Stretch Beyond Your Expectations.

Stretch Beyond Your Expectations.
®
Extension and Flexion Dynasplint Systems for the MTP
®
MTP Extension
w/Optional Shoe
mtp
M em ories of d raw ing p ictu res in the
sand w ith ou r toes, d ip p ing ou r feet in a
cold stream or ju st taking a b risk w alk
all b ring a sm ile to ou r faces. B u t for
those w ith stiff and lim ited range of m otion in the great toe, sim p ly p u tting on a
shoe can b e an u nhap p y task.
D ynasp lint S ystem s, Inc. d ev elop ed
the M etatarsop halangeal (M TP ) E x tension and F lex ion S ystem s to restore lost
range of m otion d u e to inju r y, trau m a,
su rger y or d isease. M ost com m only,
the M TP D ynasp lint ® S ystem s are u sed
after b u nionectom y or arthrop lasty su rgeries, b u t are also u sed for non-su rgical
hallu x lim itu s. A s w ith all D ynasp lint ®
S ystem s, the M TP S ystem s ap p ly a
low -load , p rolonged -d u ration stretch
(L L P S ) d irectly across the joint ax is.
They are fu lly ad ju stab le, com fortab le
and conv eniently lab eled for easy u se.
L L P S has b een u sed su ccessfu lly for
m ore than 5 0 years to treat joint stiffness and lim ited range of m otion cau sed
b y shortened connectiv e tissu e. The
sp ring-load ed D ynasp lint ® S ystem s constantly seek the p atient’s av ailab le end
range of m otion and continu e to gently
stretch the joint. D ynasp lint ® S ystem s’
technology ap p lies L L P S to p erm anently
lengthen soft tissu e u sing the p rincip le
of TE R T ( Total E nd R ange Tim e).
D ynasp lint ® S ystem s can b e u sed alone
or as an ad ju nct to p hysical therap y.
E arly ap p lication can d ram atically red u ce
tim e and cost associated w ith range of
m otion rehab ilitation— in m any cases b y
m ore than 5 0 p ercent.1
HOW TO ORDER DYNASPLINT SYSTEMS:
®
STEP 1. Call ou r toll-free nu m b er* and ask for you r local sales consu ltant
STEP 2. F ax * the follow ing inform ation:
P atient inform ation
Insu rance inform ation (inclu d e cop y of insu rance card )
R x and / or Certificate of M ed ical N ecessity (CM N )
M ost recent chart notes
*see rev erse sid e
Stretch Beyond Your Expectations.®
“Dynasplint Systems have been
®
shown to be signif icantly effective
in restoring postoperative range of
motion following hallux valgus
(bunion) surgery and in the treatment of chronic plantar fasciitis
and heel pain. Clinical studies have
been performed and have demonstrated a 53% average reduction in
rehabilitation time with the use of
Dynasplint Systems.”
®
- Darren J. Courtright, DPM
Shoreline Foot Health Center, PC
New London, CT
F EATU RES AND B ENEF ITS
- L L P S (L ow -L oad , P rolonged -D u ration S tretch) technology
has b een p rov en to su ccessfu lly treat joint stiffness and
lim ited range of m otion
- E arly ap p lication can red u ce tim e and cost associated w ith
range of m otion rehab ilitation
- S im p le, ad ju stab le and rep rod u cib le b ilateral tensioning system
- A v ailab le for rent or p u rchase
- O p tional shoe av ailab le
- B iom echanically correct
- Com fortab le to w ear
- E ach D ynasp lint ® S ystem is recycled to red u ce w aste and
help the env ironm ent
- A D ynasp lint ® S ystem s consu ltant w ill fit you r p atients and
ov ersee their treatm ent to ensu re the b est p ossib le resu lts
- O v er a q u arter of a m illion p atients hav e b een su ccessfu lly
treated w ith D ynasp lint ® S ystem s
- Conv eniently lab eled and easy to u se
ROM REHAB TIME AND C OST REDU C TION
53% avg reduction in
Ther apy + D y nasplint
®
time and cost associated
with ROM rehabilitation
MTP Extension w/Optional Shoe
Ther apy A lone
C OMMON
DIAG NOSES
B u nionectom y
H allu x lim itu s
Tend on and ligam ent
rep airs
Toe im p lants
R heu m atoid arthritis
A rthrop lasty
Clinical stu d ies hav e show n
that early incorp oration of
D ynasp lint ® S ystem s into a
p atient’s treatm ent regim en
can d ram atically d ecrease
tim e and cost associated
w ith range of m otion rehab ilitation— in m any cases
b y m ore than 5 0 p ercent.1
U sed as an ad ju nct to occu p ational and p hysical therap y,
D ynasp lint ® S ystem s hav e
b een p rov en to significantly
im p rov e p atient ou tcom es.2
R OM R ehab ilitation TIME and C OST
MEASU REMENTS
MTP F lexion
MTP Extension
MTP F lexion
Adult
Adult
1. Hepburn GR, et al: Multi-Center Clinical Investigation on the Effect
of Incorporating Dynasplint Treatment into Standard Physical
Therapy Practice for Restoring Range of Motion of Elbows and
Knees, presented at the New York State APTA Chapter Meeting,
New York, NY, April 26, 1985.
Weight
1 lb 6 .4 0 oz / 0 .6 4 kg
1 lb 7 .20 oz / 0 .6 6 kg
2. Hepburn GR: Case Studies: Contracture and Stiff Joint Management
with Dynasplint. The Journal of Or thopaedic and Spor ts Physical
Therapy, Vol 8, No 10: 498-504, April 1987.
Weight w/Shoe
S m all: 1 lb 14 .4 0 oz / 0 .8 6 kg
L arge: 2 lb / 0 .9 1 kg
S m all: 1 lb 14 .4 0 oz / 0 .8 6 kg
L arge: 2 lb / 0 .9 1 kg
Flowers KR, LaStayo P: Effect of Total End Range Time on
Improving Passive Range of Motion. Journal of Hand Therapy,
pp 150 -157, July-September 1994.
Range of Length
5 .7 5 – 6 .7 5 in / 14 .6 1 – 17 .15 cm
5 .7 5 – 6 .7 5 in / 14 .6 1 – 17 .15 cm
McClure PW, Blackburn LG, Dusold C: The Use of Splints in the
Treatment of Joint Stiffness: Biologic Rationale and an Algorithm for
Making Clinical Decisions. Physical Therapy, Vol 74, No 12: 1101-1107,
December 1994.
Unit Width
4 .0 in / 10 .16 cm
4 .0 in / 10 .16 cm
Range of Motion
0 ˚ neu tral to 9 0 ˚ ex tension
0 ˚ neu tral to 9 0 ˚ flex ion
C orporate H eadq uarters:
8 0 0 .6 3 8 .6 7 7 1 toll-free
8 0 0 .3 8 0 .3 7 8 4 fax
C anada:
www.d y n a s p lin t.c o m
8 0 0 .6 6 8 .9 13 9 toll-free
9 0 5 .9 4 0 .4 7 24 fax
Stretch Beyond Your Expectations.®
DYNASPL INT ® and Dynasplint ® Systems are a registered trademark of Dynasplint Systems, Inc.
CERTIFICATE OF MEDICAL NECESSITY – ANK LE & FOOT
Corporate Headquarters: 770 Ritchie Highway, Suite W-21 Severna Park, MD 21146
Phone: 800.638.6771 / 410.544.9530 www.dynasplint.com
DIAGNOSIS
OTHER
INFO
ACCESSORY
ITEM(S)
DYNASPLINT® SYSTEM(S)
PRESCRIB ED
PATIENT
INFORMATION
D y n asp lin t® S y stems aid in resto rin g p h y sic al fu n c tio n to p atien ts w ith jo in t stiffn ess an d limited ran g e o f mo tio n . T h e k ey to its effec tiv en ess is th e lo w -lo ad , p ro lo n g ed -d u ratio n stretc h (LLP S ) th at d eliv ers a c o rrec t b io lo g ic al stimu lu s to c reate a p erman en t len g th c h an g e in
sh o rten ed c o n n ec tiv e tissu e. D y n asp lin t® S y stems h av e b een c lin ic ally p ro v en to red u c e time an d c o st asso c iated w ith ran g e o f mo tio n
reh ab ilitatio n – in man y c ases b y mo re th an 5 0 p erc en t.
First Name
D ate o f B irth
Last Name
D ate o f O n set/ S u rg ery / In ju ry
F
S tart D ate o f O rd er (MM/ D D / Y Y )
SELECT DEV ICE(S)
SELECT J OINT(S)
rMT P D y n asp lin t®
rMT P D y n asp lin t® w / S h o e
rH allu x V aru s D y n asp lin t®
rH ammer T o e D y n asp lin t®
rA n k le D y n asp lin t®
rA n k le D y n asp lin t® w / S h o e
r1 st MP J
r2 n d MP J
r3 rd MP J
r4 th MP J
r5 th MP J
rA n k le
SELECT DIRECTION(S)
SELECT TYPE(S)
rD o rsiflex io n
rP lan tar Flex io n
rA d d u c tio n
rIn fan t
rP ed iatric
rY o u th
rA d u lt
rNeu ro lo g ic al
rE x tern al Fix ato r
arc o ® S h o e (fo r u se w ith A n k le D y n asp lin t® S y stem)
rO
SELECT SIDE(S)
rR ig h t Limb
r Left Limb
r B ilateral
ACCESSORY ITEMS
rMP O
rD
2 0 0 0 ® A c tiv e C o n tro l B o o t
th er:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
SPECIAL FITTING INSTRU CTIONS:
rJ o in t Imp lan t
rB u n io n ec to my
rC h eilec to my
rH allu x V aru s
rH allu x V alg u s
rJ o in t C o n trac tu re
rA c h illes T en d o n itis
rR ear Fo o t C o n stru c tio n
rO th er_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
rH ammer T o e
rP lan tar Fasc iitis
rH eel S p u r
CU RRENT
ROM
M
GOAL
O th er
D o rsiflex io n
FAX TO
PHYSICIAN INFORMATION & SIGNATU RE
LENGTH
OF NEED
P lan tar Flex io n
1 Mo n th
3 Mo n th s
6 Mo n th s
Lifetime
P h y sic ian ’s Name [P lease P rin t]
P h o n e Nu mb er
NP I/ U P IN Nu mb er
Fax Nu mb er
S treet A d d ress
O th er:
C ity
S tate
Z ip C o d e
NO SUBSTITUTIONS ALLOWED – In my o p in io n , in ac c o rd an c e w ith ac c ep ted med ic al p rac tic e stan d ard s, th e ab o v e n amed p atien t req u ires th e
ex ac t D y n asp lin t® S y stem(s) as d isp en sed b y D y n asp lin t S y stems, In c ., fo r th e d iag n o sis in d ic ated .
P h y sic ian ’s S ig n atu re
T h is fo rm is n eed ed to b ill th e
p atien t’s in su ran c e. P lease
c o mp lete an d retu rn .
SALES CONSU LTANT
D ate
PHONE
Stretch Beyond Your Expectations.®
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