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Orthotists and Prosthetists

The Job

Prosthetists and orthotists design and create orthotics (braces and other corrective devices) and prosthetics (artificial limbs) for patients. In most cases, they work closely with the attending physician to coordinate the creation and fitting of the device.

Their work usually begins with an examination of the patient. Prosthetists see patients who have had amputations due to accidents, birth abnormalities, or disabling diseases. Orthotists see patients who need support or correction due to muscle or bone impairment or deformity. Prosthetists and orthotists test muscle strength and range of motion and observe how the patient walks. They also use tools, such as rulers, tapes and calipers, to measure limbs or stumps. It is important to note all pertinent details to make sure that the device fits properly. Each prosthesis or orthosis is individually designed to match a patient's unique needs.

Prosthetists and orthotists may make a cast or model to work on. They also draw layouts and make a tentative blueprint for the device. The actual devices may be made either by the prosthetists and orthotists themselves or by orthotic and prosthetic technicians or assistants. Prosthetists and orthotists select materials for each orthosis or prosthesis to match the needs of the patient. Considerations range from the patient's height and weight to the patient's activities. Materials used in the construction of orthoses and prostheses include wood, foam, plastics, fabric, steel, aluminum, fiberglass, and leather, as well as newer, composite materials, such as carbon-graphite. Prosthetists and orthotists use hand and power tools, such as saws, drills, and sewing machines, to skillfully manipulate these materials into the desired designs. They may glue, bolt, weld, sew, and rivet parts together or take advantage of advanced thermoforming techniques (techniques using heat) to mold and form parts. Straps or Velcro may be added to help customize the fit.

Once devices are made, prosthetists or orthotists typically see the patient several times for fittings. They evaluate the fit and work with patients to demonstrate how to use the devices. For maximum comfort and effectiveness, minor alterations usually have to be made. Prosthetists and orthotists work with many other health care practitioners, such as physicians, therapists, and specialists, to help patients adjust to their prostheses and orthoses. It is essential that all devices be comfortable, stable, and properly fitted. The finished product must meet with approval from the doctor who prescribed it.

Prosthetists also develop and create myoelectric and externally powered prostheses. A patient with a myoelectric prosthesis can use the electrical impulses of his or her muscles to power a prosthetic limb. To accomplish this, an electrode is placed on the skin over a muscle. When the patient contracts that muscle, the electrode picks up and amplifies the electrical activity from the muscle. This electrical signal then activates a battery-powered motor in the prosthetic that causes the device to move.

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