It’s part artistry, part science.
That’s how Paul Webber, CPO, describes the work being done at the Prosthetics & Orthotics Department at UCLA Health, where he and his small but mighty team of prosthetists/orthotists fit patients with artificial limbs and braces.
Simply put, an orthotic is something that supports an existing body part, and a prosthetic is something that replaces a missing body part.
“What we do is make peoples’ lives easier and better,” says Webber, the department manager, who’s been making prosthetic and orthotic devices since 1975. “That’s our goal, and that’s what we’re good at.”
Patients include individuals with neuromuscular and musculoskeletal disorders and those who have experienced amputation, trauma and surgical procedures.
Along with Webber, the team includes Robert Loose, CO; Seungyeon Lee, CPO; and Kelly Nguyen, CPO. Together they deliver ready-to-fit devices for patients in the hospital and custom-made devices for those on an outpatient basis.
Works of art
The products are fit and fabricated at the hospital system’s Michigan Operations Center in Santa Monica using state-of-the-art designs and componentry. There, a full machine shop houses grinders, welders and ovens that stay busy throughout the day. They also use a “white” light scanner to capture an image of the body part that needs support in lieu of casting where appropriate.
Webber and his team churn out about 10 prosthetic or orthotic devices each week, he says.
The process to produce a custom device starts with taking a negative cast of either the residual limb or the body part that needs supporting, filling it with plaster that is allowed to harden, and smoothing the positive cast to relieve areas of pressure (“This is where the art comes in,” Webber says). Next, a thermo-moldable plastic is applied around the cast, heated in an oven and then molded over the positive model using vacuum pressure.
Webber says it takes about two weeks to make a device, from the time the patient is cast to the initial step of fitting them with a check socket. A check socket is made from a clear plastic material that is vacuum molded over the modified cast of the patient’s residual limb to determine what modifications will be necessary for an optimum fit.
The definitive process for a prosthesis is different, as the final product is made from a thermosetting resin, which is done at a specialized facility. Finally, the modular components are attached and the device is ready for delivery.
Orthotics for the very young
Some of UCLA Health’s tiniest patients are now benefitting from the department’s work: Webber and his team fashion protective shells for babies with omphalocele, a condition in which the infant is born with a hole in the abdomen where the organs are protruding or have formed outside.
“The cases we tend to see are on the severe end, what they call a giant omphalocele, and it’s a process of several months for the doctor to actually get it reduced to the point where the organs will all be inside where they’re supposed to be,” says Loose.
Omphalocele orthosis is fabricated off of a cast taken of the baby’s abdomen. This mold is made out of plaster bandages and is the exact shape of the abdomen.
The mold is made using plaster splints the approximate size of the abdomen, wetting them with warm water and placing them over the abdomen, which is covered in a cotton stockinette. These plaster strips are left in place until the plaster bandage is hard enough to remove without losing its shape.
This negative mold is filled with a liquid plaster mix and allowed to harden. After being smoothed and evened, the positive form is vacuum molded with a layer of Aliplast foam padding, followed by a sheet of low-density polyethylene plastic. This molded piece is then trimmed to specifications and a Velcro strap is attached.
In addition, Loose creates custom splints and braces for preemies and babies born with club feet and other birth defects.
“Robert is an artist, a real artist,” Webber says with admiration.
The orthotics team also makes supportive braces (orthoses) for people affected by post-polio syndrome and “C” legs” — computerized, micro-processed knees that help prevent individuals with above-knee amputations from falling.
As people are living longer, Webber sees a busy future for the prosthetics and orthotics field.
“People need devices to help them walk and get around and even eat,” he says, noting the department makes computer-controlled arms and elbows so people can feed themselves or carry things after having a stroke.
That's gratifying work, Webber says. Even after 46 years in the field.
The Prosthetics and Orthotics Department is part of UCLA Rehabilitation Services. For more information, call 310-794-1323.
Jennifer Karmarkar is the author of this article.
