CO cheat sheet

Assessment sequence: history → physical/visual inspection → measurement → vascular and neurologic screening → functional/goal interview → documentation.

Perfusion indicators: capillary refill ≤2 s, palpable distal pulses, warm skin, and absence of dependent rubor suggest adequate arterial inflow.

Ankle-brachial index (ABI) = ankle systolic pressure ÷ brachial systolic pressure; values below 0.90 suggest peripheral arterial disease and warrant vascular referral.

Absolute contraindication to compression or rigid interface: uncompensated congestive heart failure, active deep vein thrombosis, or wet gangrene.

Residual limb length is measured from a documented bony landmark (e.g., tibial tuberosity or ischial tuberosity) to the distal end, recorded in cm.

Volume and shape change is expected in the first 12–18 months post-amputation; measure circumferences at fixed intervals from the landmark to detect trends.

Sensation screening: monofilament testing at multiple sites; absent protective sensation increases skin breakdown risk under the interface.

Contralateral limb assessment includes pulses, skin integrity, deformity, and weight-bearing tolerance, because it often bears increased load.

Plan components: prosthetic/orthotic goals, component selection, wear schedule, training milestones, expected outcome measures, and review dates.

Medicare functional classification (K0–K4) drives component eligibility: K1 household ambulation, K2 limited community, K3 community with variable cadence, K4 high-impact/high-energy.

K-level assignment requires documented mobility evidence; a higher-function component is justified only when the record supports the predicted function.

Goals should be written as measurable outcomes (e.g., distance walked, surface negotiated, independence level) with target dates.

Reimbursement requires a written order and, for many codes, physician documentation of the functional need and medical necessity.

Team roles: physician establishes diagnosis and order; prosthetist/orthotist designs and fits; therapist trains; patient/caregiver consents and adheres.

Plan must address the contralateral limb, skin condition, and fall risk, not just the device itself.

Reassess the plan when the patient's K-level, weight, or activity changes materially.

Capture shape at the correct volume: measure circumferences at defined intervals before casting or scanning to establish the reference record.

Negative model options: plaster wrap cast, hand-cast with modification, or digital scan; digital scans must be checked for artifact and completeness before export.

Cast/scan orientation landmarks (e.g., patellar tendon, tibial crest, ischial tuberosity) must be marked and transferred to the positive model.

Rectification principles: relieve pressure-sensitive areas, build up load-tolerant areas, and maintain total contact where indicated.

Alignment references for transtibial: 5–7° of flexion built into the socket, with the foot positioned to allow a smooth rollover.

For transfemoral, note the ischial containment or subischial design choice and record the M-L and A-P dimensions of the residual limb.

Measure and document all dimensions in the same units and at the same time of day to reduce volume-related variance.

Every modification made to the positive model should be recorded so the design can be reproduced.

Lamination lay-up order affects strength and weight; record resin, reinforcement type, and number of layers.

Thermoplastic sockets are vacuum-formed over the rectified model; check for webbing, thinning, and correct trim lines.

Trim lines determine relief and suspension: proximal trim should clear bony prominences and permit knee flexion without pinching.

Component alignment (bench alignment) precedes dynamic alignment; record bench angles and component selection.

Fastener torque values and thread-locking methods should follow manufacturer specifications and be documented.

Check for delamination, voids, or sharp edges before delivery; these are fabrication defects, not fitting issues.

Suspension assembly (pin/lock, suction, sleeve, or belt) must be verified for seal integrity and ease of donning.

Record lot/serial numbers of components for traceability and warranty claims.

Static fitting checks: total contact, no distal gap or excessive distal pressure, correct suspension, and tolerable pressure at bony prominences.

Dynamic alignment checks gait: observe heel strike, midstance stability, toe-off, and swing clearance; adjust for deviation observed.

Delivery documentation includes device description, components, wear schedule, care instructions, and patient/caregiver training provided.

Donning/doffing training should be demonstrated and then performed by the patient before discharge.

Skin inspection education: check residual limb daily, especially at pressure points; report redness that persists after 20–30 minutes of rest.

Sock/liner management: prescribed ply changes, laundering schedule, and rotation of liners to manage perspiration.

Wear schedule should be graduated: short intervals initially, increasing as tolerance is demonstrated.

Provide written contact information and instructions for reporting problems or seeking urgent care.

Follow-up intervals: early (days to weeks) for fit and skin checks, then periodic reviews; shorter intervals for new amputees or high-risk skin.

Outcome measures should be objective and repeatable: timed walking tests, functional mobility scales, and patient-reported measures.

Compare outcomes to baseline and to the goals set in the treatment plan; document deviations and actions taken.

Maintenance schedule: inspect suspension, liners, feet, and fasteners; replace worn liners per manufacturer guidance.

Signs requiring immediate evaluation: skin breakdown, unstable fit, sudden change in limb volume, or component failure.

Record adjustments made at each visit so trends in fit and function are traceable.

Re-evaluate K-level and component appropriateness when function changes; document the rationale for any change.

Repair vs. replace decisions should consider device age, warranty status, and functional need.

Scope of practice: perform only services within your licensure/certification and refer when outside that scope.

Informed consent: explain benefits, risks, alternatives, and costs before fitting; document the discussion.

Confidentiality: protected health information is shared only as permitted by law or with patient authorization.

Billing integrity: code for the device actually delivered and documented; upcoding or unbundling without justification is fraud.

Conflict of interest: disclose financial relationships that could influence device recommendations.

Record-keeping: contemporaneous, legible, and complete documentation supports care continuity and defensibility.

Patient rights include access to records, the ability to refuse treatment, and the right to a second opinion.

Professional standards require competence maintenance through continuing education and adherence to published clinical guidelines.