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  • Writer's pictureDenise Schindler

More than just a craft

Part 2 of our resilience series: CPOs also need a high level of inner resilience.

Orthopedic technology is a finest craftsmanship. In the workshops, CPOs take impressions, shape, file, grind, drill, and glue a wide variety of materials into prostheses, orthoses, or insoles. Using only their hands, orthotists feel the conditions on the residual limb, and can thus, take into account both hard bony areas and soft areas in the prosthesis’ manufacture so that it fits perfectly in the end. In orthotics, it is them who ensure the optimum fit of a splint or a socket with their trained eye and sure instinct. Ultimately, CPOs are the ones who put amputees like me, Denise Schindler, back on two legs or help people with orthoses and hand prostheses to master everyday life again. This makes them, along with doctors, the most important people who make it possible for us to lead a self-determined and independent life again.

1. Dexterity - manual and interpersonal

However, craftsmanship, material science and technology are only part of the job. CPOs also need educational and mental "tools". After all, they deal with people every day who come to them as a result of severe trauma, such as an accident or serious illness. This means that the CPOs - as hard as it sounds - don’t only encounter happy and cheerful faces. They’re often people dealing with a hard situation that is still so fresh, that they‘ve often neither accepted or come to terms with it.

2. See the confrontation with emotions as a challenge

Many patients get into their situation through no fault of their own. The anger and despair about the situation is often onloaded onthe very person who actually only wants to help: the prosthetist or orthotist. The reason: Here, those affected are 100 percent confronted with their situation: From one moment to the next, they’re disabled and dependent on aids. The fitting process for a prosthesis or orthosis relentlessly exposes everything that one would initially like to cover up and hide with clothing, even wants to withdraw completely. As a patient, "holding out" the residual limb so that an adjustment can be made bursts every protective shield. These are moments when anger and emotions arise and CPOs end up bearing the brunt of them directly.

3. Maintaining an emotional distance from severe fates

How do prosthetists best deal with this? It’s important to have a psychological understanding of the users and a sure instinct in dealing with their fate. This is the basis for successful cooperation. The prosthetists must understand what is going on in their counterparts' minds. They’ve to be able to pick up on the users, listen to them and respond to them. At the same time, however, they must always maintain a professional and, above all, keep an emotional distance. This is necessary so that, on the one hand, they can provide the best possible care for the users and, on the other hand, don’t take the often difficult fates home with them. This second aspect, self-protection, is probably the greatest challenge and a real balancing act. Because what all CPOs have in common, is the goal of helping others.

4. Mastering difficult situations with the observer role

Being confronted with strong emotions such as anger and resentment is certainly not easy. Especially when it comes quite abruptly. For example when asking if the socket fits, but the user may not even know where the pain is exactly. Understanding where the source of this emotion is located can help prosthetists deal with. One tip is to take the observer role. This perspective makes it possible to comprehend the situation objectively and to understand that the reaction is not meant personally.

5. Using the effect of positive images and goals

In this way, the prosthetist is able to take the user by the hand and, in the next step, outline a path that will be followed together. This is extremely important. Users really need positive images, goals and realistic time frames. When they’re shown these by their prosthetist or orthotist, this also gives the user a better feeling and reduces fears and negative emotions. It creates more understanding for the duration of the fitting process. The most important thing is to set realistic goals. Empathy and dialogue create a bridge and are therefore the key to good care.

6. Communication is the key

A perfect prosthesis or orthosis is always the result of close cooperation and a constructive exchange between the prosthetist and the user. Prosthetists can only model and adjust the prosthesis or orthosis accordingly if they receive precise feedback on the fit from the wearer. This is something that prosthetists should communicate to users so they develop an understanding of their important role in the process. If this succeeds, it’ll help the prosthetists incredibly in their daily work.

7. Often underestimated: the private balance

Every body and every fitting is different. This requires the prosthetist to adjust to the respective user again and again. This takes energy in everyday life. Even if the profession is a passion for CPOs, it is enormously important to take time out after work in order to gain distance. This works best with a hobby that has nothing to do with the profession. This way, they can really switch off after work and recharge their batteries. This ensures they can tackle the next treatment with full energy.

8. Openness and lifelong learning

For CPOs, resilience can also mean being open to something new. Trying things out and evaluating what helps them and their patients best. Digitization is also increasingly opening up new opportunities in the field. More and more scans are now being used to replace the traditional plaster cast. This method can be much more convenient for users. Corresponding scans can already be taken with simple iPads without any great technical effort. In orthosis production, even a scan in a non-corrected posture can lead to the desired result in minutes thanks to digital posture correction. Another advantage of the new technologies is that they allow a high degree of individualization in a very short time. The CPO has more time for his/her patients in the consultation as well as to see a higher volume of patients. The Mecuris Solution Platform is a great example of this, because it facilitates the work of the prosthetist on many levels. Plus, it can be used flexibly at different points in the orthotic fitting process. Keeping an eye on innovations like this and lifelong learning are essential for prosthetists to become a successful duo with those they care for.

9. Acceptance and flexibility

The most important realization for prosthetists and users (see part 1) is that nothing is permanent. A prosthesis that fits perfectly today can lead to major inflammation and discomfort in the residual limb tomorrow. The same applies to orthoses: Adjustments and new fittings are particularly frequent in children, as they have not yet completed the growth phase. The greatest challenge in fitting is certainly posed by children and competitive athletes: The constant changes due to growth and training can sometimes drive CPOs to the brink of insanity. I know it from myself: First, everything fits perfectly and makes me smile, then a month later I come back to the workshop crestfallen. Frankly, there's one thing you can always rely on: Our body is constantly changing, and so sooner or later the fit of the orthosis or prosthesis will too. This insight is important for prosthetists and should also be communicated sensitively to the patient by means of simple images: The perfect prosthesis is always a snapshot. That is why the team of prosthetists and users must constantly adapt to new requirements. Acceptance and flexibility on both sides help here, because prostheses are never "finished", but must develop along with the users. Acknowledging the situation makes it possible to maintain enthusiasm, counteract disappointment and always work positively toward the optimum.

From my point of view, the most important principles for more resilience for CPOs are:

  1. Having tact and sensitivity - both in terms of craftsmanship and interpersonal skills

  2. Seeing the confrontation with emotions as a challenge

  3. Keeping a professional and emotional distance

  4. Taking on the role of observer in difficult situations

  5. Showing ways together, setting goals and using the effect of positive images

  6. Holding dialogue & empathy with the user

  7. Seeking private balance

  8. Having an openness to new developments & lifelong learning

  9. Demonstrating acceptance and flexibility

At this point, I can only express my heartfelt thanks to my CPO of many years, Thomas Wellmer of Reha-Technik Wellmer und Schmidbauer. He has always provided me with the best possible care since I was a child and has always been open and supportive.

On the other hand, I can only appeal to the users: be patient with yourself and your environment. Stay open and fair and set out to become an unbeatable team with your CPO. You can read how I do this in part 1 of this resilience series.


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