The future of Orthotics and Prosthetics

As we reflect on the future of prosthetics and orthotics, several thoughts come to mind. The past and what we have learned, the present and what we are doing and the future and where we are going. In the past, wood prostheses with leather thigh corsets were the norm.

Prostheses weighing in excess of 15 pounds were considered state-of-theart.

Orthoses made of strong heavy metals were utilized exclusively.

Leather wore out; metal broke, clicked, and squeaked. Prostheses basically unloaded remnant limbs by transferring weight-bearing areas to muscle compression and skeletal loading. Orthotists were considered glorified shoe cobblers and braced according to physicians’ knowledge and prescription.

Presently, prostheses weighing less than five pounds are the norm, with no wood involved and very little metal. They are self-suspending with silicone liners that cushion and protect the residual limb. Orthoses are mostly constructed of lightweight plastics which are very durable and do not incorporate any leather that retains perspiration, and is not receptive to any sanitizing efforts, to name a few inherent problems.

Scientific methods of fitting residual limbs are prevalent now utilizing muscle contouring, total surface bearing and myoelectric muscle testing to harness muscle impulses, which in turn, will operate hands, wrists and elbows, instead of using gross body movement by harnessing existing contra- lateral functions. Life-like cosmetics enhance upper and lower extremity prosthetics to the extent that hair, veins, skin blemishes and perfect skin tone can be obtained. Orthotists and prosthetists are required to study anatomy, physiology, kinesiology, pathologies, physical therapy, occupational therapy and surgical procedures so that they can complete the medical team approach utilized today to fully manage patients. Practitioners are required to maintain continuing education to retain certification.

Orthotic and prosthetic facilities are held to strict protocols in order to maintain accreditation and further the future of the field.

The future of the Orthotics and Prosthetic filed is both dim and bright.

It has been estimated that by the year 2005, the existing practitioners and graduating practitioners combined will only be able to cover 65% of the population needing their services. Thus, there is a strong need for more graduate programs. The future is bright as new techniques are currently being refined and tested. Prostheses attached directly to skeletal bone is now a reality. Sense of touch is now available so that an upper extremity amputee can feel when they are grasping something hot or cold, and onboard computer systems automatically adjust grip force by utilizing sensors in the fingertips. Electrodes on the bottom of prosthetic feet now allow patients to differentiate between when their foot is flat on the floor, toe is off, heel is off, or foot is unloaded totally by sensor feedback in the inner face of the prostheses. Knee units have onboard computers that anatomically adjust the stability and walking/running attitude 50 times per second. Falling due to knee instability or a missed step is very quickly going to be a thing of the past.

The field of Orthotics and Prosthetics has advanced since shoe cobbling and wood whittling. Futuristically, their field is very exciting and in dire need of more qualified practitioners, and will continue to be a good choice of medical careers. The individual patient is still their main concern and as they continue to stay abreast of cutting edge technology, they will be able to serve their community in a professional manner.