In the not-too-distant past, a prosthetist was someone who had skills in boot-making or blacksmithing, who’d craft devices from metal, leather and wood. Today, the prosthetics and orthotics profession – ‘P&O’ in industry lingo – has evolved to focus not just on building prostheses, but on providing expert clinical care and cutting-edge research, too.
The need is high. In Australia alone, some 8,000 lower limb amputations are performed each year. Stepping up to support them are dedicated La Trobe alumni like Katie, Monique and Stefania, who are applying their degrees to improve the quality of life for people with limb loss.
“Being hands-on, while being creative” – Katie Dorrell, graduate prosthetist
Katie Dorrell (Bachelor of Applied Science/Master of Clinical Prosthetics and Orthotics) describes her journey to prosthetics as ‘coming full circle’. Having first trained as a graphic designer, she recently took a career change to bring her design skills to the P&O profession.
“My father lost his leg in a farming incident when he was 18. He always thought I’d love the field and suggested I look into P&O when I finished high school. But from a young age my heart was set on being an architect, designer or illustrator,” Katie says.
Katie launched her own freelance graphic design business, but in the wake of the 2008 global financial crisis, design work became harder to find. It was around this time that a physio friend suggested Katie make the move to a career in allied health.
“I came across the La Trobe course description and realised that everything that drew me to design could be applied to P&O, too: being analytical, solving problems and using maths and physics, but also interacting with clients, being hands-on and making things, while still being creative,” she says.
“It seems so obvious in hindsight. Having an amputee father, being around prostheses was already the norm for me. I think that’s why I’m so focused now on helping people live life to the fullest, because I’ve seen firsthand what someone can achieve after limb loss.”
Katie secured a job with APC Prosthetics in her final year at La Trobe, having met the team at the 2018 Australian Orthotic Prosthetic Association congress while she was still a student.
“I had an interview and job offer before even graduating, which was such a relief heading into exams.”
For Katie, the career change has paid off.
“Every day at work is a highlight. I work with amazing and encouraging colleagues and I get to help people live their lives in a meaningful and engaged way, achieving their goals and realising that they’re capable of more than they thought,” she says.
And while it’s still ‘early days’ in her prosthetics career, she's already proud of many things – from legs she’s made, to high quality socket finishes. Having studied and worked in design, she’s also enthusiastic about applying technologies like 3D printing to P&O.
“I’m excited for the future of prosthetics, especially in the digital space around things like scanning, mods and manufacture. Our future jobs aren’t doomed with the development of 3D printing. Scanning, carving and printing are all simply tools that skilled and educated clinicians can apply to their practice,” she says.
“If anything, I see these new technologies as something that will grow the industry.”
Looking back on her time at uni, Katie is most thankful for the support of La Trobe staff.
“A lot of people don’t know it, but I battled an autoimmune disease during most of my degree. I’m so grateful for the support of the P&O staff at La Trobe, for listening to me and assisting me when I said I didn’t want to quit or go part-time in a degree I was so passionate about,” she says.
“The La Trobe degree helped me get into my new career, but my personal health struggle taught me what real strength and determination is, to finish something you’ve started. I like to think I’ve taken that into practice as a health professional this year, by listening sensitively to people’s health experiences and goals.”
“One size doesn’t fit all” – Monique Van den Boom, director and senior prosthetist
After graduating from La Trobe, alumna Monique Van den Boom (Bachelor of Prosthetics and Orthotics with Honours) built her clinical skills as a prosthetist in London. Since then, she’s volunteered in Haiti for a non-profit organisation, providing prosthetic services after a devastating earthquake; been part of the technical team for the Gold Coast 2018 Commonwealth Games; and joined the board of the Australian Orthotic Prosthetic Association.
Through all of these roles, she’s learned a lot from clients who ‘constantly surprise her’.
“I’m amazed by people’s perseverance, dedication and resilience in overcoming a significant traumatic event in their lives. I’ve learnt that things aren’t always easy in recovery and that it takes a mindset to be willing to deal with the tough times. I’m very fortunate to work with these clientele – I take a lot from their resilience and attitude,” Monique says.
Monique currently works as a senior prosthetist and co-director at ProMotion Prosthetics, where she balances her clinical, technical and admin skills with the responsibilities of running a business.
“The clinical aspect sees me work directly with clients, assessing their needs, and casting, fitting and adjusting their prostheses to optimise fit, comfort and function. The technical part requires me to manufacture the devices. It’s very hands-on and you’re working with many different materials,” she says.
“And, as prosthetic devices are fully funded in Australia, there’s also a high level of admin to provide the clinical justification to support each prescription.”
Like others in her field, Monique is motivated most by helping her clients meet their goals.
“I love working closely with my clients to achieve the best for them. Whether that’s getting back to doing what they did for work or hobbies before their amputation, or fulfilling a new goal, it’s so rewarding to play a part in their achievements,” she says.
Recent technological leaps make reaching clients’ goals ever more possible. Monique is excited by an innovative surgical procedure called targeted muscle reinnervation, which can improve people’s control of upper limb prostheses. By transferring residual nerves from an amputated limb, muscles that have otherwise lost their function can be reinnervated, bringing more intuitive control of advanced devices like prosthetic arms.
“Targeted sensory reinnervation looks very promising for restoring sensory feedback to people using upper limb prostheses and is completely new for people with this type of amputation,” Monique says.
Monique’s workplace has been part of a surgical and rehab program that gives their clients access to this technique, in combination with some of the world’s most technologically advanced upper limb prostheses.
“Our new socket technique has had global impact” – Dr Stefania Fatone, Professor at Feinberg School of Medicine, Northwestern University
Dr Stefania Fatone (Bachelor of Prosthetics and Orthotics with Honours; PhD in Human Biosciences) was the first student in Australia to enrol in a PhD in prosthetics and orthotics. She was also one of the first people to be made a professor in her field.
Today, the former DM Myer University Medal winner continues to excel in her research career. She sees her time at La Trobe as formative.
“My La Trobe education defined my professional identify as a prosthetic and orthotic clinician who conducts research. It empowered a very unique view of what I could contribute to the profession,” Stefania says.
Stefania has stayed connected to La Trobe throughout her career, most recently in collaboration with alumnus Dr Michael Dillon, an Associate Professor in P&O at La Trobe. Together, they’ve designed a Decision Aid, which helps people facing difficult decisions about amputation surgery to make truly informed choices.
“I love that I get to contribute new knowledge to our profession, helping to better define what we do, and make the lives of people who need prostheses and orthoses better. My research is always motivated by a gap in knowledge and the desire to empower prosthetists and orthotists with the knowledge they need to provide better patient care.”
Stefania’s greatest career highlight has been developing a new transfemoral (above-the-knee) socket technique. Currently, standard sockets for people with an above-knee amputation fit not just over the remaining thigh, but also over the pelvis.
“The high profile of the socket is the leading source of complaints by users. Our goal was to develop a prosthetic socket with a lower profile that would eliminate all contact with the pelvis, support body weight fully through the remaining thigh, and be more comfortable. The socket also had to be equally, if not more, functional,” she explains.
Stefania’s innovation has proven to be much more comfortable for people with above-knee amputations. The new socket uses materials that are highly compressive and flexible and is designed using an algorithm and rectification mapping, to capture the unique shape of a person’s residual limb.
“The project allowed me to cross the entire spectrum: from development and research, to teaching the technique to prosthetists and having a direct impact on the lives of prosthesis users. In a very short time, this new socket technique has had a global impact.”
For Stefania, every research project is a firm reminder of the need for customised care.
“My research has taught me that while problems may be universal, solutions to those problems need to be tailored to each individual.”
Discover the power of prosthetics to restore human lives at La Trobe's upcoming Bold Thinking lecture, Body tech: the new frontier for humans? in Melbourne on Thu 21 November 2019.