CMSG-POPS Services:


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. 


Artificial Limb


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:

  • Through Hip         
  • Above Knee         
  • Through Knee         
  • Below Knee         
  • Through Ankle          (Symes) 
  • Partial Foot (Chopart)

     Upper Limb Prosthesis:        Upper limb prosthetic aids are also often manufactured in fiberglass. These are        fitted to following levels of amputations or loss: 

  • Through Shoulder         
  • Above Elbow  
  • Through Elbow         
  • Below Elbow  
  • Through Wrist         
  • Partial Hand

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: 

  • To have your limb          repaired; 
  • To have your limb          adjusted; 
  • To enable us to          keep a check on your progress; 
  • To have new limbs          made. 

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.

Orthopedic Braces


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:

  • Halo Systems
  • Cervical Orthoses
  • Spinal & Scoliosis Orthoses (including TLSOs and LSOs)
  • Hip Orthoses
  • Lower Extremity Orthoses (AFO, KAFO, UCB, SMO)
  • Custom and ready-fit Knee Orthoses
  • Orthopedic, Custom Molded, and Diabetic Healing Shoes
  • CAM Walkers
  • Custom Foot Orthotics 
  • Wrist, Hand, and Elbow Orthoses
  • Fracture Orthoses
  • Custom and ready-fit Helmets
  • Vascular Support and Burn Compression Garments 
  • Post Mastectomy products
  • Post-op Prosthetic Care
  • Custom Upper Extremity Prostheses
  • Spinal Orthoses
  • Lumbosacral Supports
  • Neoprene Supports
  • Knee Immobilizers
  • Abdominal Binders
  • Wrist Supports

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.