Role of Prosthetists and Orthotists in a Rehabilitation Team

Original Editors - Naomi O'Reilly and ReLAB-HS

Top Contributors - Naomi O'Reilly, Shaimaa Eldib, Ashmita Patrao and Kim Jackson      

Introduction[edit | edit source]

Prosthetics and orthotics often comprise similar steps in service delivery and similar tools, equipment and working methods and are therefore usually taught, promoted and practised together. “Prosthetics and orthotics” is the umbrella term for the science, technology, education and application of prostheses and orthoses. Prosthetics is a specialty within the medical and health care field concerned with the research and development, design, manufacture and application of prostheses. Similarly, orthotics is a discipline concerned with with the research and development, design, manufacture and application of orthoses. [1]

Prostheses (artificial legs and hands) and orthoses (braces and splints) enable people with physical impairments or functional limitations to live healthy, productive, independent, dignified lives and to participate in education, the labour market and social life. The use of prostheses or orthoses can reduce the need for formal health care, support services, long- term care and caregivers. Without access to prostheses or orthoses, people who need them are often excluded, isolated and locked into poverty, which increases the burden of morbidity and disability. [1]

Governance[edit | edit source]

In many countries governance of the development and management of prosthetics and orthotics services are limited or non-existent, with limited guiding frameworks in use.[3][1] In a recent study only 30 out of 197 countries[3], had some degree of regulation of the prosthetist and orthotist workforce. This study also highlighted that there is currently no international professional governing body specifically for Prosthetists and Orthotists, as is seen with many other health and social care professionals e.g. World Physiotherapy or World Federation for Occupational Therapy.

The International Society for Prosthetics and Orthotics (ISPO), is a multidisciplinary membership organisation that promotes access to appropriate and equitable rehabilitation, mobility devices, and other assistive technology to improve the quality of life for people with reduced mobility. As a global, multidisciplinary, non-governmental organisation aiming to improve the quality of life for persons who may benefit from prosthetic, orthotic, mobility and assistive devices, ISPO provides a platform for the exchange and communication on all aspects of the science, practice, and education associated with the provision of prosthetic and orthotic care, rehabilitation engineering, and related areas. ISPO has approximately 3,300 members of different professional disciplines in over 100 countries which is not limited to prosthetists and orthotists and prosthetic and orthotic (P&O) technicians but also includes orthopedic surgeons, rehabilitation doctors, physiotherapists, occupational therapists, orthopedic shoemakers, nurses and biomechanical/rehabilitation engineers. [3]

Different Roles[edit | edit source]

Prosthetics and Orthotics is a dynamic and expanding allied health care profession. Prosthetist and orthotist are individuals who have completed an approved course of education and training and are authorised by an appropriate national authority to design, measure and fit prostheses and orthoses. While technically, Prosthetics and Orthotics are separate disciplines, their common goals in rehabilitation unite them into one cooperative entity. In many cases individuals may have dual training, while some may have training only in prosthetics or orthotics. Currently there is a global shortage of prosthetics and orthotics personnel.[4]

Prosthetist[edit | edit source]

A prosthetist is a healthcare professional who assess and treat the physical and functional limitations of people resulting from illnesses and disabilities, including limb amputations and are trained to prescribe, design, fit and monitor prosthesis, which is an artificial device attached or applied to the body to replace a missing part. [5]

Orthotist[edit | edit source]

An orthotist is a healthcare professional who assess and treat the physical and functional limitations of people resulting from illnesses and disabilities, and are trained to prescribe, design, fit and monitor orthoses, which are externally applied devices that are designed and fitted to the body to achieve one or more of the following goals: [5][6]

  • Control biomechanical alignment
  • Correct or accommodate deformity
  • Protect and support an injury
  • Assist rehabilitation
  • Reduce pain
  • Increase mobility
  • Increase independence

Prosthetic and Orthotic Technicians[edit | edit source]

A prosthetic and orthotic technician is a non-clinical service providers, who work under the supervision of the orthotist or prosthetist to support the technical design of prosthetic and orthotic devices and are competent in prosthetic and orthotic device fabrication. They generally specialise in device fabrication and have a background in material science, engineering principles, technical procedures/ processes and their role is generally in the design and fabrication of the devices and have no clinical contact with patients in relation to clinical aspects such as fitting adjustments, static or dynamic alignment, although they may provide support to resolve technical issues with the devices. [7]

Where they Work[edit | edit source]

Prosthetists and Orthotists work in a wide variety of settings with adults and children of all ages with a wide range of conditions including children born with congenital limb deficiency or cerebral palsy, people who have had an amputation following an accident, patients with muscular weakness after a stroke or spinal injury, patients with diabetic foot ulcers or the elderly who have lost a limb as a result of vascular disease.

The practice of prosthetics and orthotics occurs in various settings, including independent private orthotic or prosthetic practices, hospitals, inpatient and outpatient rehabilitation facilities, rural outreach clinics, home health settings, short term nursing facilities and long term care settings and Non-Government Organisations (NGO). Individuals may also work within academia, research and education in universities.

Knowledge and Skills[edit | edit source]

Prosthetist and orthotist help improve movement and function through the provision of prosthetic and orthotic devices to increase quality of life and optimise function. With rapid advances in technology and health care, the roles of the prosthetist and orthotist have expanded from a technologic focus to a more inclusive focus within the rehabilitation team. Prosthetic and orthotic occupations are a spectrum of specialised health care disciplines that combines a unique blend of clinical and technical competencies to provide assistive products for people with physical impairments. Patient examination, evaluation, education, and treatment are currently significant responsibilities of practitioners. In addition to treatment planning and the implementation for custom prosthetic and orthotic interventions, professionals may also be responsible for modular or prefabricated devices, soft goods, mobility aids, postural supports, wheelchairs and other assistive products related to prosthetic and orthotic services.[1][5] Most technical tasks are completed by technicians who work in the office, in the laboratory, or at an increasing number of central fabrication facilities. The advent and availability of modifiable prefabrication systems have reduced the amount of time that the practitioner spends crafting new prostheses and orthoses.[8]

Assessment[edit | edit source]

According to the American Board for Certification in Orthotics, Prosthetics & Pedorthics patient assessment may include, but is not limited to, the evaluation and documentation of:[9]

  • Anthropometric Data
  • Cognition
  • Circulation
  • Skin Integrity
  • Protective Sensation
  • Pain
  • Central and Peripheral Nerve Integrity
  • Endurance
  • Biomechanics
  • Gait Analysis including temporal and spatial assessment
  • Range of Motion
  • Muscle Strength
  • Posture, balance and safety
  • Proprioception
  • Orthotic and/or Prosthetic requirements
  • Myoelectric activity and potential for use of Functional Electrical Stimulation and/or Neuroprosthetics
  • Activities of daily living
  • Environmental barriers including social, home, and work reintegration
  • The need for physical and occupational therapy modalities

Management and Intervention[edit | edit source]

Formulation of a treatment and intervention plan follows a comprehensive assessment to design an intervention that will alleviate limitations, improve function and enhance quality of life. Orthotic and prosthetic intervention includes, but is not limited to: [9]

  • Preparatory Care
  • Material Selection
  • Fabrication of Orthoses and/or Prostheses
  • Prototype development including evaluative wear
  • Structural Evaluation
  • Diagnostic Fitting
  • Assessment of Intervention
  • Functional Exercise
  • Gait Training
  • Functional Training (both self care and work related)

Resources[edit | edit source]

WHO Standards for Prosthetics and Orthotics. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.

ISPO Education Standards for Prosthetic and Orthotic Occupations. 2018

The Australian Orthotic Prosthetic Association Scope of Practice

The Australian Orthotic Prosthetic Association Competency Standards

References [edit | edit source]

  1. 1.0 1.1 1.2 1.3 WHO standards for prosthetics and orthotics. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
  2. Physiopedia.Yeti Niraula - What is the Role of Prosthetists and Orthotists in Rehabilitation ? Available from: https://vimeo.com/606350752/c003c10d60[last accessed 30/07/21]
  3. 3.0 3.1 3.2 Clarke, L., Puli, L., Ridgewell, E. et al. Regulation of the global orthotist/prosthetist workforce, and what we might learn from allied health professions with international-level regulatory support: a narrative review. Hum Resour Health 19, 83 (2021). https://doi.org/10.1186/s12960-021-00625-9
  4. WHO standards for prosthetics and orthotics. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
  5. 5.0 5.1 5.2 The Australian Orthotic Prosthetic Association. What is an Orthotist / Prosthetist?. Available from; https://www.aopa.org.au/careers/what-is-an-orthotistprosthetist-2 [accessed on 30/06/2021]
  6. The Australian Orthotic Prosthetic Association. About Orthoses and Prostheses. Available from: https://www.aopa.org.au/careers/what-are-orthoses-and-prostheses. [Accessed 30/06/2021]
  7. International Society for Prosthetics and Orthotics. ISPO Education Standards for Prosthetic and Orthotic Occupations. 2018
  8. Chui KK, Jorge M, Yen SC, Lusardi MM. Orthotics and Prosthetics in Rehabilitation (Fourth Edition).2020
  9. 9.0 9.1 The American Board for Certification in Orthotics, Prosthetics & Pedorthics. Scope of Practice -Differentiating Scopes of Practice. Available from https://www.abcop.org/publication/section/scope-of-practice/delineation-of-scopes-of-practice [accessed 30/06/2021]