An orthotist and a prosthetist design, make, and fit appliances for body deformities and missing limbs following the prescription of a physician. These appliances include artificial arms and legs, neck, back and leg braces, and surgical supports.
An orthotist specializes in planning, making, and fitting orthopedic braces and similar devices such as surgical supports and corrective shoes; these are used to support weakened body parts or to correct physical defects.
A prosthetist specializes in planning, making, and fitting artificial limbs. The orthotist and prosthetist follow basically the same procedures in their work although each deals with different abnormalities, designs, and patients.
At Combined Medical Services Group and Pediatric Orthotic & Prosthetic Services, we also specialize in ocular prosthetics and maxillofacial restorations, as well as correcting positional plagiocephaly in infants.
Prosthetic aids are appliances fitted to patients who have lost their limbs due to any disease, accident or it may even be a congenital loss.
Lower Limb Prosthesis: Lower limb prosthetic aids are often manufactured in fiberglass. These are fitted to following levels of amputations or loss:
Upper Limb Prosthesis: Upper limb prosthetic aids are also often manufactured in fiberglass. These are fitted to following levels of amputations or loss:
Almost any upper arm through shoulder prosthetic can be fitted with a mechanical elbow that allows easy flexion at the prosthetic elbow joint. Almost all arm prosthetics can be fitted with either a mechanical or electronic hand. For a partial hand prosthetic, however, only a cosmetic hand can be fitted. In all above cases, the prosthetic hand is covered with a PVC glove that has an appearance of a real hand.
Electronic Hand Prosthesis: The electronic hand works with microswitches, because an alternative to the myo-electric prosthesis is the switch control system. In this system, micro-switches are used which are activated by fitting these inside the socket where muscle signal or stump contact with the micro-switch, is most prominent.
The electric source for the electronic hand is six volts nickel cadmium batteries, fitted within the prosthesis. When the micro-switch is activated the current passes through the circuit board to the motor, which gives the drive to the specially fabricated gear assembly. This results in opening of all four fingers and the thumb. When the signal is released from the switch, the fingers are closed. The gripping force is good and it can hold a glass full of water very comfortably. The grip of this hand is enough to hold an object of over two kilograms. The fingers and palm are molded in ABS. This is covered with a PVC cosmetic glove to give a natural appearance and to protect the hand mechanism and circuitry from dust and moisture. The battery is charged with a special charger in about 15 hours. The life of the battery is about 2 years. The weight of a motor powered hand is about 500 grams.
Your Visit To Our Clinic: The aim of the CMSG-POPS is to help you regain as full and active a life as possible following the loss of your limb(s). We are all here to answer your questions and to help in any way we can. If there is any assistance we can give, please do not hesitate to ask.
You will probably have a lot of questions on your mind and it is important that you discuss them with your prosthetist. Don't worry if you don't remember them all at once because at each visit you will have the opportunity to ask about something you have forgotten or need to remind yourself about. You will also be able to talk to other people who will be able to pass their experiences on to you.
When your hospital team feel you are well enough, and if your wound has healed satisfactorily, they will refer you to us for your prosthetic treatment.
When you arrive, our receptionist will check you in and inform your prosthetist that you have arrived. During your visit you will also meet other members of the clinical team who will discuss your needs with you and assess your suitability and general fitness for using an artificial limb. During this visit you will be shown various artificial limbs and be able to ask any questions you may have.
If it is decided to make an artificial limb, the prosthetist will first take various measurements of your stump and of your sound limb, and then take a plaster cast of your stump. This will take about 20 to 40 minutes, and then you will be ready to leave. Before you leave, our receptionist will make another appointment for you to return to have a fitting and take delivery of your new limb. Each limb is individually made in the workshop and usually takes approximately five working days. When you return for the fitting and delivery of your limb, the prosthetist will get you to try it on and will make adjustments to it until both of you are satisfied with the fit. If you are to have a lower limb fitted, please make sure you bring a pair of shoes with you for the fitting.
Once you have received your artificial limb, you will have to learn to walk with it. Your walking training will take place in hospital physiotherapy. It will take a lot of hard work, determination and practice to learn to walk with your new limb, but your physiotherapist will help you with this.
After you have been fitted with your new limb, you may still need to visit us for a number of reasons:
Remember, if you are having any problems at all with your limb or stump, always contact us as soon as they start. Do not wait, hoping they will go away.
If you or someone you know is in need of an artificial limb, contact us today to find out how we can help you.
Orthotics is the design and fitting of supportive braces and splints to patients who because of muscle weakness or deformity have disabling conditions of the limbs or spine. The patient may have been born with a deformity or may have developed their problem later in life. The splint may only need to be worn temporarily, perhaps after an accident or an operation, or permanently if the weakness or deformity cannot be corrected. The devices (orthoses) which are fitted by the orthotist cover a very wide range of products including collars to support the neck, spinal supports, splints, belts, corsets, leg callipers and splints and special footwear and include:
Most orthotic devices last two to five years on average and depend on the material, the patients weight, and the patients activity level. However, annual follow-up visits are recommended for optimal functioning of the orthotics.
The principles of orthotic management involve the external application of a supportive brace to achieve various desired outcomes. Regardless of the shape or form of the brace, orthotic management incorporates basic principles of tone reduction, pain control, contracture reduction, and physiologic alignment to achieve the desired outcomes. These straightforward interventions can make a significant difference for the impaired individual.
Orthotic braces contribute to the cost-effective management at essentially no risk. For example, catastrophically impaired individuals can benefit from orthotic bracing to reduce painful spasms. Orthotists incorporate known patterns of muscle movements, such as flexor and extensor synergy patterns, to reduce spasms and increase joint range of motion. A wrist/hand orthosis can improve, for example, upper extremity spasticity and the feeding abilities of an individual with a cervical spine impairment. An orthotic device for the ankle and foot, as another example can reduce painful spasms in an individual who has suffered a stroke. Braces for the spine can allow certain individuals with unstable or painful spines to maintain an upright posture and improve their respiratory and circulatory systems.
Pain management frequently involves the stabilization of painful structures to reduce discomfort and allow functional activity without the unwanted side effects of immobility. For each of these conditions, orthotics can play a significant role in management.
There are numerous medical benefits of a comprehensive orthotic approach for catastrophically impaired individuals with severe musculoskeletal impairments. A comprehensive approach can treat the entire kinetic chain of the musculoskeletal system. As with many issues in the care of elderly individuals, a small improvement in one may have positive repercussions in other areas.
Orthotic devices of the upper extremities can decrease tone and pain and allow the individual some independence with feeding and activities of daily living. Proper orthotic devices to the spine and pelvis can help with pain, tone, transfers, continence, skin care and constipation. Lower extremity orthotics are likewise useful in maintaining skin integrity, edema control, tone and contracture reduction, and improving lower extremity blood flow.
Perhaps one of the most important aspects of orthotic bracing is the maintaining and improving a patient's psychological condition through increased social interaction and an enhanced quality of life. Individuals placed in more physiological alignment are better able to establish eye contact and interact with the environment.
Foot and leg orthotics take various forms and are constructed of various materials. All are concerned with improving foot function and minimizing stress forces that could ultimately cause foot deformity and pain.
Orthotic devices are also effective in the treatment of children with foot deformities. Most podiatric physicians recommend that children with such deformities be placed in orthotics soon after they start walking, to stabilize the foot. The devices can be placed directly into a standard shoe, or an athletic shoe.
Usually, the orthotics need to be replaced when the child’s foot has grown two sizes. Different types of orthotics may be needed as the child's foot develops, and changes shape. The length of time a child needs orthotics varies considerably, depending on the seriousness of the deformity and how soon correction is addressed.
If you or someone you know is in need of orthopedic braces, contact us today to find out how we can help you.
Individuals who suffer from traumatic accidents, eye disease or ocular and orbital cancer sometimes require the need of orbital implants. Due to advances in surgical techniques and orbital implants, an excellent cosmetic outcome can be achieved.
When a diseased or injured eye must be removed (enucleated), most patients have the choice to acquire an orbital implant. This is the procedure where the muscles of the eye are preserved and are are used to attach the spherical implant. By using the eye's natural muscles, a proper volume of the orbit is achieved, allowing motility of the implant. The implant is generally secured in place by suturing it to the outer layer of the natural eye.
About 6 weeks following orbital reconstruction, the ophthalmologist will refer the patient to a specialist who specializes in the fitting of a false eye. This specialist is known as an ocularist. The prosthesis itself is a thin, often porcelain, shell which is designed to look like the patient’s other eye. The prosthesis is designed after taking moldings of the patient’s orbital tissues and eyelids, so that the prosthesis fits nicely and comfortably. The prosthesis is often designed after making measurements and taking photos of the opposite eye.
The prosthesis itself is placed beneath the eyelids and on top of the orbital implant (and overlying tissues). It is typically left in place for weeks or months at a time, occasionally needing to be removed to examine the underlying tissues or for cleaning and polishing of the prosthesis itself. If the surgeon was able to attach the muscles of the natural eye to the orbital implant, the prosthesis will usually have motility that tracks the opposite eye. In some cases, when motility of the prosthesis is limited, the surgeon may place a peg in the implant, which fits into a depression in the back surface of the prosthesis. This will often allow greater and more natural eye movements. In many cases, when the eye muscles are attached to the orbital implant, it is difficult for the casual observer to distinguish the natural eye from the artificial one.
If you or someone you know is in need of an ocular prosthesis, contact us today to find out how we can help you.
A maxillofacial prosthesis is a man made replacement for parts of the face damaged by injury or disease, such as cancer.
Facial prostheses themselves are anything but new. The first known facial prostheses were metal noses, invented and affixed to the face by the French dentist Pierre Fouchard in the 1700s-often in patients with syphilis. President Grover Cleveland was diagnosed with tumors of the maxilla, or upper jaw bone, and was successfully treated with a prosthesis; he was able to speak before Congress following a speedy rehabilitation. Sigmund Freud likewise was diagnosed with a tumor of the maxilla, but didn't fare as well. His original diagnosis was squamous cell carcinoma, a serious skin cancer; after thirty-three surgeries and a prosthesis so troublesome he referred to it as "the monster," Freud died from inoperable cancer.
Today, maxillofacial prostheses are infinitely more successful. Artfully crafted from silicone, they are indistinguishable from real skin. They are customized for each patient, down to the brown age spots found on many older patients. From wrinkles around the eyes to the redness of Terry Donelon's ears, modern prostheses are amazingly lifelike. Doctors will even fashion a "winter ear" and "summer ear" for farmers and others who spend a good portion of their warm-weather days outdoors, so the prosthesis will match the patient's tanned real ear.
One of the most common and easily remedied craniofacial deformities in children is a cleft lip, cleft palate, or both, occurring once in every 700 to 800 births. If the cleft condition is not repaired, the child probably will not eat, speak, or hear properly as he or she grows. While a cleft lip and palate are congenital conditions, typically able to be corrected surgically without a prosthesis, many situations require a maxillofacial prosthesis.
Some children are born with no ears, or with incomplete ears or "ear tags." One teenager lost his ear in an auto accident; an adult patient had his ear bitten off in a bar fight. Probably the most common need for maxillofacial prostheses among adults is in cancer patients; ninety percent of all head and neck tumors are squamous cell carcinoma. That kind of cancer can and does occur anywhere-in nose tissue, on the scalp, in a lip-and surgical removal often leaves a gaping hole. Today, that hole can be replaced by a prosthesis to restore normal breathing, hearing, speech, eating, and appearance.
The implant system involves several stages. The doctor makes an impression of the area-the remaining good ear, if the prosthesis is to be an ear-using alginate, the same substance dentists use to make impressions of teeth. A stone cast is made from that impression and the prosthodontist forms a wax model of the missing ear. The patient is ready for his or her first "fitting" to check the size and shape of the new ear. The model ear is then processed into hard acrylic and other materials that can be seen radiographically. A CAT scan is done with the new ear in place, showing how much bone and soft tissue is present in relation to the desired position of the ear. This allows for the surgeon to plan for the best positioning of the implants and requires the prosthodontist and surgeon to work closely as a team.
If you or someone you know is in need of a maxillofacial restoration, contact us today to find out how we can help you.