Tahir Abdul Raheem
VHSF Fellow '23
Senior OT
King Fahad Hospital
Saudi Arabia
Occupational therapy (OT) education requires educators to provide students with entry-level skills in orthotic fabrication. These traditional face-to-face sessions are being taught in classrooms and labs in which the OT Instructor would provide step-by-step demonstrations on orthosis making, or any other skills being taught, then students would be paired up to follow the step-by-step instructions to produce a similar orthosis. The OT educator would move from station to station to provide feedback to students. This process aims to equip students with the proper skills to produce orthotics, thus meeting one of the educational standards.
An orthosis is defined as “an orthopedic device for immobilization, restraint, or support of any part of the body”. Orthoses aim to mobilize, immobilize, position, or protect a specific joint/s or body part/s. Occupational therapists, particularly those specialized in upper limb and hand therapy, are known for their orthosis-making skills. The task of making orthoses from raw materials is a highly complex skill that requires knowledge of the properties and handling characteristics of different thermoplastic materials, knowledge of anatomy and kinesiology, and knowledge of pathology and pathomechanics. Designing and fabricating custom-made orthoses requires problem-solving, decision-making, risk-taking, and skillful execution of the splint design.
The concept of distance education or online learning has evolved over the years with the advancement of technology. It started with print media, and radio broadcasting, and progressed to utilizing video conferencing but currently, it relies heavily on using the internet to deliver quality, cost-effective, and convenient education. In early 2020, the closure of educational activities in the Kingdom of Saudi Arabia and worldwide due to the COVID-19 pandemic resulted in an unplanned shift from traditional learning to a setup that exclusively involved digital teaching and learning. The restrictions imposed during the lockdown gave me enough time to learn some new concepts and to revise others; one of them was orthosis fabrication. During my university days, I attended a few classes on orthosis fabrication as a part of my curriculum, but it was restricted to acquiring basic knowledge about a few orthoses like wrist cock up, thumb spica and finger extension splint, etc. The hospital in which I am currently working has many nerve and tendon injury cases in addition to various fractures of the hand. Since the OT department was new, and due to the high no of cases there was hardly any communication between the surgeons and the therapist. All the cases that I was receiving had already been completed 6 weeks post-surgery and hence there was no discussion regarding fabrication of orthoses.
It was during COVID-19 that I got time to connect to people around the world who were dealing with traumatic cases of hand and especially tendon injury cases. To my astonishment I found most of the surgeons and therapists were talking about early rehab and the use of various orthoses to enhance movement and at the same time protect the repaired tendon or nerve. This was something new to me and at that moment I decided to learn about various orthoses using videos from YouTube and taking help from my new friends all around the world. By the time COVID-19 restrictions were lifted, I had some idea about various protocols and orthoses that can be used in tendon and nerve repairs, but the main problem was to convince the surgeons and then also to fabricate the proper orthosis based on the patient’s needs. The previous knowledge from my university days and the new concepts acquired during COVID restrictions allowed me to bridge the gap a little bit and it started helping my patients. I went on to meet some hand surgeons and tried to convince them to send patients for rehab as early as two weeks post-op to which some of them agreed. During this process I felt that orthosis fabrication is not that easy as we must have knowledge of anatomy, physiology, kinesiology, and biomechanics of joints and the solution was to attend some courses which can keep me updated in the field of hand therapy.
It was early 2023 that I came to know about Virtual Hand to Shoulder Fellowship which was one year, and the content and curriculum amazed me so much that I could not stop myself to get enrolled in that fellowship.
I started the fellowship and every day I came across something new in the field of hand therapy. The curriculum of the fellowship increased my confidence and I saw the results in my patients. I kept on learning new concepts and new ways of fabricating orthoses through the course of the fellowship. I came to know about the fabrication of various orthoses like Dorsal Block splint (DBS), Relative Motion Orthosis (RMO), reverse RMO, elbow splint, and mallet finger splints other than functional and wrist cock-up. Orthotic fabrication and to some extent the principles behind them became easy and with little difficulty I started applying them to patients which gave excellent results. I feel that for students and professionals who have basic knowledge about orthosis fabrication, teaching online orthosis fabrication is a good choice with the advancement in technology.
In a recent study done by Katherine Scofield et.al [1]. In ‘’Perspective on Remote Learning of Orthotic Fabrication by Certified Hand Therapist” it was found that online learning is beneficial for professionals who have had clinical experience and knowledge from previous courses. Most participants felt that novice clinicians and students would not gain enough skills and confidence from online courses. However, participants with all levels of experience found the courses valuable.
Husny et.al(2013) in their study[2] ‘’Using distance education in teaching orthotic fabrication to occupational therapy students’’ which was done on 40 students and investigated the effectiveness of orthosis fabrication using online pedagogy in teaching OT students the skills of orthosis making(experimental group), v/s the traditional classroom teaching(control group). They found out that there was no difference in the quality of orthoses made by the two groups.
Online learning has certain advantages like convenience of time, cost, accessibility, and the ability to revisit the topic as needed also certain disadvantages including limited instructor feedback and peer interaction but still the author feels that with advancements in technology and busy schedules online learning is beneficial in many ways.
References
1. Katherine A. Schofield, Deborah A. Schwartz & Charlotte Bolch: Perspectives on remote learning of orthotic fabrication by certified hand therapists Journal of Hand Therapy; February 2024.
2. Husny Amerihl, Mohammad S. Nazzal, Hassan Elsalloukh: Using distance education in teaching orthotic fabrication to occupational therapy students, Vol.5, No.5, 908-912 (2013)
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