The Future of O&P (December 1996)
The Future of O&P (December 1996)
by Alvin C. Pike, CP
A revolution is brewing. CAD/CAM technology, introduced into prosthetic design several years ago, will alter the future of the profession. While it has been slow to find its place in the prosthetist's arsenal of weapons, eventually it will play a major role in the direction and future of this profession. Just as Mr. Otto Bock and his company changed the fabrication method in his time with industrialized prostheses, the computer will bring about the next revolution in prostheses for both fitting and fabrication.
Don't confuse this revolution with evolution. Big changes are coming. The next century will see an entirely new class of computer-driven O&P facilities, in my opinion, similar to the optician or dentist offices of today. They will be located in medical complexes and larger shopping malls. They will not be staffed by traditional orthotists and prosthetists, but by a new breed of professionals who will evolve into a new level of practitioner. Let's call them Physical Restoration Engineers (PRE's).
Deep into the next century, these PRE's will be drawn from the biomedical and bioengineering programs found in many universities today throughout the world. They will be a meld of disciplines: orthotics, prosthetics, anaplastology, and the as yet undefined field of osseointegrated prostheses. This new profession will not be hampered by old traditions, conflicts, or paradigms. PRE's will thrive because they will quickly grasp how present and emerging computer technology can be used to completely change the 20th century system for the delivery of orthoses and prostheses. These elite professionals will be aware and online, plugged into the new technologies being developed in the world's research laboratories. They will feel compelled to constantly take advantage of new opportunities in the rapidly changing marketplace of orthotic and prosthetic services. In short, they will be the techno-wizards of body rebuilding.
Years into the 21st Century, an amputee will visit a computerized PRE office with access to a large database of successful outcomes of prosthetic device prescriptions. From their home computers, amputees will have already input data about their needs. This input will include facts about their lifestyle, workstyle, and playstyle that will guide the PRE's efforts.
At the PRE's fingertips will be extensive information about socket shape, components, alignment, and other factors to be cross-referenced with what has already proven successful for many other amputees. The database technology used to cross-reference this anatomical data will be similar to that used in law enforcement today to match fingerprints. And it will be shared by PRE's globally.
Selecting componentry will change dramatically. Many of today's prosthetic components are so similar that it has become virtually impossible for the practitioner to know what makes each and every component unique. Ironically, so many choices often limit the practitioner. He often remains with what he is most familiar, reducing the options available to the amputee. Indeed, every time an amputee is fit today, prosthetists start over from point A with their own cast. Prosthetists depend upon years of personal experience and memory of what has worked in the past, applying that to their next fitting. In essence, this method relies upon the many shortcomings of the human mind complicated by a list of unknown factors. The decision processes of the 21st Century will remove much of today's subjectiveness, improving the potential for a successful outcome with the very first prosthesis.
Decades from now, the PRE will apply an advanced generation of CAD/CAM systems using "fuzzy logic." Information about successful fittings will be returned back to individual PRE systems and global databanks. The memory of the computer will augment that of the human practitioner. Indeed, the computer will be able to apply the memory of thousands of successful fitting outcomes from hundreds of practitioners. These practitioners will continuously consult online in real time using images and other computer tools to constantly add to this body of knowledge of successful outcomes. Developing these additional tools will require the kind of nontraditional thinking that allowed John Harlan, Craig Pratt, Ernest Burgess, MD, and David Boone, CP, to envision and develop their world-famous Shapemaker software. And so it will be for the new PRE's of the next century.
One can easily envision an encounter at the physical restoration facility of the future. An amputee with a transtibial (BK) amputation presents. A pneumatic cuff placed on the remaining limb inflates to a series of pressure settings. Differential readings obtained from the pressure transducers within the cuff produce a realization of the soft tissue and bony substructure. This data is augmented with individual and global information from the PRE. A socket template is selected to produce a test socket. The skill and talent of the traditional prosthetist won't be lost, but these new tools will elevate these skills to a much higher plane.
After the test socket, a definitive socket could be produced using rapid prototype manufacturing technology similar to the "squirt shape" system developed at Northwestern University, or by another method using a direct laser cutting or fusion process. The final prosthetic socket will intimately fit the residual limb. It also will feature an outer shape that will permit inserting or attaching the socket to the present prosthesis while still retaining the previous alignment.
To obtain information for alignment, shape cosmesis, and length, a laser scanner or digitizing imager such as those already being developed for other major industries would be utilized. Such a device would be coupled with a measurement-based system as currently in use by Otto Bock, Vorum, BioSculpter, IPOS, and others for above-knee sockets. These new systems will be driven by computers incorporating neural net technology.
For this revolution to occur, a strong external force will be required to change the paradigms of traditional thinking about O&P. This force could be nontraditional industries seeking opportunities in our marketplace. By way of example, for better or worse, agribusiness revolutionized farming with capital expertise and a business imperative, applying new technologies to family farm thinking. It may be the same for O&P. Or, it may be the cumulative force of continuous change in the healthcare delivery system. Surely, the labor-intensive aspect of the O&P field as it exists must be dramatically reduced. The computer will be a prime mover in this inevitable process.
Be forewarned: evolution is occurring now. But revolution is on its way. The process will not be without casualties. The healthcare system in the United States is undergoing disruptive change. Change is something the orthotics and prosthetics industry historically has been slow to accept, at least voluntarily. But change will come and it will even include the demise of patient care facilities for orthoses and prostheses as we know them today.
My vision is purely intuitive, based on my own personal experiences. How close are we? CAD/CAM systems used today are but first-generation systems. Even still their value is being proven in this country and abroad in less-developed nations. Practitioners and amputees are already linked by E-mail, discussing the outcomes of prosthetic fittings and components used. Mergers and consolidations are occurring everywhere in the O&P field. Managed care changes are speeding along faster than the profession's ability to react. No sooner do we digest and respond to one change than another enters the scene. Society demands mobility and O&P's technologic orientation fits the future mindset.
Will today's professionals sense the move of the future? It will be
difficult, but I believe they will. That's why my faith is reinforced in the
future of O&P professionals as they confront the coming decades of the next
century.
Alvin C. Pike, CP, is a past president of the American Academy of Orthotists
and Prosthetists and a member of the AAOP CAD/CAM Society. He is also on the
BioMechanics Board of Editorial Advisors.
© Copyright 1996, International Features, Inc.
