March 2011 Archives

It's always encouraging to hear of advances that help to restore a person's identity that they once knew before their life-altering injury.

RealLifeProsthetics is an organization devoted to improving the quality of life for individuals affected by disfiguration and amputation through the sensitive replication of natural anatomy. Michael Scarzello-Kaczkowski, BFA, Director of Alloplastics, has over 20 years experience in alloplastic/anaplastology reconstruction. He is an artist, inventor, and prosthetic skin technology pioneer. RealLifeProsthetics specializes in prosthetic eyes, fingers, hands, arms, feet and legs.

What's particularly interesting is RealLifeSkin, a branch of RealLifeProsthetics that specializes in prosthetic skin. What's unique about their approach to prosthetics is the revolutionizing prosthetic-alloplastic technology. This technology is not just prosthetic skin, but an entire process that is adaptable for fabrication into alloplastic and prosthetic devices as small as a fingertip or as large as entire leg. 
In real human skin, the epidermis layer has fingertips and skin detail; it also contains pigment called melanin. When the skin is exposed to the sun, more melanin is created to help counteract the damaging rays of the sun.

Likewise, RealLifeSkin's epidermis skin layer contains remarkably realistic fingerprints and skin detail along with a simulated melanin. When an amputee wearing a RealLifeSkin prosthesis gets a tan on their real skin, they can be supplied with "prosthetic melanin: so that the prosthesis can be made to match their new tan. Each user is able to apply it directly on the prosthesis where it is absorbed immediately into the epidermis layer. Each subsequent rubbing of the tanner makes the RealLifeSkin gradually dark.

Check out this brief video of a RealLifeSkin recipient successfully typing with the use of his prosthetic. He states that the typing experience, given the very low weight of the arm, is extremely comfortable.

Yes, Virginia, there is a proper way to speak to or about people with disabilities. No matter what you do, brushing up on your communication skills is always a good idea. For a full primer on proper etiquette for speaking to or about people with disabilities, visit the U.S. Department of Labor, Office of Disability Employment Policy and review Communicating With and About People With Disabilities.

Generally speaking, it is important to always speak affirmatively and place emphasis on the person, not the disability. When working with a person who has mobility impairment, pull up a chair and put yourself at the user's eye level to make communication with the person more comfortable.

The three most important things to remember when communicating with a person who has a disability:

1 - Relax.

2 - Treat the individual with dignity, respect and courtesy.

3 - Listen to the individual.

And for your viewing pleasure, watch this short video by Darlene O'Brien, founder of Blind Ambition, a consulting and training business that provides disability etiquette training. According to Darlene, the community of disabled individuals is the largest minority in the U.S. and one that will continue to grow exponentially in the coming years...

Working with complex care patients can be a challenge. All of a sudden, a patient can develop an ulcer wound or several wounds that can get out of hand very quickly and lead to many other complications. This is not only an issue with paralyzed patients. Any patient who is bed ridden or confined to a wheelchair for a few weeks, like with a broken bone, could be susceptible to ulceration wounds. When you know a patient will be immobile for any length of time, getting a pressure mapping image on file is a good idea.

What is pressure mapping?

Pressure mapping provides a graphic image of surface pressure, where the skin comes into contact with a surface such as a wheelchair cushion or a mattress. Listen to a podcast by Rehab Management, The Interdisciplinary Journal of Rehab Medicine to learn more about it. The podcast is just under 11 minutes in length.

Zack Craft, vice president of rehabilitation technology and complex care at Total Medical Solutions, says, "Pressure imaging is an essential and handy tool to use any time you have a patient that may be immobile for more than a couple of weeks." Zack recommends pressure mapping on any file where a home visit presents potential issues. "It is especially critical when you are aware of other existing issues with a patient. For example, if the patient has diabetes or obesity, any change in pressure on certain parts of the body could lead to wound development right away." Providing a pressure mapping image at the onset of an injury or surgery is prudent.

Change Your Underwear, Man!
a.k.a. Zack's Underwear Case

Pressure mapping is just one piece of a complex puzzle, but can play a critical role when considering how new wounds have developed. Consider Zack's "underwear case." Zack used pressure imaging on a case once to rule out wheelchair cushion problems, mattress problems and a host of other potential issues. When a long-time paraplegic patient developed wounds all of a sudden, Zack was called in for a home visit. The patient was otherwise healthy and there seemed to be no visible changes that would have caused the wounds. After the home visit and quite a bit of sleuthing, Zack figured out that the patient's underwear was the cause.

Yep, that's right, his underwear. You see, through a detailed series of questions and answers, Zack discovered the wife had recently started buying her husband silk briefs as opposed to cotton ones. In complex care, we get real up close and personal. You have to. Subtle changes like a change in fabric can cause major differences in friction or shear between the patient's skin and the surfaces it touches.

So, while pressure mapping didn't solve Zack's underwear case, it definitely played a crucial role. Zack was able to use pressure mapping images to rule out a lot of other causes. Often, wheelchair cushions are thought to be the blame, or mattresses, etc. and new ones are ordered without consideration. This can add up to hundreds, or thousands of dollars on a claim, and in many cases is completely unnecessary.

Does Your DME Provider Offer Pressure Mapping?

Any time you have a patient who is immobile, whether your patient is paralyzed, or has a short-term injury, it is a good idea to ask your DME provider for a pressure mapping image as soon as possible. Establish a baseline image on the file, then, consult with your complex care specialist to determine how often a new image should be taken.

This Real Ramping Project is brought to us by Mobility Specialist, Scott Lucia. This injured worker had a fractured hip and a broken leg. He was discharged from the hospital non-weight bearing in a wheelchair. The fasted solution to getting the injured worker into his home was to install this ramp system. He was able to transfer from his vehicle into the wheelchair and right up the ramp into his home. The ramping is a fast and temporary solution until he becomes weight bearing, and was installed in about two hours. What's great is the ability to re-use the ramping for future injured workers by banking in our warehouse, saving the carrier thousands! It requires no building permits, is maintenance free, virtually indestructible and does not reduce the value of property. This is a great example of a temporary use to help an injured worker gain access until he gets back on his feet. Once he was done, it took about 30 minutes to break down the system to return to the banking warehouse. 

Before:                    

After:     

If you have any questions about aluminum ramping, Total Medical Solutions would be happy to help. Feel free to contact them at 1-800-700-9393 or visit www.NewTMS.com.

An article by Satish Misra, MD posted on iMedicalApps states the U.S. spent over $70 billion on home health care in 2009. "Medical kiosks - a new drive-thru model for healthcare? " also talks about how a Massachusetts-based telehealth company has been working on several platforms for delivering healthcare in remote locations. The three platforms currently available by BL Healthcare include: television, kiosk and touchscreen.  

Dr. Misra points out that the kiosk technology holds some promising opportunities for people who are physically unable to make regular visits to the doctor for preventative care. If the kiosk technology can be packaged into "mobile care units" it could allow patients with limitations the ability to get regular preventative care, keeping them out of the hospital and improving their quality of life. Learn more about BL Healthcare's healthcare delivery platforms.

Will the iPad change the way doctors practice medicine?

The iPad 2 event was big news last week all over the airways and the blogosphere. The unveiling of the iPad 2 certainly created a log of excitement to say the least. In another article on iMedicalApps, "iPad 2 keynote video by Apple: the iPad will change the way doctors practice medicine", Iltifat Husain explains how Dr. John Halamka, Chief Information Officer of Beth Israel Deaconess Medical Center, was featured in the iPad video presentation titled "2010, the year of the iPad" video. In the video, Dr. Halamka says "The iPad will change the way doctors practice medicine."

Steve Jobs also made reference in the keynote speech to the plethora of apps available for the iPad in vertical markets like medical. Watch the iPad 2 keynote video at Apple's website.

As evidenced by the launching of the 2nd generation of iPads in a year's time, technology continues to evolve at a rapid pace. It will be interesting to see what innovations lie ahead in healthcare delivery. Be sure to watch Dr. Halamka's blog, Life as a Healthcare CIO, as he is sure to provide an interesting perspective.

According to the American Diabetes Association, approximately 25.8 million children and adults in the United States -- 8.3% of the population -- have diabetes. 1.9 million new cases of diabetes were diagnosed in people aged 20 years and older in 2010.

Managing diabetes at any age can be both time consuming and tedious. However, with the technological advances of this day and age, instruments are being developed to help improve and simplify that process.

Cellnovo mobile diabetes management tools provide the freedom from the arduous task of managing this disease. Through a symphony of connected devices, the goal is to reduce the burden while providing more insight to people with diabetes, their healthcare team and their family. This mobile diabetes management system is drawing comparisons to Apple Inc.'s blockbuster iPhone and iPod platforms.

Creators of this technology believe this will revolutionize the lives of insulin dependent individuals. "If people understand Cellnovo as a device that sends data to a website, they are missing the point," CEO Bill Mckeon told the medical device publication Invivo last year. "If you had asked Steve Jobs at Apple about his new MP3 player called the iPod, and how it compares to other MP3 players, he might have said, 'I am not making an MP3 player. I'm bringing entertainment into your life in a number of ways.'"

Read more about Cellnova's goals in the mobile approach to diabetes care in this article.

This technology will hopefully bring some additional exposure to successfully managing this disease in an effort to improve the lifestyles of injured workers' dealing with diabetes alongside their injury.

As it exists now, communication with machines has always been limited to conscious and direct forms through physical commands we conduct. For example, switching on a household light doesn't take an expression of one's feelings or emotions -- it's a simple command when we flip a light switch. However, for someone with a life-altering injury, these simple commands aren't quite as simple.

Emotiv Systems is a neuroengineering company whose vision is to revolutionize human-computer input. Based on the latest developments in neuro-technology, they have created an innovative new personal interface for human computer interaction. The Emotiv EPOC is a high resolution, neuro-signal acquisition and processing wireless neuroheadset. Mouthful, right? It uses a set of sensors to tune into electric signals produced by the brain to detect an individual's thoughts, feelings and expressions and connects wirelessly to most computing applications or devices.

All this fancy jargon for a fancy toy, but what's the significance to us? It's HUGE! For an individual who is wheelchair bound with limited function of their extremities, being able to instruct the lights to turn on or electric-track curtains to close, with merely thinking about it, is pivotal. This puts a whole new light on Environmental Control Units within an injured person's home.

What's cooler? This technology can be devised to, through the power of the mind, steer and drive a wheelchair. For a complete quadriplegic, this provides a freedom their injury once stole from them. This TED talk video of Tan Le, co-founder and president of Emotiv, shows the remarkable advances they have already made. She demonstrates live on stage someone using this technology of thought. Of particular interest, once the video gets to the 9:00 minute mark, she demostrates a real-life example of this technology with someone in a wheelchair. Incredible? I know!

You've heard us talk about this before, but it is so true. One small detail missed could easily end up costing $50,000 or more on a claim. Multiply that over a couple of dozen claims and you've wasted over a million dollars. Missing small details happens more often than you think. Here are a couple of recent examples to ponder...

Treating physician prescribes standing frame.

We were recently asked to provide an evaluation for a home modification for a new 23-year old paraplegic patient. The injured worker already has a manual wheelchair and the treating physician has prescribed a standing frame. Our rehab technician meets with the injured worker and his family in their home, which is a small condominium. The technician notices right way that the home will not accommodate a standing frame. He also notices that the patient is young and very active.

Our technician recommends a new manual wheelchair that allows the injured worker to stand anywhere he likes. While the equipment is expensive, it eliminates the need for a standing frame and the home modifications required to accommodate it. Most importantly, the new equipment provides the patient with a better quality of life, giving him the ability to stand at parties, concerts and other events. The injured worker and his family are overjoyed with the new equipment. A happy claimant with an improved quality of life is much less likely to litigate their claim...another significant level of cost savings.

If it doesn't fit, you must a-quit!

In another recent case, an injured worker was fitted for a power chair in a facility far from her home. When she got home, she was surprised to find that the new $55,000 power chair would not fit through the front door of her home. The payer had to spend another $45,000 on a new chair that did fit and was unable to return the original chair. Uh oh.

Just two claims - and over $100,000 in savings hidden amongst two very small details. It pays to have an experienced provider review the details of your claims. How much money are you losing on your complex claims?