Orthotic technicians and prosthetic technicians (also known as medical appliance technicians) make, fit, repair, and maintain orthotic and prosthetic devices according to specifications and under the guidance of orthotists and prosthetists. Orthotic devices, sometimes also referred to as orthopedic appliances, are braces used to support weak or ineffective joints or muscles or to correct physical defects, such as spinal deformities. Prosthetic devices are artificial limbs and plastic cosmetic devices. These devices are designed and fitted to the patient by prosthetists or orthotists. Orthotic and prosthetic technicians read the specifications prepared by orthotists and prosthetists to determine the materials and tools required to make the device. Part of their work involves making models of patients’ torsos, limbs, or amputated areas. Most of the technicians’ efforts, however, go into the actual building of the devices. Some technicians specialize in either orthotic devices or prosthetic devices, while others are trained and able to work with both types.
A technician whose work is closely related to that of the orthotic and prosthetic technician is the arch-support technician. Arch-support technicians make steel arch supports to fit a patient’s foot according to prescriptions supplied by podiatrists, prosthetists, or orthotists.
Orthotic and Prosthetic Technician Careers History
Throughout history, different societies have sought ways to replace lost limbs artificially and to support or correct the function of weak body parts. The ancient Egyptians, Greeks, and Romans studied and knew a great deal about dislocations, muscular paralysis, and other musculoskeletal disorders. The famous Greek physician Galen introduced some of the terms still used in the design of orthotic devices and described therapies to accompany their use. The Egyptians began experimenting with splints around 5,000 years ago, and archaeologists have discovered evidence that even prehistoric people made use of crude braces and splints.
The modern origins of both orthotics and prosthetics are usually traced to the 16th century French surgeon Ambroise Pare. Some of the orthotic and prosthetic devices dating from that century include metal corsets, splints made out of leather and other materials for deformities of the hips and legs, special shoes, and solid metal hands.
During the 17th century, there was rapid progress in the field of orthotics in England. This was spurred, at least in part, by the Poor Relief Act of 1601, which created certain kinds of government responsibility for the disabled. The introduction of splints and braces to treat deformities arising from rickets dates from this time. It was also during this era that leather-covered wooden hands and single metal hooks were introduced to replace lost hands.
During more recent centuries, improvements in design and materials have generally come during or after major wars, especially World War I and World War II. Following World War II, for instance, prosthetic designers discovered new lightweight plastics for use in artificial arms and hands. The process of cineplasty, in which a part of the control mechanism inside a mechanical prosthesis is attached to the end of a patient’s bicep muscle, allows for finer control over the moving parts of the prosthesis. All of these developments have made prosthetics more sophisticated, useful, and lifelike.
Similar dramatic developments have occurred in the field of orthotics during the past two centuries. During the 19th century, some of the most famous practitioners in this field, such as Hugh Owen Thomas, Sir Robert Jones, and James Knight, developed many of the appliances and treatments we use today. Development in this field led to greater specialization; orthopedic surgeons began writing “prescriptions” for the kinds of braces needed by their patients. Orthotists then designed and built them.
As noted earlier, growth in both fields was spurred in the 20th century by the two world wars, the Korean War, and the Vietnam War. Other factors have been an increase in sports-related injuries and accidents resulting from the use of automobiles. Finally, the new developments have allowed more ailments to be successfully treated with orthotics and prosthetics and have further stimulated growth of the field. This has led to yet further specialization and to the need for specially trained technicians to assist orthotists and prosthetists in their duties.
Orthotic and Prosthetic Technician Job Description
The work of orthotic and prosthetic technicians is similar to that of the skilled craftsworker. They usually have very limited contact with patients, spending most of their time working on the orthotic and prosthetic devices. Their job begins with reading the diagrams and specifications drawn up by the orthotist or prosthetist to determine the type of device to be built and what materials and tools are needed.
Technicians often make models, or casts, of patients’ features to use in building the devices. They rely on these models when making plastic cosmetic replacements, such as ears, noses, or hands, and also in fitting artificial limbs to the patient’s residual limbs. To make these models, technicians use a wax or plastic impression of a patient’s amputated area. They make a mold from the impression and pour plaster into the mold to make the cast. In order to make sure that it matches the patient’s body part, technicians may have to carve, grind, or build up parts of the model.
In building orthotic devices, technicians bend, weld, and cut pieces of metal or plastic in order to shape them into the structural components of the device. To do this, they use hammers, anvils, welding equipment, and saws. They then drill and tap holes into the components for rivets and rivet the pieces together.
To ensure a proper fit of the device when finished, they often shape the plastic or metal parts around the cast model of the patient’s torso or limbs. When the basic structure of the device has been assembled, they cover and pad the structure, using layers of rubber, felt, plastic, and leather. To build the component parts of prosthetic devices, technicians cut, carve, and grind wood, plastic, metal, and fabric. They may use rotary saws, cutting machines, and hand cutting tools. They drill and tap holes for rivets and screws; glue, bolt, weld, sew, and rivet parts together; and cover the prosthesis with layers of padding.
When prosthetic technicians finish building the basic device, they fit it with an outer covering, using sewing machines, riveting guns, and hand tools. When necessary, they mix pigments to duplicate the skin coloring of the patients, and they apply the pigments to the outer coverings of the prosthesis.
Both orthotic and prosthetic technicians must test their devices for freedom of movement, alignment of parts, and functional stability. They must also repair and maintain orthotic and prosthetic devices as directed by the orthotist or prosthetist.
Like orthotic and prosthetic technicians, arch-support technicians work with plaster casts. These are supplied by podiatrists, orthotists, and prosthetists. Working from these models, technicians determine the shape and size of the support to be built. They select stainless steel sheets of the correct thickness and cut the sheets to the necessary size. They hammer the steel in prescribed contours to form the support and check the accuracy of the fit against the model. They also polish the support with abrasive polishing wheels, glue protective leather pieces to it, and rivet additional leather pieces to it for additional patient comfort.
Orthotic and Prosthetic Technician Career Requirements
While in high school, you should take as many shop classes as possible. Courses in metal shop, wood shop, and machine shop should provide a good background for working with materials and tools used in this profession. Math classes, especially algebra and geometry, will teach you to work with measurements and numbers. You may also want to take art classes to develop your eye-hand coordination, sense of design and proportions, and knowledge of materials such as leather, metals, and plastics. Biology, health, or anatomy classes will give you an understanding of the structure of the human body, which will be needed in your future career. Computer science courses will also be helpful, as computer technologies are used in the designing of devices. Because technicians work closely with orthotists and prosthetists, they need excellent communication skills and the ability to follow directions precisely. Therefore, you should take English classes to hone your writing and speaking skills and develop your ability to interpret directions.
Following high school, you have two options. You may enroll in a two-year program of supervised clinical experience and training. This method, which is the most common, is basically on-the-job training, in which the trainee works under the supervision of a certified orthotist, prosthetist, or orthotist-prosthetist. After the two years of training are successfully completed, the trainee achieves technician status.
The second method is to enroll in a one- or two-year program of formal instruction leading to a certificate or associate’s degree in orthotics-prosthetics technology. The programs typically include classes in anatomy and physiology, properties of materials, prosthetic and orthotic techniques, and building devices, as well as supervised clinical experience. Currently there are only five technician programs offered in the United States that are accredited by the National Commission on Orthotic and Prosthetic Education (NCOPE). For a listing of these schools, visit the NCOPE Web site at http://www.ncope.org/. Because of the scarcity of training programs, a much smaller number of technicians choose this method of training to enter the field.
Certification or Licensing
There are presently no licensing requirements for orthotic and prosthetic technicians. There is, however, a program for voluntary registration conducted by the American Board for Certification in Orthotics and Prosthetics (commonly called ABC). Candidates must have a minimum of a high school diploma and must have completed either the two-year supervised on-the-job training program or a one- or two-year program of formal instruction in an NCOPE-accredited institution. In addition, all candidates must pass an examination administered by ABC. Depending on their area of concentration, technicians who pass the examination are designated as registered technician, orthotic, registered technician, prosthetic, or registered technician, prosthetic-orthotic. To maintain registration, a technician must complete a certain number of ABC-approved professional continuing education credits every five years.
To be a successful orthotic or prosthetic technician, you will need to enjoy working with your hands and have excellent eye-hand coordination. You must also be patient and detail oriented, since this work will involve using precise measurements and working on a piece until it is an exact fit. Technicians should be committed to lifelong learning, as new technologies, materials, and processes are continuously being developed. A good sense of color will also be helpful because your responsibilities may include matching the color of a device to a patient’s skin tone.
Exploring Orthotic and Prosthetic Technician Career
There are very few opportunities for people without training to get part-time or summer work in the orthotics and prosthetics field. Your first actual exposure to the work will probably be as part of a supervised training program or a clinical experience in a formal degree program. There are, however, some ways you can find out more about this kind of work. Teachers or guidance counselors can arrange a visit to a rehabilitation center or hospital with an orthotics and prosthetics department. On such a visit, you can see technicians at work and perhaps talk with them about what their jobs are like. You can also become familiar with the field by reading about it. For example, you might want to read an issue of or even subscribe to the O&P Almanac (http://www.aopanet.org/publications/op-almanac-magazine/), a magazine published by the American Orthotic and Prosthetic Association that covers business, government, and professional news concerning the industry.
A good way to gain some exposure to the health care field is to do volunteer work. Volunteer at your local hospital or a rehabilitation center where you will have the opportunity to interact with patients and staff. Even if your duties do not allow you to see patients at various stages of being fitted for a device, you will still benefit from the experience of working in a health care setting. Volunteering will also demonstrate your sincere interest in the field to training program admissions officers and future employers.
Typical employers of prosthetic and orthotic technicians include hospitals, rehabilitation centers, private brace and limb companies, and the Veterans Health Administration.
Graduates of one- or two-year programs of formal instruction usually have the easiest time finding a first job. Teachers and placement offices will have valuable advice and information about local employers that they can share with students about to graduate. Also, check into some of the trade publications for the orthotics and prosthetics industry. These publications often carry classified advertising with listings of job openings.
If you have no prior experience and want to enter a supervised training program, you should contact hospitals, private brace and limb companies, and rehabilitation centers to inquire about programs. You might also watch the local newspapers for entry-level job openings in the field.
In some large orthotics and prosthetics departments in hospitals or rehabilitation centers, it is common to advance to the position of orthotic or prosthetic assistant after you have acquired enough experience. Another form of advancement might be specialization in a certain aspect of the work. In some cases, the experienced and skilled technician might be able to move into a supervisory position.
In general, however, significant advancement is open only to those who pursue additional training and education. With additional education and by meeting prescribed training requirements, technicians can become certified orthotists, certified prosthetists, or certified prosthetist-orthotists. Becoming an orthotist or prosthetist requires a four-year degree in orthotics or prosthetics or completion of a one-year certificate course program.
Technicians working for the Veterans Health Administration or other state or federal agencies will find that advancement is conducted according to civil service rules and procedures.
Salaries for orthotic and prosthetic technicians vary widely, depending on several factors. The most significant factor influencing salary level is certification. Technicians who have received their certification earn an average of approximately $3.50 more per hour than those who are noncertified, which translates into a difference of more than $7,000 yearly. Other factors influencing salary differences include area of the country where a technician works, size of employer, type of employer, and years of work experience. According to Diversity Allied Health Careers’ 2004 salary report, the median annual salary for medical appliance technicians was $27,495. The U.S. Department of Labor reports that in 2005 the median earnings for medical appliance technicians were $29,080. The lowest paid 10 percent earned $17,470 while the highest paid 10 percent earned $52,010.
Technicians working for the Veterans Health Administration or other federal agencies will find that their salaries are determined by their Government Service rating. Government Service ratings are determined by a number of factors including level of training, area of expertise, and performance on standardized tests.
Orthotic and prosthetic technicians usually work five-day, 40-hour weeks. There typically is little need for overtime, weekend, or evening work.
Orthotic and prosthetic technicians spend much of their time in a workshop setting, which may be cluttered, loud, and dusty from the machinery and the cast-making. In some cases, they may have to work in uncomfortably hot oven rooms to soften the materials they use. They also work with power tools and sharp hand tools, which means that there is a chance of injury. However, careful adherence to safety procedures greatly reduces that risk.
Technicians usually work on their projects individually, but they do collaborate with the orthotist or prosthetist to make sure the finished product meets specifications. The actual contact with patients is handled by the orthotist or prosthetist, which may be a relief to some technicians. However, for some, this distance from the people they are trying to help may be a source of frustration.
The satisfactions of this job are in many ways similar to that of other skilled craftsworkers—the sense of pride that comes from a job well done. In addition, orthotic and prosthetic technicians have the satisfaction of knowing that their work is a direct source of help to people in need.
Orthotic and Prosthetic Technician Career Outlook
Employment for orthotic and prosthetic technicians is expected to grow at a rate that is about as fast as the average through 2014. The need for technicians is driven by such circumstances as the rapid growth of the health care industry, increasing access to medical and rehabilitation care through private and public insurance programs, improving technologies, and our country’s aging population. According to a study prepared for National Commission on Prosthetic Education, by 2015, the aging Baby Boomer population will largely increase the demand for both orthotists and prosthetists. By 2020, the number of people who have an amputation and are in need of prostheses will increase by 47 percent.
Edward Haddon, the director of orthotic and prosthetic education at Century College in White Bear Lake, Minnesota, predicts that employment for these technicians will be excellent. “There are more positions for orthotic and prosthetic technicians than can be filled by all the graduates from all the orthotic and prosthetic technician programs. There are also an ever-increasing number of people who need orthotic and prosthetic treatment, which will increase job opportunities. The variety of the fabrications keeps interest in the job at a high level.”