind. Working as a Team, I encourage each member to provide the best and appropriate care for each patient using the professional skills and knowledge we each possess. I would also like the freedom to recommend what I deem as the most appropriate care for each patient. To solve some of these difficult cases orthotically, I need to use all the knowledge, orthotic skills, patient care skills, and support from the Team to reach achieve the results we all strive for.

Good therapy and nursing alone on many clients is often inadequate. Most restorative care splints and orthotic devices are only to hold and prevent further deformities. As therapy progresses and improves stretching and ROM, the orthotic device can be adjusted to follow the progression.

With twenty-three plus years in Prosthetics and Orthotics experience,three years in the Rehabilitation setting as a PT aide and as a developer of therapeutic and assistive devices, I have found that a respectful working Team, with a common goal, will shine in comparison to those individuals who have their own agenda. One profession may unintentionally undermine another professional's work when they don't collaborate.

I propose that as a Team, we try to establish a baseline for all clients who have range of motion and/or contracture concerns, even if minimal. DynamicBracingSolutions™ would be willing to help the Team to gather and establish these baselines. This is a practice done regularly at DBS with all our clients. We believe this measurement it is essential if we are to evaluate improvement, prevent future problems, or solve any concerns.

You are all well aware that the limited time your staff has to do improvement. Typically clients who are young in age can truly tolerate the pressures of a corrective device. Yet, we have all seen some of our senior citizens respond favorably with decreased contractures. Unfortunately, we also have seen many not respond well at all. I have seen many of those fail due to a breakdown of the Team, the technology available, and funding issues. But even today, in a Managed Care society, I find that if there is a strong appeal for the most appropriate care, it is rarely denied. If we can show and demonstrate what is medically sound and agreed upon by a Team, money is usually not an issue, as long as there is a fair price for the services rendered. Granted, the funding for a particular service may be limited, but rarely flatly denied.

I believe we can readily demonstrate to anyone that providing the most appropriate initial care and prevention saves tremendous amount of precious resources. In the younger population, I can prove that I am preventing many surgeries, among them Total Joint Replacements of the knee and hip. The cost of appropriate orthotic treatment at the appropriate time saves millions of dollars. The same goes for appropriate Nursing, PT, and OT. All services and treatment when offered at the appropriate time can save millions of dollars in the future.

You may be aware that studies have shown that for every day that a contracture is developing, it takes ten days to undo it. Can we not afford to prevent as many as possible? If we can prevent the hip, knee, ankle, and foot contractures think how much easier it would be to transfer that patient and possibly ambulate the patient with less assistance. We may prevent upper extremity contractures to allow easier donning and doffing of clothes.

I am pleased that we have a start to a long and lasting working relationship and that we can coordinate our services as a Team. We can and should demand the most we can do for each patient in our respective professions. I would like to meet with the Team so we can develop a system that will work for everyone with the clients in mind. I also know that we will set a standard for which all other facilities should follow, because it is what is the most appropriate and cost effective.

DynamicBracingSolutions™ is the first P&O facility to take Senior Care very seriously. As far as we know, we are the first to establish such a Senior Care Program. We have been researching and gathering as much information as we can. Due to the fact that there have been no other providers of quality care in this arena, you are probably unaware of the potential services and resources that we can provide for you. I can demonstrate the quality of care that we provide at DynamicBracingSolutions™, with a functional outcome based video. This can give you an idea of what we can do for some of your clients if we are allowed to make our professional recommendations.

Please call within a week to hopefully schedule our first Team meeting.


Marmaduke D. R. Loke, C.P.O.

Many catalogue devises (prefab) are poorly designed. Some work quite well for a few, but not for all. Most will provide good support, position, & comfort in one aspect, such as, hold the wrist in good position in one direction, but not in another.

Other examples are:

  • can hold the knee flexion contracture, but not the foot & ankle

  • can hold the ankle from plantar flexion, but not in varus/valgus

  • can hold the elbow, but not the wrist & hand in a functional position

Most (prefab) splints are inadequate for one or more aspects that we are trying to prevent or support. This leads to wasted time & money. Many believe that using such devises save money. It is more often than not, that the prefab devise is inadequate and a custom made device is later required, after many professional hours have been required by several Team members. Don't get me wrong, prefab devices can play an important role at times, to meet the needs of those appropriate clients.

About Company

DynamicBracingSolutions™ is The National Network of Clinicians dedicated to a 21st Century approach to HOLISTIC bracing for neuromuscular disorders.

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"The challenge, was it worth it? Yes! Definitely worth it. There are times that I can sort of march, that I was never able to do before. I can go longer distances when I walk my dog and I don't feel like my knee is going to buckle." -- M.E. MD

"The challenge was worth every bit, I mean, it just gets you all excited about (it) and you want to go do it again. That's what life's about, it's challenges and pushing yourself to another goal." -- E.W. All American Over Sixty TriAthlete

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