Andrew Principal Prosthetist, West Midlands Rehabilitation Unit “The most important thing to keep in mind when you're fitting prosthetic limbs is that you must be enabling the patient and not further disabling them. I have a passion for my job and a passion for improving the design of artifical limbs.”

Andrew has worked for many years as a prosthetist, designing and fitting artificial limbs. He is now a senior person in one of the largest rehabilitation centres in Europe. He's also a leader in the field of prosthetic research and a specialist in paediatric prosthetics.

What might come up in a week?

Clinics - I always spend some time with patients. I might get on with some research, writing articles, and I’m part of a primary team of ten  people – five of whom are prosthetists. My role is to manage and be responsible for patient allocation.

Do you specialise in one group of patients?

I'm a specialist in lower limb replacements but I can work with upper limb, too; I take a special interest in paediatrics and run a dedicated clinic once a week to care for this patient group. My patients can be of any age; and you stay with the patient from cradle to grave – my grave for some of them because they're young! A lot of our patients are older people, though.

You see babies?

Yes. Babies may come because they have a congenital absence, or they've suffered a trauma (electrical, chemical or mechanical), or their loss is through an illness. The same reasons are true for adults of course.

I don't always fit a prosthesis for babies. Young babies learn through sensory exploration, feeling things with their hands and feet. Now if a baby has an absence of a foot the baby has feelings at the end of their leg. If I fit a prosthetic foot I'm depriving that child of an important experience. In fact I'm further disabling the baby, not enabling him or her. The baby doesn't really need a prosthetic foot until they reach the pulling-up stage. A request for a prosthesis for a small baby may be more for the parents' need. I have to make sure that we're benefiting the patient – that's the baby.

It must be very distressing for the parents when a baby has a limb missing.

It's devastating. So we have counsellors here. When we see children for fittings we see children with parents, parents on their own, and sometimes children on their own too.

You don't always fit limbs then?

No. If we fit a child with short arms with prosthetic arms, they lose the sense of touch, which is very important in our development as well as leading to a lot of frustration. Think how irritating it would be walking around all day wearing boxing gloves. We've disabled the child in effect, we'll fit artificial limbs when it's appropriate and the young person will wear them when it's appropriate for them.

Prosthetic limbs are about locomotion or about grasp – they're tools. Think of a Black and Decker – very useful sometimes, but you don't carry it around with you all day. If you have an above-the-knee prosthetic leg, it takes 50% more energy to drive it. For a trans-pelvic replacement limb (where the amputation is across one side of the pelvis) it takes 200% more energy. This would be like perpetual jogging. Some of our elderly patients have no metabolic reserves (spare energy.) Again, we must make sure we're not disabling the very person we're trying to help.

With modern technology, do patients have high expectations about what you can do for them?

Sometimes... they might have unrealistic expectations or be setting themselves goals that are too tough. Sometimes they come with a sort of shopping list, but what we have to keep in mind is what they're going through on a first visit – they may be anxious, frightened, wondering what's going to happen, will it hurt? Patients only take in about 10% of the information on a first visit. We help them manage their expectations and suggest realistic targets for them to aim at.

How do you set about your research and development?

I use computers a lot. I design prosthetic limbs using CAD (Computer Aided Design) then using another piece of software I create a virtual cast of it and can test out forces so I can tell how well it'll stand up to use. I’m working with Birmingham University to develop new methods and materials to use. I often write articles for magazines and speak at conferences.

How did you get into prosthetics?

It was through a family discussion. I wanted to work in medicine, I'm a good communicator and I loved engineering – like messing about with old cars. My parents came up with the idea of working with artificial limbs.

Any downsides to your job?

Well... whenever I go out I can't stop watching the way people walk. I'm waiting to discover what's 'normal'.

Best bits of the job?

After a lot of years working in this field I still get a buzz when I see a patient go home with problems solved; it's the “Yes!” factor.