Tell me about it
Prosthetists design and fit prostheses (artificial limbs) for people who have lost an arm or a leg due to disease or an accident, or for those born without a limb.

Depending on the person's needs, modern-day prostheses may incorporate electronic or microprocessor-controlled parts, and pneumatic and hydraulic mechanisms. With these new technologies, an artificial arm or leg may not only appear natural, but can be made to move.

Orthotists work in very similar areas, but their specialism is to design and fit orthoses, which are external devices that support or control parts of the body. These include braces for the arms and legs, callipers, neck collars and splints that support the person's limbs or spine, and special footwear and insoles.

The work involves working with patients to assess how much movement they currently have, taking into account their level of fitness and physical abilities. Prostheses and most orthoses are individually designed and made by hand.

Throughout the fitting process, prosthetists and orthotists help people cope with the circumstances that have led to their need for a fitting. They work with each patient to make sure that the equipment works properly and feels comfortable. They also liaise closely with physiotherapists, who help patients learn how to move and walk effectively after the fitting, and with occupational therapists, who teach patients how to undertake everyday activities with the device.

Entry level
Practice as a prosthetist or orthotist requires registration with the Health Professions Council, the first step towards which is to study for an honours degree in prosthetics and orthotics. Only two UK universities - Salford and Strathclyde - offer the required courses and entry is competitive.

For detailed application information, you should consult the websites listed at the end of this article. Salford usually looks for a total of 180-240 UCAS points at A level/H grade, including biology and preferably maths or physics or both, plus five GCSEs/S grades (A-C/1-3) including English and maths. Alternative qualifications may be accepted.

Strathclyde offers entry with either four H grades (BBBB) including maths and two science subjects, preferably physics or human biology or both, or three A levels (CCC) including maths and at least one science.

The degree courses at Salford and Strathclyde last four years. They are not identical, but both combine academic studies, practical and clinical training, and clinical experience. In the fourth year there are two six-month, full-time clinical placements in approved hospitals in the UK or Europe, one in prosthetics, the other in orthotics. You would gain clinical experience in assessing and fitting prostheses and orthoses with volunteer patients, and practical training in the manufacture of the limbs.

It is likely that, from 2005, continuing professional development will be compulsory if you are to maintain your registration.

Making the grade
With experience, progression is to senior and managerial posts. You may specialise in a particular area of clinical work or work in research and development. Alternatively, you could go into prosthetic and orthotic teaching. There are opportunities for working abroad, particularly in the USA. Countries afflicted by war and land-mines also need people with this skill.

Personal qualities
As a prosthetist or orthotist, you should have good hand skills to control the interaction between devices and individual patients. You must have a thorough knowledge of anatomy and physiology, together with an excellent understanding of biomechanics and the properties of the materials and components from which devices are made.

You should be sensitive, tactful and be able to gain people's trust, and you must be capable of communicating well with people of all ages and from all backgrounds, some of whom will be upset or emotionally troubled.

Looking ahead
This is a small and highly specialised profession, with only some 275 prosthetists and 545 orthotists registered in the UK. There has been gradual growth in the number employed, but there is still a national and international shortage of people with this knowledge and skill.

Most start by working for the commercial manufacturing companies contracted to the NHS. There are, though, increasing opportunities for work within the NHS itself and this accounts for about 25 per cent of those in this job.
Some may find work abroad, in Europe and elsewhere, with health services and health organisations, manufacturing and servicing companies or voluntary organisations, such as the Red Cross. There are currently excellent career prospects in the United States.

Alternative suggestions
You might also consider training as a biomedical scientist, chiropodist/podiatrist, dental technician, mechanical engineer, medical physicist, occupational therapist, physiotherapist or radiographer

Take-home pay
Starting salaries are around £22,000 a year. With experience, it is possible to earn between £28,000 and £35,000.

Some earn up to £50,000 working for manufacturers or in the most senior NHS positions.

Effects
Full-time prosthetists and orthotists normally work between 37 and 40 hours a week from Monday to Friday. Part-time and flexible working hours are possible.

Prosthetists are usually permanently based in a specialised centre in a large city hospital and see people in light, spacious clinics. They also liaise with workshop technicians, who may or may not be on site. Orthotists tend to be based at an outpatients' service in one or several hospitals and may be more mobile, also visiting health centres.

Sources of information
British Association of Prosthetists and Orthotists: www.bapo.com
Directorate of Prosthetics and Orthotics, University of Salford: www.healthcare.salford.ac.uk/prosthetic
National Centre for Training and Education in Prosthetics and Orthotics, University of Strathclyde: www.strath.ac.uk/prosthetics/index.html
Health Professions Council: www.hpc-uk.org
NHS Careers: www.nhscareers.nhs.uk

CRCI: JF