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Health // Doctor in the House
Rasa Fournier

Fashioning Braces And Prosthetics

Ken Mandler
Orthotics manager at Shriners Hospitals for Children

Where did you receive your schooling and training?

I received my bachelor’s degree from Cal State-Fullerton and then I attended the Long Term Certificate program at Rancho Los Amigos Medical Center in Downey, Calif., which is a large rehab center. After graduating from Rancho, I did a residency for a year before taking my boards.

How long have you been in the field of orthotics and prosthetics?

Since 1989.

What made you choose this field?

It’s something that I’ve always loved. It’s my passion – I can’t imagine doing anything else. I feel that it is a privilege to work for Shriners. What they do for the kids here is amazing.

When someone comes to you needing a prosthetic or brace, what happens next?

We’ll evaluate them and spend some time to get to know them. We’ll figure out what their activity level is and what kind of prosthesis or brace will work best for them. Then, typically, we’ll take a mold of them and do the fabrication and have them come back in a couple of weeks and we’ll do a fitting. Sometimes they will receive it that day, sometimes they have to come back for an additional fitting.

Can you describe what happens behind the scenes in your Orthotics and Prosthetics Department?

In the Orthotics and Prosthetics Department, we have a staff of five. We make braces and artificial limbs for the kids who need them. We let them choose the patterns they put on their braces, to have some ownership of the brace. We have everything from butterflies and hearts to soccer balls and cammo. It’s important to give the kids choices. It makes them feel good. Most kids don’t necessarily want to wear a brace, so if they feel like they’re making the decision about what pattern goes on it, or the color of the straps, it makes it easier for them to want to wear it and show it off.

When we fit kids with artificial limbs, we are able to do some creative things with the lamination. If the kids pick a cloth pattern, we can laminate it in, or if they see a picture, we can manipulate it and put it onto the leg and actually laminate it into the prosthesis.

Rey Bactat and Tammi Asato do all of our fabrication. They make most of the braces out of medical-grade plastic and the prostheses out of carbon fiber. We take a mold of the kids and fill it with plaster of Paris. Then we strip away the negative and have a positive impression of their leg or foot, as the case may be. Then we mold heated plastic around that. Everything is custom made.

Rey first started at Shriners in environmental services. When Shriners opened the orthotics and prosthetics program, he already had really good hand skills. They brought him in, taught him how to do the tech work and he’s been doing it for 20 years.

Do you work with children of all ages?

Yes. We treat children with orthopaedic and neurodevelopmental conditions up to 18 years. Patients may get extensions if we are still treating their original condition, so some of our patients are up to 21 years old.

What parts of the body do you make braces and prosthetics for?

We do upper extremity, lower extremity, spinal – anything that needs it, from head to toe.

How many braces and prosthetics is your team working on at any given time?

Typically, anywhere from 20 to 50, especially when we go on outreach. We are re-launching the outreach program for our Orthotics and Prosthetics Department soon. We go to the Neighbor Islands, Guam and Saipan.

Are the casts and prosthetics more functional or aesthetic?

Mostly, they are functional, but we try to make them as cosmetically appealing as possible. For instance, we have a young man who is very active, so we make him several legs. He has a cosmetic leg he wears for daily use. He’s a college kid, he wants to blend in – but he also does stuff like parkour. Yes, with a prosthetic leg! So he has another leg for high-level activities and then a water leg so he can go surfing. We use a wetsuit type of material that comes to the mid-thigh and holds it on. There’s a hole so water can drain out of it.

Do you make metal legs, or cheetah prosthetics, like Olympians wear?

If the kid requests it and the doctor feels it is appropriate, yes, we can make those types of legs for them. But in many cases it is cost prohibitive. Here in Honolulu, we don’t see a lot of prosthetic patients. Most of the kids we see, we fit with orthoses or braces. We have probably about 20 to 25 prosthetic patients we see on a yearly basis, so that’s maybe two a month. Most of what we do is bracing for the extremities and the spine.

How long do the braces and prosthetics last?

They last typically about a year, or whenever the kids outgrow them. We try to do things to make them last as long as possible, like things for growth adjustments. Most of the kids wear them during the day, though some have to wear them at night as well.

Is the problem generally something genetic or something temporary that they can grow out of?

It runs the gamut. We see kids here from the 300-pound football player who tore his ACL, to the newborn baby who has hip dysplasia or club feet. Some of the kids will require some sort of orthopedic device, maybe for the rest of their life.

Others might have something temporary that they use to go through rehab and then they don’t need it anymore.

There’s no barrier to coming here. We take children regardless of their ability to pay or their background with or without insurance. We always tell patients don’t worry, we will take care of you. Sixty percent of the kids are from Hawaii, 40 percent are from elsewhere, mostly from the Pacific Basin.

Anything else you would like to mention?

We do incredible things for rare diseases and conditions, but also everyday things like fractures and sports injuries, especially torn ACLs, scoliosis and club feet. Those things are all quite common. We have everybody necessary right here in one facility – the doctor, nurses, physical therapists, occupational therapists and recreational therapists. It’s a small enough facility that we all know each other and really get to know the kids.

A lot of these kids have pretty severe disabilities. But here, they’re treated like everyday kids because they are regular kids who just happen to need special services.

Everybody here is friendly and warm, and our physicians spend quite a bit of time with the kids and get to know the families.

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