Orthotists design and make braces, shoe inserts, and other corrective devices to support the spine or limbs weakened by illness or injury. Prosthetists design, make, and fit artificial limbs for persons missing an arm, leg, or other body part as a result of injury or illness. There are approximately 6,000 orthotists and prosthetists currently employed in the United States.
Orthotist and Prosthetist Careers History
Throughout history people have attempted to replace lost limbs and to support weak body parts. Braces, splints, and other corrective devices have been used since prehistoric times. The earliest known prosthetic device is a wooden toe found on a 3,000-year-old Egyptian mummy, whose big toe had been amputated. Devices used during the Middle Ages included metal corsets, splints made out of leather for hips and legs, and special shoes.
Some of the most dramatic advances made in the fields of prosthetics and orthotics have occurred during and after major wars. After World War II, for example, prosthetists discovered new lightweight plastics that could be used to make artificial arms and hands. In addition, a process known as cineplasty was developed: Part of the control mechanism inside a mechanical limb is attached to a patient’s bicep muscle for better control over the moving parts of the limb. The Korean War and the Vietnam War also spurred improvements in the design and manufacture of prostheses and orthoses.
Advances in the fields of prosthetics and orthotics continue to be made; specially trained prosthetists and orthotists are always striving to design more comfortable, more useful, and more natural-looking devices. There is a great need for skilled workers in this field, since more than 125,000 people lose a limb each year to illness or injury, and thousands of others have some sort of physical disability that requires orthotic assistance.
Orthotist and Prosthetist Job Description
Both prosthetists and orthotists follow prescriptions written by physicians to design the special devices that help their patients. In most cases, they continue to work closely with the attending physician to coordinate the creation and fitting of the device.
Their work usually begins with an examination of the patient. Prosthetists see patients who have had amputations due to accidents, birth abnormalities, or disabling diseases. Orthotists see patients who need support or correction due to muscle or bone impairment or deformity. Prosthetists and orthotists test muscle strength and range of motion and observe how the patient walks. They also use tools, such as rulers, tapes and calipers, to measure limbs or stumps. It is important to note all pertinent details to make sure that the device fits properly. Each prosthesis or orthosis is individually designed to match a patient’s unique needs.
Prosthetists and orthotists may make a cast or model to work on. They also draw layouts and make a tentative blueprint for the device. The actual devices may be made either by the prosthetists and orthotists themselves or by orthotic and prosthetic technicians or assistants. Prosthetists and orthotists select materials for each orthosis or prosthesis to match the needs of the patient. Considerations range from the patient’s height and weight to the patient’s activities. Materials used in the construction of orthoses and prostheses include wood, foam, plastics, fabric, steel, aluminum, fiberglass, and leather, as well as newer, composite materials, such as carbon-graphite. Prosthe-tists and orthotists use hand and power tools, such as saws, drills, and sewing machines, to skillfully manipulate these materials into the desired designs. They may glue, bolt, weld, sew, and rivet parts together or take advantage of advanced thermoforming techniques (techniques using heat) to mold and form parts. Straps or Velcro may be added to help customize the fit.
Once devices are made, prosthetists or orthotists typically see the patient several times for fittings. They evaluate the fit and work with patients to demonstrate how to use the devices. For maximum comfort and effectiveness, minor alterations usually have to be made. Prosthetists and orthotists work with many other health care practitioners, such as physicians, therapists, and specialists, to help patients adjust to their prostheses and orthoses. It is essential that all devices be comfortable, stable, and properly fitted. The finished product must meet with approval from the doctor who prescribed it.
Prosthetists are also involved in the development and creation of myoelectric and externally powered prostheses. A patient with a myoelectric prosthesis can use the electrical impulses of his or her muscles to power a prosthetic limb. To accomplish this, an electrode is placed on the skin over a muscle. When the patient contracts that muscle, the electrode picks up and amplifies the electrical activity from the muscle. This electrical signal then activates a battery-powered motor in the prosthetic that causes the device to move.
Orthotist and Prosthetist Career Requirements
If you are interested in becoming an orthotist or a prosthetist, take high school courses that are college preparatory. Mathematics classes such as algebra and geometry will be useful. Also of importance are biology, physics, and chemistry classes. These classes will familiarize you with basic anatomy and the properties of various materials. Computer science courses will prepare you to use computer-aided design and computer-aided manufacturing technology for making mechanical drawings and blueprints. Shop classes or sculpture classes that teach you how to work with metal, plastic, or wood will familiarize you with the materials and processes the orthotist or prosthetist uses in creating braces or artificial limbs.
A bachelor’s degree, preferably in prosthetics or orthotics, is required in order to work as a prosthetist or orthotist. You may choose to get a bachelor of science (B.S.) degree in orthotics and prosthetics from a school accredited by the National Commission on Orthotic and Prosthetic Education. Or you may get a bachelor of arts (B.A.) or B.S. in any field. However, if you earn a degree in a field other than orthotics and prosthetics, you will then need to complete a one-year certificate program following college. In either case, your college coursework should include classes in anatomy, biology, chemistry, computer science, physics, math, and English.
After earning a college degree, and, if needed, completing the one-year certificate program, most practitioners enter a one-year or 1,900-hour clinical residency program. Residency experience is required in order to become certified.
Certification or Licensing
Certification is highly recommended. The American Board for Certification in Orthotics and Prosthetics (ABC) grants three credentials: certified orthotist (CO), certified prosthetist (CP), and certified prosthetist/ortho-tist (CPO). The Board for Orthotic/Prosthetic Certification (BOC) also offers the following certifications: BOC orthotist, BOC prosthetist, and certified orthotic fitter (COF). In 2004, each organization offered the other organization’s members reciprocal certification as a means to unify the sometimes confusing certification process in the field. Contact the boards for more information on this development and certification requirements.
Licensing is required for orthotists and prosthetists in some states. Practitioners need to check with the laws of the state in which they intend to practice for licensing requirements.
A person considering a career as an orthotist or prosthetist should have an interest in the health care field and a desire to help people. He or she should have the capacity to visualize and invent. Finally, mechanical aptitude, manual dexterity, and an eye for detail are important qualities for success in these jobs.
Exploring Orthotist and Prosthetist Careers
Without the necessary educational and work requirements, it is very difficult to get part-time or summer jobs in the fields of prosthetics or orthotics. There are, however, ways to learn more about what it is like to work in these fields.
Teachers and counselors, for example, may be able to arrange for a visit to a hospital, clinic, or rehabilitation center so you can talk with practitioners. In addition, you can visit departments of prosthetics and orthotics in colleges and universities. High school and college courses in science and engineering may also give you an opportunity to evaluate your interest and aptitude for work in these fields.
Approximately 6,000 orthotists and prosthetists are employed at hospitals, rehabilitation centers, private brace and limb companies, and Veterans Administration facilities.
Since individuals must have a bachelor’s degree to enter the fields of prosthetics and orthotics, many get help in finding a job from their college or university career services office. Many professional journals and associations also list employment opportunities. Job seekers can apply directly to the personnel offices of any area hospitals or rehabilitation centers that have orthotic and prosthetic departments.
The U.S. Department of Veterans Affairs often has openings for qualified orthotists and prosthetists. Those who are interested in a government job with the Veterans Administration (VA) should check with local VA offices for the monthly recruitment bulletin.
In large prosthetics and orthotics departments in hospitals, clinics, and rehabilitation centers, certified practitioners may advance to supervisory, training, or other specialized positions. Other certified prosthetists and orthotists may decide to start their own private practice. Some decide to further their education and go into research or teaching.
Salaries of prosthetists and orthotists vary according to education, clinical experience, and certification. Practitioners who work on their own earn substantially more than those who work for others. These practices can be extremely lucrative, but success depends on the practitioner’s ability to draw new clients to his or her business. Salaries for independent practitioners usually range from $60,000 to $120,000 per year.
According to the U.S. Bureau of Labor Statistics, in 2005 the median annual salary for prosthetists and orthotists was $53,760. The lowest paid 10 percent earned $29,110 and the highest paid 10 percent earned $93,310. Salary.com reports that in 2006, the median annual earnings for prosthetists and orthotists were $61,717 with most earning between $51,159 and $67,264.
Most prosthetists and orthotists work regular five-day weeks. There is very seldom any need for overtime or evening work. Working conditions are usually good. Offices, examination rooms, and fitting rooms are clean, well lit, and well ventilated. If the prosthetists and orthotists fabricate the devices themselves, however, they may also spend time in a lab or brace shop. These areas typically do not offer ideal working conditions; they may be hot, cluttered, dusty, and loud with the sounds of machinery.
Prosthetists and orthotists often work closely with other health care practitioners. They also work individually with their patients to perform fittings, make alterations, and help them adapt to their devices. In some cases, this interaction with coworkers and patients may be very pleasant and satisfying, while at other times, the orthotist or prosthetist may find it frustrating and difficult. Many who work in these jobs find a great deal of fulfillment in the knowledge that they are helping others to lead more normal and active lives.
Orthotist and Prosthetist Careers Outlook
According to the U.S. Department of Labor, the employment of orthotists and prosthetists is expected to grow faster than the average for all occupations through 2014. Many factors contribute to the growth of this profession, including the increasing elderly population and the greater access to medical and rehabilitation care brought about by private and public insurance companies. Advancements in technology and new, lightweight materials will only increase the value of those individuals who can design and fabricate attractive orthoses and prostheses.