RevoFit Practitioner Education Series
Welcome to the RevoFit Practitioner Education series by Click Medical. We developed
this series to help practitioners learn how to integrate the RevoFit adjustable prosthetic
socket system into their practice. The series is designed to be cumulative in that each
course builds upon the previous. As such we recommend that the courses be taken in
order.
For more information on the RevoFit adjuatable prosthetic socket system please visit
www.ClickMedical.co/revo.
01
Clinical
Considerations
• Identify your patient to match their needs
with the best adjustable socket
• Learn indications and contraindications
for adjustable socket fitting
• Understand design configuration
needs based on the patient evaluation
RevoFit
Education
03
Optimize
Fit & Function
This course covers the basics of how to fine tune
the adjustable socket fit & the function of the
RevoFit system and how to perform regular
maintenance of the RevoFit reels.
Design
Considerations
This course covers the basics of how to configure
a RevoFit socket & communicate important
information to guide the fabrication process.
02
RevoFit
Education
Design
Considerations
This course covers the basics of how to configure
a RevoFit socket & communicate important
information to guide the fabrication process.
02
02 - Design Considerations
for
RevoFit Adjustable Sockets
Introducing the world’s leading adjustable socket solution
Developed by Pam Hale, CPO
Clinical Services, Click Medical
© 2016, Click Medical LLC
About This Course
AGENDA
This course will focus primarily on RevoFit design considerations that come into play when
fabricating your adjustable socket.
In this course we will cover:
Technology Review
Design Considerations
Socket Optimization Review
CLINICAL CONSIDERATIONS LEARNING OBJECTIVES
•Learn what goes into matching your patient's goals and needs with the best design
•Learn the basics of configuring a RevoFit socket
•Communicate important information to guide the technician for fabrication
Design
Considerations
Design Considerations
Designing the RevoFit Adjustable Socket starts with WHY the patient needs it (volume management, suspension, easy
donning/doffing)
Some things to consider:
•Suspension needs
•Clothing issues
•Panel and reel location - approximated to meet the patient’s needs
•Number of reels and zones - different for each patient depending on goals
•Cosmetic finish
•Dial access for the patient
*Reel placement on the posterior or medial aspect of the socket may make the reel more prone to being exposed to
excessive forces during sitting or riding a motorcycle/horse.
Design Considerations
Patient Benefits
•User controlled 1mm micro & macro adjustment for compression and tension
•Easy donning/doffing without the friction of “pushing” through
•Adjustability of the dial through clothing with no need of removal
•Broader range of fit with the adjustable multi panel socket design
•Release for seated comfort all without having to remove the socket
•Easy one handed use with just a simple turn of the socket dial
•Easy to use with impaired strength and/or dexterity
•Target pressure areas by tightening/loosening through the day
Indications
Improved Socket Fit & Function
Volume Management
Suspension Enhancement
Improve Patient Compliance
• A priority for patients
• To decrease or increase the size of the socket
• Available all throughout the day
• Accommodating volume fluctuations
• Providing compressive forces to maintain
total contact fit
• Empowerment through self adjustability
• Minimal effort and disruption of activities
Indications
Volume Management In More Detail
Adjustable socket designs can meet the needs of many
patients.
The RevoFit adjustable socket is indicated for patients who
experience volume fluctuations.
Patients are empowered to adjust their socket as needed
throughout the day or over a longer period of time.
Patients can adjust the socket volume by either
decreasing the socket volume when the residual has
decreased in volume and the socket volume can increase
if more volume is needed for comfort, fit or function.
RevoFit allows for the accommodation of significant
volume fluctuations (up to 10 sock ply!) so the user can
adjust the socket throughout the day or over a longer
period of time as their leg changes in volume.
In summary…
• Daily and chronic volume fluctuations
• Body weight fluctuations
• Muscle expansion
• Diurnal volume fluctuations
• Global or targeted volume fluctuations
• Provides up to 10 sock ply of accommodations for
the patient
Indications
Suspension Enhancement
The RevoFit adjustable socket is indicated when enhanced suspension is
required.
By increasing the tension of the RevoFit system the panels and ”proximal
strap” provide increased compression and help accommodate volume
fluctuations which enhances suspension by maintaining total contact within
the socket.
Rotational Control – targeted compression with pretibial and posterior panels
can aid in controlling rotation within a transtibial socket. Adjustable medial
and lateral panels within a transfemoral socket compression can aid in
controlling rotation.
A Symes door or supracondylar door suspension can be accomplished with a
single panel design and padding on the door can provide increased
compression over a targeted area.
A removable medial brim Supracondylar design can also be constructed as
either a primary or auxiliary suspension method.
When patients require suspension augmentation the RevoFit Adjustable
socket can provide Immediate, specific and targeted adjustability that will
enhance suspension by improving the socket fit.
In summary…
• Compression through increasing the
socket tension
• Volume management through the day
• Rotational control: targeted
compression with pretibial/posterior
panels in TT sockets, and medial/
lateral panels in TF sockets
• Supracondylar suspension through
single panel design and padding on
the door
• Immediate and specific targeted
micro/macro adjustability for the
socket
Indications
Improved Patient Compliance In More Detail
When patients have a need for improved compliance a user adjustable socket can aid
the patient in making adjustments to improve fit and thereby function of the socket
with little effort.
Patients can make large and small adjustments accurately & timely and because they
can make adjustments without removing their socket or clothing and they can make
adjustments without having to stop activity or sit down which is typical behavior for
someone utilizing socks to make fit adjustments. Many times patients will delay sock
ply adjustment because it is inconvenient to stop an activity or they cannot access the
privacy they need in order to make an adjustment.
By creating a socket that is convenient to adjust, patients will make the adjustments
when they are needed and reduce the potential for the detrimental effects of a socket
that is too loose or too tight or not fitting well.
Continued…
Indications
Improved Patient Compliance In More Detail
The RevoFit adjustable socket is indicated when a patient
may have limited dexterity, strength and/or ability to only use
one hand – the RevoFit dial is easily turned and has provides
a 4 to 1 mechanical advantage. The dial can also be modified
in order to meet the patient’s needs.
Offering a socket that can expand for donning and doffing
can reduce excessive shear forces on the residual limb with a
bulbous distal end. Thereby permitting the patient to more
comfortably and completely don their socket.
Many patients spend the majority of their day seated with risk
of dependent edema and or discomfort.
When providing a socket with adjustable movable panels and
straps, patients do not need to remove their sockets to
maintain seated comfort.
And when they are ready to stand and walk they can easily
engage the RevoFit system and then adjust as needed as
they continue to move.
In summary…
•Accurate and timely volume management
•Adjustment without disruption of activities or
removal of clothing
•Don/doff without friction of “pushing” through
•One handed use
•Easy to maneuver with impaired dexterity and/or
strength
•Reduction of excessive shear force on a bulbous
distal end
•Maintenance of seated comfort without removal of
the socket
RevoFit Fabrication Overview
Best Practices
First make sure to sketch out panel location and size and indicate the location of the reel(s) and trim lines. Note: trim lines are
established prior to fabrication in order to identify areas that may be trimmed during fitting.
1. Identify panel location during check socket fitting by placing thin pads inside the
socket at identified locations so the patient can feel where the pads will be
located and to avoid boney or sensitive areas, then draw where the panels should
be located.
2. Take pictures once you have the check socket market for panel and reel location.
3. Take measurements of panel locations and sizes.
*Please look to the next slide to see an illustration of our best practices.
Best Practices
Please review the below illustration to show you best practices.
Suspension Options
RevoFit can be used with most suspension options. Suspension will help optimize the function of the system so it is quite important!
AK
BK
Symes
Suspension
Suction Valve
Pin Lock
Lanyard
Suction Valve
Pin Lock
Lanyard
Sleeve
Supracondylar
PTB Strap
Medial Panel
Lateral Panel
Posterior Panel
Interface
Skin Fit
Locking Liner
Seal-In Liner
Cushion Liner
Locking Liner
Seal-In Liner
Cushion Liner
Foam
Skin Fit
Gel Liner
Note some vacuum systems may not be compatible with a RevoFit Adjustable Socket
Flexible Insert
Length
AK
BK
Symes
Proflex
Proflex
Short/Medium
Blister 3/8” (9.5 mm)
Blister 3/8” (9.5 mm)
Long
Blister ½” (12.7 mm)
Drape 3/16” (4.76 mm)
Drape 3/16” (4.76 mm)
Medium Puff
¼” (6.35 mm)
NOTE: FINISHED THICKNESS OVER ADJUSTABLE AREA 1/8” (3.175 mm) MAX
To Remember…
•Any flexible material may be used
•Insert must be thick and strong enough to allow for movement of the liner when tension is applied and panels are compressed.
•If the liner is too thick or can’t move, the reel will not be able to be turned.
RevoFit Kit Design
AK
KitDesign
BK
Symes
Versa–remotemount
Direct–in-linemount
Versa
Direct
There are two types of RevoFit kits: Versa and Direct.
1. Versa - The filament enters the base of the reel in parallel which allows it to be placed anywhere on the socket
and routed to the area of adjustment. It allows for more versatility and placement options.
2. Direct - The filament enters the base on opposite sides which allows the reel to be placed on a moveable panel or
on the socket frame.
Please refer to the next two slides for more specific illustrations on these two kit types.
RevoFit Kit Types
The RevoFit Versa is designed to
allow the reel to be placed
anywhere on the socket.
RevoFit Kit Types
Here are examples of both
RevoFit Direct and Versa kit
options for multi-panel designs
in a TT socket.
Once you have identified the
panel and reel location, the
correct RevoFit kit can be
identified.
RevoFit Kit Types
Here are examples of the
both RevoFit Versa and
RevoFit Direct options for a
Symes single panel door.
Panel Size Considerations
•Panel size, shape, and position should be identified
•There is no minimum panel size requirement, however a smaller panel will not distribute pressure over a large area and can be
uncomfortable.
•The combined area of the panels should not be any larger than ¼ of the socket circumference.
AK
Size
BK
Symes
Individual panel size Min = None
Combined panels – Max = 1/4 of socket
circumference
Weight Considerations
•RevoFit is most appropriate for patients under 250 pounds. Best practices
suggest a single reel for configuration, however multiple reels can be used for
controlling separate zones if needed.
•RevoFit can be used for patients over 250 pounds but it is highly suggested that it
is made with two systems that control separate zones of the socket so the load is
shared.
The filament is 500# test Spectra lace the filament is very strong however it is
susceptible to wear if it passes over a rough area of lamination.
Transfemoral Applications - adjusting the proximal circumference
When combined with a flexible insert, custom laminated
Transfemoral sockets can incorporate a RevoFit system to
control circumference at the proximal brim.
Some advantages are:
•Ease of donning/doffing by increasing the circumference
and decreasing the resistance of the proximal socket
•Tissue containment by opening the proximal brim during
donning
•Seated comfort
•Comfort throughout the day
•Changes in activity level
Transfemoral Construction Details - proximal strap
For a Transfemoral socket, we usually construct a proximal
strap for volume adjustment.
Here are a few things to consider regarding this:
•You need to choose the location of the reel
•The most typical choice of location is proximally but they can
also be mounted distally
•Where the proximal trim lines are located and how much
adjustability is needed
•Be careful not to trim too closely to the reel or tubing
•Make sure to keep the trim line within no less than ½” of the
tubing or reel structural integrity
Transfemoral Construction Details - adjustable panels
Easily add a second zone that includes adjustable panels. Panels are located where the
patient may require increased compression for a improved fit and function by
accommodating volume fluctuations or need for a ”boney lock”.
Considerations:
•Number, location, and size of the panels
•Locate panels where patient may require increased
compression for improved fit and function
•Choose location of the second reel. We mostly
locate them proximally but they can also be
mounted distally.
Transtibial Applications
Transtibial sockets utilizing the RevoFit system are typically are fabricated with multiple panels. The position, size and shape of the
panels can address patient needs including volume management, rotation control and donning/doffing difficulties.
Patient Benefits:
•Adjustable moveable panels help manage volume fluctuations
•Expanding the socket volume and decreasing resistance eases
donning/doffing
•Rotation of the limb applies compression AND create a boney
lock within the system
•Manage both global and targeted weight changes from
edema or muscle expansion
Transtibial Construction Details - panels
When using multiple panels (most typically two anterior panels and one
posterior panel), there are considerations to remember:
•You can choose the combination of number of panels you prefer for
your patient
•You will need to choose the location of these panels, their size and
their shape
•You can use thin pads during the check socket phase to evaluate for
size and placement
Remember:
*1 posterior panel for muscle expansion of the calf
*2 anterior panels for creating rotation control
*3 posterior panels work to ease don/doff & the two anterior panels to
manage volume
Transtibial Construction Details - reel number
How many reels do you need?
•Reel Number is determined by how you would like the panels to function and the
patient’s weight.
•If you want to control panels individually you would need a reel for each panel. If
you want the panels to engage together you could use a single reel connected to
the panels.
•Remember that the first panel attached to the reel will move first when the dial is
turned. Also, if the filament attached at the proximal section of the panel – the
proximal section will move first.
•If using the Click Medical RevoFit Order Form please upload pictures of your check
socket or plaster model with location of reels with measurements indicated.
Otherwise provide technical staff with the photos and sketched design on the check
socket or negative or positive model.
Transtibial Construction Details - reel location
When choosing the reel location, consider the following:
•You can mount the reel on the adjustable panels OR on the socket frame
•Panel mounting allows for easier don/doff because the reel acts like a
handle to pull open the adjustable panels.
•A frame mount allows one to place the reel in either a hidden location
(for decreased reel profile) or mounted distally (for easy access by the
patient)
Transtibial Construction Details - panel mounting
Choose where you want the reel mounted:
You can either mounted the reel on
the adjustable panels or on the socket frame. Panel Mounting allows for easier don/doff
because the reel acts like a handle to pull open
the adjustable panels.
Transtibial Construction Details - frame mounting
A Frame mount, allows one to place
the reel in either a hidden location
(for decreasing profile of the reel)
or mounted distally, or proximally
on the socket for easy access by the
patient.
Transtibial Construction Details - reel location in summary
If you cannot determine where to locate your reel, work with your technician to
determine best placement.
Symes Applications
RevoFit Solutions for a single panel “door”
The RevoFit Solution for a “door” always uses
a single-panel design. It is great for managing:
•Donning and doffing with use of a flexible insert
•Accommodation of the bulbous distal end
•Suspension
•Volume management
•Rotation control
Symes Applications - panel design
Considerations for your panel design:
•For a Symes socket, we typically utilize 1 moveable panel. It
can be placed laterally, medially, or posteriorly.
•You will need to choose the location of the panels, it’s size,
and shape.
•Indicate whether you would like the RevoFit reel to be located
on the socket frame, or on the adjustable panel.
Longer Panel Schematics
•When a longer panel is
necessary, too many crossings of
the filament through the panel will
result in increased friction.
•Moving the panel as needed with
the least amount of crossings
means less friction
The goal of filament routing is to reduce
friction!
Unique Panel Shape & Placement Schematics
•The advantage of the RevoFit Adjustable
Socket is that the design and fabrication
are custom utilizing the same processes
and materials typically used to fabricate
prosthetic sockets.
•Not all panels are the same size or shape.
•Panels and filament paths should be
designed around the patient need and/or
residual limb shape – taking the
practitioner and patient recommendations
the technician will finish based on the
overall function of the system.
• Understand d
needs based
Re
Educ
Next Steps
Here are the next steps you can take when using adjustable sockets for your
patients.
•Identify patient
•Design RevoFit Adjustable Socket
•Fabricate
•Optimize fit and function
•Instruct patient
**Instructing your patient is vital. Knowledge is power!**
03
Optimize
Fit & Function
This course covers the basics of how to fine tune
the adjustable socket fit & the function of the
RevoFit system and how to perform regular
maintenance of the RevoFit reels.
Take the next course:
Optimize Fit & Function