Prosthetics and Orthotics – The Basics

INTRODUCTION TO PROSTHETICS AND ORTHOTICS

Prosthesis: It is an artificial body part that is designed, fabricated, and fitted on the human body part for the purpose of treatment, which replaces the form and/or functions of a missing body part.

Prosthetics: It is the study of the design, fabrication, fitting, and maintenance of artificial body parts.

Orthotics: It is the study of the design, fabrication, fitting, and maintenance of orthosis.

Orthosis: It is a device that is designed, fabricated, and fitted on the human body externally to support, augment, improve or correct the functions of a weak or diseased, or deformed body part.

Prosthetist: It is the person who is professionally trained to design, fabricate, fit and maintain prostheses.

Orthotist: this is the person who is professionally trained to design, fabricate, fit and maintain orthoses.

PHILOSOPHY OF THE COURSE

The Bachelor’s degree in Prosthetics and Orthotics (P&O) program of studies is to train P&O professionals, equipped with adequate theoretical and practical knowledge, clinical skills, sense of purpose, and devotion to patients’ care using prosthetic and orthotic devices/appliances.

OBJECTIVES OF PROSTHETICS AND ORTHOTICS

To train prosthetics and orthotics (P&O) professionals that will be able to fabricate, assemble and fit prosthetic and orthotic devices on patients and clients in conformity with the prescription in the rehabilitation of patients.

The objectives of this program include to:

(i) Fabricate all varieties of prosthetic and orthotic devices
(ii) Fabricate prosthetic and orthotic devices according to prescription
(iii) Identify component parts of prosthetic and orthotic devices
(iv) Maintain prostheses and orthoses
(v) Apply the skill and plaster procedures on patients according to prescription.

SAFETY PRECAUTIONS OF THE ORGANISATION

  1.  Wear a laboratory coat to avoid chemicals from splashing on your skin.
  2. Wear protective goggles or eyeglasses to avoid particles from entering your eyes.
  3. Wear hand gloves to avoid injury to the finger or hand since it is the most exposed part of the body that is used for manipulating or holding the workpiece.
  4. Wear a nose mask to avoid inhalation of dust or tiny particles coming out of the workpiece.
  5. Switch off electrical appliances when the power goes off and before leaving the laboratory at the close of work.
  6. Do not press any button on a machine that you do not know the function of.
  7. Have your fire extinguisher in your laboratory or workshop.
  8. Your environment should be kept clean to avoid the incubation of microorganisms.
  9. Your environment should be kept clean to avoid the incubation of microorganisms.

PROSTHETICS & ORTHOTICS FACILITY LAYOUT

P&O facility which can be a laboratory, workshop, or clinic is a place where P&O devices are designed, fabricated, fitted, and also tested. It has to be established to meet up with the professional standards, guidelines, and requirements.

Such P&O facilities have different sections which include:

  • Assessment section
  • Measurement or Casting section
  • Lamination or Fabrication section
  • Alignment section
  • Trial and Fitting section

EQUIPMENT USED IN PROSTHETICS AND ORTHOTICS 

(i) Router machine: It is used to file and grind the edges of a workpiece.
(ii) Cast cutter: It is used to remove POP or negative cast, Also known as an Oscillating saw.
(iii) Drilling machine: It is used to make holes.
(iv) Vacuum press (Suction machine): It is used to prevent air pockets during lamination.
(v) Gig saw: It is used to cut out the plastic from the lamination.
(vi) Heat gun: It is used to dry and heat the workpiece.

MATERIALS USED IN PROSTHETICS AND ORTHOTICS

  1. POP bandage: It is used to immobilize fractures for healing
  2. POP powder: It is used to develop a positive cast for lamination.
  3. PP sheet (Polypropylene): It is used to laminate P&O devices.
  4. Resin: It is a liquid plastic used for lamination of the positive cast.
  5. Gums (adhesives): It is used to hold together P&O materials.
  6. Fabrics: It is used to hold the residual limb (stump). Examples are straps, belts, leather, and arm strings.

TOOLS USED IN PROSTHETICS AND ORTHOTICS 

¶ Bench vice: It is used to hold a workpiece at a place while working.

¶ Chisel: It is used to remove excess materials from a workpiece.

¶ Surfoam file: It is used to modify a positive cast.

¶ Drill bit: It is used to make holes on a workpiece.

¶ Spanner: It is used to tighten and loosen the bolts and nuts.

¶ Bowels (Resin): It is used to collect water in plaster making.

¶ Mandrel: It is used to hold a positive cast in position while working.

¶ Tape: It is used to take measurements of the stump in P&O.

¶ Funnel: It is used to drive or direct liquid resins during lamination.

¶ Allen keys: It is used to tighten and loosen bolts.

CASTING PROCEDURE

CAST: A hard circular dressing with soft padding inside of it used to immobilize body parts and protect them until healing occurs.

Casts don’t accommodate for swelling and it is made of the following materials;

(a) Plaster of Paris (POP): A hard white substance made by the addition of water to powdered and partly dehydrated gypsum used for holding broken bones in place.
(b) Fiberglass: A resin-impregnated mesh used for orthopedic casting. It is a common type of fiber-reinforced plastic.

REASONS FOR CASTING

  • Casting provides immobilization.
  • It protects the injury part.
  • Casting prevents further injury.
  • Casting decreases pain.
  • Casting is used for the correction of deformities. In children, club foot deformities are conservatively corrected by bi-weekly application of a cast.

TOOLS AND MATERIALS FOR CASTING

(i) Cast Saw: An oscillating power saw designed to cut Plaster of Paris and fiberglass casting material.

(ii) Manual Cast Cutter: it is used for cutting cast manually.

(iii) Cast Spreader: It is used to pry open an orthopedic cast.

(iv) Cast Shears: It is used for cutting and trimming casts edges.

(v) Cast Knife: It is used for cutting cast tape.

(vi) Cast Scissors: It is used for cutting stockinette.

(vii) Cast Padding: A cotton or synthetic roll of material used to pad an orthopedic cast.

(viii) Cast Tape: A fast-drying adhesive or resin-impregnated mesh used for orthopedic casting.

(ix) Stockinette: A stretchy, knitted fabric used as a barrier between the skin and cast padding in the cast.

STEPS/ PROCEDURES IN CASTING

Casting procedures are classified under the following headings;

Pre-casting Procedure:

This is carried out mostly by a health care professional. They include;

  1. Complete neurovascular assessment,
  2. Wound dressing,
  3. Immobilization of the joints proximal and distal to the fracture,
  4. Gathering all supplies necessary for the completion of the casting,
  5. Explanation of the treatment procedure to the patient.

Casting Procedure:

  • The patient should be positioned directly in front of the technician.
  • Draping should be applied to prevent the patient from wetting.
  • Apply gloves to your hands.
  • Begin cast padding application distally and proceed proximally.
  • Immerse cast tape in water for 4 seconds at 45 degrees and allow excess water to drip from the material before use.
  • Roll cast evenly and rub the layer to laminate into a solid cast.
  • Before casting material sets, mold cast for a good anatomical fit using the palms and heel of your hand.
  • Check and correct soft spots that may occur when applying the cast.

Post-casting Procedure

(a) Evaluate the patient.

(b) Instruct the patient to call a physician if any symptom of compartment syndrome is noticed, for example, pain and swelling.

(c) Patients should be instructed on how to care for and manage their cast.

CAST CUTTING

This is the removing or splitting of the cast with an electrical cast saw or manual cast cutter.

Steps in Cast Cutting:

This includes;

¶ Position your patient in a stable chair.

¶ Apply gloves to your hands and drape the patient.

¶ Prepare your patient and earn his or her trust.

¶ Inspect the cast.

¶ Plan your cuts strategically.

¶ Stabilize the cast and begin to cut from the middle.

¶ Release the cast and cut the cast pad or stockinette.

¶ Clean your patient and inspect.

PROSTHETICS

Prosthetics is the study of the design, fabrication, fitting, and maintenance of artificial body parts.

An artificial body part that is designed, fabricated, and fitted on the human body part for the purpose of treatment, which replaces the form and/or functions of a missing body part is called a Prosthesis.

CLASSIFICATION OF PROSTHESES BASED ON AMPUTATION

(a) Transradial prosthesis (Below elbow): It is an artificial device that replaces the functionality and/or appearance of a missing body part below the elbow.

(b) Transhumeral prosthesis (Above elbow): It is an artificial device that replaces a missing part of the body from above the elbow.

(c) Transtibial prosthesis (Below knee): It is an artificial device that replaces a missing part of the body from below the knee.

(d) Transfemoral prosthesis (Above knee): It is an artificial device that replaces a missing part of the body from above the knee.

TRANSTIBIAL OR BELOW-KNEE PROSTHESIS

It is an artificial device that replaces the functionality and/or appearance of a missing body part below the knee. This body part may be lost through disease (diabetes mellitus, tumor, etc.) or trauma.

Materials Used in Transtibial Prosthesis Fabrication 

  • Stockinette
  • Cast cutter
  • Allen keys
  • Surform file
  • Fiberglass (For reinforcement in casting during lamination)
  • PVA (polyvinyl arsenate)
  • Cosmetic socks (For lamination in the absence of coloration (pigment) to get a colour almost the same as the patient’s skin.
  • Silicon liner (For suspension and pain relief).
  • Pylon

Components of Transtibial Prosthesis

  1. Socket
  2. Suspension
  3. Socket adapter
  4. Pylon
  5. Foot adapter (dynamic, carbon fiber, SACH foot, etc.)

Step-By-Step Processes Involved in the Fabrication of Transtibial Prosthesis 

¶ Assess the patient clinically and take the measurement of the stump. Put into consideration, the patella tendon (PTB), pressure-sensitive parts, and pressure tolerant parts on the stump.

¶ Put a waterproof on the residual limb of the patient before taking the negative cast. This is to ensure easy removal of the negative cast. Wear the stockinette on the waterproof of the residual limb.

¶ Develop your positive cast from the negative cast.

¶ Modify the model.

¶ After modifications have been made to the model, then the socket is formed over the model by mixing resin, addictive, and colour.

¶ The socket produced is coupled with the pylon and SACH foot for donning.

STAGES INVOLVED IN THE FABRICATION OF PROSTHESIS

 Measurement and recording
 Negative casting
 Positive casting
 Modification of cast
 Lamination
 Alignment
 Assembling and fitting
 Fitting

PRODUCTION OF ORTHOSIS

The nomenclature of an orthosis is gotten from the part of the body it is worn.

Any device that is designed, fabricated, and fitted on the human body externally to support, augment, improve or correct the functions of a weak or diseased, or deformed body part is an Orthosis. 

An Orthotist is a person who is professionally trained to design, fabricate, fit and maintain orthoses.

CLASSIFICATION OF ORTHOSES

6.1.0 Upper Limb Orthoses 

(a) Elbow wrist hand orthosis
(b) Elbow wrist orthosis
(c) Wrist orthosis
(d) Hand orthosis
(e) Finger orthosis

Orthoses are commonly used to treat stiffness and limitations in the passive range of motion. The treatment of stiff joints like elbow joints is based on the visco-elastic nature of connective tissue and its ability to respond to tensile loading of the soft tissue.

Therapists can choose to fabricate:

(i) Dynamic orthoses – it allows flexion and movement of joints)
(ii) Serial static orthoses – They completely immobilize joints and
(iii) Static progressive orthoses – They do not fully extend but can accommodate a different range of movements as in flexion contraction.

Lower Limb Orthoses 

(a) Supra-malleolar orthosis
(b) Hip knee ankle foot orthosis
(c) Knee ankle-foot orthosis
(d) Ankle foot orthosis
(e) Foot orthosis

TYPES OF ORTHOSES

  • Soft orthosis
  • Rigid orthosis

PROCEDURES FOR THE FABRICATION OF STATIC/STATIC PROGRESSIVE ELBOW WRIST HAND ORTHOTICS. 

  1. Place precut in 150 to 160ºc (66 to 71ºc) water for optimal heating.
  2. Place the warm splint on the pronated arm; Make sure the palmer flap is on the ulnar side of the hand, facing toward the wrist.
  3. Fold up both lateral flaps symmetrically along the fold lines. Press firmly to improve rigidity.
  4. Position the wrist and mold the hand arches.
  5. Trim borders as needed and lightly flare the proximal edge. Apply straps 2” (5.1cm), 2” (5.1cm), and 1” (2.5cm) wide strap across the forearm, wrist, and dorsal hand (as needed) respectively.

PROCEDURES FOR THE FABRICATION OF SOLID ANKLE-FOOT ORTHOSIS

¶ Put the stockinette to protect the skin.
Place Eva foam on the anterior part of the leg to enable easy cutting.

¶ Deep the pop bandage in water and apply it to the limb.

¶ Place Eva foam on the malleolus and use nylon to covert it so it would be easy to remove, the thickness of the negative cast should be thick.

¶ Bony prominences, medial and lateral malleolus should be properly padded.

¶ Manipulate the negative cast when applying the pop bandage.

¶ Make a mark following the line of the Eva foam and Cut the pop bandage when set.

¶ Fill the negative cast with pop paste having your mandrel in it.

¶ Heat the high-density polypropylene and heat above 100ºc for some minutes.

¶ After heating, bring the HTTP out and wrap around the positive cast while wearing hand gloves.

¶ Allow it to set, mark your trim lines, and cut.

¶ Modify the HTTP that was cut out and add straps.

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