title: Biomechanical assessment and treatment in lower extremity prosthetics and orthotics: a clinical perspective.
abstract: Biomechanical treatment is like a jigsaw puzzle with two complex counterparts having many pieces. The physical and mechanical components are equally important and cannot be separated from each other. The patient with a prosthesis or an orthosis represents a biomechanical system; total treatment is essential. All of the pieces to the puzzle must be used to complete the picture. Given the present structure of the educational system, there is a separation of disciplines necessary to provide one truly biomechanical treatment. Physical therapists are educated in the bio aspect of treatment, whereas prosthetists/orthotists are educated in the mechanical aspect. Biomechanical treatment requires the direct interaction and integration of the two disciplines. Physical therapists and prosthetists/orthotists need each other. One without the other can provide only half of the treatment necessary for optimal outcomes. The patient needs both. Physical therapists need to become more familiar with mechanical treatment and learn how to integrate this into their physical treatment program. Prosthetists/orthotists must become more familiar with the importance of physical treatment and the internal corrective forces necessary for efficient ambulation. The traditional label of orthotics and prosthetics and related technology as products must be replaced with biomechanical treatment that includes orthotics and prosthetics services. Professionals working with each other is a positive step, but they need to be working together as a team toward a common goal. They need to be in the same place at the same time and work together consistently to provide total treatment. This is more than a multidisciplinary approach. It is one treatment. In this way, each benefits the other as they teach and learn simultaneously. At present, this teaching and learning can be done only on an individual basis. It is the author's hope that experienced prosthetists/orthotists and physical therapists reading this article will see the need to combine their efforts to provide truly biomechanical treatment. By working together, they can expand their present knowledge and skills. In this way, treatment and outcomes can improve and serve as the guiding force for a new generation of rehabilitation specialists. This process can be expedited through the educational system by offering advanced clinical degrees specializing in biomechanical treatment specifically designed for clinical practice rather than research, administrative, or academic positions. For this idea to become reality, educational institutions representing the physical and mechanical aspects of biomechanical treatment also must work together; this would expedite the learning curve so that it would not take so long to put the pieces of the puzzle together.
authors.affiliation: OrthoTherapy LLC at Bray Orthotics and Prosthetics, 217 Old Hook Road, Westwood, NJ 07675, USA. rabedotto@juno.com
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bedotto
mesh_terms: D000671:Amputation, Surgical / Q000534:rehabilitation*; D001186:Artificial Limbs; D001696:Biomechanical Phenomena; D002985:Clinical Protocols; D005081:Exercise Therapy / Q000379:methods; D006801:Humans; D007699:Kinesthesis / Q000502:physiology; D007858:Learning / Q000502:physiology; D007866:Leg; D008124:Locomotion / Q000502:physiology; D009048:Motor Skills / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology; D009140:Musculoskeletal Diseases / Q000503:physiopathology / Q000534:rehabilitation*; D009989:Orthotic Devices; D010347:Patient Care Planning; D010808:Physical Examination / Q000379:methods; D016059:Range of Motion, Articular; D016896:Treatment Outcome