The History Of The Orthotic And Prosthetic Professions
22 Nov 2017
The origin of orthotic and prosthetic practice is traceable back to ancient times. The first orthotic craftsmen applied leather, textiles and the metals at their disposal to splint-making and bone-setting. The earliest prosthetists emerged from mankind’s physical and spiritual need for functional and cosmetic wholeness in response to limb loss in battle or an accident or a congenital absence. Evidence exists of prosthetic limbs being applied as far back as 2500 BC.
Though those early practitioners were surprisingly innovative, their craft was extremely slow to develop through the 19th century. They learned their trade on the job and functioned in small independent workshops; there was no organized education, formal research or group collaboration for sharing ideas and experience.
That situation began to change in late-World War I when representatives of the nation’s 10 leading prosthetic firms gathered discuss the state of U.S. prosthetic practice and technology, which was then significantly lagging Europe. That meeting led to the creation of the Artificial Limb Manufacturers and Brace Association, an event now considered to be the turning point for O&P growth and development in this country.
By providing a national forum for developing educational and scientific programs, ethical standards and building better relationships with other health and rehabilitation practitioners, the national organization (since renamed the American Orthotic & Prosthetic Association) shepherded a transformation of practitioners from craftsmen to skilled clinicians providing direct care to patients. In 1948, the formation of the American Board for Certification in Orthotics and Prosthetics (ABC) set minimum standards for practitioner education and experience and testing their clinical knowledge.
The large number of American casualties in World War II and the polio epidemic of the 1950s greatly increased the need for orthotic and prosthetic care in America and with it the need for formalized education programs and scientific research. An explosion of innovation followed, accompanied by creation of university-based orthotic and prosthetic training programs. In 1970, the American Academy of Orthotists and Prosthetists was established to further the scientific and educational attainments of O&P practitioners.
Increased demand for O&P services led to improved technology in components, materials and clinical skills beginning in the 1960s. Particularly noteworthy was the introduction of composite materials such as fiberglass and high-temperature thermoplastics in the 1970s.
Accelerated innovation in orthotic and prosthetic design has continued into the 21st century, driven by increased worldwide demand, microprocessor technology and government programs to provide top-quality prostheses and orthoses for military casualties of U.S. campaigns in Iraq and Afghanistan. Though still in their infancy, powered prosthetic limbs and electric orthoses promise to be the “next big thing” in our field; many other exciting concepts are also on the drawing board.
Although its roots are thousands of years old, the practice of orthotics and prosthetics may just now be coming into its own.
Orthotic And Prosthetic Terminology
Like our counterparts in other medical specialties, we who practice prosthetics and orthotics use a somewhat specialized vocabulary pertaining to the work we do. The terms are not difficult but tend to be confusing to some folks.
Take prosthetic… It will come as a surprise to more than a few people who use it frequently that this word is not a noun! It is correctly used only as an adjective, as in prosthetic rehabilitation. The proper term for what in past times was generally called an “artificial limb” is a prosthesis (pl. prostheses)…not a “prosthetic.”
Similarly, an orthotic device (popularly termed a “brace” in past times) is correctly termed an orthosis (pl. orthoses).
Adding further confusion to the discussion are the words prosthetics and orthotics, which are nouns, as they refer to the science and practice of providing prostheses and orthoses. (Prosthetics are not more than one replacement limb, nor are orthotics two or more orthopedic braces.)
And finally, the individuals who provide prostheses and orthoses: An orthotist is a practitioner who measures, designs, fabricates, fits and services orthoses to support or correct disabilities; likewise, a prosthetist is a practitioner who measures, designs, fabricates, fits and services prostheses for replacement of a missing limb or appendage (hand, fingers, toes) due to congenital or acquired limb loss.
Now, further muddying the water are different uses of these terms by other specialties. For example, while the technically correct term for a molded shoe insert is a foot orthosis, that particular product is often called an “orthotic” by some podiatrists and sellers of prefabricated inserts. Moreover, providers of various devices that do not have an impact on the musculoskeletal functions of the body — artificial eyes or appliances for the eyes, dental plates, and largely cosmetic ears and noses for example — like to call these items “prostheses.” So it can be confusing.
A few other terms pertinent to our specialties:
O&P (or P&O) — Widely used abbreviation for orthotics and prosthetics.
Pedorthist — An individual trained in the manufacturing, fitting and modification of foot appliances and footwear for the purposes of alleviating painful or debilitating conditions of the lower limb.
Rehabilitation team — A group of allied health care professionals that frequently includes physician, surgeon, orthotist/prosthetist, physical and/or occupational therapist, social worker and counselor assembled to help a debilitated individual regain a functional life.
Residual limb — The portion of an arm or leg remaining after amputation… sometimes referred to as a stump or residuum.
If you have any questions about orthotics or prosthetics, please feel free to call one of our offices. We are conveniently located in Beaumont, Nederland and Jasper, Texas. We see many patients from around southeast Texas including Orange, Port Arthur, Liberty and Woodville.