Expedited fitting works with collaborative team approach

LEIPZIG, Germany — John Miguelez, CP, president, Advanced Arm Dynamics, regularly sees complex patient cases with high level amputations. Before any issues are addressed, he and his team spend time with the patient to understand their goals and expectations. The team approach is generally understood in the O&P profession. The patient needs a prosthetist, surgeon, rehabilitation coordinator, physical therapist and even a good psychologist to work collaboratively in order for the patient to succeed. But too often this team of well-intentioned practitioners forgets to include the most important person in the conversation — the patient.

  John Miguelez
  John Miguelez

“We forget to ask the patient if he or she understands the process and is okay with the structure,” Miguelez told the audience at the ORTHOPÄDIE + REHA-TECHNIK 2012 International Trade Show and World Congress

The prosthetist should have a plan in mind before he or she meets the patient. This requires preparation and a passion for learning.

 “For a good prosthetic prescription, the prosthetist needs to be aware of all technologies, all techniques and all types of interface designs,” he said. “They need to be prepared for psychological or physiological issues before they even walk in the room.”

The therapist should have a comprehensive training program with repetitive drills and self care. The goal is independence so the patient can return to work. Training should help the patient focus on becoming proficient at a variety of activities and help the patient to don and doff the prosthesis independently.

“Some would call a patient that is able to pick up and place pegs from one side to the other a success,” Miguelez said. “That’s just the beginning. There’s a lot more therapy that needs to be done. It has to become predictable for the patient.”

The team also focuses on reintegrating the patient into social situations. In order to achieve success, Miguelez puts patients through a series of tests during the therapy cycle.

“Part of our therapy cycle is sending them off into difficult areas like a Wal-Mart and have them shop on their own,” Miguelez said. “Our therapist will be watching and advising what kind of maneuvers the patient should perform.”

Advanced Arm Dynamics has been successful with expedited fitting, according to Miguelez. The goal is to fit a functional prosthesis on the patient within 24 to 48 hours of the initial meeting. During that time, the team is optimizing alignment and fit of the prosthesis.

“There are a lot of linear patient care approaches out there right now,” he said. “You get a little therapy, then the prosthesis, then more therapy and off you go. In our clinics, these things happen simultaneously.”

While the prosthetist is working on the fitting, the therapist is working on controls and motion with the patient. When the therapist is training the patient with the prosthesis, the prosthetist is checking alignment and making sure the fit is comfortable.

“It only works if you have a collaborative team,” he said.


Miguelez J. Improving outcomes for high level upper limb amputees. Presented at ORTHOPÄDIE + REHA-TECHNIK 2012 International Trade Show and World Congress. Wednesday. May 15-18. Leipzig, Germany.

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