Suggested Guidelines for the Prescription of Orthotic Services, Device Delivery, Education, and Follow-up Care: A Multidisciplinary White Paper.

Objectives: This article establishes needed guidelines for determining orthotic prescriber authority, documenting medical necessity, and ensuring continuity of care for patients needing orthoses. It also identifies "off-the-shelf" (OTS) devices that can safely and appropriately be delivered to patients without professional adjustment as well as those that cannot.

Methods: A multidisciplinary task force made up of experts in orthopedics and physical medicine physicians, along with therapists and certified orthotists, applied a consensus approach to answer key questions: (i) When can a device be safely, effectively delivered to the patient OTS without professional guidance or education, and which caregivers have a role in that decision? (ii) What documentation is appropriate for physicians and other caregivers to determine medical necessity? (iii) What documentation/communication ensures continuity of care among physicians, therapists, and orthotists?

Results: Guidelines developed for consideration of OTS orthoses include accepting documentation from collaborating caregivers, including therapists and orthotists; keeping that documentation as part of the patient's total medical record for clinical, medical necessity determinations and reimbursement purposes; and using the physician's prescription for the device as the key determinant of whether a device is delivered OTS or as a custom-fitted device.

Knee resistance during passive stretch in patients with hypertonia.

The aims of the study were to determine by a portable method (1) whether velocity-dependent changes in knee resistance in patients with spastic paresis differ from those in non-disabled subjects, and (2) whether biomechanical measures of resistance can differentiate between neural and other factors that contribute to hypertonia (increased resistance). Biomechanical (hand-hold dynamometer, electrogoniometer) and bioelectrical (EMG) measures of resistance were evaluated under static (slow stretch) and dynamic (fast stretch) conditions in twenty patients with hypertonia and 19 non-disabled subjects. Measures calculated for non-disabled subjects (control limbs) were compared to those calculated for patients (spastic limbs).

Biomechanic characteristics of patients with spastic and dystonic hypertonia in cerebral palsy.

Objective: To determine what biomechanic characteristics of knee joint motion and walking show potential to quantitatively differentiate spasticity and dystonia in cerebral palsy (CP).

Design: Descriptive measurement study.

Setting: University hospital.

Quantitative evaluation of reflex and voluntary activity in children with spasticity.

Objective: To determine whether increased reflexes are related to functional impairment in children with spasticity.

Design: Descriptive measurement study.

Setting: Rehabilitation department in Poland.