Pressure Casting System (PCAST)

A main cause of amputation and injury in developing countries is from landmines. Since the 1960s as many as 110 million landmines have been deployed throughout the world in approximately 70 countries. Other major causes of amputation are from chronic conditions, domestic and occupational injury and factors related to poverty. The World Health Organisation has reported that 26 million people in Asia, Africa and Latin America are in urgent need of prosthetic/orthotic devices to improve mobility and quality of life. The vast majority achieve restoration of function and re-integration into society if provided with well-fitting and comfortable prosthetic/orthotic devices. There are only 24 schools in developing countries graduating approximately 400 personnel per year in prosthetics and orthotics with many developing countries providing no training. Mobility is of great importance for a person’s quality of life. It is a basic need and right for all people and is necessary for accessing food, shelter, education, employment, income and equal opportunity.

Prosthetics provide people with the ability to participate more fully in activities of daily living leading to improved quality of life as well as gainful employment. There is, however, a significant gap between those who can afford custom-made prosthetics and those who cannot, with prohibitive costs and access to skilled prosthetists identified as the main barriers to addressing these needs. Hence, there is a need for technology that is inexpensive, high quality and accessible. Low-cost technology and therapy also minimises the operating expenses of rehabilitation centres and makes the long-term survival of these centres more viable and sustainable.

Developed by members of our team, the Pressure Cast (PCAST) system was scientifically evaluated in Vietnam between 2010 and 2015. This was funded and supported by the CASS Foundation, Rotary Club Australia and the Promobilia Foundation (Sweden) which demonstrates the team’s capacity to attract other sources of funding required to sustain the project in the future. Moreover, the team is published in this field (refer to publications list). This work showed that the PCAST technique can be successfully used with low-cost prosthetic components to assist patients in a developing country. This work was one of the largest of its kind to assess mobility and patient satisfaction outcomes (~ 80% satisfaction) with these sockets following short (2 days) and extended (160 days) usage periods in a developing country.  The primary aim, which was successfully achieved, was to develop a water-based (hydrostatic pressure) socket casting system. Our work showed that the PCAST produces a definitive socket shape through hydrostatic pressure requiring little to no rectification, reduces skill dependency, fitting errors, labour cost, and is highly portable (can be used in urban, regional and country settings).

Related reading

  1. Laing S, Lythgo N, Lavranos J, Lee PV. (2019). An investigation of pressure profiles and wearer comfort during walking with a transtibial hydrocast socket. American Journal of Physical Medicine and Rehabilitation, 98(3): 199-206 
  2. Laing S, Lee P, Lavranos J, Lythgo N (2018). The functional, spatio-temporal and satisfaction outcomes of transtibial amputees with a hydrocast socket following an extended usage period in an under-resourced environment. Gait and Posture, 66, 88-93.
  3. Laing S, Lee P, Lythgo N, Lavranos J, Nguyen T, Lee P (2017). Transtibial Prosthetic Socket Fit in Developing Countries: a study to compare initial outcomes in Pressure Cast hydrostatic and Patella Tendon Bearing designs. Gait and Posture, 58, 363-368.
  4. Lee P, Lythgo N, Laing S, Lavranos J, Nguyen T (2014).  A Pressure Casting Technique for Transtibial Prosthetic Socket Fit in Developing Countries. Journal of Rehabilitation Research and Development, 51(1), 101-10.
  5. Walsh NE, Walsh WS (2003). Rehabilitation of landmine victims - the ultimate Challenge. Bulletin of the World Health Organization, 81 (9).
  6. World Health Organisation (2004) – Report on guidelines for training personnel in developing countries for prosthetics and orthotics services.
  7. McDonald CL, Westcott-McCoy S, Weaver MR, Haagsma J, Kartin D (2021). Global prevalence of traumatic non-fatal limb amputation. Prosthetics and Orthotics International, April 1;45(2):105-114.

Biomechanical Therapy

Musculoskeletal conditions impose a substantial burden of illness in disadvantaged communities throughout the world BJD online). Conditions affecting the bones, muscles, and joints are the most notorious and common causes of severe, long-term pain and disability throughout the world, especially in lower-income communities, with a significant impact on health-related mobility and quality of life (BJD online).The WHO continues to urge individuals, governments, and nongovernment organisations to collaborate on innovative models of sustainable health care that address these concerns at governmental, philanthropic, and grass-root levels (BJD online).

Health services in lower-income countries are often not freely available or easily accessible. The needs may be even greater for people living in poverty in rural or remote communities and for those with minimal education and employment options.

The problems may be compounded by many people living in poor communities relying on heavy, repetitive physical labour as part of their employment. This includes occupations such as farmers and factory workers that can also involve children and older people the elderly as workers. In these communities, there is usually minimal access to affordable and culturally suitable health care for pain relief.

There is growing evidence for the effectiveness and cost-effectiveness of tactile therapies in delivering simple and safe musculoskeletal care (Vickers and Zollman, 1999; Vindigni, Polus & Edgecombe, 2009; Vindigni, Polus & van Rotterdam, 2011). There is also a need to formally re-introduce such practices in a regulated manner linked to national health priorities and governing authorities such as health departments (BJD online; Bodeker, 2008).

The Biomechanical Therapy program, collaboratively developed by YAKKUM (Pusat Rehabilitasi) in Indonesia and the Hippocrates Institute is an example of a musculoskeletal training program for community healthworkers that has successfully developed and delivered an effective, cost-effective and sustainable program to manage painful, disabling conditions, promote mobility and improve the quality of life of people living in poor Indonesian communities.

The Biomechanical Therapy component of the Digital Health Hub Rehabilitation Project aims to augment the existing BT (Kinesio Program) which has been successfully delivered in Indonesia over the past five years. In particular providing a range of audio-visual learning and teaching materials to complement existing approaches to teaching.

Apart from helping to flexibly increase the reach and benefits of BT (Kinesiotherapy) to other Indonesian communities in need, is the goal to collaboratively establish, deliver and support community health workers in other Asia-Pacific countries including Timor-Leste and Cambodia.

 The aim is to develop online and face-face training material in Biomechanical Therapy

The current project includes a further two levels of Biomechanical Therapy at more advanced levels.

  • Level 1 - is an introduction to Biomechanical Therapy and includes basic anatomy & physiology and basic principles of managing musculoskeletal conditions.
  • Level 2 - Builds upon this foundation and includes the application of soft tissue therapy techniques.
  • Level 3 - In this level, the Biomechanical Therapy course provides greater depth in the diagnosis and management of common, uncomplicated musculoskeletal conditions.
  • Level 4 -  In this more advanced Level, students acquire knowledge and skills in more diverse and complex diagnosis and management procedures.

Related reading

  1. Bervoets DC, Luijsterburg PA, Alessie JJ, Buijs MJ & Verhagen AP. (2015). Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review. Journal of Physiotherapy, 61(3), 106-116.
  2. Kumar S, Beaton K & Hughes T. (2013). The effectiveness of massage therapy for the treatment of nonspecific low back pain: a systematic review of systematic reviews. International Journal of General Medicine, 6, 733.
  3. Nelson NL, & Churilla JR. (2017). Massage therapy for pain and function in patients with arthritis: a systematic review of randomized controlled trials. American Journal of Physical Medicine & Rehabilitation, 96(9), 665-672.
  4. Kong LJ, Zhan HS, Cheng YW, Yuan WA, Chen B, & Fang M. (2013). Massage therapy for neck and shoulder pain: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine,
  5. Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD & Ferguson AJ (2020). Noninvasive nonpharmacological treatment for chronic pain: A systematic review update.
  6. Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, & Vos T. (2020). Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10267), 2006-2017.
  7. Vindigni DR, Polus B, Edgecombe G, Howard M, van Rotterdam J, Redpath F, Ellen E (2009). The STTEP: a model for musculoskeletal health care in marginalized communities. The Journal of Alternative and Complementary Medicine, 15(8), 885–890.
  8. Vindigni D, Polus B, van Rotterdam J, da Costa C, Edgecombe G, Walsh M, Howard M, Bromwell T, Biasbas A, Cohen M, Charlotte Patterson C (2011). The sustainable training, treatment, employment program model: effects of manual therapy on musculoskeletal pain and limitation in a filipino squatter community Journal of Manipulative and Physiological Therapeutics, July/August, 381 - 387.
  9. Vickers A, Zollman C. ABC of complementary medicine: Massage therapies. BMJ 1999;319: 1254–1257.


Mobility and psycho-social wellbeing are essential for human dignity and quality of life. Limb Loss (LL) is common in developing countries especially the regions affected by war and natural disasters. Though it primarily produces physical disability, it has impact on the overall psychological well-being of individuals. Persons with LL experience mental health issues such as grief, post-traumatic stress disorder (PTSD), depression and anxiety. Experience of such mental health conditions make their adjustment to their loss more challenging. LL is accompanied by shock, grief, body image disturbances, pain, difficulty in adjusting to daily activities, feeling of helplessness and loss of meaning to life. Changes experienced by a person with LL may also lead to impaired social functioning and social discomfort. Furthermore, ongoing assessments and procedures associated with the process of medical management will produce considerable distress. LL can present physical, psychological, social and occupational challenges (e.g., cost, poor access to prosthetic services) impacting the individual’s overall quality of life. In some cultures, absence of limb is equalled with total disability, incompetence, inability to perform daily activities, and family life which leads to impaired social functioning and social discomfort. LL not only alters the affected person’s life and overall functioning but can also impact their family and carers. Hence it is important that psychological, sociocultural, and environmental factors associated with LL need to be addressed. Efforts to enhance coping, positive adjustment, affective distress, manage pain are some of the challenging issues. Unfortunately, the low-income countries have meagre facilities, resources and infrastructure to train the required personnel to satisfy the need and provide appropriate services and care.

Early detection, assessment and management of these mental health and psychological issues can bring in positive impact on their overall quality of life and well-being. Implementing comprehensive mental health and counselling programs leads to better adjustment to loss, management of psychological distress and minimization of impact of disability. Persons with LL will benefit from mental health supports and counselling through the journey of amputation including at the time of occurrence of trauma, pre- and post-operative stages, during the physical rehabilitation process and following artificial limb implantation. Such mental health programs with individuals and their family members are essential components of comprehensive multidisciplinary rehabilitation of persons with LL amputation and chronic pain.

Engaging persons in psychological intervention programs can influence the overall functioning and adjustment, enhance their coping abilities, improve their self-perception, improve their social withdrawal, and acceptance of the absence of a limb through recovery in addition to the effective management of the range of mental health issues identified. Psychological approaches also help coping with and effective management of pain experienced during and subsequent to amputation. A wide range of evidence-based psychological approaches can effectively be implemented to manage the above issues in persons with LL and their families. Psychological approaches are also important to assist the individual to develop strategies to return to normal life following such therapeutic approaches as PCAST. Training the locally available staff in detection, assessment and management of these psychological and psychosocial issues can produce positive outcomes to persons and their families.  The current project attempts to develop assessment and intervention strategies to manage the above outlined psychological and psychosocial aspects associated with amputation. This project attempts to train the locally available staff with evidence-based approaches. The training programs will focus on management of the above issues as part of the psychological approach. Training in a wide range of therapeutic skills will be imparted to the practitioners who will be able to provide clinical care to the persons with LL.

Related reading

  1. Horgan O & MacLachlan M (2004). Psychosocial adjustment to lower-limb amputation: A review. Disability and Rehabilitation, 26, 837-850.
  2. Jo S-H, Kang S-H, Seo W-S, Koo B-H, Kim H-G & Yun S-H (2021). Psychiatric understanding and treatment of patients with amputations. Yeungnam University Journal of Medicine, 38, 194-201.
  3. Pedras S, Vilhena E, Carvalho R, & Pereira MG. (2018). Psychosocial adjustment to a lower limb amputation ten months after surgery. Rehabilitation Psychology, 63(3), 418–430.
  4. Rosca AC, Baciu CC, Burtaverde V & Mateizer A (2021). Psychological consequences in patients with amputation of a limb. An interpretive-phenomenological analysis. Frontiers in Pyschology, 12: 1-11.
  5. Sharma RK, Singh B & Sharma S (2016). The efficacy of cognitive behaviour theapy and quality of life in the amputees. The International Journal of Indian Psychology, 3, 151-166.
  6. Rehabilitation after traumatic injury NICE Guideline draft for consultation (2021).
  7. Sahu A, Sagar R, Sarkar S & Sagar S (2016). Psychological effects of amputation: A review of studies from India. Industrial Psychiatry Journal, 25, 4-10.


  • Identifying the elements of a flexible, digitally based, good practice framework for international partnerships to provide more equal access to health care for the disadvantaged. PhD candidate Salma Arabi
  • Lower limb amputation, disability and mental health: the role of psychological interventions. A scoping review. Dr Dawn Wong Lit-Wan, Dr Prasad Podugu.
  • Further development of the PCAST system to assist children and people with above knee amputation. Associate Professor Noel Lythgo, Professor Peter Lee, Chris Fitzgerald.
  • Honours and Higher Degree by Research (HDR) projects. For further information, please contact Associate Professor Noel Lythgo.

Scientific Advisory Committee


Professor Christian Doerig, Associate Professor Paul Merrick, Professor Kerryn Butler-Henderson, Associate Professor Noel Lythgo

The purpose of this committee is to support the implementation and continuity of the project by:

  • Reviewing ethical issues related to research projects
  • Reviewing and providing scientific advice on publications (pre-submission) to ensure scientific rigour and integrity
  • Mentoring personnel involved in the project (all sites, all personnel levels)
  • Monitoring logistic capabilities and issues
  • Ensuring the emergence of a solid basis for project continuity beyond present funding window
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Acknowledgement of Country

RMIT University acknowledges the people of the Woi wurrung and Boon wurrung language groups of the eastern Kulin Nation on whose unceded lands we conduct the business of the University. RMIT University respectfully acknowledges their Ancestors and Elders, past and present. RMIT also acknowledges the Traditional Custodians and their Ancestors of the lands and waters across Australia where we conduct our business - Artwork 'Luwaytini' by Mark Cleaver, Palawa.

aboriginal flag
torres strait flag

Acknowledgement of Country

RMIT University acknowledges the people of the Woi wurrung and Boon wurrung language groups of the eastern Kulin Nation on whose unceded lands we conduct the business of the University. RMIT University respectfully acknowledges their Ancestors and Elders, past and present. RMIT also acknowledges the Traditional Custodians and their Ancestors of the lands and waters across Australia where we conduct our business.