Mopani Pharmacy consulted with Nelspruit’s homegrown talent, medical orthotist and prosthetist, Nicholas Kidd. He gave some insights into the profession and what orthotics and prosthetics entail.
Although Kidd’s field involves application of devices to the exterior of the body, it is imperative that he has an in-depth knowledge to understand the body. “In order to treat a patient’s injury or ailment, I have to understand the whole picture and ensuring the planned treatment is safe, effective and achievable. The treatment for every patient and every case is quite unique”, said Kidd.
What is the difference between orthotics and prosthetics?
“Orthotics are used to support, immobilise or correct the body segment, with forces by means of an external device. An example would be a hand splint, with custom moulding plastic. This will immobilise a patient’s injured forearm in the optimum position, limiting the stress and movement that could compromise healing. An example of corrective orthosis is the use of scoliosis bracing. The objective is to prevent progression and ideally correct abnormal spinal curvature.”
“Prosthetics and custom artificial devices used to supplement an amputation. Prostheses are broken into two main categories; functional and cosmetic. This depends on the area of amputation and the personal preference of the amputee. We can replace just about every extremity, except the head, of course!”
“Some of the more advanced prosthetics are starting to use neuromuscular input (your nerves and muscles working together), through electrodes in contact with the myoelectric prosthesis. It utilises electrical energy that innervates the remaining muscle structures to, to help the prosthesis function.”
Do you see a variety of patients?
“Yes, we treat patients of all different ages and backgrounds as well as different injuries and ailments; from trauma to chronic medical conditions such as diabetes. Diabetes is becoming a more prevalent illness in today’s society. Our goal is to aid in the management of the lower limb side-effects primarily with speciality footwear, orthotics and compression socks. We have found, diabetes has become the leading cause of lower limb amputation.”
Why is diabetes such a major problem?
“Diabetes is becoming a severe problem world-wide. Primarily Type ll diabetes, often labelled ‘lifestyle caused’, has become a problem that effects all demographics of the population. Patients range from the affluent to the underprivileged. I believe, it is the result of a combination of unhealthy lifestyle, poor education on management techniques, and the potential severity of mismanagement.”
“I believe educating the patient, and their family is imperative as the patient requires support and understanding of the contraindications. The blanket understanding as ‘sugar sickness’ leads to misconceptions on the dietary responsibility and proper use of medication.”
“Understanding the importance of taking medication at the correct time intervals, managing the risk factors such as walking barefoot and dietary mishaps would drastically decline the chronic cases that continue to cripple and maim our effected population.”
How can we promote prevention, so the we can begin to combat these health problems?
“Early and regular screening for common ailments and proper communication with your GP or house doctor about your physical state is key. There used to be screening and health checks performed in schools such as dental and vaccination programs. Before my day, they screened young children for spinal curvature problems, in some places.”
“The best way to promote prevention is to start the screening program as early as school-age, and couple it with education. Something as simple as a glucose test could change a child’s life. The education in management techniques could allow that child to properly guide a parent or family member to a better state of health."
“Community projects that educate on diabetes and dispel some myths and aid in the prevention of future generations suffering the same fate are important. We are lucky to already have an existing infrastructure for HIV and AIDS that could be complimented by this.”
Are orthotics and prosthetics still stigmatised?
“Orthotics are seen as a means to an end and a temporary ailment, and are therefore not stigmatised as much. Wearing a brace to treat an injured ankle for a few weeks, knowing it won’t be forever, is reassuring. They know they will be better soon and can get rid of the device.”
“Prosthetics on the other-hand, can be stigmatised. A person may be seen as a cripple in some communities. In these circumstances, the patient that require prosthetic intervention will be focused on the cosmetic or aesthetic appearance of the prosthesis. They will want it to be as visually indistinguishable as possible.”
How do people cope with amputation?
“Every amputee responds and copes differently with amputation. Factors such as the type or level of amputation play a big role but as a whole there is a sense of loss which in some cases the patient can undergo grief similar to that of losing a loved-one.”
“Depending on the patient’s lifestyle before amputation, the build-up to amputation, getting to grips with the life changing procedure can be easier or more difficult. We believe early prosthetic intervention helps. It instils hope where it has been lost, and a goal to achieve where dignity has been taken!”
How do children respond to treatment?
“Children are generally fantastic patients. Their sheer will to play, learn and socialise numbs them to the smaller things. They often far exceed the projected device requirements, breaking them, just to keep up and be like the other kids. Children are inherently very trusting. Once convinced to use the device, they will do so as a means to play, breaking that trust is detrimental to the child and the treatment.”
How often do children outgrow their device or prosthesis?
“Children grow at different rates at different ages, between ages of one and six, they change almost weekly. Children in general change dimensions erratically and quickly, we try to always take this into account. Their treatment requirements for long term orthotics or prosthetics are generally far more frequent than their adult counterparts.”
Why is it often important to get custom made devices?
“Every person is unique and thus every case is unique. Some pathologies require a wearer-specific device that will be most effective on them and them alone. Custom made devices ensure that the fit and feel of the device is optimal, and the planned function of the device is best suited for the specific individual. Sharing of custom devices or reselling is highly discouraged as the device would most likely be counterproductive and uncomfortable to the recipient.”
“When it comes to prosthetics, the coupling or connecting part of the device to the body must be 100% custom. No patient’s residual limb is the same in terms of volume, shape and pressure tolerance.”
“For sure, there are devices that we name OTS (off the shelf) items that can be multi-user functional. It is important to consult with the practitioner that you received it from to ensure that it can be donated or given on without risk of harm to the intended recipient. Devices that fall into this category mainly include mobility aids as these are designed to work with the publics variations in dimensions and carry much lower risk of injury to the recipient.”
What is the most interesting procedure / device you have created?
“I am lucky to have many great experiences. One of my greatest thus far, was a recent case in which our team fabricated a hip-disarticulation prosthesis for a young man. The type of prosthesis was not foreign to me, but it is one of our rarer cases. In this case specifically, the experience was made by the patient and his reaction.”
“The patient was able to walk quite easily and function very efficiently, within the first five minutes of donning the prosthesis. In this type of prosthesis, this is nearly unheard of! The patient’s reaction and experience will stay with me forever, as something special. My team and I were part of something that changed someone’s life in an instant. The feeling of gratitude was palpable, I could never truly fully understand it, but I would without doubt would never forget it!”
If you need a consultation with Nick Kidd, you can book an appointment on 0137457163 or email nick.kidd60@yahoo.com. The B.M.K. orthopaedics practice is located at Mediclinic Nelspruit, consulting room G06.
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