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Prosthetists: A Physiotherapist’s Perspective
By Miki Fairley "I appreciate prosthetists who are excited about
their profession and share their knowledge," says Linda McLaren,
BSR (PT), clinical resource physiotherapist-amputation, GF Strong
Rehab Centre, Vancouver, British Columbia,
Canada.
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Constable Laurie White (left) of the Royal Canadian Mounted Police works with physiotherapist Linda McLaren, BSR (PT), in return-to-work kicking tasks. Photo credit: Alignment 2000, published by the Canadian Association of Prosthetists and Orthotists (CAPO). |
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When a prosthetist calls her to come and see new
products that a manufacturer's rep is showing, she's glad to go.
"It helps to see a prosthetist evaluating a new product and saying
whether it's good or a piece of junk-and why he thinks that. I
appreciate most the prosthetists who enable me to learn about their
industry and who are willing to show me when a prosthesis is
well-made or shoddy." This information also helps her when clients
have questions about products they have seen in consumer-oriented
publications, such as InMotion or Active Living.
"Trying to improve my knowledge and skills in amputee
rehabilitation has been a frustrating educational adventure,"
McLaren continues. "Little in this area is offered within the
physiotherapy profession."
McLaren has been working with prosthetists and amputees for the
last eight years, but notes that few physiotherapists have a
knowledge of prosthetics sufficient to enable them to work
effectively with prosthetists for optimum patient benefit. "With a
regular turnover in physios, prosthetists have to rehash the basics
with each new one-often, they never got beyond the basics, and
prosthetists tell me that is frustrating."
To improve her knowledge, McLaren has started attending P&O
meetings, such as the ones held by the Association of Children's
Prosthetic-Orthotic Clinics (ACPOC) and the American Academy of
Orthotists and Prosthetists (AAOP).
Teamwork
When the prosthetist and physiotherapist evaluate the patient
together in an area large enough to walk alongside the patient,
they save time and achieve a more accurate evaluation, McLaren
says. In one case, she and a prosthetist evaluated a patient, and
the prosthetist made three alignment changes. "In most cases, the
prosthetist would have made one alignment change in the office,
then not see the client for another two weeks," she says. "By
seeing the client as a team, we could ask each other, What do you
see? What do you think the problem is? What do you think the
solution is?'"
When evaluating patients with the prosthetist, McLaren notes
that the language the two disciplines use is often very
different-and sometimes confusing, both to each other and to the
patient. "On the whole, prosthetists use very technical language
which often makes absolutely no sense to the new amputee. Physios
tend to demonstrate gait deviations and exercises by using their
own bodies. We need to explain our concepts in lay language more
than in medical terms they may not understand."
McLaren uses a video camera almost every day. "It's amazing what
people pick up about themselves and can describe. I think we need
to spend more time letting them see how they look as they perform
various activities." McLaren also films amputees at the job site
and in return-to-work programs. She has received appreciative
feedback from prosthetists when showing them a difficult job task
in which prosthetic suspension or stability might be important
factors.
McLaren appreciates honesty, forthrightness, and openness from
prosthetists. "For instance, if they don't have an opinion yet when
evaluating a patient, or if they don't know the answer to a
question, they should just say so. If they aren't honest with a
colleague, how honest are they going to be with their clients?"
Prosthetists and physiotherapists gain more respect from their
clients when they are forthright, McLaren believes. "You can say, I
don't know, but I'll look it up and get the answer for you,' or, if
it's a really a question for the physician, tell them they need to
talk to their doctor."
The Good, the Bad, and the Ugly
In her years of working with prosthetists, McLaren has seen the
good, the bad, and the ugly. "There is a level of accountability
that is missing in the prosthetic industry-and it is very much an
industry. There are prosthetists who are incredibly dedicated and
go the extra mile in the devices they provide, but there also are
people who are less diligent about their hand skills and what they
produce. A segment of amputees suffer more than they need to
because of what they are getting from some prosthetists, and the
prosthetic fitting process is more frustrating and more drawn out
than it needs to be." With added experience, she says she now can
generally "read between the lines" to distinguish between what a
prosthetist says he provides and what he actually does.
Amputee Education: A Crucial Factor
Amputee education is a crucial area that is not adequately
addressed, McLaren stresses. She works with over 80 amputees a
year; about two-thirds are new amputees "who know absolutely
nothing. They don't know what to expect and what they should do-or
not do-to prevent pain, skin breakdown, and other problems. Nor do
they understand their options if they become disenchanted with
their first prosthetist."
Patients often equate the best care with the most expensive
care, she notes. "We need to spend time explaining about the
different categories of prosthetic feet and knees and tying them in
to the client's function, so they feel they are getting what's best
for them-including the durability of the product- and not
necessarily responding to marketing hype." McLaren has a museum of
broken components and bad sockets; she uses these to educate her
patients.
"Our ultimate goal is to produce educated consumers who spend
their money for the most appropriate devices. The goal is that they
get back their life as soon as possible. For instance, if they were
working, we want to enable them to return to their jobs. And if
meaningful leisure activity was a part of their life before
amputation, then we want to enable a return to that too."
To McLaren, one of the most rewarding aspects of her job is when
clients come back to visit and show pictures of their holiday or
their wedding-when they have indeed gotten their lives back.
Linda's List for Prosthetists
Linda McLaren, BSR (PT), has many thoughts on what can be done
to stimulate physiotherapists' interest, learning, and longevity in
amputee rehabilitation. Here, she lists some requests based on what
prosthetists have done to increase her prosthetic knowledge and
ability to work effectively as a rehab team member with a
prosthetist:
- Show me what educational prosthetic journals you subscribe
to;
- Sponsor me to go to a trade show and take me from booth to
booth, explaining what's a good product and what's not;
- Tell me about Robert Gailey's One Step amputee rehab course. If
you've taken it, lend me the videos or booklet series that you
purchased;
- Help me pay for registration to go to one of the big five
international conferences: Association of Children's
Prosthetic-Orthotic Clinics (ACPOC), American Academy of Orthotists
and Prosthetists (AAOP), International Conference on Advanced
Prosthetics (ICAP), International Society for Prosthetics and
Orthotics (ISPO), and the Canadian Association of Prosthetists and
Orthotists (CAPO);
- If a prosthetic intern is working in your facility, get us
together-they have lots to learn about the physio role, assessment,
and treatment;
- Show me good sockets and bad ones and explain the differences
in detail, including shortcuts in casting, fabrication, lamination,
etc;
- Fabricate a "teaching prosthesis" for me to wear-I completely
changed my approach to the treatment of transfemoral amputees,
especially in the area of balance skills, after trying some of my
own exercises wearing a prosthesis. This "teaching prosthesis" is a
fantastic tool for me when I have to educate physiotherapy students
and new staff members;
- Tell me about other amputation physiotherapists whom you
respect.
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Arizona Couple Shows Patient Advantages of O&P, PT Partnership
- March 2006
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Physical Therapists: Colleagues or Combatants?
- March 2006
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PT 'Direct Access' —Why Is It Considered a Threat?
- July 2005
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PT Direct Access: Threat to O&P?
- September 2003
Should physical therapists have “direct access” to patients—being able to provide physical therapy
services without a physician’s prescription?
With or without the passage of “direct access”
legislation, should physical therapists be allowed to provide orthotic and prosthetic services and devices, without additional education, training, licensing, and/or certification, as part of their scope of practice?
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It’s All About Education, Training, and Experience
- June 2003
Perspective
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Physical Therapists: Are They Encroaching on O&P?
- April 2003
Are the two disciplines complementary or competitive? How much do they overlap? Here, two physical therapists with wide experience in working with prosthetic and orthotic patients give their views.
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Physical Therapists: Partners or Competitors?
- October 2002
Orthotists and prosthetists share their views on this controversial question. Next month, physical therapists and those who practice in both fields will get their say.
Feature
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Table Of Contents - March 2003
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