June 2007 • Vol. 3, No. 3
	Advancing Orthotic and Prosthetic Care Through Knowledge

Are We Really Just Gnomes in the Basement?

One of the wonderful things I have been able to do since being elected president of the Academy is participate in a variety of meetings that I or even we (as a profession) would normally not be invited to attend. The most notable of these events was the Keck Foundation conference on "Smart Prosthetics." It seems a bit strange, but of the 160 guests, there were only two clinical prosthetists in attendance. The remainder of the attendees were tissue, electrical, or mechanical engineers; biomechanists; physicians; robotics specialists; brain or neural researchers; and even nuclear scientists. What did we talk about? Well...we talked about the future of prosthetics, brain interfaces, neural feedback mechanisms, brain implants, etc. Throughout the conference I was consumed by the idea that I was attending a conference on prosthetics supported by the National Institutes of Health (NIH), Institute of Medicine (IOM), and the National Academy of Engineering (NAE), and I was one of only two people who actually practiced the profession of "prosthetics."

And then it happened—the reason I was only one of two prosthetists at this event became clear. A noteworthy and impressive MD, PhD, who spent a good portion of his career studying the engineering of the upper extremity, turned to me and said, "If we design the ultimate prosthetic device, are the gnomes in the basement going to have the education and knowledge to provide and fit these devices to patients?" There it was. I flashed to those kitschy holiday cards I had seen advertised for years showing Santa's elves fabricating prostheses and orthoses to be sent to needy children everywhere. Surely he couldn't be talking about us. Unfortunately, the question was a valid one.

"If we design the ultimate prosthetic device, are the gnomes in the basement going to have the education and knowledge to provide and fit these devices to patients?"

The same thing happened while I was in Washington DC two weeks later. While planning a specialty program in pros­thetic care in rehabilitation centers, I—the lone prosthetist—was regarded with strange looks and concern when I dared to suggest that prosthetists must be formally considered part of the rehabilitation team. "Do you realize that you would have to formally evaluate patients who may not be candidates for prostheses?" was the response from the organizers.

Does everyone outside our small but essential world think of us as "gnomes in the basement"? Why would they think that? Well let's see. Perhaps it starts with our classification and cohabitation with durable medical equipment (DME) in the insurance world. Next, it goes to our lack of recognition as a licensed profession by many states. Or maybe it's a certification body that takes experience as appropriate training and a video tape as evidence of our ability to do no harm. Or it may even be our lack of quality research demonstrating that what we do is valuable and necessary...

Are you angry yet?

Maybe we are "gnomes in the basement," and that is where we should stay, making our arms and legs, being told by others what parts to put on and what plastics to use. Perhaps that is ok...Yet, I don't buy it.

We have a problem, and part of the problem is how we are perceived by the rest of the scientific, medical, and professional communities. It is easy to say, "Who cares what they think?" And you're right...to a point. However, they are the ones making the rules, and they are the ones paying for our services, and they are the ones who think they can do it better. The problem really is ours. We are the only ones who can fix it, and we need to do everything we can to do so.

As I conclude my year as president of the Academy, I am proud to say that we have focused on laying the foundation for setting the record straight. We have worked hard to create a new public relations packet and brochure. These packets clearly outline our profession and the rewards of becoming an orthotist or prosthetist.

The Academy, through its grant from the U.S. Department of Education, recently distributed nearly ten thousand copies of its new DVD, The Sky's the Limit, and the public relations packet to ABC-certified practitioners for use in promoting the O&P profession.

The efforts of the Academy go way beyond this, however. From the activities of the research council in bringing evidence-based practice to the forefront of our profession to the expansion of our educational opportunities and our membership directory, as well as the expansion of our presence in Washington DC, through the Alliance and the Professional Issues Council, are all geared toward getting us out of the basement and into the limelight.

Explore this website and see what else the Academy is doing for you.