Scope of Practice

An ABC certified orthotist and/or prosthetist is a health care professional who is specifically educated and trained to manage comprehensive orthotic and/or prosthetic patient care. This includes patient evaluation, formulation of a treatment plan, implementation of the treatment plan, continuation of the treatment plan and practice management. Documentation by the orthotist and/or prosthetist is part of the patient’s medical record and assists with establishing medical necessity for orthotic and/or prosthetic care.

Orthotic care includes patient evaluation and the design, fabrication, fitting, modification, maintenance and repair of orthoses to treat a neuromusculoskeletal disorder or acquired condition. This also includes the provision of partial foot prostheses for transmetatarsal and distal amputations.

Prosthetic care includes patient evaluation and the design, fabrication, fitting, modification, maintenance and repair of prostheses to restore physiological function and/or cosmesis. This includes the post-surgical provision of a bone-anchored prosthesis (also known as osseointegration or OI).

Orthotic and/or prosthetic care does not include independent provision of invasive procedures, including, but not limited to, injections and initial application or replacement of skull pins. The orthotist and/or prosthetist certified by ABC is bound by the ABC Code of Professional Responsibility which is enforced by a Professional Discipline program. The certified orthotist/ prosthetist is obligated to support and conform to professional responsibilities that promote and assure the overall welfare of the patient and the integrity of the profession. The time limited certification expires without compliance with requirements of the Recertification program. The practice of an ABC certified orthotist and/or prosthetist includes, but is not limited to:

1) Evaluation of patients with impairment of human movement or musculoskeletal abnormalities that would impede their ability to participate in their social/work environment or other activities in order to determine a functional intervention. Patient assessment may include, but is not limited to, the evaluation and documentation of:

• anthropometric data
• cognition
• circulation
• skin integrity
• protective sensation
• pain
• central and peripheral nerve integrity
• endurance
• biomechanics
• gait analysis including temporal and spatial assessment
• range of motion
• muscle strength
• posture, balance and safety
• proprioception
• orthotic and/or prosthetic requirements
• myoelectric activity and potential for use of Functional Electrical Stimulation and/or Neuroprosthetics
• activities of daily living
• environmental barriers including social, home, and work reintegration
• the need for physical and occupational therapy modalities

2) Formulation of a treatment plan is based upon a comprehensive assessment to design an intervention to alleviate limitations, improve function and enhance quality of life. Orthotic and prosthetic treatment includes, but is not limited to:

• verification of prescription/documentation
• evaluation of the prescription rationale
• a recommendation incorporating patient and/or caregiver input
• development of functional goals
• use of evidence based practice
• analysis of structural and design requirements
• assessment of potential physical and occupational therapy requirements
• consultation with and/or referral to other health care professionals

3) Implementation of the orthotic and/or prosthetic treatment plan includes, but is not limited to:

• acquisition of anthropometric data
• modification and/or rectification of anthropometric data
• preparatory care
• material selection
• fabrication and/or assembly of orthoses and/or prostheses
• prototype development including evaluative wear
• structural evaluation of the orthosis and/or prosthesis
• diagnostic fitting
• assessment of intervention
• functional exercise
• gait training
• functional training (both self care and work related)
• documentation of patient education and instruction
• supervision of the provision of care
• documentation of patient encounters

4) Utilization of a follow-up treatment plan that ensures successful orthotic and/or prosthetic outcomes, patient health and quality of life which includes, but is not limited to:

• documentation of patient encounters, including functional changes and progress in meeting goals and expected outcomes
• formulation of modifications to ensure successful outcomes
• reassessment of patient goals
• reassessment of treatment objectives
• development of long term treatment plan
• documentation of on-going patient education and instruction

5) Compliance with practice management plans to develop and document policies and procedures to ensure patient protection which includes, but is not limited to:

• adherence to applicable local, state and federal laws and regulations
• following patient care guidelines and procedures
• maintaining a safe and professional environment for patient care
• comprehension of claims development and submission

6) Promotion of professional practice includes, but is not limited to participation in:

• continuing education
• training of residents/students
• clinical research
• evidence based studies
• promotion of public awareness of the orthotic and/or prosthetic profession
• consumer organizations, governmental and non-governmental organizations