Orthotics and prosthetics are very complex clinical and technical rehabilitation health care services, which involve a unique blend of various medicine and engineering sciences. Practitioners trained and skilled in providing comprehensive orthotic and prosthetic health care services must have appropriate clinical skills and knowledge to interact with all types of physicians and health care professionals. Further, the Orthotist and Prosthetist must have both the combined clinical and technical knowledge of orthotics and prosthetics to provide input regarding the care and management of an individual in either an acute, comprehensive rehabilitation or chronic care setting.
For the Orthotist, this input can involve the clinical assessment of a patient for consultation with the attending physician regarding the most appropriate orthotic care and treatment of a typical leg or arm fracture. The orthotic care and treatment could involve the fitting of a simple prefabricated leg or arm orthosis or the development and fitting of a custom designed orthosis. In a severe emergency situation, the Orthotist may be called in for consultation and to provide orthotic management of a complex fracture of the spine requiring the skilled fitting and/or development of a custom designed cervical or spinal orthosis following a traumatic accident. The Orthotist's services, in this situation, require appropriate skill and knowledge of potential life threatening fractures and the potential for permanent or partial paralysis without proper stabilization of the spine. Additionally, in a comprehensive rehabilitation setting, an Orthotist may be required to assess the orthotic needs of a child or adult with lower/limb paralysis for the development of full leg orthoses intended to allow a child or an adult with lower/limb paraplegia to stand and ambulate.
For the Prosthetist, this input can involve the clinical assessment of a geriatric patient for consultation with the attending physician regarding the most appropriate prosthetic care and treatment of a forefoot amputation secondary to peripheral vascular complications. This may involve the fitting of a simple insole-type partial foot prosthesis or the development of a custom designed forefoot prosthesis to lessen the potential for a higher amputation. In a more severe situation, the Prosthetist may be called in for emergency consultation to provide input to a physician as to the appropriate level for a leg or arm amputation following a traumatic accident. This can also require the Prosthetist to provide an appropriate immediate post-operative prosthesis directly following the surgical amputation in the operating room. In a more comprehensive rehabilitation setting, the Prosthetist may be called in to assess the prosthetic needs of child with a congenital limb deficiency or an adult with an acquired amputation of a complete hand or arm. This may involve assessing their potential for use of an advanced functional myoelectrically controlled hand or complete arm prosthesis and provide the physician with appropriate input as to their rehabilitation potential and needs. Additionally, the Prosthetist can be called in to assess an individual's needs for an advanced above or below/knee prosthesis, which will enhance their potential to return to their former vocational or avocational activities.
The knowledge, clinical, and technical skills of these uniquely trained practitioners are particularly essential to providing the comprehensive level of orthotic and prosthetic services required within all health care settings. These highly skilled practitioners have a well-rounded medical knowledge of the common musculoskeletal and neuromuscular disorders, as well as the etiology and pathology of the vast variety of disabling conditions and disorders of the human body. Besides their basic knowledge of medicine, human anatomy, and kinesiology, they are further trained in the areas of biomechanics, pathomechanics, and gait analysis.
Additionally, the training of an ABC credentialed practitioner includes a knowledge of the primary treatment concepts in neurology, orthopedics, physical medicine and rehabilitation as they relate to orthotics and prosthetics. Comprehensive education and training is essential for thorough clinical assessment of an individual's orthotic and/or prosthetic needs and for providing health care consistent with those needs.
Along with the clinical aspects of orthotic and prosthetic health care, these practitioners are trained and skilled in multiple engineering sciences, which must be properly utilized to address a particular individual's disability needs. These engineering sciences include mechanical, plastic, metal, and electronic engineering concepts, as they may relate to the design and development of a custom fabricated orthosis or prosthesis. Additionally, this includes a knowledge of a broad range of orthotic and prosthetic components and materials available for use in the custom development of a particular orthosis or prosthesis, which meets the need of the individual.
The National Commission on Orthotic and Prosthetic Education (NCOPE), along with the American Board for Certification in Orthotics and Prosthetics (ABC), have well-established educational standards and credentialing requirements. These must be met by an individual to be qualified to provide comprehensive orthotic and prosthetic rehabilitation health care services. The standards of these organizations are intended to provide the best possible assurance to the general public, and to the physicians responsible for the health care of an individual, that an allied health care practitioner is appropriately trained and skilled. Furthermore, ABC has recently updated its Facility Accreditation Standards to better address the outcome and goal oriented standards expected in health care today, as well as the continuing quality assurance standards of such organizations as the Commission on Accreditation of Rehabilitation Facilities (CARF) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
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