Orthotics & Prosthetics

You will be seen in an orthopedic clinic by a team that includes your doctor, prosthetist or orthotist, physical or occupational therapist, nurse, and psychologist. Orthotic and prosthetic devices need to be prescribed by a physician at Scottish Rite for Children. Once the prescription and treatment plan are developed, your child will be scheduled for the same day or a future appointment with the next available prosthetist or orthotist. If you prefer to see the same person each time you visit, you may call us in advance to schedule an appointment. At various times, a technician may step in to assist with repairs or various steps in the fabrication process.

Each time you come for an appointment, please bring all equipment the child uses, including the prosthesis or orthosis, any socks, liners or special pads, crutches, walkers, etc. For lower limbs, please also bring a pair of loose-fitting shorts. This allows us to more easily take casts or measurements and to check and modify the devices as needed. For arm prostheses, a loose-fitting T-shirt or tank top is preferred.

Each orthosis is custom-fitted, with many being custom-fabricated specifically for a child, often by using a mold to appropriately size the orthosis and reshape key areas based on the child’s orthopedic needs. When making a custom device, we typically mold the patient at the first visit and see them back in approximately two weeks for fitting and delivery of the device. As a patient grows, the orthotics team makes adjustments to the brace or braces to ensure a good fit. A brace typically lasts about one year before needing to be replaced due to growth.

Orthotists and technicians monitor and adjust shoes and braces throughout the treatment process, ensuring that each child receives the best care possible. They also add lifts to patients’ existing shoes when needed due to differences in leg length.

Our staff prosthetists create a custom-made prosthesis for each patient. It takes approximately four to six weeks to complete the first three stages of developing a prosthesis. When required, physical or occupational therapy is provided on-site, usually over a one- to two-week period. If ongoing outside physical therapy is required, the Physical Therapy department can help you make those arrangements. The steps to make a prosthesis include:

• Evaluation, Measurement and Molding (Casting): 1-2 hours
• Test Socket Fitting: 1-2 hours
• Alignment/Wearing Trial: 2-4 hours
• Delivery: 1-2 hours
• Training (Physical or Occupational Therapy, If Needed): Usually 1-2 hours per day, over several weeks

Prosthetics staff members also work closely with therapists who train patients to use their prostheses in everyday activities. Physical therapy or occupational therapy is usually required for first-time prosthetic fittings and when a major change in prosthetic design or patient goals requires further training. Patients should bring their most recent prosthesis to each appointment and wear clothes appropriate for being casted or measured.

• Impression/Measurement Stage: Prosthetists make a plaster mold of the child’s residual limb that will be fitted.
• Test Fitting: The child is fitted with a clear plastic socket.
• Alignment: Components such as feet and knees are added. The child is given some initial training and a chance to try out the system. Usually, temporary, adjustable components are used so that changes to the position, height and angle of the prosthesis can be made.
• Physical Therapy: The child receives in-depth training on how to use the device, how to gradually apply more weight onto the prosthesis and how to do other routine activities, such as climb stairs.
• Delivery: After the child goes through alignment and training, the prosthetic components are attached in a more permanent, durable way. The device is then completed with a cosmetic finish. Each child determines how their prosthesis looks. Some are skin-toned and natural looking, and some are sporty and brightly colored, while others may not have a cover at all, looking a bit more “high tech.” These choices reflect the needs and preferences of the person wearing the device.
• Follow-up: Because children grow quickly, they are usually seen at least four times per year for adjustments to the prosthesis. On average, prostheses need to be replaced about every 15 months.