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Todd DeWees shares the difference between an orthotic and prosthetic device, the types of in-house orthotics and prosthetics services offered, the types of resources offered at the Portland Shriners Hospital.

Brace Yourself

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Melanie Cole, MS (Host): Brace yourself because today we’re talking about orthotics and prosthetics. My guest is Todd Dewees. He’s an orthotist and prosthetist at Shriners Hospitals for Children in Portland. So Todd, I'm so glad to have you with us today. Tell us a little bit about the Portland Shriners Hospital.

Todd Dewees (Guest): So the Portland Shriners Hospital is one pediatric orthopedic hospital, which just means we only treat kids and we only treat kids that have issues with their bones, joints, muscles. It’s part of a system of 22 hospitals. 20 of those are in the U.S., one in Canada, one in Mexico. We are located here in beautiful Portland, Oregon where we get to service the kids of the northwest, which is Alaska, Oregon, British Columbia, Alberta, and then some kind of trickles outside of that reach area.

Host: So then can you tell us about the in-house orthotics and prosthetic services that you offer there?

Todd: Prosthetic and orthotic services here at Shriners Portland are a little different that happen at most hospitals. So most hospitals or medical centers don’t have an in-house system. So it’s done by somebody out in the community. We have our staff here that evaluates the kids, works with the families to kind of develop what’s an appropriate device and what needs does the child and how do we address that. Then we actually build those devices in-house here at the hospital and then fit and deliver them, which is pretty rare. Most places don’t have all of those pieces, and a lot of places don’t have any of those pieces. So it’s kind of unique that way.

Host: Do you work directly with the patients and fabricate everything they need? Or are you working with their physicians, their physical therapists?

Todd: Yes to all of the above. So the nice thing about being an integrated system like Shrine Portland is that I get to work with the physicians who are ordering the device and the physical therapists who are helping with the rehabilitation of the child. I work with the families who have to deal with the device every day, the child who has to deal with the device every day, and then that device is then fabricated here in-house. So kind of all of those components I'm able to keep my hands on. So it makes everything run smoother for the family and the patient.

Host: For the listeners that may not know, Todd, tell us the difference between an orthotic and a prosthetic device.

Todd: So the difference is kind of subtle. If you think about an orthotic device as something that kind of helps a body part that isn’t working quite right. A prosthetic device is something that replaces a body part that isn’t there anymore. So if we think about somebody that has had an amputation of a foot, it would be a prosthetic that we would put underneath them. If it’s somebody that has lost function in the foot, say they’ve had a stroke and their ankle doesn’t work anymore, then it would be an orthotic that supports how that foot should function.

Host: So Todd, as you work with kids—and I'm a mom of kids—we know they grow, and they require lots of different devices throughout at their childhood and as they grow for different sports. Or maybe the devices get damaged or they grow out of it. How does that work with kids that you work with?

Todd: With kids we have to replace those devices much, much more often than we do with adults because of growth, because of activity. We think of growth—As adults, we tend to think of a growth as getting heavy. With kids, it tends to be that they're getting longer. So they're putting much, much more force on these devices, which wears them out quicker and it makes them not fit. I mean you think about how quick do you have to change shoes for your kids because they’ve grown in shoe size. It’s the exact same concept in replacing orthotics and prosthetics. They change all the time.

Host: So thank you for that answer because it really does explain how that works, but what are some of the range of conditions that you provide care for. While you're telling us about what you do there at Portland Shriners Hospital, tell the listeners who may not know what is an orthotist and a prosthetist?

Todd: So an orthotist or a prosthetist is somebody that interacts with the patient, interacts with the physician, interacts with the rehab staff or the physical or occupational therapist, and designs and develops an appropriate device for that patient to meet their needs and to augment function that isn’t there or isn’t working properly. So that lets us kind of develop a relationship with the patient. We work with them to give them what it is that they need.

Host: So how is your role so important to the patients that you work with? Tell us some of the more rewarding parts of your job?

Todd: So my role is really about developing a relationship with these families because I see them for years. I mean some of them I will see for 20 years. It’s about educating the family. When they come to see me the first time, they don’t know what an orthosis or a prosthesis is either. So we have to start with a really basic level of education. By the time I've seen them five, seven, ten years, they're living this every day. So they know more about the specific orthotic or prosthetic care of their child than I ever will. So I'm really there to kind of facilitate for the family, to advocate for the family, and to educate the family. The mechanical part of what I do, lots and lots of people could do. It’s understanding how that works with the patient physically how they interface with the device. How they deal with it emotionally, how they deal with it as a family unit. All those kinds of things, that’s my job is to kind of help them navigate that as they grow.

Host: Why is that so rewarding for you?

Todd: Well, it’s so rewarding because I get to see these kids grow up. I mean I have a child of my own, but I have probably 1,500/2,000 other children that I see really, really regularly. I get invested in what are they doing academically? What are they doing extracurricularly? How is their family life going? All those kinds of things. It’s just kind of like being an uncle to all these other kids where I get to watch them grow up and really become kind of a part of the family. And really know that we’re making an impact in their lives that’s allowing them to engage and do the things that they want to do, to fulfil their dreams, to grow up and get to be productive parts of our society.

Host: What a great job you have, Todd, helping so many children. So when they come to you, what is something you want to tell the parent who’s child needs an orthotic or a prosthetic device? As you said earlier, you educate them and then they pretty much take it on themselves because they're living with it every day. What do you tell them at the beginning of what to expect or what you would like them to learn from this?

Todd: I think the first thing that I say is it’s going to be okay, right? Because it’s something that most people have no idea about. They don’t really have an understanding for when they first come to see me. It can be kind of scary and overwhelming, and usually there’s other medical treatment that’s going on along with what I'm doing for them. So it’s starting to establish that relationship and starting to build that trust that hey, what we’re gonna do for your child is going to help improve their life. This is not the end of the world. We’re going to be able to get through this. We’re here as a team to support you. Just that kind of understanding, that kind of support I think is huge for the family.

It’s one of the rare things that you have at some place like Shriners Portland is that you have all of that under one roof with one focus and that is supporting that child and their family as they move through what can be a quite difficult part of their life. You know the parents have this vision and this dream for what their child is before they're born or before an injury. And then that gets changed and they have to kind of rewrite their expectations of life and how they're gonna fulfill their dreams and how the children’s going to fulfill their dreams. So to be able to come along the fight of the family and help them through that I think is just a really rewarding thing to be able to do.

Host: Well it certainly is. So what resources do you have available to you? What resources does the Portland Shriners Hospital have access to?

Todd: One of the biggest resources is we have people that only see kids, they only see orthopedic conditions. They do it all day, every day, and they’ve been doing it for years and years and years. So that expertise is just hard to find it any place else. We have all of our professionals under one roof. So we’re always in communication. Having the physicians and the physical therapists and the social workers and the motion analysis laboratory and us. Just all of this plethora of things that you need to get quality healthcare and excellent outcomes, having it all together so it works together is just a really, really rare thing. Then having the access to the technologies that make us kind of a world class institution, it’s just really hard to beat it.

Host: Well that was going to be my next question. What about some of the cool technology you get to use?

Todd: For us, we use scanner technology which basically takes a three-dimensional image of the body part that we’re producing either a prosthesis or an orthosis for. It allows us to manipulate that in the digital environment. Then we either carve that out in foam, or we’re starting kind of preliminarily to move into additive manufacturing—so 3D printing—for some components. That portion of the world is still a bit on the edge. It’s not quite ready for prime time, but we’re moving that way as an industry as a whole. But as Portland Shriners Hospital, we’re kind on the cutting edge of that. So we have those tools available to us. The tools kind of throughout the hospital are all just top notch. We have access to x-ray technology that allows us to treat our scoliosis patients—who tend to get a lot of x-rays because we follow them for a long time—with very, very low doses of radiation so that we’re not risking radiation injury to the kids that maybe they would have potentially been exposed to say 20 or 30 years ago. I mean it’s just all these little things that make a huge difference in how I'm able to practice, and it makes a huge difference in what the outcomes are for our children and their families.

Host: What great information Todd. So, as we wrap up, what makes the Portland Shriners Hospital the best destination for kids with orthopedic needs? What would you like the listeners to know about what you do and Portland Shriners and why it’s such a great place.

Todd: I think I would like them to know that putting the patient first is in our DNA. I mean we’ve been here for over 90 years. We have it so engrained in us that what the patient needs, what’s appropriate for the patient comes first. Everything else is second. So to have that level of commitment to the patient and not have some of the burdens that other health centers have about do they have the right insurance? Do they live close enough, so they don’t have to travel? I mean all those kinds of things are supported through the Shriners and through the hospital.

Host: Thank you, Todd, for coming on with us today and sharing your expertise about the services offered at Portland Shriners. That wraps up this episode with Shriners Hospital for Children. Check out portlandshrinershospital.org for more information and to get connected with one of our providers. If you found this podcast informative, please share with your friends and family, share on social media, and be sure to check out all the other interesting podcasts in our library. Until next time, I'm Melanie Cole.

About The Speaker

Todd Dewees

Todd DeWees is a CPO at Shriners Hospital For Children — Portland.

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