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VOLUME 5, ISSUE 2 

 2022 

 

EDITORIALS 

 

Raschke S.U. Technology management as a core component of a client-centric prosthetic orthotic practice model. Canadian Prosthetics & Orthotics Journal. 

2022; Volume 5, Issue 2, No.1. https://doi.org/10.33137/cpoj.v5i2.39001 

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1 

Raschke S.U. Technology management as a core component of a client-centric prosthetic orthotic practice model. Canadian Prosthetics & Orthotics Journal. 2022; 
Volume 5, Issue 2, No.1. https://doi.org/10.33137/cpoj.v5i2.39001 

 

 

 
EDITORIALS 

 

TECHNOLOGY MANAGEMENT AS A CORE COMPONENT OF A CLIENT-CENTRIC PROSTHETIC 

ORTHOTIC PRACTICE MODEL 

Raschke S.U. * 
 

British Columbia Institute of Technology (BCIT), 3700 Willingdon Avenue, Burnaby, British Columbia, Canada. 
 

 

 

 

 

  

 

 

 

 

 

 

 

Technological innovation has transformed how we 

communicate, work and conduct business over the past two 

decades and is now visibly evolving the health care sector. 

Technology translating into health includes: data collection 

tools, smart technology, new communication platforms and 

additive manufacturing, with the objectives of improving 

access to care, outcomes and productivity. The new 

technology also potentially supports the concept of 

personalized medicine and creating opportunities for 

patients to becoming actively engaged in health care 

decisions as a client-patient. Over the next decade, 

additional tools will be developed that will significantly 

change how we experience health care both as a health 

care professional and as the client-patient.  

Being device oriented, prosthetics and orthotics (P&O) 

examples are commonly cited as what transformative 

technology in health looks like, with examples ranging from  

 

 

 

exoskeletons, to microprocessor-controlled components, to 

sensors and the ever-popular 3D printing (additive 

manufacturing) of prosthetic and orthotic devices. All 

consistently capture the attention of the media and 

imagination of the public.1 

A range of the hands-on activities once done manually by 

the prosthetist orthotist are becoming digitalized and data 

driven through the use of practice management software, 

clinical outcome measures, scanners, digitizers and remote 

fabrication options. In parallel, the palette of componentry 

and device deigns available to address a client-patient’s 

needs are expanding rapidly to include highly sophisticated 

and complex components, such as sensors giving sensory 

feedback, alongside simpler approaches such as 

comparatively low cost and easy to fit supportive smart 

apparel that replaces a number of hard orthotic brace 

designs.  

These changes present both an opportunity and a challenge 

to prosthetists orthotists. Extensive effort was made to 

update prosthetic orthotic education over the past two 

decades in many countries globally. The changing 

curriculum typically emphasised the development of a solid, 

deeper and broader understanding of the clinical aspects of 

prosthetics orthotics. The same emphasis was not given to 

 
OPEN  ACCESS Volume 5, Issue 2, Article No.1. 2022 

 

 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

 

ABSTRACT 

Technological innovation has transformed how we communicate, work, and conduct 

business. Over the next decade how we experience health care both as health care 

professionals and as client-patients will also change significantly. This presents both an 

opportunity and a challenge to medical clinical professionals that are device-focused, 

including prosthetists orthotists, as they consider how best to adapt. Current prosthetic 

orthotic education and practice is heavily clinically weighted, with less emphasis being given 

to engineering and business skills. Yet all three are essential core elements of a successful, 

sustainable prosthetics orthotics practice. Furthermore, it is the latter two that will heavily 

influence the future face of prosthetics & orthotics. It is not certain how current prosthetic 

orthotic practitioners can best adapt in response. One solution, proposed in this editorial, 

could be by rebalancing their professional persona to equally weight the three essential core 

elements. The result, a Clinical Prosthetic Orthotic Technology Management Professional, 

would engage in a professional practice that is functionally grounded, uses a client-centric 

model and incorporate eight professional attributes: professional, advocate, scholar, leader, 

communicator, collaborator, assistive technology expert and business justification specialist.  

CITATION 

Raschke S.U. Technology management as a 

core component of a client-centric prosthetic 

orthotic practice model. Canadian Prosthetics 

& Orthotics Journal. 2022; Volume 5, Issue 2, 

No.1. https://doi.org/10.33137/cpoj.v5i2.39001 

KEYWORDS 

Orthosis, Prosthesis, 3D Printing, Prosthetics, 

Orthotics, Funding, Economic, Health Care, 

Assistive Technology,  

* CORRESPONDING AUTHOR 

 

Silvia Ursula Raschke, PhD, Editor-in-Chief 

British Columbia Institute of Technology (BCIT), 3700 Willingdon 
Avenue, Burnaby, British Columbia, Canada. 

E-mail: Silvia_Raschke@bcit.ca 

ORCID ID: https://orcid.org/0000-0001-7964-4295 

https://doi.org/10.33137/cpoj.v5i2.39001
https://jps.library.utoronto.ca/index.php/cpoj/index
https://doi.org/10.33137/cpoj.v5i2.39001
mailto:Silvia_Raschke@bcit.ca
https://orcid.org/0000-0001-7964-4295


 

2 

Raschke S.U. Technology management as a core component of a client-centric prosthetic orthotic practice model. Canadian Prosthetics & Orthotics Journal. 2022; 
Volume 5, Issue 2, No.1. https://doi.org/10.33137/cpoj.v5i2.39001 

ISSN: 2561-987X 
TECHNOLOGY MANAGEMENT IN PROSTHETICS AND ORTHOTICS 

Raschke S.U, 2022 CPOJ 

 
broadening and deepening the knowledge base supporting 

prosthetic orthotic design and engineering principles or on 

the critical economic and business complexities which 

govern the prosthetics orthotics market. In hindsight, this 

overemphasis on one of what are three core elements that 

are required for the successful and sustainable practice of 

prosthetics orthotics, has made the sector vulnerable to 

disruption by external forces with skills and expertise in the 

two underemphasized elements.  

The dilemma presented by this imbalance became visible to 

the BCIT MAKE+ applied research group as early as 2015. 

Having been using 3D printers in medical and assistive 

device prototyping since 2001 we saw a sharp increase of 

potential clients seeking to engage us to apply 3D printing 

to the production of orthotic devices, citing known 

challenges with the current provider model and untapped 

market potential.  They had identified prosthetics orthotics 

as a sector ready for disruption. 

To explore the opportunity further, a workshop was held 

inviting a small, international group of engineering and 

clinical prosthetic orthotic academics, alongside end user 

representatives, to grapple with how emerging technologies 

could impact current device provision processes and 

business models using a SWOT (Strength, Weakness, 

Opportunity, Threat) model. It was during this day that one 

of our facilitators commented: “It seems to me that your 

problem is one of technology management”.   

The ensuing discussion stayed with me. He did not mean 

that emerging tools and technologies were a problem to be 

managed. What he meant was that prosthetist orthotist’s 

ability to adopt and mange new technology was key to the 

sector surviving and thriving. A clear threat identified that 

day was that technology innovation well beyond 3D printing 

was allowing non-traditional actors to insert themselves into 

the provision process by creating potentially better designs 

at lower price points – a legitimately attractive value 

proposition to payors.   

His pointed out that the traditional value proposition of the 

prosthetist orthotist has been that they are the best, or most 

knowledgeable person, to accompany the client-patient on 

the path from prescription to receiving a functioning and 

well-fitting device. This was a reasonable assumption at a 

time, when the device production process required 

specialized skills and equipment along with access to 

prosthetic orthotic components from component 

manufacturers who only sold them to recognized 

prosthetists orthotists. The result was an ecosystem that 

was easy to control, as long as payors continued to accept 

that value proposition.  Unfortunately, the proposition was 

vulnerable at two of the three core elements identified 

above; vulnerabilities which had been identified as 

opportunities by the tech development community. Unless 

prosthetists orthotists begin to develop strengths in those 

two underemphasized core elements, maintaining the 

current model will become challenging. 

The next evolution of health care is being carried out by well 

funded teams of technical experts working with tech sector 

business strategists and is attracting the attention of large 

companies and investment funds that previously had not 

been active in the medical device sector.2,3 Device-based 

and fee-for-device elements of the health care system have 

been identified as ideally situated for positive disruption. 

Engineers and industrial designers have become 

recognized as partners in improving health care delivery as 

technology-based solutions begin to permeate every aspect 

of health care under what has been identified as Medicine 

4.0.4 It is difficult for small professions to keep pace with 

such co-ordinated and well funded impetus, to say little of 

maintaining control and attempting to guide it. 

Given the unavoidability of this newly developing 

ecosystem, the facilitator suggested that there is the 

potential for prosthetist orthotist to secure their place 

proactively by proposing a new value proposition and 

repositioning themselves as “technology managers”. This 

repositioning would see the role of the prosthetist orthotist 

broaden slightly from a medical-clinical focus to one that 

also guides client-patients in navigating the increasing 

number of technology options, which will come in a range of 

price points, to arrive at optimized and affordable solution 

for a client-patient. The final solution arrive at might take the 

form of a custom made and fitted device or might not.  

Such a repositioning would not require abandoning the 

current clinical role of the prosthetist orthotist. Instead, it 

would be a re-balancing of their professional identity to 

include, with equal emphasis, all three core elements of the 

prosthetic orthotic provision model identified above. It would 

also reduce the fear associated with new technologies 

disrupting the current provision model and dampen 

frustrations linked to the reimbursement process.  

Strengthening competencies in the two weak core elements 

will allow prosthetist orthotists to master those core 

elements, as opposed to being controlled by them.  

Such a shift is not outside the realm of possibility, with a 

number of sources already pointing in directions compatible 

with such a rebalancing. Without being explicitly stated as 

part of a Client-centric Care Model, technology 

management is already, informally, an ad hoc part of the 

device provision process. In a recent professional opinion 

written by Dr. Chris Hovorka (2022) it is proposed that the 

next generation of prosthetic orthotic education will be 

based on a curriculum that is functionally focused, as 

opposed to disease or condition focused, using the World 

Health Organization’s (WHO) International Classification of 

Functioning, Disability and Health (ICF) model.5 He 

suggests informing such a framework with the Prosthetic 

and Orthotic Practice (POP) model described by Jahn and 

Ramsted,6 who describe a model for how ICF can be 

applied within prosthetic orthotic curriculum and practice.  

Finally, he suggests adopting the six key attributes from the 

competency based medical education framework 

developed by the Royal College of Physicians and 

Surgeons of Canada as part of their Competence by Design 

https://doi.org/10.33137/cpoj.v5i2.39001


 

3 

Raschke S.U. Technology management as a core component of a client-centric prosthetic orthotic practice model. Canadian Prosthetics & Orthotics Journal. 2022; 
Volume 5, Issue 2, No.1. https://doi.org/10.33137/cpoj.v5i2.39001 

ISSN: 2561-987X 
TECHNOLOGY MANAGEMENT IN PROSTHETICS AND ORTHOTICS 

Raschke S.U, 2022 CPOJ 

 
initiative (CanMEDS)7 into the prosthetic orthotic 

professional persona. These are: professional, advocate, 

scholar, leader, communicator and collaborator, and have 

been identified as components necessary for physicians to 

serve their client-patients well.  Considering the threats and 

stressors to the current prosthetics orthotics practice 

models identified in the 2018 BCIT workshop, it could be 

proposed that two further attributes specific to the prosthetic 

provision process should be added, namely, assistive 

technology expert and business justification specialist. 

An amalgam of the above would create a new practice 

model that could be described as a Clinical Prosthetic 

Orthotic Technology Management Professional, 

encompassing all three core elements of a successful and 

sustainable prosthetic orthotic provision process with equal 

weight and competency. As a Client-centric model it 

recognizes what prosthetists orthotists already do, 

strengthens the two weak core practice elements that 

currently leave the sector vulnerable to disruption and does 

so using an inclusive model which engages the client-

patient in decision making and cocreation processes.8 It 

remains to be seen what the future will bring, but what is 

already clear is that all device-based health services will 

require a high level of technology management activities, 

whether officially recognized and supported or not.  

ACKNOWLEDGEMENTS 

None. 

DECLARATION OF CONFLICTING 

INTERESTS 

Dr. Silvia Raschke is a member of the Midwestern University’s 

Advisory Board for the Prosthetics and Orthotics M.Sc. Program as 

of Spring 2022 and in this capacity has participated in discussions 

that may have influenced her opinions on this topic. These opinions 

and ideas expressed in the editorial are those of Dr. Raschke and 

have not been reviewed by or endorsed by Midwestern University.   

SOURCES OF SUPPORT 

None. 

 

 

 

 

 

 

 

 

 

 

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