As Aimee Mullins so eloquently suggests, prosthetics are all around us, and are now commonplace, whether as a result of replacement surgery, or from spectacles, hearing aids, false teeth, and the list goes on. This is quite an interesting quote from Aimee however, as she is one of the most famous bilateral amputees in the USA right now, having had both her legs amputated at a young age as a result of a severe medical condition. What I want to examine very briefly in this blog, is the role of the clinician in the care provided to both upper and lower limb amputees.
It is now the case in the UK at least, that prosthetics and orthotics are taught and assessed together. All people going through the education and training process, which as mentioned in a previous blog is at graduate level, will dual qualify, and will then be able to practice in either, or both disciplines. There is clearly a reason for this cross-over, and whilst the two fields may seem unconnected, this could not be further from the truth.
I guess I should begin by outlining precisely what prosthetics are, particularly as the opening quote may have already caused some confusion. Put simply, a prothesis is a device that replaces a missing body part. This can of course be any body part, hence the mention of false teeth, as these are strictly speaking, prosthetics. In the context of this blog however, we are referring to limbs, as opposed to more general body parts.
Prosthetic limbs can be necessary following congenital loss (at birth), loss due to vascular issues, as a result of diabetes, or as a result of trauma. Amputees have become more visible in recent years in the UK as a result of the work of organisations such as Help for Heroes, and the work they do with military personnel, who have lost limbs in the line of duty. Whilst we see and hear more about prosthetic legs, there are obviously a whole range for the upper body too.
Prosthetic limbs, whilst doing fundamentally the same job that they have always done, are now incredibly technologically advanced, and there has been a distinct shift in the attitudes towards them, both by wearers, who often used to feel as if a prosthetic limb was something they had to hide or disguise, and indeed the general public, who now see them as ‘normal’. In fact, many amputees are now more than happy to display their prosthesis, with all its technology on show, as opposed to hiding them or feeling shame. This doesn’t of course diminish the seriousness and trauma of having to cope with amputation, or indeed with having to learn to use such an alien device.
I’ve already noted that most Orthotists are qualified Prosthetists, and vice versa, and whilst it may not be immediately obvious how their work is so similar, the answer of course, as mentioned so many times in previous blogs, is biomechanics. The Orthotist manages existing limbs, whilst the Prosthetist manages replacements, but biomechanics is fundamental in both areas. It is also true that the Orthotist will very possibly still be called upon to provide treatment for the amputee in so many cases. For example, whilst it is the job of the Orthotist to manage the diabetic foot, largely in order to prevent amputation, if this does become necessary however, they will still work with the patient to manage their residual limb, as it is often the case that there will only be a partial amputation, and the gait and biomechanics will then change significantly.
Orthotists also work with amputees, as they very often have particular issues with the biomechanics of there remaining limb. Take for example someone who has lost their right leg. Their left leg, foot and ankle, will have different forces placed upon them, and they will require orthotic intervention, to reduce pain, increase stability, and maximise mobility in this existing limb, and this is doubly important as they then handle to tough task of using a prothesis.
I appreciate that talk of amputation and prosthetic limbs is not always cheery, and many are living with this trauma each day. No matter how ‘trendy’ and technologically advanced a prosthetic limb can be, it is still a replacement, and we should not forget the pain and mental anguish that most amputees experience as they undergo their treatment, and most would turn back the clocks where possible, in order to prevent such life changing events. Orthotists work tirelessly to manage limbs, and this is often in order to prevent amputation, be this with a diabetic, a heavy smoker, people living with disorders or disease, and they have an incredible success rate. Rest assured however, that if amputation is the only option available, the Prosthetist and Orthotist will still be there to minimise pain, maximise stability, and promote increased mobility.