For many, including physicians and allied health professionals, orthotics and prosthetics have been somewhat of a mystery with respect to who provides them and what qualifications one must possess to do so. In any community, orthotics and prosthetics are an important medical resource; thus, knowledge of the field and its qualified providers is invaluable to patients and practitioners alike.
Before discussing this topic, it is perhaps worth differentiating and defining “orthotics” from “prosthetics.”
A prosthesis is an external artificial limb designed to replace a natural limb lost from an amputation or congenital limb difference.
An orthosis tends to stir up more confusion largely due to the numerous “orthotic” providers in this country. An orthosis, from the Greek for “to make straight”, is an external appliance that supports, corrects, stabilizes or immobilizes a joint or limb. This includes foot orthoses, often referred to as “orthotics,” but also includes the vast number of other custom and off-the-shelf devices that support the joints of the body.
In Canada, there can be many who say they are providers of “orthotics”, but there is only one professional qualified who has the specific training and specialized knowledge in the profession of orthotics as a whole. Enter the Certified Orthotist.
We cannot best describe the Certified Orthotist without discussing the required education. There are two main schools in Canada that yield the qualifications to become orthotists: George Brown College (GBC) in Toronto and British Columbia Institute of Technology (BCIT) in Burnaby. Each program incorporates both lectures and hands-on clinical and technical practice. As the two fields are very closely related, students learn both prosthetics and orthotics theory, and relevant topics are studied very thoroughly. These include anatomy, physiology, pathology, biomechanics/patho-mechanics, materials science and clinical assessment applications.
Both programs are two years in length with the pre-requisite of a four-year undergraduate degree in a related field such as kinesiology, physiology, biology, engineering, etc. Typically, GBC accepts eight students per year, while BCIT accepts 12 every second year. Acceptance, therefore, is difficult based on statistics alone. Entrance exams, along with interviews and CVs, are used by both institutions to screen more than 100 candidates for final enrolment.
Orthotically, this includes clinical presentations and pathologies of the feet, ankles, knees, hips, spine and upper limbs. Being clinically oriented programs, there is a strong focus on performing a detailed neuro-musculo-skeletal assessment, gait analysis, and subsequent orthotic treatment. This also involves taking an accurate capture of the relevant body segment…either through a casting or scanning along with a series of measurements. This is then followed by skilled training in the sculpture and necessary modification of the model. Fabrication and treatment evaluation of each brace are not ignored, as they are critical to the function of the orthosis and the outcome of the patient. This is just the start of becoming a Certified Orthotist.
Upon graduation, a 3450-hour (nearly two year) residency begins. This residency takes place under supervision of a Certified Orthotist and culminates with the national board certification exams which include written and practical segments. After a minimum of six years of in-class studies, a minimum of two years of a supervised residency and then passing a stressful nationally administered exam administered by your peers one has earned the credentials to call themselves a Certified Orthotist. The entire process ensures that the Certified Orthotist is well-prepared to provide the necessary care and services for their patients.