What WorkSafe will pay for
The WorkSafe Agent (the Agent) can pay the reasonable costs of equipment and related services as a result of a work-related injury or illness under Victorian workers compensation legislation.
The Agent may periodically review a worker's ongoing entitlement to equipment to ensure that it continues to promote recovery and/or function following a work-related injury or illness and is reasonable and appropriate in the circumstances. This policy must be read in conjunction with the following documents:
- WorkSafe Equipment List.
In this policy:
- Health professional refers to a registered medical practitioner or allied health professional who uses their expertise to recommend and clinically justify the most appropriate equipment to maximise a worker's rehabilitation or medical function.
- Supplier refers to a manufacturer or retailer that provides equipment and related services to a worker.
- The WorkSafe contracted supplier equipment list is a guide to equipment available through WorkSafe's contracted suppliers. The list is a resource for treating health professionals to use when recommending equipment.
- The WorkSafe equipment purchasing team source non-contracted, specialised and/or custom made equipment for workers through non-contracted suppliers.
- The Community Integration Program (CIP) is an initiative that provides specialist care for eligible catastrophically injured workers in partnership with the Transport Accident Commission (TAC). Eligible workers are defined as those who have an accepted claim for compensation for a spinal injury resulting in quadriplegia/paraplegia or an acquired brain injury rated as severe or moderately severe.
What can the Agent pay for in relation to equipment?
The Agent can pay the reasonable costs of supply (purchase/hire), delivery and installation of equipment where:
- required as a result of a work-related injury or illness
- there is clinical justification that the equipment will measurably improve a worker's:
- level of pain or discomfort
- community involvement (through vocational, educational or leisure activities)
Who can request equipment?
The Agent can pay the reasonable costs of equipment when requested by a registered medical practitioner or health professional with relevant expertise. Depending on the type of equipment, a range of medical practitioners and health professionals may be able to request certain items. Refer to the sections on specific equipment categories below for information about which items medical practitioners and health professionals can request.
Supply of equipment
Equipment can be obtained from a range of suppliers through WorkSafe, private and public hospitals, medical practitioners or other health professionals, depending on the type of equipment and the worker's circumstances.
Standard items are provided by WorkSafe's contracted equipment suppliers and are included in the contracted supplier equipment list. Where equipment items are to be provided by non-contracted suppliers (including customised or specialised items) these must be organised via the equipment purchasing team. In certain circumstances equipment can also be supplied public hospitals, private hospitals or health professionals.
Bed fees paid in Victorian public hospitals cover the cost of aids and equipment, including surgical supplies, provided to a worker whilst an inpatient.
Victorian public hospitals are responsible for the provision of aids, equipment and domiciliary oxygen free of charge (no deposits or hire fees) to facilitate a safe and effective transition for a period of 30 days post-discharge from hospital following an acute, subacute or rehabilitation admission.
In the event that a worker requires equipment of a non-reusable nature, WorkSafe expects that these items are purchased by the hospital and not provided on a hire basis.
Following the initial 30 days after discharge, WorkSafe is responsible for providing aids and equipment that are reasonable and/or necessary for the worker's work-related injury or illness once a claim is accepted.
Victorian public hospitals must contact the Agent to determine whether the Agent will organise alternative provision of the hired aids and equipment or whether the current hire arrangements will continue. Equipment hires or purchases required after the first 30 days post-discharge can be organised through the WorkSafe contracted equipment suppliers and/or the Equipment Purchasing Team.
Bed fees paid in private hospitals cover the cost of aids and equipment provided to a worker whilst an inpatient. Theatre fees cover the costs of surgical supplies provided during operating room procedures. Refer to the Private Hospitals Policy.
For equipment up to $500 required for inpatient discharge or where the worker has only received outpatient services, private hospitals can order directly from the WorkSafe contracted supplier and send the invoice to the Agent.
A list of approved equipment can be found on the Hospital Direct Order form (up to $500). Standard items not on the Hospital Direct Order Form or on the approval items list require written clinical justification and should be ordered from the WorkSafe Contracted Supplier Equipment List.
Workers must have an accepted claim before orders can be made by private hospitals.
Equipment items up to $200 can be sourced from the small stock items list (see below).
For equipment up to $200 on the small stock items list (below) health professionals can order directly from the supplier and send the invoice to the Agent.
This list has been developed to allow workers to quickly access items that may assist them to recover from their work-related injury or illness by:
- stabilising the injury
- assisting with self-management
- allowing the worker to perform activities of daily living more independently.
In relation to the supply of these items, please note the following:
- The Agent accepts that the reasonable costs of these items is the recommended retail price
- The Agent expects that health professionals will not invoice for consumables (ie. tape, ultrasound gel, dry needles, wax therapy) used as a part of in-rooms treatment - the approved items are intended to be supplied for the worker to take home to assist with the management of their work-related injury or illness
- The Agent will undertake periodic reviews of invoicing patterns of providers and may audit providers from time to time to ensure supply of these items is clinically justified.
Small stock items list
The following items can be supplied to workers by either private hospitals (for inpatient discharge and outpatients only) or health professionals, without prior approval from the Agent. Small stock items have a cost price of up to $200 per item and include:
- taping (zinc oxide, Fixomull, strapping etc)
- bandages (compression, Tubigrip, gauze products, etc)
- oedema control and dressing bandages
- thermal supports, pressure garments and gloves
- soft collars
- lumbar rolls
- braces and splints
- hand putty/Theraputty, Digi-flex, exercise foam, Thera-band, etc
- walking aids (sticks, crutches, etc)
- triangular slings
- ice packs, heat packs,
- Hibitane, Iso-wipes, Skin-prep, applicators, etc
- adaptive cutlery
- dressing aids
- pick-up sticks
- hand weights up to 3kg
- silicone gel sheeting (one 10x13cm sheet only) or in equivalent liquid form
Please note that the small stock item list differs from the small stock category on the WorkSafe Hospital Equipment List, which deals with supply of equipment within the inpatient stay.
The Agent can pay the reasonable costs of maintenance for some high cost equipment items paid for by the Agent such as:
- electric adjustable medical beds
- alternating air mattresses
- wheelchairs (powered, manual and tilt is space)
- electric scooters
- room temperature control units
- electric ceiling or standing hoists
- commodes (shower or transporter varieties)
- feed pumps.
Repairs and replacement
The Agent can pay the reasonable costs of repairs and replacement to equipment purchased directly by the WorkSafe equipment purchasing team or the WorkSafe Agent arising from normal wear and tear. The Agent can fund modifications to equipment where the equipment is adaptive or disability-specific (for example wheelchairs, commodes, electric scooters).
It is expected that equipment either partially or entirely paid for by WorkSafe is used in a responsible manner consistent with its intended use. Equipment should be maintained appropriately, stored responsibly and in no way wilfully damaged.
Workers should take out an appropriate level of insurance at their own cost.
Pre-approved repair order (PARO)
PARO is a service where a pre-determined number and reasonable cost of repairs is pre-approved by WorkSafe for high-cost equipment. This minimises the administration required and enables responsive servicing where:
- the worker's mobility or safety is at risk and/or
- the equipment requires servicing or repair to be operable
The worker is able to contact the equipment supplier directly and arrange repairs.
WorkSafe PARO only applies to high-cost equipment purchased directly by the WorkSafe equipment purchasing team or the WorkSafe Agent.
From 1 October 2018, a PARO will be established for all high-cost equipment listed in the categories below. This excludes any repairs done under warranty periods or conditions.
What repairs are covered by the PARO?
PARO can only be arranged for the following high cost equipment:
- electric beds
- alternating air/pressure care mattresses
- wheelchairs (powered and manual)
- powered scooters
- room temperature control units
- electric hoists
- feed pumps
- respiratory – ventilator and suction units
- repairs up to the value of $1000 per repair
- 2 repairs per year for the first 2 years of the life of the equipment, and
- 3 repairs per year for every year after that.
PARO will be set up initially for a 3-year period, then be reviewed and extended if required.
If the cost of the repair exceeds $1000 or is greater than the number of services pre-approved for that time period, then the equipment supplier will be required to submit a quote to the WorkSafe agent or the WorkSafe equipment purchasing team for approval prior to undertaking any works.
Urgent after-hours repairs
If an urgent repair of Agent-paid equipment is required outside business hours, and PARO has not been set up with the worker, a worker can request repair services up to $1000 from one of the contracted equipment suppliers, and send the invoice to the Agent.
A repair is urgent when the worker's mobility or safety is at risk and the equipment requires servicing to be operable. The following types of equipment are eligible for urgent repair:
- electric beds
- alternating air/pressure care mattresses
- wheelchairs (powered and manual )
- powered scooters
- room temperature control units
- electric hoists
- feed pumps
- respiratory – ventilator and suction units
A worker will be required to contribute to the cost of equipment where:
- the worker selects equipment that is more expensive than a suitable standard model
- the equipment would be required regardless of the work-related injury or illness
- the equipment is only partially related to a worker's work-related injury or illness.
What information does the Agent require to consider paying for equipment?
Equipment that is not listed on the Hospital Direct Order Form or included on the small stock items list (above) requires written clinical justification from a worker's treating medical practitioner or therapist. The request should include:
- a summary of the worker's injuries and equipment needs
- the relationship between the equipment and work-related injury or illness
- details of the specific item, function and intended use
- the duration and expected use of the equipment
- the costs of the equipment.
Where the Agent has accepted that payment of standard equipment items is reasonable, it is expected that the items will be ordered from the WorkSafe Contracted Supplier Equipment List. Written clinical justification is required if an equivalent item is being requested from an alternative supplier.
For certain high cost or customised equipment items (manual and powered wheelchairs, pressure cushions, powered conversion kits, scooters, hoists, medical beds and related items, standing frames, tilt tables, custom toilet/shower/commode chairs and mainstream multifunction technology; the Equipment Prescription Form must be completed and submitted.
It is expected that trials of items from the Equipment List (if available) will occur before recommending an equivalent item from an alternative supplier.
Health professionals will only be paid for completing the Equipment Prescription Form for these items.
Please note: for workers who are part of the Community Integration Program the request, approval and submission of equipment requests under $1000 (with the exception of mainstream multifunction technology requests) may form part of the independence planning process.
When will the Agent respond to a request?
Upon receipt of the required information, the Agent will advise within 10 working days whether:
- the request has been approved
- the request has been denied, or
- further information is required to make a decision.
Where further information is required, the Agent will advise whether the request has been approved or denied within 10 working days of receiving the additional information.
For urgent equipment and related services, the Agent will respond promptly to ensure that, where payment of equipment is accepted as reasonable, the equipment will be supplied within the following timeframes from receipt of the request:
- Level 1: within 8 business hours – the worker's mobility or safety is at risk requiring urgent equipment service or supply (for example respiratory or mobility items)
- Level 2: 8-16 business hours – the worker's mobility, hygiene or pain management is compromised but there is no risk
- Level 3: 3-10 business days – a non-customised equipment item is required to enhance a worker's rehabilitation or independence
- Level 4: customised (delivery by notification) – the equipment item requires customisation to suit the worker's needs, for example particular specifications or enhancements.
In relation to equipment, what won't the Agent pay for?
The Agent will not pay for:
- treatment or services for a person other than the worker
- equipment required for a pre-existing condition or that is not related to the worker's work-related injury or illness
- equipment items provided to an in-patient as part of a hospital bed fee- refer to the Private Hospitals Policy
- equipment which provides no clear benefit to the worker
- insurance to cover equipment paid for by the Agent
- fees associated with non-attendance at consultations or fittings
- treatment or services provided by telephone or other non face to face mediums
- treatment, services, prostheses or equipment where there is no National Health and Medical Research Council level 1 or 2 evidence that the treatment, service, prostheses or equipment is safe and effective- refer to the Non-Established, New or Experimental Treatments and Services policy
- treatment or services provided outside the Commonwealth of Australia without prior written approval from the Agent.
Specific equipment items
Please see below for further information about these specific equipment items.
- beds and mattresses
- clothing, including compression garments
- life support equipment
- mainstream multifunction technology (MMT)
- personal alarms and monitoring services
- room temperature control
- sport and recreation
This information applies in addition to the policy guidelines above.:
Beds and mattresses
The Agent can pay the reasonable costs of medical beds and related items.
- adjustable beds
- specialist or pressure care mattresses
- pressure care overlays
- moving or positioning supports.
A medical bed is a bed (usually with side rails) that can be adjusted to raise the head, foot or middle as required.
There is currently no conclusive National Health and Medical Research Council level 1 or 2 evidence to show that sleeping on a particular type of bed or mattress can help back pain compared to other mattress types. Refer to the Non-established, New or Emerging Treatments and Services Policy.
Mattresses are generally considered a normal household item and therefore will not usually be paid for.
Requests for a contribution towards a mattress will only be considered in exceptional circumstances and as a once only capped contribution.
Any Agent contribution will be capped and determined after considering the following factors:
- The extent to which the mattress is necessary to manage the worker's work-related injury or illness beyond the ordinary requirements of an average person.
- The age and condition of the worker's current mattress. The Agent will not contribute to the cost of a mattress where the worker's mattress is of an age or condition where it would have reasonably required replacement irrespective of the work-related illness or injury.
- The size of a worker's current mattress. The Agent will only contribute towards a mattress that is the same size as the pre accident/injury mattress and will also take into consideration the worker's work-related injury or illness needs.
- Whether the worker requires the recommended mattress due to a pre-existing condition.
Mattress Capped contribution payments
|Item description Double||Maximum payment rate Up to $1900 for 100% contribution or pro-rata % based on age of existing mattress|
|Item description Queen||Maximum payment rate Up to $2100 for 100% contribution or pro-rata % based on age of existing mattress|
|Item description King||Maximum payment rate Up to $2600 for 100% contribution or pro-rata % based on age of existing mattress|
In relation to mattresses, the Agent will not pay for:
- new items where a worker's existing mattress will support their work-related injury or illness
- anything other than standard basic models
- waterbeds or waterbed heaters
- antique bed replacements or repairs
- linen or bedding
Clothing: including compression garments
The Agent can pay the reasonable costs for clothing only where required for:
- body temperature control (thermoregulation). For example thermal undergarments, thermal gloves, mittens or mitts
- reducing the risk of re-injury or deterioration. For example, wheelchair gloves
- minimising hypertrophic scarring, oedema or other similar conditions, for example, compression garments prescribed by a treating health professional for the management of wounds or burns.
The Agent can pay the reasonable costs of modification/alterations to standard retail clothing and/or clothing paid for by the Agent where this is required to facilitate independence, safety or return to work. In relation to clothing, the Agent will not pay for:
- off the shelf clothing
- custom made clothing for a pre-existing condition
- clothing normally issued by an employer
- replacement of clothing that was damaged at the time of the work-related injury or illness.
Continence equipment must be prescribed by a qualified continence nurse. The Agent will accept a prescription for a maximum of 2 years.
Continence equipment must be prescribed from the WorkSafe Contracted Supplier Equipment List using the Continence Equipment Request and Order Form – Hospital Discharge or the Continence Prescription (Community) Form.
Footwear or modifications will only be considered where a worker is unable to wear their pre-injury footwear because of their work-related injury or illness as footwear is an expense incurred regardless of a work-related injury or illness.
The Agent can pay the reasonable costs of:
- custom made or orthopaedic footwear that is required because standard off the shelf footwear or pre-injury footwear cannot be worn due to the work-related injury or illness or does not support a worker's rehabilitation needs
- modifications to a worker's pre-injury footwear or off the shelf footwear
- once only replacement of footwear that is required to accommodate an orthosis (where a therapist has demonstrated that every attempt has been made to accommodate the orthosis in the worker's own footwear).
The Agent will only accept written requests for footwear from:
- an appropriately qualified medical specialist, e.g. orthopaedic surgeon
- an orthotist
- a podiatrist.
In relation to footwear, the Agent will not pay for:
- footwear normally issued by an employer as part of OHS requirements
- standard off the shelf footwear
- subsequent replacement of footwear to accommodate an orthosis.
For further information about orthotics, please refer to the WorkSafe Policy for External Prostheses and Orthoses.
Life support equipment
The Agent can pay the reasonable costs of life support equipment, including artificial respirators and ventilators, humidifiers and enteral feed pumps.
In addition to life support equipment, the Agent can also make a contribution to the reasonable costs of provision, installation, maintenance and increased consumption of utilities associated with the running of life support equipment, such as electricity costs.
In relation to life support equipment, the Agent requires the following information:
- clinical justification based on the work-related injury or illness supplied by a suitably qualified consultant physician or specialist recognised by the Health Insurance Act (1973)
- worker's eligibility for energy concessions (e.g. life support machine electricity concession)
- proportion of the electricity account related to the worker prior to their work-related injury or illness accident (if available)
- demonstrated increase in electricity consumption (measured in kilowatts hours or cubic metres multiplied by the cost per unit, rather than the gross dollar increase), for example, copy electricity accounts.
Mainstream multi-functional technology (MMT)
Standard MMT devices such as personal computers, tablets and smart phones are considered to be a normal personal item and will not usually be paid for. WorkSafe will only consider paying MMT for eligible workers.
In this section of the policy:
- MMT means a device or service which is commercially available for everyday use by anyone, can perform multiple functions, and has not been especially designed for rehabilitative use or for disability purposes, but under this policy is being used for a rehabilitative or disability purpose.
- Devicesrefer to the hardware aspect of MMT, for example, touch screen tablet computers, smartphones, desktop or laptop computer hardware and related items.
- Softwaremeans programs or applications (apps) that are used on MMT devices and may require download from the internet to obtain and update.
- Internet servicesmeans an internet connection that allows the device to access software downloads and updates, as well as interact with online programs, websites, and other devices. An internet service is essential for downloading programs and updating the programs and applications, but is not necessarily essential for running software on the device
- Eligible workersare those who reasonably require access to an existing MMT device used prior to their work-related injury or illness, and who are:
- participating in the Community Integration Program, or
- approved by the Agent in exceptional circumstances, due to the severity of their work-related injury or illness are unable to communicate in a usual way.
The Agent can consider paying the reasonable costs of MMT for eligible workers who:
- require the MMT as part of a goal-oriented rehabilitation program in which the recommendation is that the MMT will:
- measurably increase independence, for example, via a reduction in need for support workers, and/or
- measurably improve a deficit in communication
- can demonstrate the ability to effectively use MMT (both device and prescribed software) for the reasons it has been recommended
- do not own or have reasonable access to the requested MMT or other equipment that meets the identified needs
- require a MMT device due to an injury that means the worker cannot communicate in a usual way, such as:
- acquired brain injury
- significantly reduced arm function
- upper limb/hand amputation
- brachial plexus palsy.
The Agent can pay for the reasonable costs of:
- standard model MMT devices with the minimum requirements to run the prescribed program or software
- software or apps that are prescribed to meet a worker's specific work-related injury or illness needs
- additional internet services only where required to access prescribed programs/apps.
The Agent considers the reasonable costs for MMT devices to be the recommended retail price, and will not pay above this amount.
Where the worker requires the MMT equipment for a resolving condition the Agent will not purchase the item, and will only consider paying the reasonable costs of hiring the item for the period until the condition has resolved.
The Agent will only accept written requests for MMT on the Equipment Prescription Form.
The form must be completed by an appropriately qualified and experienced speech pathologist, occupational therapist or Framework OT and the worker's medical practitioner.
Treating health professionals are strongly encouraged to contact the Agent to discuss the request before completing the form.
Consultations provided by speech pathologists and occupational therapists regarding MMT can be paid in line with the WorkSafe fee schedules for speech pathology and occupational therapy.
The Agent will not pay for:
- MMT that is not part of a goal-oriented rehabilitation plan
- costs associated with accessing the internet if a worker has sufficient existing internet services that will enable them to access and use the prescribed software
- insurance or warranty costs
- redeemable products, for example iTunes vouchers/cards
- consumables such as printer ink, paper, blank USBs and CD/DVDs
- telephone lines for the purpose of an internet installation
- costs of mobile telephone plans, telephone calls, or telephone services.
The Agent can pay the reasonable costs of:
- spectacles or contact lenses prescribed as a result of a work-related injury or illness
- optometry consultations (refer to WorkSafe's Schedule of Fees for Optometry Services)
- Refer to the Optometry Policy for information about services provided by an Optometrist.
Personal alarms and monitoring services (safety items)
Personal alarms and monitoring services can be useful for workers who would like greater independence but require daily monitoring and support for medical reasons.
The type of service or device will depend on the worker's needs and circumstances. Personal alarms and monitoring services may include:
- A personal alarm which can be worn as a necklace pendant, watch or belt clip. Otherwise, a special sensitive button or 'blow switch' can be used where a worker has limited or ataxic movements.
- A receiver unit and the required components that are plugged into the worker's telephone line - this allows the signal to be received from the personal alarm and automatically dials the monitoring centre.
- The monitoring station, which provides the 24- hour monitoring by a third party. If the worker needs assistance or if a regular 'check in' is missed, the nominated emergency contact/s will be notified.
- The Royal District Nursing Service (RDNS) Response Service - this service only applies to workers who have no nominated emergency contacts.
- Medical alert devices (such as a medical alert bracelet, pendant, vial of life and/or wallet card) are worn by a worker, with details of their medical, supervision, and emergency instructions.
- Keysafes, which comprise the safe and mounting hardware. This could be the spin-dial or pushbutton version and mounted to a wall or located on a fence, railing or pipe. A keysafe can hold several keys and is accessed by entering a pin or combination.
- On-Call Services, which are a remote service for workers who require a low level of care but do not require an attendant carer to always be present in their home. Refer to the On-Call Service Policy.
The Agent requires a written request from the worker's medical practitioner and/or assessing or treating therapist confirming that a personal alarm and monitoring service is appropriate for the work-related illness or injury. The request should outline:
- the worker's pre-accident functional ability
- the components of the monitoring system to be paid, e.g. initial set up and/or ongoing monitoring
- the estimated cost of the monitoring system
- if the worker has a nominated contact person for the personal alarm and monitoring service
- the level of support within the household (excluding medical alert devices).
The Agent cannot pay for personal alarms that are not monitored by a monitoring station.
Room temperature control equipment
The Agent can pay the reasonable costs of room temperature control equipment when required to address difficulty regulating body temperature as a result of a work-related injury or illness.
In most cases this would be a spinal cord lesion at or above the level of T6. In other exceptional cases it must be medically confirmed that the work-related injury or illness has resulted in a permanent inability to regulate temperature.
The Agent can pay the reasonable costs of provision of equipment, installation, maintenance and increased consumption of gas or electricity associated with the running of an air conditioner, evaporative cooling unit or heater.
The Agent will only accept requests for room temperature control equipment from a consultant physician or specialist, as recognised by the Health Insurance Act (1973), who is able to confirm that the worker's injuries meet the medical criteria outlined above.
In relation to room temperature control equipment, the Agent requires the following information:
- Documentation of a spinal cord injury at or above the level of T6 or other exceptional cases where the work-related injury or illness has resulted in a permanent inability to regulate temperature.
- Eligibility for energy concessions, such as the life support machine electricity concession.
- Electricity consumption prior to the installation of the equipment. For example, supplying a copy of the electricity or gas account to demonstrate pre injury usage. This can be compared to electricity consumption after the installation of the room temperature control equipment to identify any increased usage.
- The proportion of the electricity account related to the worker prior to their work-related injury or illness.
The Agent will not pay for equipment for areas of the home that the worker cannot access or does not access for activities of daily living.
Sport and recreation
This section of the policy only applies to workers who reasonably require modified or adapted equipment to enable participation in a sporting or leisure activity the worker undertook prior to their work-related injury or illness, and who are:
- participating in the Community Integration Program or,
- approved by the Agent in exceptional circumstances, due to the severity of their work-related injury or illness.
For a worker who is able to return to their pre-injury activity the Agent can pay the reasonable costs of adaptions to the worker's own equipment. For a worker who is unable to return to their preinjury activity the Agent can pay the reasonable costs of:
- hire of sporting or recreational equipment for three months
- purchase of entry level equipment for one sporting or leisure activity where a worker can demonstrate commitment to continued participation. Purchase of equipment for subsequent sporting or recreational pursuits. Where the worker has discontinued the previous activity in favour of another, it would be reasonable for the worker to contribute the trade-in value of the WorkSafe paid equipment toward the new equipment.
- making a contribution towards elite or advanced equipment where required.
In relation to sporting and recreational equipment, the Agent requires the following information:
- demonstrated commitment to the sport or recreational activity such as club membership, regular attendance and/or evidence of participation
- reasons why basic entry level equipment will not be sufficient, when requesting elite or advanced equipment.
In relation to sporting and recreational equipment, WorkSafe will not pay for:
- vehicles used for sport or recreational use.
- optional features (for example, metallic paint or tool kits)
- maintenance and repairs (except for sporting wheelchairs)
- sport or recreational clothing
- participation costs (i.e. court hire, entry fees or coaching).
For information about sporting and recreational prostheses, refer to the WorkSafe Policy for External Prostheses and Orthoses.