Scope of Practice of the Canadian Board for Certification of Prosthetists and Orthotists - October 2003

History

On August 15, 1972 the Canadian Board for Certification of Prosthetists and Orthotists was granted incorporation in Canada. The organization was born in 1966 with the express purpose of recognizing proficiency in the field of prosthetics and/or orthotics.

Individuals wishing to be granted certification must show necessary educational experience and must complete and pass the examination. These persons are then granted certification, which must be maintained and renewed according to the bylaws of the corporation.

Facilities are accredited when, through inspection and evaluation, they are considered to be capable of providing the required level of prosthetic and/or orthotic patient care. In order to be accredited, a facility must have a full-time certified practitioner in the discipline in which accreditation is desired. A facility may be accredited in prosthetics alone, in orthotics alone, or in both disciplines.

In August 1999 the Canadian Board for Certification of Prosthetists and Orthotists membership voted to accept the credentialing of the registered technicians. In September 2000 the Canadian Board for Certification of Prosthetists and Orthotists held the first registered technical exams. Registered members are subject to all rules and regulations as set by the corporation.

Individual Role Description

CERTIFIED PROSTHETIST and/or ORTHOTIST

Duties and Responsibilities As the practitioner responsible for all patient care, the certified practitioner independently provides or supervises the provision of comprehensive orthotic and/or prosthetic care. This includes clinical assessment, patient management, practice management and technical implementation activities and services. In addition, the certified prosthetist and/or orthotist is obligated to support and conform to professional responsibilities which promote and assure the overall welfare of the patient and the integrity of the profession.

Limitations The certified practitioner is bound by the C.B.C.P.O. Canons of Ethical Conduct. Time-limited certification is based upon participation in mandatory continuing education. The certified practitioner is limited to the discipline for which he/she is certified.

PROSTHETIC and/or ORTHOTIC Resident

Duties and Responsibilities Under the close clinical supervision of a C.B.C.P.O. certified practitioner in good standing with the corporation; a registered orthotic and/or prosthetic resident is competent to perform clinical assessment and patient management tasks. The resident also independently carries out practice management and technical implementation activities and services. In addition, the registered prosthetic and/or orthotic resident is obligated to support and conform to professional responsibilities which promote and assure the overall welfare of the patient and the integrity of the profession.

Limitations Performs all duties and provides patient care services under the clinical supervision of a C.B.C.P.O. certified prosthetist and/or orthotist in good standing with the corporation. The registered resident is bound by the C.B.C.P.O. Canons of Ethical Conduct. The registered resident is limited to the discipline for which he/she is registered.

PROSTHETIC and/or ORTHOTIC REGISTERED TECHNICIAN

Duties and Responsibilities Under the direction of a C.B.C.P.O. certified practitioner in good standing with the corporation; a registered orthotic and/or prosthetic technician is competent to perform technical assessment and management tasks. The technician also independently carries out practice management and technical implementation activities and services. In addition, the registered prosthetic and/or orthotic technician is obligated to support and conform to professional responsibilities which promote and assure the overall welfare of the patient and the integrity of the profession.

Limitations Performs all duties under the direction of a C.B.C.P.O. certified prosthetist and/or orthotist in good standing with the corporation. The registered technician is bound by the C.B.C.P.O. Canons of Ethical Conduct and is limited to the discipline for which he/she is registered. The registered technician is not qualified to perform clinical tasks such as casting, cast modification, adaptation or evaluation of function of a particular device. Any patient contact will be for the purpose of assisting the orthotist or prosthetist in the technical aspects of the manufacture of a particular orthotic or prosthetic device.

I - Clinical Assessment

• Obtain a history of the patient by assessment of an appropriate orthotic or prosthetic treatment plan
• Evaluate the patient visually by observing gait, coordination, present device if available, and other physical characteristics to supplement the history and physical examination
• Examine the patient manually to determine skin conditions, range of joint motion and muscle strength to verify and expand information
• Determine and assess the specific needs of the patient by integrating the information obtained from history, examination and observation
• Determine from the patient, by verbal interaction, his or her goals and expectations in order to provide an appropriate and realistic device
• Provide information to the patient, family and involved health professionals regarding potential advantages and disadvantages of a device in order to assure understanding of the treatment plan and cooperation of the individuals involved
• Analyze the data obtained by empirical methods in order to prepare a recommendation
• Develop a treatment protocol for the specific patient by review of data obtained in order to determine a specific device recommendation and plan for its use
• Obtain and record accurately appropriate measurements and other data from the patient in order to produce the recommended device

II - Patient Management

• Determine the solution to a patient's prosthetic/orthotic problem by appropriate evaluation in order to achieve proper function
• Manipulate the patient's body or body segments to provide correction, position or deformation in order to achieve the appropriate information
• Replicate the patient's body or body segments to provide an accurate anatomical impression to be used in fabrication of an orthotic or prosthetic device
• Measure a patient by utilizing proper instruments and tests in order to compile data to be used in prosthetics and orthotic design and fabrication
• Modify patient model by making necessary rectifications to ensure proper fit
• Demonstrate on a patient a properly-fitting prosthetic/orthotic design by utilizing accepted prosthetic/orthotic techniques to achieve optimum fit, function and cosmesis
• Evaluate a device to identify deviations from prescribed standards to correct impaired fit and function
• Evaluate a patient's gait by visual observation in order to achieve optimum prosthetic or orthotic function, if applicable
• Achieve optimum alignment of a patient's prosthetic/orthotic device by evaluation of the sagittal, transverse or coronal planes in order to provide maximum function
• Inform the patient of the various procedures you are about to perform and/or explain his/her role and responsibilities regarding these procedures by using appropriate communication skills to achieve successful fabrication and use of the prosthesis/orthosis
• Provide continuing patient care in order to assure proper fit and function of the prosthetic/orthotic device by periodic evaluation
• Counsel and educate the patient
• Demonstrate proper documentation of patient history by establishing record-keeping techniques in order to verify patient care Supervise others (less qualified) engaged in patient management
• Collaborate with others engaged in patient management

III- Professional Responsibility

• Select the most appropriate course of action when faced with patient-related problems by applying their experience and recognizing their limitations in providing appropriate patient care
• Provide optimum patient care by recognizing the need to pursue continuing education to remain current in practice
• Practice ethical patient care by adhering to the C.B.C.P.O. Canons of Ethical Conduct
• Inform individuals involved in patient care by utilizing appropriate communication skills to provide them with current prosthetic and orthotic information

IV - Practice Management

• Communicate clearly information concerning the patient to the appropriate people to achieve ultimate patient care
• Demonstrate proper documentation concerning the patient history and financial records by establishing record-keeping techniques in order to verify patient care and other pertinent records
• Inform the patient of financial obligations and requirements for compliance to third-party agencies by utilizing the appropriate means of communication to assure proper reimbursement
• Establish procedures for patient care that comply with accepted medical/legal requirements by maintaining current education in these areas
• Communicate roles and expectations of facility employees by providing documentation in order to create a professional, cooperative working environment and improve patient care
• Maintain a safe working environment

V - Technical Implementation

• Interpret data on measurement form by reviewing numerical values to determine appropriate procedures
• Select appropriate materials and components based on patient criteria to ensure optimum strength, durability and function
• Fabricate prescribed devices by assembling selected materials in order to prepare for fitting
• Establish inspection systems to assess systematically appropriateness of technical procedures at various stages in order to reduce product deficiencies
• Establish sound safety protocols for personnel in use of appropriate lab materials and machinery to achieve maximum safety
• Repair and maintain existing devices in use
• Communicate design criteria to those in technical implementation/fabrication
• Maintain equipment; keep working area clean and safe
• Maintain inventory

In order to relate the various caregivers to the supervisory role of the certifee, the following definitions were established:

Supervisor: The C.B.C.P.O. certified prosthetist or orthotist of good standing, who oversees and is responsible for the delivery of prosthetic and/or orthotic care to the patient.

Independent: The caregiver is qualified to provide independent, unsupervised, direct patient care as well as confer or consult with colleagues, physicians or other allied health professionals in providing patient care.

Direct Supervision: The caregiver (resident) is qualified to provide patient care under the guidance of the clinical supervisor in good standing ("C.B.C.P.O. certifee"). The supervisor must personally review the assessment and care rendered before any treatment is to proceed. The supervisor must be available for consultation throughout the delivery of care.

Table One represents the five domains listed above. Indicated for each domain is the level of supervision required for the three levels of prosthetic and orthotic care providers. These are minimum levels of supervision recognized by C.B.C.P.O. for purposes of Establishing relationships between orthotic and prosthetic patient caregivers.

Organizations and/or certified practitioners may establish, at their discretion, more rigorous levels of supervision than identified by C.B.C.P.O.

Table One

Category	Certifee	Resident	Technician
I. Clinical Assessment	Independent	Direct	NA
II. Patient Management	Independent	Direct	NA
III. Professional Responsibility	Independent	Independent	Independent
IV. Practice Management	Independent	Independent	Independent
V. Technical Implementation	Independent	Independent	Independent

Education Requirements for Prosthetics and Orthotics

I - Certified Orthotists and/or Prosthetists

• The applicant must be fluent in French or English.
• The applicant must be a Canadian citizen or a legal landed immigrant.

• The applicant first must complete a Canadian Board for Certification of Prosthetists and Orthotists approved and officially recognized clinical prosthetic and orthotic school program.    This must be followed by a 3450 hour residency in the appropriate discipline while employed in a prosthetic-orthotic facility.  The residency hours must be completed within five years of registering in the residency program and first exam attempt must also be completed within this time frame.

  If a resident has completed or is completing the required residency hours, and has not yet passed the certification exam, the resident is bound by the same requirements of direct supervision until the certification exam is passed and must be registered and active in the residency program.  It must be understood that the resident must not provide orthotic/prosthetic treatment on scheduled unsupervised days or conduct oneself in any other way contrary to the Canons of Ethical Conduct.

II - Foreign-trained applicants

Foreign-trained applicants must have their education assessed by the education committee and by

a third party assessment organization as directed by the Corporation. If foreign qualifications are

deemed equivalent to the current standards of the Corporation, then the individual will be

required to register with the residency program and complete a residency, in Canada, of 3450

hours.  The applicant must be employed in a prosthetic-orthotic facility. The residency must be

completed in Canada, under the supervision of an on-site resident certifee, in good standing with

the Corporation, in the appropriate discipline, prior to receiving consideration to sit the

certification exam. The candidate’s first attempt at the exam must be made within five years once

entered into the program. The residency chairperson may give exceptions on written approval.

III - Registered Prosthetic or Orthotic Technicians

There are two methods which can lead to the recognition of registration in orthotics and/or prosthetics. These are:

Method I: Formal Training

Registration in the First Discipline:

• The applicant must have completed a Canadian Board for Certification of Prosthetists and Orthotists approved and officially recognized technical prosthetic and orthotic school program. Applicants must be employed in a prosthetic-orthotic facility. This must be followed by 88 weeks of full-time work in the appropriate discipline, no less than 37.5 hours per week. The 88-week time period must be actual working time, which excludes any and all forms of absence from the job due to vacation, sickness, etc. This practical experience must be under the supervision of an on-site resident certifee and/or registered technician in good standing with the corporation, in the appropriate discipline.

Registration in the Second Discipline:

• To qualify for acceptance for the examination in the second discipline, technicians who obtained their first discipline after completing a recognized technical prosthetic/orthotic school program must complete a further 52 weeks of practical experience under the supervision of an on-site resident certifee and/or registered technician in good standing with the corporation, in the appropriate discipline.
• The same basic definition of supervision and restrictions for the first discipline also applies for the second.
  

Method II: Informal Training

Registration in the First Discipline:

• The applicants must be employed in a prosthetic-orthotic facility. This must be followed by 192 weeks of full-time work in the appropriate discipline, no less than 37.5 hours per week. The time period of 192 weeks must be actual working time, which excludes any and all forms of absence from the job due to vacation, sickness, etc. This practical experience must be under the supervision of an on-site resident certifee and/or registered technician in good standing with the corporation, in the appropriate discipline.

Registration in the Second Discipline:

• To qualify for acceptance for the examination in the second discipline, technicians who obtained their first discipline must complete a further 96 weeks of practical experience under the supervision of an on-site resident certifee and/or registered technician, in good standing with the corporation, in the appropriate discipline.
• The same basic definition of supervision and restrictions for the first discipline also applies for the second. Notes for Method I and Method II
• If a technician has completed or is completing the required period, and has not yet passed the registration exams, the technician is bound by the same requirements of supervision until the registration exams are passed in that discipline.
• When calculating the weeks of practical experience, the weeks up to and including the examination week may be used. All candidates are required to submit their applications through the office manager of the corporation. The fees are set in accordance with the bylaws of the corporation.
• At no time during the second discipline process may the registered technician be named or hold the position of a supervisor for any other exam applicant.