Rehabilitation in Prosthetics and Orthotics is any measure aimed at restoring the physical ability of a disabled individual through treatment, training and re-integration.
A rehabilitation team is a group of expert specialized in the rehabilitation of physical disability by appropriate measures of surgical, clinical, technical and physical intervation,treatment,training and re-intergration.The clinical team approach has proven to be the most appropriate method of providing Prosthetics and Orthotics management.
• The Patient
• Orthopaedic Surgeon
• Physical Therapist
• Occupational Therapist
• Social worker
• The Nurse
• Family member
The patient is the most important member of the clinic team; she/he is the reason for the clinics existence and therefore should be the centre of attention of clinics activities.
Some of the clinics are for teaching; this is the valuable way to teach the principles of prescription and prosthetics/Orthotics evaluation.
Successful rehabilitation is largely dependent on patient’s willingness to co operate with the clinic team’s recommendations .The patients has certain goals and expectations with regard to the end result of the rehabilitation .It is the responsibility of the team members to help the patient attain these goals, provided the expectations are realistic
Members of the team must meet regularly to discuss each patient’s progress. Every one should be given the opportunity to provide input.
The Orthopaedic Surgeon;
He is the one responsible for planning and performing the actual surgical interventions and finally in most cases for the prescription of the orthopaedic appliances.
The surgeon has to be well informed about each of the team member’s specialties and about possible complications and solutions. The surgeon has to oversee the quality of the patient care and the outcome expectations in all aspects. Internationally prescribing surgeon is being held responsible for appropriate results for the paying agencies. Accordingly not only specialized medical education but also physiotherapist and Prosthetist and Orthotist should be an integral part of their studies.
A Prosthetist/Orthotist is a professional who has been educated and trained to consider appropriate functional components and materials to design a prosthesis or an Orthosis .He or she measures/casts and modifies models ready for design,manufacture,aligning,fitting and delivery of the appliance. As the team member the Prosthetic/Orthotist must have the basic anatomy and pathology of various diseases related to P&O .He/She should be able to teach peers and patients about prosthetics and Orthotics issues.
The Prosthetist/Orthotist should able to advice the patient and the clinic team of the most appropriate options with regards to;
• Socket type.
• Component based on physical clinical assessment and the patient’s functional capabilities.
The Prosthetist/Orthotist is responsible for supervising the technical fabrication of the appliances to ensure that the device meets the requirements as set out in the prescription.
The Prosthetist/Orthotist should keep record of all modifications and inform the team any significant changes or problems with regard to fitting. It is important that the patient and the rest of the team understand the limitation of the prosthetic and Orthotic device so that expectations do not become unrealistic,
The Physical Therapist
Initially, one of the primary roles of physical therapist is to assess the patient’s muscles strength and range of motion. The therapist in consultation with the Physician/Orthopaedic Surgeon, should develop an individual programme of exercises that will improve those deficiencies identified by the assessment.
Re assessment should be performed after regular specified periods of time in order to evaluate the effectiveness of the prescribed exercise programme.The Therapist’s findings should be made available to the other team members, as this information may directly affect their treatment plan. This input will also affect the team’s expectations of the individual’s functional capabilities once prosthetic/orthotc fitting commences (if in fact prosthetic/orthotic fitting considered appropriate)
Controlling edema is another important role of Physiotherapist. The therapist will be responsible for instructing both the patients and the staff in the proper application of an elastic tensor bandage to the limbs.
The Physiotherapist will be also responsible for gait training .by monitoring the skin conditions of the limbs following these gait training sessions, the therapist is able to keep the Prosthetist/Orthotist informed if problem arise.
The Social Worker
The social worker is an integral member of rehabilitation team, while their role is to re-integrate the patient into the community, creating awareness and using community programmes, they are as well trained to observe.
• Patient behaviour
• Areas that may provoke anxiety
• Fear of family rejection.
• Fear for the inability to pay for the appliance.
• Fear of the job loss
Social worker has special knowledge of agencies that can help support the patient recovery and provide financial aid for obtaining the appliance. Social workers are a valuable liaison between the clinic team and patient’s family.
The social worker may also be instrumental in discharging planning process, especially if the patient’s existing house or apartment is inappropriate and or the patient requires a higher level of daily care.
The occupation therapist is in majority of circumstances specialized in upper extremity e.g training in the use of arm prosthesis or development of skills to cope with pathological conditions.
The role of occupational therapist is to assess the patient’s functional capabilities with respect to activities of daily living. If possible the patient should be assessed for the independent activities of daily living both with and without the use of appliances (e.g., prosthesis, crutch, walker, wheelchair etc.)
The occupational therapist will concentrate on such things as;
• Self care
• Energy conservation
• Problem solving in new situation
The occupation therapist may be also be responsible for making recommendations for home modifications that may enhance independent living. They will provide the patients with adaptive equipments where necessaries static splinting, appropriate walking aids or wheel chair. The therapist may also investigate possible occupational and vocational options available to the patient.
The nurse’s role in the rehabilitation team is a varied one. He or she has the responsibilities of medical care, i.e administering prescribed medications, dress changes. The Nurse may work with both Physiotherapist and Occupation therapist in encouraging the patient to perform activities of daily living independently and or monitor recommended exercises .Upon discharge the Nurse may also be responsible arranging appropriate patient home care services as per the recommendation of the clinic team.