Clinician Insights Series 3, Episode 3

Welcome to the final instalment of the latest series of Clinician Insights. If you’re beginning at the end, this blog series is brought to you by Radii, to open up conversations about digital tech and its role in O&P. The previous entries are available on our Substack. 

We’re lucky to have been joined in this series by John Talbot, CPO from Portsmouth Enablement Centre, UK and Gary Marano, CPO and Director at OTF Prosthetics and Orthotics, New York. Last time, we heard about the impact of technology on prosthetics and orthotics practice. To conclude this series, they’re looking ahead to the future of O&P. 

In this episode, we consider how tools and training might adapt even further for the next generation of prosthetists, and what this means for standardisation in the industry. We explore all this and more with our two clinicians.

As ever, we’re incredibly grateful to our contributors for sharing their insights and expertise. Gary and John have unique perspectives on the trends, developments and research happening in the O&P industry across the globe, and its ongoing mission to provide patients with better fit, more comfort, and the best possible experience.

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Gary - It's funny, today I was at a hospital with a rehab doctor, and they were reading the report of a guy who had a scan done to their body. Usually, a radiologist signs off on the scan, but this one didn’t have a signature, it had an automatic signature by Artificial Intelligence. 

For design, I'm thinking that evidence-based design could similarly take you rapidly through 10 steps rather than 20 steps, taking your old scans out and saying ‘What did I do here?’ or ‘What should I do?’, it could say ‘OK, instead of that set of 20 options, here are the two or three that you should go straight to.’ 

I think that's really, really good. Say you had to design a check socket–sometimes you need two, but some people need three or four. If technology could tell you one or two, that could mean money and time saved.

I believe maybe 40% of the world, maybe even more, does not have access to get what they need. They’re living remotely, the next facility is 300 miles away, or they’re in underdeveloped countries or they live in the mountains. There's a way with technology to get to more and more parts of the world.
However, we want to ensure that this technology is only used by CPOs, who understand the fitting process.

John - Does anybody look at the environmental outcome? We're all producing petrochemical cones and powder dust, billions of tonnes a year throughout the whole world annually, and where is it going? It's all supplied by the petrochemical industry, it all grinds down to powder, and it’s just shoved back into the ground again. There's obviously an argument saying, well, we used to use plaster, but at least plaster originally came from the ground and you would hope to think that it would break down a lot more quickly than a petrochemical granular foam.

Has anybody addressed these issues? If devices could be produced in sugar, if they could be produced in anything that would break down, I think the industry would certainly have a brighter future, a caring future.

Gary - I don't know how it is in Europe, but here in the States, [insurance] is getting crazy. On giving the authorizations, you’ll finalize and then submit it and–this has happened to me and I'm sure many others–they're requesting more information. They are requesting more clinical documentation to support the claim.
Where data would come in is that it could be more specific, and more scientific, to get things paid faster. Or, when it's requested, a prepayment audit could help also. I see a plus there.

Gary - They are exposed to technology, there's no question about it. iPads are used heavily, and I think that's good, it gives trainees a chance to be familiar with it, and you still have to apply the principles and the theory too. The ones that are in school now, even the ones that came out in the last few years, they’re trained more in using computers, iPads and the whole digital process. Now, how well they're trained, that I don't know! But I think that they're exposed to it and I believe all the schools are teaching it, which is a must.

John - I think the industry, certainly from a financial point of view, is drastically different from what it was years ago. Without understanding what components make a limb system, without understanding the manufacturing problems and what you're asking for, without understanding how long it takes to make something, you have absolutely no clue of what's going on. That has to be a starter.

Gary - Guidelines are used in just about all industries, and very heavily in our industry, so you're following that. Does it make that much of a difference, as far as when the client comes in and goes home happy? I don't know. At the end of the day, the user is really the one who’s going to judge: did you treat them right? Did you do it right? And are they happy? If you have every other client coming in with problems like that, then you’ve got to go back to the drawing board–cause, you're definitely doing something wrong!

John - I keep using the word ‘standardization’ because that's the one that's come up to me time and time again. How can you do teaching unless you've got a standardization of approach? This is where I come back to the standardization of some form, at least initially, of a brim system which is teachable. If it can't be taught successfully, then the system is failing. It's no good having a genius at the end of the line, who can get everything right the first time, if you can't teach it! I’m sure it could be a very great privilege to that one person, who would be extremely rich from everybody going to them–but if it can't be taught in a simplistic way then, that’s a poor system.

So if I'm doing a transfemoral patient, if we have a brim system irrespective of the different variable brims, it's a standardization of treatment. So if you're training somebody and you've got them to understand how the brim has to fit on their residual limb, then anyone can do it. You're standardizing that treatment. You're standardizing that procedure, that technology, so hopefully if the outcomes are successful, then that could be a very, very good start for standardizing the casting systems within any clinical centre. Then digital technology can copy anything you like. 

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We hope that through following Clinicians Insights, you feel part of an ongoing conversation, furthering understanding of digital technology and research supporting O&P practitioners in providing our patients with the best comfort, fit and socket fitting experience. If you’ve got thoughts, opinions or insight to share we’d like to hear from you; please feel welcome to contact us:

Thank you Gary, thank you John and thank you to you, our community, for joining us for another series! We’ll be returning with Series 4 of Clinician Insights in April, joined by two industry leaders in clinical practice, education and research; Jenn Dowell, CPO, FAAOP and Brian Ruhe, CP, PhD. We can’t wait to learn from Jenn and Brian as they share their experiences and thoughts on digital technology in the O&P industry. We hope you’ll join us and until then you can find our past conversations with O&P experts here

Speak soon,

Jenny, Josh and the Radii team.