Scope of Practice

ABC

The American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc. establishes and advocates for the highest patient care and organizational standards in the provision of safe and effective orthotic, prosthetic and pedorthic care. It is the mission of ABC to advance the competency of practitioners, promote the quality and effectiveness of orthotic, prosthetic and pedorthic care and maintain the integrity of the profession.

Ancillary Supplies

Related to Non-weight-bearing Post-operative Transtibial Prosthetic Devices

A prefabricated item that is commonly used to support the fit and function of the non-weight-bearing post-operative prosthetic device. This includes, but is not limited to, a prosthetic sock, prefabricated suspension sleeve, prefabricated waist belt, shrinker, prosthetic liner, or replacement padding. 

Anthropometric

Pertaining to the measurement of the size, weight and proportion of the human body.

CAAHEP

The Commission on Accreditation of Allied Health Education Programs is a programmatic accreditor of educational programs in the health science professions.

Cognition

The operation of the mind by which we become aware of objects of thought or perception; it includes aspects of perceiving, thinking and remembering.

Custom Fabricated Device

An orthosis, prosthesis or pedorthic device fabricated to comprehensive measurements and/or a mold or patient model for use by a patient in accordance with a prescription and which requires clinical and technical judgment in its design, fabrication and fitting.

Custom Fitted Device

A prefabricated orthosis or pedorthic device which is manufactured in quantity without a specific patient in mind. The device may be supplied as separate prefabricated components that require some assembly and/or fitting and adjustment. These orthoses or pedorthic devices must be trimmed, bent, molded (with or without heat), or otherwise modified for use by a specific patient.

Exam Applicant (Pedorthist, Assistant or Fitter)

An individual who has completed the required educational program and is actively obtaining the necessary hours of experience to qualify for the pedorthist, assistant, orthotic fitter or therapeutic shoe fitter exam is considered an Exam Applicant and can provide orthotic or prosthetic services under Indirect Supervision with the exception of initial patient evaluations and the final fitting/ assessment related to a custom pedorthic device, prefabricated orthosis or therapeutic shoes/inserts; these activities must be performed under Direct Supervision. Pedorthist and assistant applicants can be considered Exam Applicants for up to two years after completing their educational program. Fitter applicants can be considered Exam Applicants for up to one year after completing their educational program. It is at the sole discretion of ABC to determine if an Exam Applicant should be given an extension based on unique circumstances.

Exam Candidate (Orthotist or Prosthetist)

An Exam Candidate is an individual who has successfully completed an NCOPE accredited residency in a comprehensive orthotic and/or prosthetic accredited facility, has met all eligibility criteria and has applied for and been accepted to take the ABC orthotist or prosthetist certification exam. While these individuals are within their official exam eligibility window they can continue to provide orthotic or prosthetic services under Indirect Supervision.

Functional Electrical Stimulation

Functional electrical stimulation provides a low level electrical current which results in the movement of a body part to accomplish a specific task. These systems impart transcutaneous stimulation of nerve and/or muscle groups.

Mastectomy Fitter

A health care professional who is specifically educated and trained in the provision of breast prostheses and post-mastectomy services. This includes patient evaluation, formulation of a treatment plan, implementation of the treatment plan, continuation of the treatment plan and practice management. Refer to the ABC Mastectomy Scope of Practice for specific guidelines for certified mastectomy fitters.

NCOPE

The National Commission on Orthotic and Prosthetic Education is the accreditation body for the orthotic and prosthetic professions and the approval body for the pedorthic profession. NCOPE works in cooperation with CAAHEP. NCOPE’s primary mission is to ensure education and/ or residency programs meet minimum standards of quality to prepare individuals to enter these professions.

Non-custom Therapeutic Shoes

Shoes that meet the criteria of the Medicare Therapeutic Shoe Bill and that match the diabetic shoe descriptor, (i.e., off the shelf depth-inlay shoe manufactured to accommodate multi-density inserts) and are not custom fabricated from an impression or scan of the patient’s foot.

Non-custom Multi-Density Inserts

Inserts that meet the criteria of the Medicare Therapeutic Shoe Bill that match the diabetic insert descriptor, (i.e., multi-density insert, direct formed, molded to foot after external heat source of 230 degrees Fahrenheit or higher, total contact with patient’s foot, including arch, base layer minimum of ¼ inch material of Shore A 35 durometer or 3/16 inch of Shore A durometer (or higher), prefabricated) that are not custom fabricated from an impression or scan of the patient’s foot.

Neuroprosthetics

A discipline related to neuroscience and biomedical engineering concerned with developing neural prostheses, artificial devices to replace or improve the function of an impaired nervous system.

Off-the-Shelf Device

A prefabricated orthosis sized and/or modified for interim, evaluative or short term use by the patient, in accordance with a prescription and which does not require clinical judgment and substantive alteration for appropriate use.

Orthosis

A custom designed, custom fabricated, custom fitted, prefabricated and/or modified device to treat a neuromusculoskeletal disorder or acquired condition.

Orthotic Fitter

A health care professional who is specifically educated and trained in the provision of prefabricated orthoses, with the exception of those orthoses noted in this publication. This includes patient evaluation, formulation of a treatment plan, implementation of the treatment plan, continuation of the treatment plan and practice management.

Orthotist

A health care professional who is specifically educated and trained to manage comprehensive orthotic patient care. This includes patient evaluation, formulation of a treatment plan, implementation of the treatment plan, continuation of the treatment plan and practice management.

Osseointegration

The surgical procedure that creates a direct skeletal attachment for a prosthetic limb.

Pedorthic Device

Pedorthic devices are therapeutic shoes, shoe modifications made for therapeutic purposes, prefabricated below the knee orthoses, partial foot prostheses for transmetatarsal and distal amputations, and foot orthoses. It also includes subtalar-control foot orthoses designed to manage the function of the anatomy by primarily controlling the range of motion of the subtalar joint. Excluding footwear, the proximal height of a custom pedorthic device does not extend beyond the junction of the gastrocnemius and the Achilles tendon. Pedorthic devices do not include non-therapeutic inlays or footwear regardless of method of manufacture; unmodified, non-therapeutic over-the-counter shoes; or prefabricated foot care products. “Therapeutic” devices address a medical condition, diagnosed by a prescribing medical professional, while “non-therapeutic” devices do not address a medical condition.

Pedorthist

A health care professional who is specifically educated and trained to manage comprehensive pedorthic patient care. This includes patient evaluation, formulation of a treatment plan, implementation of the treatment plan, continuation of the treatment plan and practice management.

Prefabricated Device

A prefabricated device is one which is manufactured in quantity non-specific to individual patients. The device may be supplied as separate prefabricated components that may require some assembly and/or fitting and adjustment. These devices may require some trimming, bending, molding or modification for use by a specific patient.

Proprioception

Perception mediated by the sensory nerve ending in muscles, tendons, and joints that provides a sense of the body’s position by responding to stimuli from within the body.

Prosthesis

A custom designed, fabricated, fitted and/or modified device to treat partial or complete absence of an external body segment for purposes of restoring physiological function and/or cosmesis.

Prosthetist

A health care professional who is specifically educated and trained to manage comprehensive 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.

Recertification

ABC credentialed individuals are required to maintain competency by obtaining professional continuing education credits.

Residency

An NCOPE approved supervised program in a comprehensive orthotic and/or prosthetic accredited facility. This program allows the resident to acquire practical clinical training in orthotics and/or prosthetics which is part of the overall education required for ABC Orthotist and/or Prosthetist Certification.

Resident

An orthotic or prosthetic student who is actively fulfilling their residency requirements at an NCOPE accredited residency site. During the course of residency training, students should progress from observing to providing direct patient care. The care must be delivered initially under Direct Supervision, but will progress to Indirect Supervision as the resident’s competency increases and is documented by the supervising ABC certified orthotist or prosthetist.

Subtalar-Control Foot Orthosis

A lower extremity orthosis designed to manage the function of the anatomy distal to the ankle joint by primarily controlling the range of motion of the subtalar joint. The proximal height of a SCFO does not extend beyond the junction of the gastrocnemius and the Achilles tendon. A SCFO is a method of treatment for conditions related to the foot demanding additional surface area to control forces.

Supervision and Privileging of a Credentialed Caregiver

Privileging of credentialed individuals to provide services beyond their defined scope of practice must ensure appropriate, effective, ethical and safe delivery of patient care. The credentialed caregiver may be privileged, under Indirect Supervision, to provide patient care beyond the scope of their credential based on Written Objective Criteria.

Privileging of a credentialed caregiver is limited to the following:

Prosthetics:

Orthotists and Prosthetic Assistants who are credentialed by a nationally recognized Orthotic, Prosthetic and Pedorthic certifying board or are licensed¹, if applicable, may be privileged based on Written Objective Criteria to provide prosthetic care. Certified or licensed Orthotic Assistants and certified or licensed Orthotic Fitters may be privileged, based on Written Objective Criteria, to provide prefabricated non-weight-bearing post-operative transtibial prosthetic devices and related ancillary supplies.

Orthotics:

Prosthetists, Pedorthists, Orthotic Assistants and Orthotic Fitters who are credentialed by a nationally recognized Orthotic, Prosthetic and Pedorthic certifying board or are licensed, if applicable, may be privileged based on Written Objective Criteria to provide orthotic care.

Pedorthics:

Prosthetists, Orthotic Assistants, Orthotic Fitters and Therapeutic Shoe Fitters who are credentialed by a nationally recognized Orthotic, Prosthetic and Pedorthic certifying board or are licensed, if applicable, may be privileged based on Written Objective Criteria to provide pedorthic care.

ABC credentialed technicians may be privileged based on Written Objective Criteria to participate in direct patient care to provide repairs and minor adjustments, in the discipline they are credentialed, under Indirect Supervision.

The orthotic, prosthetic or pedorthic patient care services provided by the privileged credentialed caregiver which are beyond their scope of practice must not exceed ABC’s defined scope of practice for Orthotists, Prosthetists or Pedorthists. The Supervisor must review the results of care and the documentation of the services rendered by the supervised individual and is responsible for countersigning within 15 days all entries by the caregiver in the patient’s clinical record. The Supervisor is responsible for all services that the caregiver is being privileged to provide.

Supervision

Direct Supervision

This level of supervision requires the supervising credentialed individual to be available for consultation throughout the patient care process. The supervisor must be physically on site or be available in real-time via audio and visual technology while the care is being provided. The supervisor must perform a real-time visual assessment of the care provided to the patient, review the results of the services rendered by the supervised individual and is responsible for countersigning within 15 days all entries by the caregiver in the patient’s clinical record.

Indirect Supervision

This level of supervision does not require the supervising credentialed individual to be on site however they must be available for consultation throughout the patient care process. The supervisor must review the results of care and the documentation of the services rendered by the supervised individual and is responsible for countersigning within 15 days all entries in the patient’s clinical record.  The maximum permissible ratio of certified assistants to the supervising prosthetist or orthotist is 5:1.

Any privileging must be in compliance with all state laws or rules that apply to the provision of orthotic, prosthetic or pedorthic items and services.

Supervisor

The supervisor is the designated individual credentialed by a nationally recognized Orthotic, Prosthetic and Pedorthic certifying board, or is licensed, who oversees and is solely responsible for the delivery of appropriate, effective, ethical and safe orthotic, prosthetic and/or pedorthic patient care. The supervisor may oversee patient care services only in the discipline(s) they are credentialed and within the ABC defined scope of practice.

Support Personnel

An ABC credential holder may delegate certain tasks in the provision of any custom fabricated or custom fitted orthosis, prosthesis or pedorthic device to non-credentialed support personnel. Any tasks delegated to Support Personnel must be supervised under Direct Supervision. Those delegated tasks must be within the ABC credential holder’s scope of practice. These tasks must not include patient evaluation, formulation of the treatment plan, final fitting and assessment of the orthosis/prosthesis and any follow-up care that modifies the function of the orthosis/prosthesis as originally prescribed. Delivery of orthoses/prostheses to the patient after the credential holder has completed a final fitting and assessment may be performed without the Direct Supervision requirement.

If the Support Personnel holds a recognized license or certification in a related allied health profession (e.g., Physical Therapist/PTA, Occupational Therapist/OTA, Athletic Trainer, etc.), they may be supervised under Indirect Supervision.

Technician

An individual trained and qualified to assist an ABC credentialed individual by providing technical support. The technician fabricates, repairs and maintains orthoses and prostheses. The technician is proficient with current fabricating techniques, familiar with material properties and skilled in the use of appropriate equipment.

Telehealth

(See ABC’s Statement on Telehealth)

Therapeutic Shoe Fitter

A health care professional who is specifically educated and trained to provide non-custom therapeutic shoes and non-custom multi-density inserts. This includes patient evaluation, formulation of a treatment plan, implementation of the treatment plan, continuation of the treatment plan and practice management.

Unstable Spinal Condition

An unstable spinal condition has a risk of further injury due to a lack of structural or neurologic stability of the spine.  If the patient requires orthotic stabilization prior to basic activities (e.g., sitting up, standing, ambulation), the patient's condition is defined as unstable.

Written Objective Criteria

Written objective criteria is the documentation describing how a privileged caregiver’s ability to provide a specific patient care service has been assessed and verified. How the caregiver has gained the necessary knowledge and skills to be able to provide a specific patient care service must be clear and related to the diagnosis involved and the orthosis, prosthesis or pedorthic device being provided. This documentation may take different forms including, but not limited to:

• Proof of completion of continuing education courses related to a particular diagnosis or device
• Documented in-house training/in-services that are specific to the patient care service that the caregiver is being privileged to provide
• Documented specific work experience participating in supervised patient care activities

¹ Any privileging must be in compliance with all state laws or rules that apply to the provision of orthotic, prosthetic or pedorthic items and services.