Frequently Asked Questions
Will my insurance cover this device?
The answer to this question depends upon your insurance plan, the device needed and your diagnosis. Depending upon your insurance, you may have a deductible, copay or a percentage of the total cost that you will be responsible for paying. The receptionists at our clinical offices should be able to inform you of the probability of coverage. Insurance coverage is NOT a guarantee of full payment.
How long will it take for me to receive my device?
How much does the device cost?
Once you are evaluated and the full scope of the device is determined by the clinician, we will have a clearer picture of the price. We will work with you to assure your insurance is properly billed and you have a good understanding as to what, if any, will be your cost. If you do not have insurance, we do have a fee schedule and after your initial visit, we will be able to tell you an exact price.
Can I just stop at one of your offices and pick up the device?
Our clinical office patients are seen by appointment, so we prefer that you call one of our offices first. Each patient must be seen by a clinician for measuring and/or delivery of a device. It is our professional responsibility to insure that the device we provide fits and functions properly.
Can I get an extra device?
We can provide you with an extra device, but health insurances typically do not reimburse for the second product. Therefore, you would have to pay for it yourself.
What kind of training do you have?
Do I bring the device back to you when I am done with it?
No. All of our devices are for one-time use on a patient. You may dispose of it as you like.
How do I clean my brace?
How long am I suppose to wear my device?
Your physician will determine when you are to wear your brace, for how long, and what activities you should or should not do while wearing your brace. The physician will also determine when you can discontinue wearing your brace.
Why did my doctor order this device in the first place?
When should I add socks under my prosthesis?
Socks are needed when your limb changes volume. Here are some signs that indicated socks are needed:
How do I care for my liner? How do I keep them from smelling?
Gel liners need to be cleaned after each use. Warm water with a mild soap is recommended. Allow the liner to air dry. Putting the liner in the dryer will damage it. It is also recommended that once a week you wipe down the inside of the liner with rubbing alcohol. Sticking to a daily cleaning routine will cut down the amount of odor from your liner.
Can I wear my prostheses in the shower?
Most prostheses, uncovered, should not be worn in the shower. The water will rust the metal components and screws.
How long will this prosthesis last? How long will my liners last?
A prosthesis can last for several years. The length of time depends on the amount of time the patient wears the prosthesis and what type of activities it is used for. Prostheses are designed to be very strong and durable. However, it is a good idea to have your prosthesis checked out every 12 months to make sure it is in good working order. Liners will usually start to wear out in about 6 months. But they can last up to 12 months or longer. Just like the prosthesis, the longevity of the liner depends on amount of usage. Also change in weight can cause a dramatic effect on how a prosthesis fits. Regularly scheduled evaluations are a must to maintain proper fit of your prosthesis.
How do I get more supplies?
If you are ever in need of new liners, socks or some other supply, please call the office at 972-923-2285 or contact your prosthetist to order more supplies.
Can I wear my leg to bed?
It is not recommended that you wear your prosthesis to bed. Wearing the prosthesis for an excessive amount of time will most likely cause harm to your limb.
What do I do if I get stuck in my leg?
Remain calm and contact the office or your prosthetist immediately. If after hours call our practitioner at 214-315-6627.
What do I do if I get a sore on my residual limb?
Discontinue use of your prosthesis by limiting the amount of time you wear it drastically. If the sore does not heal within a couple of days, Contact the office or your prosthetist as soon as possible.
Why do I still feel my toes? Is this common?
Feeling your toes is referred to as a phantom sensation. A phantom sensation is a feeling that seems to originate from a part of the body that is missing. Phantom sensation/pain can present in other ways, such as pain in the knee or ankle, itchy skin, or cramping of muscles. The cause of this phenomenon is not clearly understood. Some believe that it originates from a psychological source, in that the body has not adjusted to the removal of a body part. Some believe that it originates from the nerves being severed at some mid point. This is a very common experience after an amputation. There are no sure fire cures, but there are several techniques people have found useful to treat the sensations or pain.
How long will it take to get my Prothesis?
The manufacturing and fitting of your prosthesis will take a few weeks. It takes an average of 3 or 4 visits with your Prosthetist to get the right fit. We understand that you are anxious to return to activities of daily living on your new prosthesis, so we do our best to deliver your prosthesis in a timely fashion.
Does insurance pay for my Prothesis?
Many insurance companies will cover a prosthesis and all necessary supplies. The percentage of coverage differs from company to company. Our billing specialist can help you determine what, if any, percentage of the prosthesis will be billed to you.
What will my Prothesis look like?
Every prosthesis is custom molded to every individual. There is a socket that fits on your limb. The componentry, ie the knee and/or foot, are connect to the bottom of the socket. There is the option of cosmetically covering the prosthesis after the fitting process is completed. The cosmetic cover will cover all of the metal componentry, making the prosthesis look more like your other leg.
How long do I wear my shrinker for each day?
Before you are fit with a prosthesis, you should try to wear the shrinker as much as possible during the day and night. Take the shrinker off to bathe. You should have two shrinkers to alternate while youre washing one. Shrinkers can be hand washed or put in the laundry with your other clothes. Once you receive your prosthesis and start wearing it on a regular basis, you dont have to wear the shrinker as much. It is still a good idea to wear the shrinker to bed to control any swelling over night, so that you can fit in to your prosthesis in the morning.
How long will my foot orthotics last?
There are many variables that come into play with regard to a devices useful life. Factors such as patient weight, activity level and the style of foot orthotic must be considered. Generally, the more rigid the device the longer it will last. A rigid plastic device may last 2-3 years although the top-cover material may not. A soft device, such as one made for a diabetic patient, may last less than one year.
What will my foot orthotics do for me?
What is different about your shoes than what I can buy at the store?
Our shoes meet the stringent standards set forth in Medicares Diabetic Shoe Bill. They have extra depth to accommodate special inserts, come in full and half sizes and in a variety of widths. We custom-fit each patient with a style that is best suited to their type of foot.
Do I have to follow the Break In Schedule for my new foot orthotics?
Why dont you have a larger selection of shoes?
How do I clean my foot orthotics?
How will I know when my child out grows their brace?
Some allowance for growth is built into the brace from day one. You will notice a small space between the end of the brace and toes. When your childs toes extend over that area it's time for a new one. Occasionally growth will be in the form of a wider foot rather than length. In this case, you would notice a significant amount of redness and indentation in the foot from the sides and top of the brace if this occurs.
Will my child have to wear these the rest of his life?
Obviously your childs diagnosis and the specifics of his/her condition are critical to answering this question. The best person to answer this type of question would be your child's physician. They would have the information needed to answer completely.
When my child is breaking in their braces, does it count if his is sitting and not active at that time?
For the initial break in period activity is not a factor. However once your child becomes active it's important to check every hour to ensure blisters are not developing.
What is deformational plagiocephaly?
Deformational plagiocephaly is characterized by unusual flattening of an infant's head and often a prominent or flattened forehead is visible. Plagiocephaly exhibits a variety of different head shapes, including flattening on one side of the back of the head with an asymmetric forehead, and brachycephalic head shapes that are flat across the entire back of the head with very prominent foreheads.
Is deformational plagiocephaly more common than it used to be?
The incidence of deformational plagiocephaly has increased since 1992 when the American Academy of Pediatrics recommended that parents place infants on their backs or sides to sleep in order to prevent Sudden Infant Death Syndrome. This highly effective program has dropped the SIDS rate in the United States and across the world by 40%. However, the additional time many infants spend in infant seats, car seats, and other supine (back) positions places them at risk to develop greater flatness and/or asymmetrically shaped heads. But this program alone is not responsible for the increased incidence. Other factors that may influence the development of deformational plagiocephaly include: premature births, restrictive intrauterine positioning, cervical spinal abnormalities and/or birth trauma. Deformational plagiocephaly is commonly seen in multiple births, affecting one or more siblings.
As many as 85% of the infants with deformational plagiocephaly also have torticollis. This condition is caused by tightness or weakness on one side of the sternocleidomastoid muscle in the neck. When one side of this muscle is shortened, the infant's head bends forward, tilts toward the shoulder on the affected side, and the face rotates toward the opposite shoulder. This muscle tightness or imbalance causes the head to rest consistently in the same position, creating areas of flatness on the back of the skull and compensatory growth in other areas of the head. Physical therapy is often prescribed to address torticollis. Home programs for stretching and massage of the affected muscle are very successful at addressing this problem.
How do cranial remolding orthoses work?
The cranial remolding orthosis treatment program focuses on redirecting cranial growth toward greater symmetry. This is accomplished by maintaining contact over the prominent areas of the head, and allowing room for growth in the areas of flattening. This treatment has been used by medical professionals since 1979 when Sterling Clarren, MD wrote the first article about the use of cranial remolding orthoses for infants with deformational plagiocephaly and torticollis.
How do I know if my infant needs a cranial remolding orthosis?
There are certain signs that may indicate that your infant needs a cranial remolding orthosis. However, please keep in mind that some degree of asymmetry in the skull is normal for everyone, so it is actually the magnitude of the asymmetry that indicates whether treatment with a cranial remolding orthosis is warranted. If you recognize that your infant's face is not symmetrical, their head is higher or wider than normal, or that there is flatness on the back side of their head, you may want to visit your physician for further assessment.
What is the ideal age for cranial remolding orthosis treatment?
The best age for treatment is between 3 and 6 months when the skull is still growing at a fast rate. However, cranial remolding orthoses can be used successfully between 3 and 18 months of age. Caregivers should try to reposition for at least one month prior to initiating treatment with a cranial remolding orthosis unless the infant is older than 6 months. At this point, infants are able to reposition themselves, and caregiver efforts to reposition are often futile.
What if my pediatrician tells me that my infant's head shape will correct on its own?
Historically, many head shape deformities present at birth disappeared within about 6 weeks because babies were placed in a number of different positions during the day and slept on their tummies at night. Since the Back to Sleep program was initiated in 1992, these head shape deformities often persist because babies sleep on their back all night and spend extended time on their backs during the day in infant carriers, swings, car seats, etc. Parents must be vigilant about changing the infant's position more than in any other period of child rearing. Babies that spend most of their time on their backs in the early months roll and crawl later than usual, which results in even more time before the infant is able to actively reposition themselves. The best way to help your infant's head correct "on its own" is to place your infant in a variety of positions during the time your infant is awake and supervised. This will encourage your infant to actively move their head through a full range of motion, strengthen their neck, shoulder and trunk muscles, and minimize pressure on the back of the head. It is possible that your efforts to reposition your infant will be rewarded with a more symmetrical head shape that does not require further intervention. However, if your infant's head does not change after one month of alternate positioning, make sure your pediatrician understands that you have tried prone and other positions to help make the infant's head more symmetrical, and the skull has not corrected. Then ask your pediatrician if your infant would benefit from a cranial remolding orthosis, and/or request a referral to a craniofacial specialist, neurosurgeon, etc.
Why is treatment more effective between 3 - 6 months than at other ages?
Even though the head grows fastest during the first 3 months of life, this time period is best spent actively repositioning your infant to encourage more symmetry. Between 3 and 6 months of age, the head grows about 1 cm per month*, and this rapid growth can be harnessed within the orthosis to produce rapid change in the desired direction of growth. At this point, the infant is starting to develop more head control and can tolerate the additional 6-8 ounces of weight from the helmet. It is actually the infant's own growth that is the most active part of any orthotic treatment program. The orthosis is specially designed to make total contact in the areas of the skull where growth needs to be curbed, and allow space in the areas where growth is desirable. Between 8-12 months, the skull still grows quickly, but the rate is reduced to 0.5 cm per month*. Between 13-18 months, the rate drops below 0.5 cm per month*, and the skull begins to get thicker. Change is still possible in these older babies, but change is slower and generally requires longer treatment programs.
Are there different kinds of cranial remolding orthoses?
Yes, there are different styles of cranial remolding orthoses. You may see pictures of various designs that are made with different kinds of plastic materials, with or without soft liners, with or without straps, with different colors or patterns, and with or without ventilation holes. Essentially, all cranial remolding orthoses work in a similar manner by directing growth of the infant's head into a more symmetrical or proportionate shape.
Is one style of cranial remolding orthosis better than another?
Currently there are no studies that compare one product to another. The FDA actively regulates the manufacturing process of all cranial remolding orthoses styles, and each design offered by Orthomerica has received FDA clearance. The specific cranial design is selected based on the infant's head shape and the treatment preferences of the orthotist and the referring physician.
Why would my physician refer me to North Texas Regional O&P for a cranial remolding orthosis manufactured by Orthomerica?
There are many reasons why North Texas Regional products are preferred.
What kind of health care professional will be treating my child?
Your pediatrician, neurosurgeon, or craniofacial specialist will prescribe a cranial remolding orthosis for your infant. At North Texas Regional you will be seen by Greg Wimbish L/CPO,an American Board Certified Orthotist who will provide the cranial orthosis and the ongoing treatment program. Orthotists are allied health care professionals specifically trained and educated to provide and manage the provision of custom orthoses (braces).
Greg Wimbish has been providing cranial remolding orthoses for several years. All our health care practitioners maintain high standards of continuing education through national certifying bodies and many have specialized pediatric orthotic experience. As key medical team members, our practitioners bring value to the orthotic treatment program with a strong background in anatomy, biomechanics, material science and patient care. Our practitioners also work closely with other members of the health care team to provide quality orthotic management to ensure that your infant has optimal results.
What is the history of cranial remolding orthoses?
Orthotists and prosthetists have treated children with deformational plagiocephaly since the 1970s. The first article written about the use of cranial remolding orthoses to treat deformational plagiocephaly was written by Drs. Clarren, Smith, and Hanson in 1979 in a study done at the University of Washington. In 1998 the FDA ruled that cranial remolding orthoses fell into the category of Class II medical devices and required strict control standards. In order to continue providing these orthoses, centers had to apply for and receive FDA 510(k) clearance, which is an expensive and labor intensive process. Many orthotists and prosthetists stopped providing cranial remolding orthoses at that time because their design had not gone through the process of being cleared by the FDA. In July 2000, Orthomerica received 510(k) clearance to manufacture and market the STARband.
What is the difference between a casting and scanning procedure?
Each cranial remolding orthosis is a custom product, meaning that each orthosis is specifically made to fit each infant. In order to create such an intimately fitting and effective orthosis, a 3-D model of the patient's head is needed. Currently, there are two means of obtaining this 3-D model 1) a cast impression of the infant's head, or 2) a scan.
The casting process involves laying a series of plaster splints over the infant's head and molding them as they dry. The cast is removed, producing a negative impression of the infant's head. The entire process takes between 15 and 30 minutes. The negative impression is then filled with liquid plaster to produce a positive, 3-D model of the infant's head.
The STARscanner is safe, accurate up to a half millimeter, eliminates the need for casting, and obtains data for a 3-D model of the infant's head in less than two seconds. This type of scan also allows an infinite number of measurements to be taken of the head, and then compared throughout the treatment program.
Once my child is scanned by North Texas Regional, how long will it take to get my child's cranial remolding orthosis?
Once Orthomerica receives the cast impression or scan, the STARband will be shipped to North Texas Regional within 5 working days. Ideally, your child will be fit with a starband cranial remolding orthosis within 08-10 days of the scanning date to assure proper fit and function. Since most insurance companies require approval prior to initiating orthotic treatment, it is important for the family and/or the orthotic facility to obtain this prior approval before casting/scanning the infant. Delays related to insurance coverage can be lengthy and frustrating because success in treatment is time sensitive and can have an impact on treatment results.
How often will my infant need to see the orthotist for follow-up and/or adjustments?
Frequency of follow-up visits usually depends on the severity of the initial head shape, age of the infant, and individual treatment protocols. Typically, the infant is seen at two week intervals for the first two follow-up appointments, after the caregivers are comfortable with the treatment we then go to a two week or longervfollow-up schedule for the duration of treatment. Younger infants may require more frequent follow up appointments since their heads are growing so rapidly.
What kind of adjustments can we expect throughout the course of the treatment program?
Cranial remolding orthoses are designed to make contact over the "high" spots, and leave voids over the "low" spots. This provides "directed growth" of the head. Throughout the course of the treatment program, material (liners) may be removed to allow more growth in targeted areas. Pads may also be added in specific areas to further enhance the symmetrical or proportional growth of the infant's head. In addition, the plastic material may be heated and recontoured as the shape of the head changes. After each adjustment, it will be important to closely monitor your infant's head to make sure that it's adapting well to the adjustments.
How do I clean a starband Cranial Remolding Orthoses?
The cranial orthoses can all be cleaned with 78-99% rubbing alcohol. Wet a soft cloth with the alcohol and vigorously wipe out the entire inside of the orthosis once a day when you remove the orthosis for your baby's bath. This will help prevent bacteria from building up on the inner liner and will reduce the odor that is sometimes present. Make sure the alcohol is completely dry before placing the orthosis back on the baby's head. If you live in a sunny climate, place the band in the sun after cleaning it to help it dry. The baby's head should be washed daily with a mild baby shampoo that will not hurt the eyes. Aveeno shampoo, or Tea tree oil shampoo made by a company called Jason can soothe some scalp irritations that can occassionally occur because of heat buildup and perspiration inside the orthosis.
How should a starband orthosis fit on my baby's head?
During the first two weeks of orthotic treatment, the cranial orthosis may shift around on your baby's head, especially if your baby has a head shape that is asymmetrical. While this may require the caregivers to frequently reposition the band, rotation is not unusual during this early treatment time as the asymmetrical head adjusts to the more symmetrical shape of the cranial orthosis. The orthosis may require an adjustment earlier than your scheduled appointment if the band rotates and blocks vision, rubs against either ear of if you notice skin problems. Contact North Texas Regional with any questions or concerns any time during the treatment process. After two weeks of 23 hour wearing time, any rotation should be minimal.
The Clarren Helmet fits loosely when it is initially fit. Depending on the cast modification process, your child's age, and type of cranial deformity, other types of cranial orthoses may also fit loosely. The orthosis may tip forward while the baby is lying on the back, but it should not impede vision. There is a tendency for orthoses to tip forward more in babies with brachycephalic (very wide and short heads), but this tends to diminish as the head develops more contour in the back. Discuss any concerns about fit with your orthotist (Greg).
Growth spurts can affect the fit of the orthosis between the casting and fitting appointments and at different times during the treatment process. This is particularly true of babies between the ages of 3-6 months since the head is growing about 1 centimeter a month during this period. If this occurs, the orthosis may fit quite snugly at the fitting, and the orthotist may remove material at this appointment to ensure there is adequate room for growth to occur. The orthosis should still fit around the baby's head, allowing one person to apply and remove the orthosis. The child's skin may be pink or even dark pink when you remove the orthosis during the break in period, but any marks should disappear in 60 minutes. At no time should the skin appear tender or blistered. If this occurs, remove the orthosis and schedule an appointment with your orthotist as soon as possible.
If I have questions regarding my infant's orthosis and/or treatment program, whom should I contact?
You should always contact North Texas Regional (Greg will usually provide you with his personal cell phone during treatment) immediately with any questions or concerns you have regarding the orthosis or treatment program. Your practitioner is the only one in a position to answer these types of questions because they have seen and evaluated your infant in person. It is very difficult to assess the fit and function of an orthosis from a photograph, and opinions solicited from other sources cannot be as accurate as those from the health care professional providing treatment.
How long will the cranial remolding orthosis treatment program last?
The average treatment program lasts between three and four months, with younger infants typically completing treatment sooner than older infants. Other factors such as severity of head shape, consistency of wear, and individual growth patterns of the infant affect the length of time for treatment. Your orthotist can best estimate the length of time necessary for completing the treatment program after the first evaluation.
Will my child need more than one cranial remolding orthosis during treatment?
Most cranial remolding treatment programs are completed with a single STARband, STARlight or Clarren Helmet. Only rare and severe(17mm Cranial Vault Asymetry) circumstances should require a second orthosis. North Texas Regional certified orthotists are experienced at adding and removing material to increase the longevity of the orthosis and reduce costs for the caregivers.
When will treatment be discontinued?
Generally, treatment is discontinued when any remaining asymmetry is so mild that it would not require treatment with a cranial remolding orthosis and you are happy with your infant's overall head shape. Greg will be taking specific measurements throughout the treatment process that will track the changes of the head shape. Sean will scan the patient during each scheduled follow-up visits. The follow-up scans will be compared to the initial scan, and the STARscanner software will measure the changes, as well as, symmetry. Once you and Greg agree on the amount of improvement seen, you will return to your referring physician before treatment is discontinued.
How often should I see my referring physician?
Your physician will advise you as to when he/she wants to see the patient during treatment. Many physicians prefer to see the infant after receiving the cranial orthosis, and at the middle and end of the orthotic treatment program.
Will my insurance cover starband cranial remolding orthoses?
Insurance companies and state plans have different criteria for coverage depending on the type of plan and premiums paid. All of these plans require extensive documentation to process the claims including the prescription, letter of medical necessity from the referring physician, proof that repositioning techniques were not successful in correcting the infants head shape. Additional information, such as, specific measurements and clinical photographs may also be required. You should contact your insurance company prior to your first visit with Stellar for evaluation and/or scanning for a cranial remolding orthosis. Ask your insurance company if they cover DME (Durable Medical Equipment) and/or cranial remolding orthoses. Cranial remolding orthoses are custom molded devices and carry a specific billing code of S1040 or an undifferentiated code of L1499 or E1399. If your insurance company says that it covers billing code L0100, tell them that the L0100 code is for a protective helmet, not a remolding orthosis. If your insurance company tells you that "orthotics" are excluded in your policy, ask what type of "orthotics" the policy refers to. Many insurance companies exclude orthotics worn in the shoes to prevent a variety of foot problems and inaccurately generalize the term to include cranial remolding and other types of orthoses.