April/May 2000

The Power of Teamwork

By Pamela M. Gibson, CPO

The importance of an interdisciplinary team approach in achieving positive orthotic and prosthetic patient outcomes.

• Necessity

• Functionality

• Effectiveness

• Adjustability

• Cosmesis (appearance of device)

• Cost

An orthosis is used to support, prevent, or correct deformities, align skeletal joints, or improve the ability to perform activities of daily living (ADLs). A CPO can, with custom-fit or custom-made orthoses, increase the patient’s comfort level, improve quality of life, and decrease the time of rehabilitation. A patient’s age and lifestyle are important factors in fitting the proper components and selecting the proper materials to fabricate an orthosis. All these factors must be thoroughly evaluated to determine if a patient will benefit from using an orthotic device. Once again, the input of other team members is essential to properly determine the optimal orthotic treatment.

Prostheses are used to replace the function and/or the cosmesis of the missing body entity. Limbs and breast prostheses are the most common. Prosthetic limbs can dramatically improve a patient’s quality of life, and promote independence, self-confidence, and a return to ADLs. Surgical patients, patients with progressively chronic or physically debilitating diseases, and patients with traumatic injuries can greatly benefit from wearing orthotic devices. In tandem, a comprehensive medical team can provide the development of pathology-specific treatment programs to maximize each individual patient’s progress.

When team resources are brought to bear early in the patient’s medical treatment, including medical consultation with a CPO, the recovery process and case management are only enhanced. If individual team members do not adhere to the team approach, the effect can be deleterious to the patient’s rehabilitation process.

For example, the neuromuscular pediatric patient may present with a variety of conditions that would be best handled by the team approach. Orthotic management, in conjunction with a proper stretching and physical therapy regimen, can improve the positive outcomes of both treatments, which in turn will influence the ADLs.

Spinal orthoses can help patients such as those with scoliosis, osteoporosis, and degenerative disc disease. These particular orthotic devices maintain three-point force control, increase intracavity pressure, re-establish spinal alignment, and are an excellent kinesthetic reminder for the patient. Other orthotic devices include those for the foot, pediatric (congenital hip dissolution, craniostenoses, scoliosis, and halo applications), and osteoarthritis knee.

The traumatic patient presents the greatest challenge to the team approach. In many instances the trauma patient may not have the opportunity to begin the rehabilitation process before being discharged from the trauma unit. By properly coordinating with case managers, the team can be aware of incoming patients and have the proper members available. In the case of the traumatic amputation, an immediate postoperative prosthesis (IPOP) may be indicated. To ensure a seamless transition to rehabilitation, coordination from acute care to rehabilitation care is essential. When properly done, the results can be astonishing.

Building the Team

As health care professionals, each discipline has its own unique talents and skills. Integrating each profession into the team unit can be challenging. The key to any team is communication. Fortunately, most institutions have the proper education mechanisms in place. These can be care conferences, specialized clinics, and continuing education. Care conferences should include all team members. I have found that a few minutes spent in open discussion on each case can help tremendously. Each team member should be able to provide input on patient care. By utilizing the experiences of all the team members, a positive outcome can be achieved. A team goal should be established, and all members should reinforce these goals to the patient.

Specialized clinics can provide a great opportunity for the team members to interact and provide input on treatment plans. Clinics should incorporate evaluation from all team members. The team should then meet and discuss the evaluations to formulate a treatment plan.

Continuing education can take many shapes. They can educate other disciplines on techniques and treatments. Team members can jointly attend educational courses. There are multiple courses offered that encourage the attendance of physical and occupational therapists, case managers, and prosthetists and orthotists. One example where CPOs have found this to be beneficial is when working with a patient who would benefit from a reciprocating gait orthosis (RGO). If a patient presents with a limp or an unsteady walk, an RGO may be the correct form of medical treatment. Since the team members have attended an RGO course together, they share a similar knowledge on the indications/contraindications and potential of this type of treatment. Multidisciplinary conferences can bring all team members together.

Multidisciplinary medical teams should work in unison to establish rehabilitation goal results and positive patient outcomes. Measurable team goals should focus on providing appropriate functionality for each individual patient and delivering advanced technology and compassionate quality care to ensure that the prosthesis or orthosis empowers the patient to reach their highest potential. Optimal rehabilitation requires the team approach. This results in reduced rehabilitation time and, ultimately, significant improvements to the patient’s quality of life.

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