A leg up! Plaster molds are created from patient casts. The positive is then used as the model to mold and fit an orthotic device.
I recently completed a 10-day road trip around the South that included Illinois, Tennessee, Alabama, Mississippi, and Louisiana. This little adventure, which has become an annual event that restores my sanity, generally involves many cemetery stops, crumbling shacks worth pulling off the road to gaze at, amazing little restaurants and bars (oh, cheesy grits and Sazeracs, you have obliterated me with your love), some kayaking in the bayou, and lord knows a million other delightful events. I’m excited to report that for the first time ever, this particular trip also included an interview with some orthotics and prosthetics makers in New Orleans who just happened to be one of the winners of ToolMade’s Sears-Craftsman Tool Giveaway.
Clare shows a custom solid ankle-foot orthoses she fabricated at the clinic.
After a plaster cast is specially made for a client, a plastic sheet is vacuum formed for an exact fit. Because plastics are now used, a heat gun can make tiny adjustments when needed as well. Yes, that’s a bag. No, that’s not what Clare usually uses.
Prostheses are damned fascinating to me and I’m telling you, they should be to you as well. In my early 20s, I had some unexpected health issues that almost made me lose one of my precious gams, so when things were scary, I made a point of researching some heroes with prosthetic limbs to try and keep a positive attitude–it’s crazy what people can do despite their perceived handicaps. I get that this is a specific experience that initially lead to my interest, but you don’t have to dig far to find something that will blow your mind–I mean, some of the earliest and also most recent innovations read like science fiction. Designers from a wide range of backgrounds are getting better and better at creating limb stabilization and replacement devices due to new technologies, tools, and materials, and that’s excellent news considering that there are nearly 2 million people with artificial limbs in the U.S. (about 185,000 amputations in the U.S. alone each year, and that number is climbing).
I’m not sure how well this picture illustrates this, but if you look closely, you can even see the grooves of the skin on the foot.
Prostheses! Different heights and body types sometimes require multiple devices to be created just for the fitting process. The plastic is thermoset plastic, which starts as a liquid and is impregnated with fabric. The inside is made of carbon fiber for added strength.
When I had an opportunity to interview Clare Wiegand and Paul Beaudette at the Bayou Orthotics and Prosthetics Center in Metarie, Louisiana, I jumped at the chance. Yeah sure, you can run with that pun. First, some definitions to distinguish these devices/fields:
Orthosis (orthotic device): “An externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal system,” or basically, something bracing what is already there.
Prosthesis (prosthetic device): “An artificial device that replaces a missing body part lost through trauma, disease, or congenital conditions.”
An orthotist fabricates and fits custom-designed external orthopedic braces, and a prosthetist creates, designs, and custom-fits artificial limbs. Both require a lot of time evaluating and following-up with patients as well.
A brief history of legs past.
As one might guess, splints and braces were the first orthotic devices (also called orthoses). With the Civil War came a desperate need for massive quantities of prosthetic limbs (prostheses) and those experimenting with the creation and attachment of limb replacements became recognized as legitimate health professionals at that time–before this period, people had to fashion them from pieces of wood by themselves. These fields have grown and become increasingly sophisticated with every major war, and more recently have boomed due to lifestyle and health changes, including an ever-increasing aging population and a dramatic increase in diabetes, obesity, and heart disease.
J.E. Hangar Company, artificial leg production workshop, post Civil War. This was serious technology at the time. Prostheses were made of whittled barrel staves and metal. The company survives today! (National Photo Company Collection)
Paul, who has been making prostheses for decades, shows off a wooden leg that he keeps in the office as a reminder of days past.
Clare, who has been making both orthoses and prostheses since 2007, was my contact at the clinic, so I asked her what tools would be useful. They use lots of drills, drill bits, heat guns, belt sanders, pliers and torque and allen wrenches. I picked her up a variety of Craftsman tools within the contest budget, consisting of:
- (2) 4 piece Pliers Sets (diagonal, slip joint, arc joint, long reach long nose, wide jaw, duckbill, linesman, and regular long nose)
- 21 Piece Titanium Coated Drill Bit Set
- 17 Piece Screwdriver Set
- 19.2-Volt C# Cordless Drill/Driver
Drills are used often and need a wide range of bits, including step bits for wider sockets.
Adjustments are crucial. There are wrenches and pliers galore around this place.
I was toured through the different stations for an overview of how knee, ankle and foot devices were created, and given a look at what some of the older models looked like. The tool stock used for making these devices has changed quite a bit in recent decades—Paul, who has been making prostheses for over 40 years, explained how wooden prostheses used to be made entirely out of hand tools—sharp chisels which would be pulled upward to shape a leg are now replaced by routers, for example. The materials are also very different and consist of things like carbon fiber and plastics, making them much easier to adjust for a precise fit for each patient. Of course, the patients have also changed over time due to both an increase in illnesses as described above, but also due to fewer industrial accidents—at least some people seem to be paying attention to OSHA?
USA’s paralympic swimmer Jessica Long. (Press Association via AP)
If you’re not sure what to do with your time on this planet and this topic is at all interesting to you, seriously consider looking into these fields, which are described good career options for those who want to be an artist/bio-mechanist/engineer/medical practitioner. Why limit yourself, right? I would also add that folks who care about others and are interested in hands-on work and tools could certainly find a niche here. There is a projected 25% increase in the number of people needing orthopedic braces due to paralysis, deformity or orthopedic impairments by 2020. And if you’re more interested in creating prostheses than orthoses, that need is expected to grow 47% in the same timeframe. Wow. Yeah, I’m really selling it. Because it’s so damned important.
What my prosthetic limb would look like (painted by Tim Beck).
For more info on innovations in the field and ways people are advancing mobility, check out some great links here:
Targeted muscle reinnervation (TMR): Your brain controls the muscles in your limbs by sending electrical commands down the spinal cord and then through peripheral nerves to the muscles. http://science.howstuffworks.com/prosthetic-limb5.htm
Photos of the latest in prosthetic limb technology: http://www.smartplanet.com/photos/the-latest-in-prosthetic-limb-technology-photos/
Stand-up Mobilization Device (this is a bit of an offshoot, but a mind opener): http://www.wimp.com/newdevice/
More about careers in these fields (includes a list of programs throughout the country towards the end of the brochure): http://www.opcareers.org/assets/pdf/Turnkey_Brochure.pdf
Make it art: http://www.thealternativelimbproject.com
…and just in case there was any doubt about whether prostheses could be sexy. Jo-Jo Cranfield wearing the snake arm created by Sophie de Oliveira. Please check out the Alternative Limb Project when you have a few minutes. http://www.thealternativelimbproject.com