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Student Newsletter, October 2017
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Student NEWS
Fall 2017

AOPA Policy Forum 2017: Student Advocacy in O&P

Kate Farrell, University of Hartford, MSPO 2018

As a master’s student, your priorities become focused on coursework and research. The majority of your time is devoted to studying and learning about patient care. Upon graduation, priorities shift to completing your residency and studying for the board exams. Spare time is spent researching new technology in the field, deciphering L-Codes, and learning about various insurance companies. It is easy to forget about legislative issues.

If you take some time to read through the current, relevant legislation, it doesn’t take long to realize that these bills impact all aspects of the O&P field. Pertinent topics include funding master’s programs, patient and clinician rights, and insurance coverage for various orthotic and prosthetic devices. Because these things span just about every aspect of the O&P field, they deserve our attention and advocacy.

The 2017 AOPA Policy Forum was held May 24–25 in Washington DC and included students, residents, clinicians, amputees, manufacturers, and organizations that serve the O&P community. I was lucky enough to attend and am the first to admit that I was not well-versed in the legislation that impacts O&P. Upon my departure from Washington DC, however, I felt much more informed about current O&P legislation. I would like to share my Policy Forum experience with other students so that we can all start being part of the changes that need to happen.

Prior to my arrival on Capitol Hill, I received various packets of information related to the legislation that would be discussed. I reviewed this material to the best of my ability, but once I arrived, it became clear that I had only breached the surface of the complex and detailed acts and bills. I quickly learned that even as a student, it is important to be knowledgeable concerning these issues. As future clinicians, current students will be responsible for continuing the advocacy efforts that are crucial for our patients and the O&P community as a whole.

There are a few key legislative issues that are currently important for us to focus our attention on:

  • Medicare Orthotics and Prosthetics Improvement Act of 2017 (S. 1191, H.R. 2599)
  • Injured and Amputee Veterans Bill of Rights (H.R. 2322)
  • Wounded Warrior Workforce Enhancement Act
  • American Healthcare Act (AHCA)
  • Competitive Bidding
  • Moratorium on Medicare’s Draft Local Coverage Determination (LCD) on Lower Limb Prosthetics and all audits related to lower limb prostheses

I would like to focus on two of these and explain how each relates to O&P students in particular.

First off is the Medicare Orthotics and Prosthetics Improvement Act of 2017. This act is full of provisions that will be beneficial to the O&P field. One of the changes incorporated into this act focuses on having the Centers for Medicare and Medicaid Services (CMS) implement a system that links provider qualifications and O&P device complexity to Medicare payment. This would ensure that patients are receiving the proper time and attention required to safely deliver the specific devices they need. It would also help Medicare avoid paying under-qualified practitioners who are providing unmoderated care to patients. Among other important changes, this act calls for orthotists' and prosthetists' clinical notes to be used as part of the justification process that determines medical necessity and clearly separates orthotics and prosthetics from durable medical equipment (DME) in terms of regulation.

These changes directly relate to students, as we are all undergoing extensive training in accredited master’s programs. Graduation is followed by clinical residencies in both orthotics and prosthetics so that we are eligible to take the exams that will qualify us as certified clinicians. We spend years learning everything from diagnoses, patient care, treatment plans, and insurance coverage to the latest technology that is impacting the field. Certification shows the level of expertise that we have in the profession. Therefore, as thoroughly qualified professionals, we should be able to determine and provide the best plan of care for our patients, and Medicare should recognize this.

Separating O&P from DME is also recommended since most O&P patients require long-term treatment plans, while the majority of patients requiring most types of DME do not. This separation would regulate the legislation that sometimes fails to take into account the major differences between DME and O&P, which ends up negatively impacting our patients’ access to the follow-up care that is necessary for their full rehabilitation.

These changes, along with many other necessary changes, are defined in the Medicare Orthotics & Prosthetics Improvement Act, which requires our advocacy to ensure that it passes and is enacted.

Another act deserving students’ attention is the Wounded Warrior Workforce Enhancement Act. This act is fairly straightforward; its purpose is to gain funding for accredited O&P master’s degree programs. According to a study conducted by the National Commission on Orthotic and Prosthetic Education (NCOPE), a projected 60 percent increase of O&P providers will be necessary to keep up with the growing demand for O&P clinical care within the next ten years. Currently, fewer than 250 students graduate each year from the 13 accredited master’s programs in the United States, which will not be enough to serve all the patients requiring O&P care in the coming years.

This act calls for the creation of grants that will help universities establish new O&P education programs or expand existing programs. The act calls for a total of $15 million distributed via smaller grants to various qualified universities over a three-year period. As students, it is our responsibility to be aware and proactive when it comes to recruiting more students to the O&P field, as we will be providing care to the increasing patient population in the near future. We need to be prepared and unified in the distribution of this care to ensure that all patients are receiving the care they need.

More information about these two acts, as well as other legislative pieces that were discussed at the 2017 AOPA Policy Forum, can be found on AOPA’s website: www.aopanet.org/legislative-regulatory/2017-policy-forum

As students, it is easy to believe that there is not much we can do to help, but that is a misconception, as I learned while attending the 2017 AOPA Policy Forum. Amazing and well-informed resources surround us, including our teachers, clinical instructors, and multiple organizations across the nation that will help and encourage us to get involved. Understanding these issues now will increase our awareness when we enter the field as clinicians.

We can also advocate in our home states. Send an email or call your state representatives, senators, or governor. The sooner we become active in these efforts, the sooner we can make changes to benefit the O&P field and help our future patients live up to their full potential.

Adaptive Recreation
Duran Pardue, University of Texas Southwestern, MSPO 2018

Physical activity has been documented to improve multiple facets of life1 for people with disabilities, from cardiovascular to psychosocial health. Sports have been lauded for able-bodied people and people with disabilities as essential aspects of life. In fact, the United Nations recognizes play and leisure as fundamental rights.2 It has been observed that an inability to participate in leisure activities leads to a diminished sense of independence.3 Conversely, people with disabilities who participate in physical activities describe themselves not by their disabilities, but by what they are able to do. As such, physical and recreational activities clearly have a positive effect on patients’ body image.

In order to reap these benefits, participants must first be able to find adaptive sports programs. Ironically, rehabilitation therapists and healthcare providers are often cited in the literature as the least helpful for introducing sports to patients with disabilities. More often, athletes with disabilities report that they learned about sports from seeing something on television or through a local support group.4 Athletes with disabilities say that their therapists were unknowledgeable of available programs. Additionally, therapists tended to underestimate their patients’ potential or the positive effects recreational activities could have for people with disabilities as a whole. Therefore, as clinicians, it is important that we go beyond providing a device. We should also provide our patients with the resources for finding recreational programs and be supportive and encouraging of active lifestyles.

Having an exhaustive list of every possible program is not practical. However, clinicians should be prepared with resources that highlight a variety of relevant organizations. Some well-known organizations that offer sports and recreational activities for people with disabilities are the Wounded Warrior Project (woundedwarriorproject.org) for veterans and the Challenged Athletes Foundation (challengedathletes.org). The United States Paralympic Team (www.teamusa.org/US-Paralympics) has an excellent database that can be searched by location, type of sport, and demographic characteristics (adult, youth, veteran). Disabled Sports USA (www.disabledsportsusa.org) has a similar database. With the increased popularity in functional fitness activities and sports, organizations such as I Am Adaptive (www.iamadaptive.com) and Team Some Assembly Required (www.teamsomeassemblyrequired.com) have large social networks for connecting athletes and sharing tips and tricks.

Finding support groups can be difficult, and people with altered abilities shouldn’t be left to fend for themselves in finding a group to join. Preparedness and teamwork throughout the entire care team can help to accomplish this. The benefits to the patient will be invaluable.

References

  1. Blauwet, C., Willick, S. E. (2012). The Paralympic movement: Using sports to promote health, disability rights, and social integration for athletes with disabilities. PM&R 4(11): 851–856.
  2. Sabatello, M., Schulze, M. (Eds) (2014). Human rights & disability advocacy. Philadelphia, PA, University of Pennsylvania Press.
  3. Bundy, A. C. (1993). Assessment of play and leisure: Delineation of the problem. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association 47(3): 217–222.
  4. Levins, S. M., Redenbach, D.M., Dyck, I. (2004). Individual and societal influences on participation in physical activity following spinal cord injury: A qualitative study. Physical Therapy 84(6): 496–509.

 

The Value of Shadowing: A Student’s Perspective
Sheila Pach, Northwestern University, MSPO 2018

I began pursuing a career in orthotics and prosthetics three years ago. With a degree in mechanical engineering and a full-time job in information technology, I found myself wanting to enter a profession that would allow me to help others restore their mobility. My exploration began when I started spending Saturdays shadowing in a physical therapy clinic. After shadowing there for several months, I began speaking with and eventually shadowing a variety of healthcare professionals—occupational therapists, physician assistants, and orthotists and prosthetists. It was through these discussions and opportunities to shadow that I found clarity in my career path and began my O&P education.

Three years later, I find myself shadowing in Chicago-based clinics as part of Northwestern’s master’s in prosthetics and orthotics curriculum. Shadowing while enrolled in an MSPO program allows students to reinforce and supplement the clinical and technical skills we are currently learning in the classroom. For instance, we see concepts from our behavioral science classes come to life when we watch practitioners handle the complexities of wide-ranging patient populations and personalities. I appreciated the importance of reading nonverbal cues and implementing principles of family-centered care when I was shadowing in a pediatric clinic. In the clinic, we saw a patient whose rare disorder caused, among other symptoms, incessant teeth grinding. The grinding noise created a palpable unease in the room. Noticing the family’s anxiety, the orthotist asked if the grinding habit was new, noting that he would expect them to have gotten used to it after a certain number of years. The parents admitted that the grinding had been happening for eight years and they had indeed grown accustomed to it, but they were still acutely aware of it in the presence of new people. Once the orthotist told them that we were also used to it, the atmosphere in the room shifted dramatically. Their unease gave way to comfort. For the remainder of the appointment, the parents spoke openly about the challenges of caring for their child and what goals they hoped to achieve with a new orthosis.

Shadowing also supports the open mindset that our instructors promote. In our practicum courses, we are encouraged to think creatively about each patient’s individual goals. Instead of entering an appointment with a preconceived notion of what orthosis or prosthesis is best suited for a given diagnosis, we are taught to carefully assess the individual’s presentation and consider if and how an intervention might help the patient achieve his or her goals. This concept was clearly demonstrated during a shadowing experience in which a prosthetist delivered a transfemoral prosthesis with two knees. The patient was very tall and had a short residual limb with a hip flexion contracture. When sitting in a standard-sized chair, his knee extended higher than the seat, forcing his residual limb to flex excessively at the hip. To allow the residual limb to relax during sitting, the prosthetist added a manual locking knee just distal to the socket. The second knee, which flexed in the opposite direction of the true knee, allowed the residual limb to extend down to the seat surface during sitting. Witnessing this ingenuity first-hand inspires me to explore how my studies can be blended with creativity to achieve desired clinical outcomes.

Finally, shadowing helps students build relationships with other professionals. Developing these relationships with practitioners, residents, and other students have further opened my eyes to all that practitioners do to help patients and their families, support their colleagues, and advance the O&P profession. It is exciting to begin feeling like my classmates and I are becoming part of this tightly knit O&P community.

Without the generosity of practitioners allowing me to shadow them, I would not be pursuing a career in O&P. It is with sincere gratitude that I thank the many people who have shared their time and wisdom with my classmates and me through the invaluable experience of shadowing.


Survey Analysis: Let’s Get to Know Each Other
Melissa Burner (co-editor), Eastern Michigan University, MSPO 2013

When I decided to specialize my education in orthotics and prosthetics, one of the aspects that drew me most strongly was the multidisciplinary nature of the field. I had wanted to be a doctor since childhood, but after completing a bachelor’s in pre-med, I struggled to find an adequate professional outlet for my creative impulses. O&P quickly jumped into view as a profession that matched all of all my interests and skills. As one could expect—and as most of you are likely already aware—our profession invites brilliant and eccentric people from all walks of life, multiple educational and professional backgrounds, and many different countries. These diverse experiences, and the ways in which they fit together generate a palpable synergy.

Naturally, this made me curious about where we all come from and where we’re headed. Combined with our desire to make the newsletter more interactive for you, this inquiry was the springboard for launching our new survey feature. We aim to shed light on the composition of our distinctive group to help each member cultivate an idea of where they fit into the whole and what kinds of ideas future clinicians will be bringing with them.

Thus, I present to you: The results of our survey!

Question 1:
 
(All data and figures were pulled directly from our SurveyMonkey analysis tab, as of 7/8/2017.)

Most of the responses were received on the first day the survey was sent out. I would like to extend my gratitude to everyone who participated! As the responses kept coming in, I looked at the metadata trends, and they didn’t fluctuate significantly from day to day. While the precise numbers changed, the percentages largely didn’t, which gives me greater confidence in the reliability of the survey. (An important element to note is that I enabled respondents to check multiple boxes for both questions, so those of you with careful eyes may notice these percentages total more than 100%.)

The greatest number of students came from an engineering field (33%). I decided to group each subset of engineering into one category for simplicity’s sake, but I’d be curious to see the breakdown of this group. My guess would be that most students come from a background in mechanical engineering, based on my personal experience and the inherent biases that come with it, but this may not be supported.

In close second, more than a quarter of respondents (28%) selected “Other.” This surprised me. Based on the small sample size of my 2013 cohort, I wouldn’t say our stats reflected these numbers. However, this category is admittedly very broad and obviously deserves further breakdown. How many in this category are coming from a STEM field that wasn’t mentioned in the other options? How many from non-STEM?

One of the laments of data analysis is that sometimes it raises more questions than it answers. Was my own cohort composed of these ratios? If it wasn’t, was this due to the fact that our class size was only 20? Are a growing number of students from diverse disciplines becoming interested in our field? At a time when the demand for more practitioners is increasing, I think this is a question that could provide great insight. And I definitely regret not allowing an open response option for this section.

In third and fourth places are kinesiology (26%) and biology (17%), respectively. As you can easily see from the figure above, all of the other categories had far fewer respondents than the top four. Even when combined, the number of responses from these additional categories don’t total the number from the category preceding it. Contrary to making this section of people sound less important, however, I think it actually highlights how invaluable these perspectives are. Each opinion holds the opportunity for profound insight and creative problem-solving, and the further from the norm it falls, the greater potential it has to stretch the minds of those who receive it.

Question 2:

These results speak for themselves. The overwhelming majority of you plan to complete a clinical residency, at minimum. Many of you selected several additional choices as well, with few overlapping combinations. I attempted to provide analysis for these multi-answers, but this proved to be quite cumbersome. (I’m sure at least one of you has a much better grasp of data analysis than I do and could easily develop a method for sharing the information.) Suffice it to say, you’re a very ambitious group with very bright futures.

With 13 currently accredited universities and countless residency sites scattered across the U.S. (not to mention those outside it), students often have little opportunity to meet people from other schools and clinical experiences. Our goal in sending surveys is to help our readers feel a shared sense of the educational and personal richness in our profession. O&P is both cognitive and physical, creative and logical, right-brained and left-brained. I hope these simple graphs have helped to provide a small window into the vastness of our field, and I hope that you are finding the same interdisciplinary fulfillment so many of us do. The next time you work in a group with your classmates or colleagues, challenge yourselves to cross-pollinate your ideas in honor of your contrasting, yet complementary, backgrounds. The results may surprise you.


Something to Say? Share it with Student NEWS

The Academy Student NEWS is designed for students, residents, and educators to share their personal O&P experiences. The Academy welcomes columns from O&P students, residents, and educators to publish in future editions of Student NEWS. Potential topics are listed below:

  • Current research
  • Student volunteer initiatives
  • Volunteer opportunities
  • Personal stories of success
  • Updates on what's happening at your school
  • Reflections on your experience in O&P so far
  • Your experience at Academy meetings and events

Please include a headshot of yourself with your contributions.

The Academy Student NEWS is not a vehicle for advertising products or services.


44th Academy Annual Meeting and Scientific Symposium 

Thursday, February 15
Residency Networking Session
6:30 – 7:45 PM

O&P students won’t want to miss this informative networking session. During this program, students will meet with representatives from the National Commission on Orthotic and Prosthetic Education (NCOPE) to learn about the residency process. Representatives from the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC) will discuss the post-residency steps to becoming certified. The Academy will share how the directed study reports are reviewed and selected for Academy Resident Awards. Residency directors from a variety of O&P facilities will provide insight on what students should look for in a residency site. This event is open to students, residents, and educators only.

O&P Student Social 
7:45 – 8:45 PM

The Academy invites all O&P students, residents, and educators to an informal networking session. Light refreshments will be served courtesy of ABC and NCOPE. This event is open to students, residents, and educators only.

Friday, February 16

Women in Orthotics & Prosthetics Reception 
6:45 – 7:45 PM

Join the growing number women who are making a difference in O&P. During this New Orleans flavored reception, the Student/Resident Committee will discuss the Academy mentoring program and how you can get involved. This reception is open to all students (men and women).

Saturday, February 17

Resume Writing and Interview Skills 
8:00 – 9:30 AM 

Designed for students, residents, and new clinicians, this session focuses on resume writing, interviewing skills, and creating professional networks through social media. This presentation is sponsored by the Student Resident Committee.
Charles Kuffel, MSM, CPO, FAAOP; Terri Kuffel, Esq.; Nick Sellas, CPed

Want More Information?

To learn more about the Academy's programs please contact Nia B. Abdul-Malik by phone at
(202) 380-3663 or by email at nmalik@oandp.org

Connect

Contact

The American Academy of Orthotists & Prosthetists
1331 H Street NW, Suite 501 Washington DC, 20005
(202) 380-3663
info@oandp.org