HomeVA ProstheticsVA Handbook 1173.3 - Amputee Clinic TeamsDefinitions

3.3. Definitions

a. Computer Assisted Design or Computer Assisted Manufacture (CAD/CAM). CAD/CAM is a process of fabricating and fitting artificial limbs using computer aided design and manufacturing techniques.

b. CAD/CAM Host Facility. A CAD/CAM Host Facility is a Prosthetic Referral Center equipped with CAD/CAM technology and designated as a central fabrication center to fabricate sockets for other VA Orthotic Labs.

c. CAD/CAM Remote Facility. A CAD/CAM Remote Facility is a VA Orthotic Laboratory that has CAD/CAM technology and equipment to scan patients and send modem- modified images to a Host Facility for fabrication of socket.

d. VA Orthotic Laboratory. A VA Orthotic Laboratory is a VA facility employing at least one orthotist and/or is prosthetist-equipped to provide custom mobility aids, such as: artificial limbs, orthotic devices, power or manual wheelchairs, and non-custom items like cervical collars, elastic hose, and crutches.

e. Prosthetist or Orthotist. A Prosthetist or Orthotist is an individual trained in mechanics and biomechanics to manufacture and fit custom or non-custom devices, and to assist physicians in prescribing these devices.

f. Preparatory Prosthesis. A preparatory prosthesis is the first limb a new amputee wears. It consists of a plaster or fiberglass cast (applied during or shortly after surgery) and basic components, which are easily removed. It controls swelling and protects the residual limb while allowing minimal (standing, touchdown, weight bearing) ambulation.

g. Temporary Prosthesis. A temporary Prosthesis is an artificial limb designed for the evaluation and training of a new amputee. It consists of a plastic socket attached to modular (alignable) components. Temporary limbs are worn the first few months following amputation until the residual limb has matured. Components are adjusted or changed until optimal function is achieved.

h. Permanent Prosthesis. A permanent prosthesis is an artificial limb used by amputees whose residual limb has matured and the amputee has satisfactorily completed the temporary limb phase. The socket and components are manufactured to provide lasting durability and a proper cosmetic appearance.

i. Exoskeletal Prosthesis. An exoskeletal prosthesis is an artificial limb whose cosmetic and structural components are combined. Wood or plastic is used to provide structural support and is then shaped to resemble the uninvolved side. A laminate is applied to the exterior of the shaped part to provide color and additional strength.

j. Endoskeletal Prosthesis. An endoskeletal prosthesis is an artificial limb whose cosmetic and structural components are separate. Internal components are used to provide structural support and then foam is shaped to resemble the uninvolved side. Cosmetic hose or a "skin" is applied to provide color.

k. Recreational Prosthesis. A recreational prosthesis is an artificial limb that is specifically designed to permit the amputee to participate in a particular activity, e.g., swimming, skiing, running, etc., when a conventional prosthesis is not suitable. These prostheses are constructed in such a manner as to resist environmental conditions and/or external forces which would adversely affect conventional prosthetic designs.

l. Prosthetic Sheath. A prosthetic sheath is a sock-like item made of synthetic materials manufactured in one thickness, which is worn over the residual limb to reduce abrasion.

m. Prosthetic Sock. A prosthetic sock is made of a soft fabric that is applied directly to the residual limb; it acts as an interface between the residual limb and the prosthetic socket. Prosthetic socks are used to provide comfort, absorb perspiration, reduce irritation and re- establish proper fit of the socket. They come in varying thicknesses called ply (usually from one to eight ply) and in varying materials (usually wool, cotton, nylon, or a blend of man-made materials). In addition, prosthetic socks are available with varying thickness of silicone gel impregnated into the fabric.

n. Artificial Limb Contract. An Artificial Limb Contract is a competitively-bid contract locally awarded to preferred providers and used by VA personnel for the purchase of artificial limbs.

o. Non-contract Artificial Limb. A non-contract artificial limb is a commercially available artificial limb, which is not on the current Artificial Limb Contract.

p. Terminal Devices. Terminal devices are artificial hands or hooks designed for use with upper-extremity prostheses.

q. Myoelectric or External-powered Devices. Myoelectric or external-powered devices are upper-limb prostheses that can be operated through use of electrodes contacting the skin or by switches attached to the harness or prosthesis.

r. Microprocessor Knee Units. Microprocessor knee units are on-board microprocessors which control hydraulic fluid flow in the knee joint allowing optimum swing control and, in some prostheses, stance control.

s. Standard Upper-Limb Prosthesis. Standard upper-limb prosthesis is an artificial limb used in partial or complete arm amputation. Components can be endoskeletal or exoskeletal. The prosthesis provides cosmesis, prehension, movement, and function by body movement, usually through a harness and cable system.

t. Centers for Medicare and Medicaid Services (CMS) Lower Extremity Functional Levels. CMS has used a rating scale (K0 to K4) to determine the level of daily activity and ambulation that a patient may achieve on a daily basis. This functionality rating enables the selection of the appropriate componentry for the potential level of the patient. 

(1) K0  Lower-extremity prosthesis functional level 0. The patient does not have the ability or potential ability to ambulate or transfer safely with or without assistance and a prosthesis does not enhance the patient's quality of life or mobility.

(2) K1  Lower-extremity prosthesis functional level 1. The patient has the ability or potential ability to use a prosthesis for transfers or ambulation on level surfaces at a fixed cadence. Typical of the limited and unlimited household ambulator.

(3) K2  Lower-extremity prosthesis functional level 2. The patient has the ability or potential ability for ambulation with the ability to traverse low-level environmental barriers such as curbs, stairs, or uneven surfaces. Typical of the limited community ambulator.

(4) K3  Lower-extremity prosthesis functional level 3. The patient has the ability or potential ability for ambulation with a variable cadence. Typical of the community ambulator who has the ability to transverse most environmental barriers and who may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion.

(5) K4  Lower-extremity prosthesis functional level 4. The patient has the ability or potential ability for prosthetic ambulation that exceeds the basic ambulation skills, and exhibits high-impact, stress, or energy levels, typical of the prosthetic demands of a child, active adult, or athlete.

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