PubMed2000
The introduction of computer aided design and computer aided manufacturing into the field of prosthetics and orthotics did not arrive without concern. Many prosthetists feared that the computer would provide other allied health practitioners who had little or no experience in prosthetics the ability to fit and manage amputees. Technicians in the field felt their jobs may be jeopardized by automated fabrication techniques. This has not turned out to be the case. Prosthetists who use CAD-CAM techniques are finding they have more time for patient care and clinical assessment. CAD-CAM is another tool for them to provide better care for the patients/clients they serve. One of the factors that deterred the acceptance of CAD-CAM techniques in its early stages was that of cost. It took a significant investment in software and hardware for the prosthetists to begin to use the new systems. This new technique was not reimbursed by insurance coverage. Practitioners did not have enough information about this new technique to make a sound decision on their investment of time and money. Ironically, it is the need to hold health care costs down that may prove to be the catalyst for the increased use of CAD-CAM in the field. Providing orthoses and prostheses to patients who require them is a very labor intensive process. Practitioners are looking for better, faster, and more economical ways in which to provide their services under the pressure of managed care. CAD-CAM may be the answer. The author foresees shape sensing departments in hospitals where patients would be sent to be digitized, similar to someone going for radiograph or ultrasound. Afterwards, an orthosis or prosthesis could be provided from a central fabrication facility at a remote site, most likely on the same day. Not long ago, highly skilled practitioners with extensive technical ability would custom make almost every orthosis. One now practices in an atmosphere where off-the-shelf orthoses are the standard. This reduced fabrication time, but compromised the accuracy of the fit of a custom made orthosis. Computer aided design and manufacturing has the ability to combine the accuracy of custom made with the speed and labor savings of off-the-shelf systems. This would be a substantial benefit to patients, practitioners, and third party payors as well. The field may run full circle and return to custom made systems at off-the-shelf costs. As scientific knowledge base increases and computer aided design improves, one still needs the interface between the design methodology and the patient. That interface is the prosthetist/orthotist. The clinician and the clients they serve have a lot to gain from further research in this field. If one does not lose focus on how one can improve prostheses and orthoses for the consumer, one can expect great things from the methodology of CAD-CAM. There is no question that computerization is here and will continue to influence the fields of prosthetics and orthotics.