A know-how of Prosthetics and Orthotics Education in India

The last known case of poliomyelitis in India was recorded in 1994. The impact of a well-coordinated immunization program in the world’s largest democracy was so evident. India eradicated polio from the country and supported various low-income countries, lower middle-income countries, and developing countries with polio vaccines. This unprecedented feat is a real achievement for a nation like India. Big names are associated with the program, and we still see the awareness programs being run.

However, it is missed out often in the situation and status of the long list of people living with PPRP (postpolio residual paralysis) in our country and living with a permanent disabling condition status throughout their lives. With time, PPRP is taken over by new disabling conditions viz., cerebral palsy, muscular dystrophy, NCDs (Non-communicable diseases), spinal injuries, RTA (Road traffic accident) amputations, neuromuscular and musculoskeletal disorders, and so on. Affected individuals would require some or other form of assistive mobility devices to manage their day-to-day living. The rehabilitation programs were initiated in India decades back, with the concept of prosthetics and orthotics leading it. Currently, prosthetics and orthotics have formed a major segment of the assistive technology framework worldwide. The program on rehabilitation has been started under the aegis of the Ministry of Social Justice [currently, Ministry of Social Justice and Empowerment (MSJ&E)].

The government took cognizance of the need for developing human resources, material and technology, research and development, and service delivery model to reach out to various corners of the country and serve people with disabilities. Key national level training and research institutes were set up in strategic locations across the country in West Bengal, Orissa, Delhi, and Uttar Pradesh, and state level set up in Mumbai, Vellore, Chennai, and some private institutions. These centers are still the leaders in the rehabilitation programs of the country. Developments in these programs have taken place down the decades when certificate-level programs were upgraded to diploma levels and then to bachelor’s degrees in the early 90s under various universities in the country. Gradually the need for the post-graduate program was realized and the last decade has seen various universities taking up the courses. These programs have opened a new professional platform for the young generation entering skill development programs.

Today, the bachelor’s and master’s degree courses in prosthetics and orthotics have become an important part of allied health sciences in the country offering professional-level certification. Fresh graduates on completion of such programs have options to explore their prospects with government setups, private setups, NGOs (Non-governmental organizations), INGOs (International non-governmental organizations), start-ups, self-employment, research institutes, and other institutes of higher education.

We must understand the nomenclature of this field in more detail.

Prosthesis/ses: A substitute or replacement of the missing part of a body by an externally fitted device. A prosthesis could be in the form of an artificial limb, which is provided as an external assistive device to help replace the missing part of the body in the form of lower legs, either below the knees or above the knees, and various other levels of amputations. It could be in the form of artificial hands substituting the absence of the upper extremity either above the elbow or below the elbow, covering various levels of amputations.

Prosthetist: A clinically trained personnel who is skilled in the art of design, fabrication, and fitment of a prosthesis/ses as per the individual requirement. To qualify as a prosthetist, one must complete the structured training program at the bachelor’s level and could opt for the master’s level. In India, every qualified prosthetist is required to register as a professional with the Rehabilitation Council of India (RCI), a statutory body under the MSJ&E.

Prosthetics: A branch of science that deals with the study of prosthesis/ses; the art of designing, fabrication, fitment, and training.

Orthosis/ses: An external device that is applied over a weakened part of the body to support it from further deterioration. It corrects or accommodates a deformity caused, and helps the individual to maintain a better position of proper or acceptable weight bearing.

Orthotist: A clinically trained personnel who is skilled in the art of design, fabrication, and fitment of an orthosis/ses as per the individual requirement. To qualify as an orthotist, one must complete the structured training program at the bachelor’s level and could opt for the master’s level. In India, every qualified orthotist is required to register as a professional with the RCI, a statutory body under the MSJ&E.

Orthotics: A branch of science that deals with the study of orthosis/ses; the art of designing, fabrication, fitment, and training.

The need in the country: The census of India 2011 mentions that out of 26,810,557 individuals with a disability, over 20% are with movement disorders and need some type of assistive prosthetics and orthotic devices for their mobility and mainstreaming. This number is increasing every day, and by the 2021 census (scheduled for 2023), the figures could be very different. As per RCI, there are 16 institutes conducting diploma, undergraduate (UG), and Postgraduate (PG) level programs with 100 diploma, 295 UG, and 75 PG intake seats. Every year, the training institutes in the country produce around 260 trained professionals and this is far behind the adequate requirement. The alarming mismatch between the service providers and the receivers is a matter of concern and India needs many trained personnel to be available for professional services, especially in the rural area.

This seemingly new profession has seen strong developments in material science and technological advancements. The introduction of digital transformation and additive manufacturing, CAD (Computer-Aided Design), CAM (Computer-Aided Manufacturing), AI (Artificial intelligence), and ML (Machine learning) in the last decade has helped develop new avenues and partnerships with institutes of higher education for the prosthetists and orthotists.

The Rajiv Gandhi University of Health Sciences, located in South Karnataka is perhaps the first allied health sciences university in the country to take up the prosthetics and orthotics program at UG and PG level, to open the amazing world of this profession to the country and the region.

Acknowledgement: I thank Mrs. Ritu Ghosh, Associate Professor, Academics Director, Department of Prosthetics and Orthotics, Mobility India, Rehabilitation Research & Training Centre, Bengaluru for reviewing and providing assistance to prepare the editorial.