Prosthetics is the branch of surgery concerned with the replacement of missing body parts with artificial substitutes.
Description
While prosthetics is defined as a branch of surgery, those involved in this profession include the surgeon, nurse, prosthetist, and physical therapist. Others involved in treatment can include a prosthetics technician, prosthetics assistant, rehabilitation counselor, and social worker.
The goal of prosthetics is to replace all or part of a missing limb so that a patient can function. This replacement can involve fitting a man with an artificial leg so that he can walk, or equipping a woman with an artificial hand so that she can hold objects. An artificial appliance is often called a "prosthetic" or a "prosthesis." Prosthesis can also refer to the replacement of a missing part with a prosthetic.
Historical perspective
The practice of prosthesis dates back to ancient times. During the sixteenth century, a German knight was
Guide for preprosthetic evaluation
Item to be evaluated
Observe for:
SOURCE: Sanders, G.T. Lower Limb Amputation: A Guide to Rehabilitation. Philadelphia: F.A. Davis Co. 1986.
Activities of daily living
Transfers; ambulatory status; home (including hazards and barries); sel-care
Medical status
Cause of amputation; associated diseases/symptoms; medications
Neurologic
Sensation; neuroma; phantom pain; mental status
Psychological
Emotional status; family and work situations; prosthetic goals
Range of motion
Hips; knee; ankle
Residuurm length
Bone length; soft-issue; redundant-tissue length
Residuurm shape
Cylindrical conical, hourglass, "dog-ears", bulbous, above-knee adductor roll
known as Gotz of the Iron Hand because of his prosthetic. The appliance's movable fingers enabled the knight to hold a sword.
Wood, however, served as the primary material for prosthetics until the twentieth century. In the aftermath of two world wars, research led to the development of prosthetics made of aluminum alloys, metals, and fiber material.
Throughout the centuries, prosthetics were made with mechanical devices and rubber band-type material to allow their wearers to grip objects and move more easily. Movement devices in prosthetics now include hydraulic knees and computer-programmable hands that sense muscle movement.
Legs, arms, feet, and hands are the most commonly known artificial appliances. Other prosthetics include artificial eyes, hip joints, breasts, and heart valves. Prosthodontics is the branch of dentistry concerned with the replacement of teeth.
Contemporary prosthetic care
Patients requiring prosthetic care range from children born with missing limbs to elderly adults requiring hip joint replacement surgery. Such trauma as an automobile accident may cause the loss of a limb, and such conditions as diabetes may lead to the amputation of a limb.
Health care roles
Patients are seen by a prosthetics health care team, which can include a surgeon, nurse, prosthetist, prosthetics technician, prosthetics assistant, and physical therapist.
Prosthetics is sometimes also grouped with orthotics in allied professions. Orthotics is concerned with producing and fitting braces (orthoses) for patients' limbs and spines.
Work settings
Members of the prosthetics health care team work in hospitals, rehabilitation facilities, medical centers, medical schools, colleges, and universities. Prosthetics technicians may work in those settings or in labs and facilities that manufacture prostheses.
The prosthetist designs and fits prostheses. When surgery is planned, the prosthetist consults with the surgeon about where a limb is to be amputated. The prosthetist's input includes recommendations about fitting the prosthesis after surgery.
Pre-operative preparation
For some members of the health care team, patient contact begins before surgery. The doctor examines the patient to determine if more treatment is needed. If amputation is required, those who counsel the patient may include the doctor, nurse, and social worker. They will try to help the patient prepare emotionally and physically for surgery and rehabilitation.
The prosthetics health care team
Prosthetists may supervise several staff members. In some workplaces, the prosthetics assistant assists the prosthetist and may fabricate, repair, and maintain artificial appliances. However, prosthetics may be made by the prosthetics technician, an allied health worker who takes direction from the prosthetist and the prosthetics assistant. The technician also repairs and maintains prostheses. In some settings, the technician may have no contact with patients.
After surgery, the patient may be seen by the surgeon or primary care doctor. During the rehabilitation phase, the prosthetist and therapist will help the patient adjust to the prosthetic. The nurse and social worker may provide patient education and support. If needed, the patient may be referred to a rehabilitation counselor or a vocational counselor.
In addition, the patient will see the prosthetist, prosthetics assistant, or prosthetics technician if the prosthetic needs adjusting.
The early stages of all prosthetic treatment usually involves the prosthetist working with the physical therapist. The therapist can evaluate such factors as the patient's strength and ability to wear a prosthetic.
Education and training
Members of the health care team, such as surgeons, nurses, physical therapists, and social workers, may receive training in the use of prosthetics while studying for their respective professions. Prosthetists earn a four-year bachelor of science degree that includes specialized prosthetic training. They also serve a clinical residency. Programs for prosthetics assistants and technicians range from six months to two years. In addition, people working in these allied health professions can receive certification through the American Academy of Orthotics and Prosthetics. Board certification is based on education, employment, completion of certification of program modules (continuing education courses), and membership in the academy.
Advanced education and training
The name of the American Academy of Orthotics and Prosthetics reflects the relationship between the fields of orthotics and prosthetics. While orthotics usually focuses on temporary treatment with a brace, prosthetics involves permanent replacement of a body part with an artificial appliance. However, some patients require both prosthetics and orthotics, so schools offer degrees and certificates in both disciplines. Allied health professionals with education and experience in both disciplines will be twice as employable as those with degrees or certificates in only one of the professions.
Education is the key to career advancement for an allied health employee with only one specialty. A prosthetics technician can advance to assistant and then prosthetist by completing more classes.
The American Academy of Orthotics and Prosthetics offers continuing education courses and forums so that allied health workers remain knowledgeable about new developments in their professions.
Future outlook
The need for prosthetists, prosthetics assistants, and prosthetics technicians is expected to increase with the aging of the baby boomer generation. The existence of a rapidly growing senior population is a global trend, and prosthetics care should be in increasing demand worldwide. Among the needs for older populations are hip replacement and replacement of limbs amputated because of diabetes and other conditions.
BOOKS
Lusardi, MM, and CC. Nielsen, Orthotics and Prosthetics in Rehabilitation. Butterworth-Heinemann, 2000.
May, Bella. Amputations and Prosthetics: A Case Study Approach. Philadelphia, PA: F.A. Davis Co., 1996.
Wilson, A. Bennett. A Primer on Limb Prosthetics. Springfield, IL: C.C. Thomas, 1998.
ORGANIZATIONS
American Academy of Orthotists and Prosthetists. 526 King Street, Suite 201, Alexandria, VA 22314. (703) 836-0788. <http://www.oandp.org>.
American Board for Certification of Orthotics and Prosthetics. 330 John Carlyle Street, Suite 200, Alexandria, VA 22314. (703) 836-7114. <http://www.opoffice.org>.
