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You're a what? Prosthetist.

Jeff Keith made news all across America this past summer and fall. He traversed the continent on a cross-country run. Even in today's fitness-oriented society, his demonstration of strength, conditioning, and determination was extraordinary. Jeff Keith is an amputee. Every stride he made with his left leg was followed by one from his artificial one, or prosthesis.

Jeff's accomplishments serve as an inspiration to thousands of people around the country who have suffered the trauma of the loss of a limb or who were born with similar disabilities. The road to rehabilitation is not an easy one, but the disabled do not travel alone. A trained team of health professionals can help them overcome the obstacles to an active life. A key member ofthis team is the prosthetist, who combines science and art to make artificial limbs. Ivan Sabel and Joan Weintrob are two prosthetists who work in the Washington, D.C., area. We visited them recently to gain insight into this profession.

OOQ: What is prosthetics?

Sabel: Prosthetics is the design, manufacture, and fitting of artificial replacements for arms, legs, fingers, hands, and feet. It is closely related to orthotics, which is the design and development of braces, or orthoses, for people who need support or correction due to musculo-skeletal damage or deformity.

OOQ: Is every device unique?

Sabel: Yes. Every prosthesis is designed and custom made tomeet an individual patient's needs. Patients differ not only in size, shape, and weight but also in their vocations and avocations.

Weintrob: For example, we treat a young person differently from an older one. Prosthetics for younger people are heavier and more durable because they lead a more active life. For an elderly person, we use lighter weight materials and components.

OOQ: How did you decide upon a career in prosthetics?

Sabel: I was studying business administration with the intention of joining my family's business, orthopedic shoe manufacture. My father was lecturing at New York University's School of Orthotics and Prosthetics and suggested I take a look at the program. My interest had switched frombusiness to a health career. I transferred and graduated with a B.S. in orthotics and prosthetics.

Weintrob: I graduated from Tufts University with a degree in occupational therapy. After working as a therapist for several years, I decided to pursue another career. At the time, the American Board for Certification in Orthotics and Prosthetics and orthotic technology. Upon completion of these courses and a 1-year internship in each specialty, I took the certification examination and became a prosthetist/orthotist.

OOQ: Are these short courses still offered?

Weintrob: No. Several years ago it was decided that the growth in prosthetics and orthotic technology necessitated more education.

OOQ: What educational options are now available for the student interested in the field?

Sabel: A student is able to sit for the certification exam under three different options: The candidate must posses 1) a B.S. degree in orthotics and prosthetics plus 1 year's experience in each discipline for which certification is sought; 2) a bachelor's degree in any field, completion of a long-term or certificate program in prosthetics and/or orthotics, and a minimum of 1 year's experience in the field; 3) an associate's degree in any field, completion of a long-term certificate program, and a minimum of 4 years' experience. At least 1 year's experience must be obtained after completion of the certificate program.

Weintrob: Experience is always required to finish off the person's education. It's sort of a baptism by fire.

OOQ: What course of study do you follow under the B.S. option?

Sabel: The first 2 years one follows essentially a liberal arts curriculum. In the last 2 years, a student pursues introductory and advanced courses in biology, physiology, anatomy, kinesiology-or movement--and several lab courses in prosthetics and orthotics.

OOQ: How do patients find you?

Sabel: All of our patients are referred to us by physicians. The physician writes a prescription for prosthetic or orthotic treatment, similar to the procedure followed with pharmacists. The doctor relies upon the expertise of the prosthetist/orthotist to determine the patient's particular needs as to the design and construction of the device.

OOQ: Can you describe the process for us?

Weintrob: In the initial interview, we explain to the patient what we're going to do. We try to be as realistic as possible. We obviously cannot replace what was lost, but we can design a device that functions like a limb in many ways. Then we'll make a plaster cast or model of the residual limb, followed by linear measurements to make certain we construct a device of the proper length. From the plaster model we construct a socket, which fits over the residual limb. If we are dealing with a leg or below-the-knee amputation, we will also need the patient's shoe to get proper foot size and heel height. Then comes an alignment jig, which represents the shin, to connect the socket to the foot. Certain adjutments can be made to allow the patient to walk normally.

OOQ: Do you help the patient learn to use the device?

Sabel: To a certain extent, of course. But remember that we are part of a clinical rehabilitation team and work with doctors, therapists, and social workers. Helping a patient adjust to his or her prosthesis is more the province of the therapist.

OOQ: What sort of materials do you use?

Sabel: We use a variety of plastics, acrylics, and high-grade metals, such as titanium. Wood, steel, and leather are still used to a degree as well. Not long ago, exoskeletal devices--hardshelled prostheses--were used almost exclusively. Today, endoskeletal prostheses are more frequently used. These are modular devices that can be easily adjusted or replaced. They are covered with a kind of foam, which resembles actual limbs.

OOQ: What are some other innovations in prosthetics?

Weintrob: Within the last decade, increasing use has been made of myoelectric upper-extremity devices. These prostheses use electrical energy generated by the contraction of a patient's residual muscle to simulate the function of a lost limb. For instance, a myoelectric hand can simulate the grasping function of a normal hand.

OOQ: Are most prosthetists in private practice, like yourselves?

Sabel: Many are; others work in prosthetics laboratories. Large hospitals--including veterans' hospitals--may have their own department of prosthetics and orthotics.

Weintrob: When I received my certification, I worked in a hospital for a few years until I decided that I would be happier being my own boss. I now have two other prosthetists working with me.

OOQ: What particular skills do you see as important for the prosthetist?

Sabel: Good hand-eye coordination is essential. As we said, each device is custom made, a mix of art and science, so you must work well with your hand. Good communications skills and empathy are very important in developing a positive relationship with a patient.

OOQ: What about working conditions and salary?

Weintrob: Most prosthetists work a 9-to-5, 5-day week. My hours are a bit longer because this is my own business.

Sabel: The hours are pretty clear cut, unlike those of doctors, who are always on call, and nurses, who may have to work a variety of shifts. The pay is pretty good, too. A prosthetist can expect to start at around $15,000-$19,000, depending upon geographic location. After several years' experience, $25,000-$30,000 is not unreasonable. Of course some make more, others less.

OOQ: Do you see any negative aspects to the job?

Sabel: To me, there aren't many. You have to enjoy working with your hands and not mind getting dirty now and then. There's often a lot of plaster and sawdust flying around. We're also dealing with people who have suffered a great loss. If you're not prepared to confront the pain, this wouldn't be a wise career choice.

Weintrob: For me, that's the most difficult part of the work. We have to deal with a lot of anger, bitterness, and sadness. But we have to be realistic and up front with the patient. And I believe that the patient appreciates this honesty.

OOQ: But the satisfaction you derive from your job is compensation for the difficultie?

Sabel: Absolutely. The chance to help people reconstruct their lives is a tremendous opportunity. That's what makes the job for me.

Weintrob: I couldn't agree more. I work with a lot of kids, many with congenital defect that have prevented them from walking. To see them walk out of my office gives me a wonderful feeling.

OOQ: Where can a student go for more information about careers in prosthetics and orthotics?

Weintrob: I suggest they contact the America Orthotic and Prosthetic Association (AOPA), 717 Pendleton Street, Alexandria, Va. 22314.
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Publication:Occupational Outlook Quarterly
Date:Mar 22, 1985
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