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How do you make the prosthetic devices?
When someone comes to any of our 5 centres, they will first be assessed in our clinic by our multidisciplinary team.
Patients waiting in the Vientiane clinic.
Patient being assessed in the Xieng Khuang clinic.
Once the assessment is completed a decision will be made about the most appropriate course of action. This might include physiotherapy, surgery, a device or a combination of all three! If the patient requires any surgical intervention, such as to make the stump suitable for a prosthesis, or to release contracted muscles prior to having an orthosis made, COPE will organise the operation in conjunction with the local surgeons and cover the cost. We can also liaise with other services if further information is required to make the right decision.
A homemade leg!
We supply several different types of prostheses, depending on which body part is missing. Most common is a below knee prosthesis.
A prosthesis is always made for the individual. It is a technical task that requires a lot of training. Many patients come to us with legs they made by themselves. They are very happy to find that legs can be made to fit them!
A prosthesis cast.
In order to make a prosthesis, "the residual limb" or stump is cast, using plaster of Paris bandage, and several measurements of the stump and the sound side are taken. The completed mould is filled with plaster so the prosthetist is left with a positive model. This model of the stump needs to be "rectified", a process which involves adding plaster to areas of the stump which are sensitive to pressure, and removing plaster from the areas which can tolerate pressure in order to create a comfortable load`bearing surface. Once happy with the shape of the cast, the prosthetist will make sure that it is very smooth, ready for the socket to be made.
The socket is made by heating up a piece of polypropylene in an oven and draping it over the model of the stump: once sealed, a vacuum pump takes all the air out, ensuring a perfect fit. Next, the excess material is cut away, and, when cool, the plaster is removed from inside.
Various limb components.
The components which go into the limb attach to the bottom of the socket. These components are made by recycling the waste polypropylene which is generated during the vacuum-forming process. The waste material is chipped using a special machine, heated and injected into moulds for different parts required for each limb. This is done at our centre in Vientiane and uses technology introduced by the ICRC. (International Committee Red Cross)
The components inside a limb are crucial to the success of the finished prosthesis. Each component fits to the next to allow adjustment of the angle and position of the socket and the foot on the shank or shin. Each person walks slightly differently so these adjustments are crucial to make sure the prosthetic limb does not cause any damage to other joints, such as the knee (for a below knee amputee), hip or back. Once the patient has learned to walk and the prosthetist/ orthotist is happy with the alignment of the device, the limb will be finished by covering it with a polypropylene outer shell to make it look as close as possible to the original.
Steps in fitting the prosthesis.
A compressed rubber foot.
Feet are also made in our rehabilitation centre in Vientiane, by compressing rubber in a press and then heating it up to vulcanise it The piece which joins the foot to the prosthesis is known as the keel, which is also made from recycled polypropylene.
Here is a photo of one of our younger patients putting his new leg to good use!
Khampat in action!