Prosthetic Limb Research Paper
Prosthetic Limb Research Paper
Prosthetic limbs all started with a very simple problem. Do you just give up hope when you lose an arm or a leg, or is there some other way to make the best of a situation? Hope was not given up by us persistent human beings and that is how artificial limbs were thought of. Instead trying to get around, we thought of artificial legs to help those who have lost them. Instead of only having one arm, we thought of artificial arms to be able to have two again.
Prosthesis not only brought hope to those who were seriously injured and lost their limbs, but it helped these people bring their lives back to as normal as it could be. Of course prosthesis did not start off as being perfect and high tech, but they slowly progressed throughout thousands of years to the technology we have today, as well as the ideas we have for the future. Artificial limbs date back all the way to the times of the ancient Egyptians. These were very basic prosthetics and were made from the materials they had readily available such as wood, iron or leather. Alan J.
Thurston discusses the early Egyptian prosthetic, “One of the earliest examples comes from the 18th dynasty of ancient Egypt in the reign of Amenhotep II in the fifteenth century BC when members of an Egyptian–German mission working in the Sheikh Abdel-Gurna area of the Theban necropolis were carefully brushing away accumulated dirt from the burial shaft inside the rockhewn tomb of Mery, a priest of Amun. The mummy that is on display in the Cairo Museum has clearly had the great toe of the right foot amputated and replaced with a prosthesis manufactured from leather and wood (Fig. 1).
An even older example comes from the fifth Egyptian dynasty (2750–2625 BC) discovered by archaeologists, as being the earliest known splint from that period” (Thurston 1114). The ancient Egyptians and other early cultures to use prosthetics did so not only for the physical need for them, but to have a feeling of being whole and complete. Many cultures feared amputation over death because they wouldn’t be whole in the afterlife. So if a person had to have an amputation and had a prosthetic put in place, they would save their old limb and be buried with it so they would have their whole body in the afterlife with them.
The first written record of artificial limbs was from around 3500 BC. It was a poem written by Rig-Veda and was about a queen who lost her leg in battle and had an iron prosthesis put in place to where her leg was supposed to be so she could return to battle. The next recorded records of prosthetics that were actually made for rehabilitation came from the ancient Roman and Greek civilizations. “The books by the Greek historian Herodotus of Halicarnassus, report a prosthetic replacement. Herodotus states that in 484 BC, a Persian soldier escaped imprisonment by cutting off his leg then replacing it with a wooden prosthesis.
The report states that he was able to travel 30 miles to Tregea. He was unfortunately captured by Zaccynthius and was promptly decapitated. This has been validated with the finding of a copper and wood leg in Capri, Italy, in 1858, which has been dated to 300 BC (Fig. 2). 5 Lower-limb prostheses of the time were typically made of bronze plates with a wooden core and leather straps” (1114). As seen here, this was the first step to actually have a limb that served a function to help the man walk. The concept of an artificial limb had slightly progressed and become a better tool.
The next stage of prostheses came from around 450-1000 A. D. These are the typical peg legs that people think of and are typically thought of as what pirates like “Captain Hook” had. Peg legs made of again wood, leather or metal were used to help people walk. “Hook hands” were also made to replace people who lost a hand. “This style of prosthesis that is basically a modified crutch with a wooden or leather cup persisted into the early part of the twentieth century (Fig. 3). The use of these basic materials persisted until relatively recent times and many examples have survived. ” (1114).
So for many years people were content with this simple type of prosthetic limb and it wasn’t for about 500 years until it began to progress into something better. The next “wave” of prosthesis came from Ambroise Pare, a Frenchman born in 1510. He was a surgeon for the French Army and was prominently known for his treatment to gunshot wounds. He also made great progress in artificial limbs. “His ‘Le Petit Lorrain’, a mechanical hand operated by catches and springs was worn by a French Army captain in battle. He also devised an above-knee prosthesis consisting of a kneeling peg and a prosthetic foot.
It had a fixed equinus position, a locking knee and a suspension harness, features that are still in use today” (1117). This hand was the starting point for the advanced prostheses in existence today as well as the leg he developed. It was the first successful leg to have the locking knee, suspension harness and the equinus position and it set the bar for other prosthetics to come. Also Pare was the first to make a prosthesis with joints; “The leg he designed for amputation through the thigh is the first known to employ articulated joints” (Wilson Jr. 2).
The next wave of progression with artificial limbs came from the Civil War, and with anesthetics present, the surgeries were improved tremendously. Also the United States government paid for prosthesis for war veterans so they became more common. There was unfortunately not much advancement in prosthesis during this time period; “Many patents on artificial limbs were issued between the time of the Civil War and the turn of the century, but few of the designs seem to have had much lasting impact”(6). World War I also didn’t create much advancement in artificial limbs because of low casualties and the depression.
After World War II , prosthetic research developed the beginnings of the prostheses in widespread use today” (Spaeth vii), in what was called the Artificial Limb Program. They even further developed artificial limbs by making things such as; “the patellar-tendon-bearing (PTB) below-knee prosthesis, the quadrilateral socket and accompanying method of alignment, the Henschke-Mauch hydraulic knee unit, a totally new armamentarium for management of upper limb amputees, and the amputee clinic team of concept. Of tremendous significance was the emphasis on early fitting and saving the knee when amputation was necessary due to arteriosclerosis”(6).
All of these progressions were very important in changing prosthetics from a simple peg leg to the types of artificial limbs present today. If it weren’t for these, we wouldn’t be nearly as advanced in the field or prosthetics and would be far behind. From here many organizations were made in order to support amputees. Also because the profession of being a prosthetist was only taught by experienced prosthetists and there was no other way of learning available, the University of California started offering classes in around the 1950’s.
With classes now available about artificial limbs, this also encouraged a “take-off” in the field and brought great awareness to the public. From here classes began to expand to universities such as “New York University and at Northwestern University Medical School in Chicago”(8). After these schools began teaching, many colleges and universities began to follow and the field began to expand. The next milestone for artificial limbs came in 1965 when the Medicare bill passed. This bill gave people over the age of 65 little to no cost to receive an artificial limb.
So because of this, the need for prosthetics increased and more and more studies were made on them. This leads us all the way to the prosthetics available today in 2012. The next progression of artificial limbs came from about 1945-1970 with the idea of bionic arms, or artificial limbs controlled by electricity. It would use myoelectric control to power the limbs; “The concept of a myoelectric prosthesis is simple. The electrical activity naturally generated by contracting muscle in a residual limb is amplified, processed and used to control the low of electricity from a battery to a motor, which operates an artificial limb (Muzumdar 1).
It was the Germans who first claimed to be able to accomplish this feat, but it would be extremely difficult to make the limb look and feel normal. Reinhold Reiter was the first one to implement myoelectric control in 1945. His prototype however was not realistic because it was not portable. His prototype was essentially never going to work, but his beginnings of research on myoelectric control started a new wave in artificial limbs. This then sparked a worldwide quest to successfully control myoelectric electricity.
Major countries began to compete and try to progress to successfully make a myoelectrically controlled prosthetic. The United States became close to having a successful and efficient one, but logistics problems caused the procedure to be unsuccessful. Then in the turn to the 60’s a Russian scientist named A. Y Kobrinski was able to create a “self-contained myoelectric control system. This was one of the first stand-alone, battery-powered systems to be used on a number of amputees” (56).
Between the 70’s and the 80’s many different types of the “new” artificial limbs were used on adults as well as children. They were very successful and many people benefited from them. During this period, myoelectric hands were the main myoelectric powered prostheses. Competition sprang between corporations during this time period and they looked to make artificial limbs lighter and more efficient. Then in the 90’s, prosthetics began to be powered by computer technology “During the 90’s, the myoelectric prosthesis industry began to turn towards computer technology to provide programmable controls systems.
These advanced controllers can be adjusted, while on the patient, to give a variety of functions from one or two electrode sites” (57). This computer technology leads all the way to the types of artificial limbs present today. Battery technology has also increased tremendously during the past years, which gives the prosthetics greatly improved battery life. Artificial limbs today are extremely efficient and the batteries last a long time. Also the computer technology available creates greater memory for movement and control, which allows the prosthetics to feel more natural.
The artificial limbs today vary greatly depending on the need of the patient. There are cosmetic prosthetic limbs, also called a cosmesis. These are the prosthetics that look exactly like real limbs. “Advanced plastics and pigments uniquely matched to the patient’s own skin tone allow a modern day cosmesis to take on an amazingly life-like appearance. Even details such as freckles, hair and fingerprints can be included, bringing the cosmesis to the point where it’s nearly indistinguishable from the original missing arm or leg” (Clements 5).
There are also the basic artificial limbs which just serve the purpose to walk and aren’t as natural looking. An example of this could be the prosthetics you see the runner in the Olympics wearing. Regardless, the essential components of prosthetics are generally the same. They are composed of the plyon, which is the skeletal frame for the limb and the main support. Today these are generally made of lightweight but strong metals such as carbon fiber components. Next there is the socket, which connects the artificial limb to the stub where the patient’s limb used to be.
It is very important the socket is built correctly or it can cause further damage to the patient; “Because the socket transmits forces from the prosthetic limb to the patient’s body, it must be meticulously fitted to the residual limb to ensure that it doesn’t cause irritation or damage to the skin or underlying tissues” (3). The next and final essential component is the suspension system. This is the part that makes the artificial limb stay connected to the body and not fall off. This is generally done by a suction system, which uses an airtight seal to prevent the limb from falling off when it’s pushed on.
Prosthetic limbs today are all unique in their own way. The type of amputation and where the limb is cut off all has a great effect on the type of prosthetic limb needed. A below the knee prosthetic for example is far different from an above the knee. The above the knee prosthetic will need an articulated knee and takes much more technology to make. It also needs to attach to different nerves as well as many other factors. One problem with these high tech limbs however is their price. Prosthetic limbs are extremely expensive, and the more high tech they are, the more expensive they become.
There are even some prosthetic limbs today that use microprocessors and can remember your body movements; “Advanced prosthetic legs can be equipped with a microprocessor (computer chip) and sensors that measure angles and forces while a patient walks. Over time, the microprocessor learns how the patient walks and constantly adapts the stiffness of the knee accordingly” (5). This is an example of the type of limb that would cost a patient tens of thousands of dollars. One of the really cool and amazing prosthetics technology today has brought us to is the targeted muscle reinnervation or TMR.
It was developed by Dr. Todd Kuiken and it has to do with controlling artificial limbs with your brain. When a person loses a limb, he created the idea to attach the nerves from that limb to a muscle close by that contributes to moving the “former limb”. When this is done and the patient goes to try to move the “used to be limb” it then is able to send electrical currents, which causes Kuiken’s prosthetic limbs to move. This breakthrough he made is fascinating and extraordinary and opens doors to artificial limbs of the future.
University/College: University of Arkansas System
Type of paper: Thesis/Dissertation Chapter
Date: 9 September 2016
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