Prosthetics by:David - Brittany Elves - Kelsey - Renee - Kerstyn

= A Brief History of Prosthetics = Prosthetics have made leaps and bounds from the days of pirate peg legs to modern day fashionable robotic accessories. The following is a summary of the ideas, materials and innovations which resulted in the seamless technologies in use today.

The Dark Ages (476 - 1000AD)
During this period, little advancements were made to the existing hook hand and peg leg prosthetics. Outside of battle, only the wealthy were privileged enough to use such devices in daily life. The function of a prosthesis at this time was to hide an unfortunate deformity or injury sustained in battle. Knights were fitted with prosthetics intended to hold a shield or fit into a stirrup while on horseback, little attention was paid to functionality. People of all trades contributed to the making of prosthetics. Watchmakers were particularly instrumental in designing intricate internal functions such as springs and gears.

The 1500s
In 1508 Gotz von Berlichingen, a German mercenary, lost his right arm during battle causing him to adopt a technologically advanced pair of iron hands. These hands could be easily manipulated by setting them with the natural hand and were moved by relaxing a series of releases and springs while suspended by leather straps. For upper and lower extremity amputees in 1536, Ambroise Paré invented a unique above-knee device. The artificial limb consisted of a kneeling peg leg and foot prosthetic that had a fixed position, adjustible harness, knee lock control and other engineering features still in use today.

The 1800s
In 1800, Londoner James Potts designed a prosthesis made of a wooden shank and socket, steel knee joint and an articulated foot. The prosthetic was controlled by catgut tendons, tough thin cords made by treated sheep intestines used for surgical ligatures, which extended from knee to the ankle. Benjamin Palmer came into the picture in 1846 through his concern for the unsightly gaps between components on artificial legs in particular. He improved upon appearances by adding anterior springs, a smoothed casing and concealed tendons to stimulate natural-looking movement.

1900 to the Present Day
In 1912, Charles and Marcel Desoutter made the first lightweight aluminum prostheic, they were the first to approach the problematic tendencies of heavier, iron prosthetics in decreasing the functionality of the limb for the wearer.

The United States Civil war saw a drastic increase in amputees, forcing Americans to enter the field of prosthetics. Their entrance was put to use following World War II as veterans were dissatisfied with the lack of technology used in limb devices and demanded improvement. Rather than investing in artilery, the United States Government brokered deals with military companies to improve upon prosthetic functioning. This agreement paved the way to the development and production of modern day prosthetics.

Much like the Desoutter brothers hoped, today's devices have become much lighter through the use of aluminum and plastics to provide amputees with the most functional devices possible. The advent of microporcessors, computer chips and robotics in modern day devices are desinged to return amputees to the daily lifestyles they were accustomed to, rather than providing simple functioning and a pleasing appearance.

= Types of Prosthetics = There is a large misconception that the term “prosthetics” only applies to artificial legs and arms. In fact, any artificial body part is considered a prosthetic. This means that artificial teeth, joints, and heart valves are all prosthetics. Prosthetics can be grouped into four broad categories:

Limb Prosthetics
Limb prosthetics are artificial pieces that replace any jointed appendage of an animal. Arm, leg, hand and food prosthetics are in this category. Limb prosthetics have three main parts: the interface, the components and the cover. The interface is the part that attaches to the person. It contains a socket which is made of plastic and a frame made of graphite which gives support to the socket. Limb prosthetic users must wear a lining between their body and the interface. The components are the working parts of the prosthetic. The working parts are beginning to be powered myoelectrically by microprocessors that create movement with electric charges naturally produced by muscle contractions. Bionic prosthetics are now becoming available. These pieces make easy moving possible by rerouting the nerves from an amputated area to a healthy area where the prosthetic limb can interpret impulses from the nerves and move accordingly. Prosthetic limbs may also have covers to protect the working components of the prosthetic.

Joint Prosthetics
Prosthetics in this category include replacements of any joints. Joints that commonly need replacement are knees, hips and shoulders. Because of the large amount of movement in joints, these prosthetics must be made of strong material such as metal. Upper body joints require light material to allow for large movements. Most joint prosthetics are made for patients with osteoarthritis.

Prosthodontics
These are oral prosthetics used in dentistry. There is a large range of prosthodontic devices that replace teeth and supportive dental structures. Examples include crowns which cover unstable teeth and dentures.

Implanted Prosthetics
These prosthetics are implanted into the human body. Damaged heart valves can be replaced by artificial ones to improve major blood vessels. Plastic surgery uses implanted prosthetics made of silicone to smooth facial wrinkles. The most commonly known prosthetics in this category are breast implants, however, glass eyes and pace-makers are also implanted prosthetics.

= Benefits = There are many benefits to Prosthetics. Prosthetics help people that have had amputations or don’t have ordinary limbs to attempt at a normal life. There are many recent advances in prosthetic technology despite past problems. Prosthesis has created pain for people including blisters and other skin problems, but now there are special devices to help the prosthetics stay comfortably attached to the person. An example would be “Easy Sleeves” a gel like sleeve which create a comfortable barrier between the prosthesis and skin.

There are also different types of attachments such as the bowling attachment, baseball attachment, and a working attachment.There are three types of fastening, Suction and Valve, Harness and Liners with a Lock Pin, all of which are being improved to better fit people with prosthesis.

People are also able to use cosmesis to help customize their limb with tattoos, hair, skin color, texture, veins, shaping and freckles. Scott Sabolich Prosthetics and Research Inc. is a company which researches to develop new cutting edge prosthetics. They have developed a Sensory Feedback System that helps amputees restore feeling in their limbs as well as improve prosthetics by making them lightweight and flexible and match the prosthetics to muscular and bone density. Other technologies being developed elsewhere include Microchip technology: turns thought process in the brain into actual physical movements in the prosthetics, and Myoelectric; which are EMG signals that come from voluntary contracting muscles from a person’s limb on the surface of the skin which controls movements of the prosthesis.

Resources for People with Prosthetics

 * “Dating for Disabled”: a online service which helps disabled people connect on many levels
 * Safewalk: dedicated to educate people about dangerous situations
 * Jim Mullen Foundation: give away free computers
 * N.O.S.E.: National Odd Shoe Foundation- provides odd shows or a pair of different sized shoes

These things to only help Amputees live a normal life by being ale to work and participate in activities, but also lead a healthier more confident life.

=Detriments= External prosthesis can be very expensive and constantly need to adjust due to weight changes, changes in gait and residual limb size or volume changes. Expenses are also expended in the need for both preparatory prosthetic that is used to practice and adjust to new gait or limb functions and the definitive prosthetic which is adjusted and personally fitted to ensure the best comfort and fit possible. These expenses including the fittings and doctors visits regularly need a pay-source, financial aid as most insurance policies have very little coverage.

With external prosthesis there can be a lack of functionality resulting in a limited lifestyle. With recovery time, rehabilitation and continual training there can be multiple difficulties. One of the biggest obstacles during the post-prosthesis recovery is maintaining an active lifestyle.

Depending on the amputation it can be termed ‘difficult to fit’. These amputations are problematic due to the shape and length of the residual limb; especially the weight-bearing amputations and can limbs limit prosthetic options. Maturation, stabilization of the residual limbs is needed prior to the fitting of the prosthesis requiring extended examination times and rehabilitation. Physical tests are needed to ensure sufficient maneuvering and control of the trunk, especially in lower body amputations. Sufficient trunk control, adequate knee strength, good upper body strength, proper posture, static and dynamic balance are all requirements.

Pain and irritation are common cons of an external prosthesis. These can be due to the malfunctions of the prosthesis in the ergonomics, size, weight, improper engineering, or low durability. The pain can be strictly physical, induced by the body or by the prosthesis itself, or mental in phantom pain. Bodily pain includes bursas, skin rashes, blisters, cysts, skin macerations and folliculitis. Prosthesis can cause pressure areas to become sensitive; these areas include the tibia and fibula as well as the tendons on weight-bearing prosthesis. An additional con of the external prosthesis is the extra energy consumptions that increase as the amputations area becomes larger. Energy consumption for a unilateral prosthetic increase’s by 40 percent from a below-knee situation to an above-knee amputation. Bilateral prosthetic energy consumptions increase from more than forty percent to over two hundred percent in the same situation.

Many of the internal issues that occur with prosthesis are from the malfunction of the prosthesis. Prosthesis valves may fail, or stick due to scar tissue build-up, infection or blood clotting. An additional con is operation times, recovery times, rehabilitation times and possible reoperation times. These vary with the operation, the intensity, any complications and the urgency. Perforations in implanted prosthesis can also cause pain and repetitive operations. Dissatisfaction with implants can also be a personal issue caused by the patient’s self-image. Personal anxiety of self image caused by the prosthetic is also a con of the prosthesis product; a societal view can be a disadvantageous as the sense of self is compromised.

= Prosthetic Aesthetics = At first glance, some prosthetics are meant to look just like any other arm. These limbs can be quite deceptive, being the same colour, shape and even possess minute detailing such freckles, moles and even hairs. The problem with these limbs is that when they are touched people realize that they are, in fact, artificial and can lead to a sense of shock and sometimes revulsion. To solve this problem, this technology is now headed the way of eyeglasses. Glasses, in the past, were once just functional and as of today they have turned into a sense of fashion and identity. New materials and looks associated with these new prosthetic limbs avoid the feeling of just being technology sleeved within flesh coloured silicon. A bonus of this new wave of prosthetic is that, firstly, it solves the previously discussed problem of shock of uncertainty because it becomes more apparent that the person is okay with their disability. Secondly, these next-generation limbs can offer more freedom than those offered by mother nature. For example, a South African runner's new legs were debated to use only a fraction (up to 25% less) of the energy that an able bodied runner would use. New limbs can also improve mobility by offering greater movement where required, like an elbow that could move virtually anywhere within its socket. As for the sense of style, there has even been some inventors who have designed their own fully functional prosthetic limbs, just like any other fashion item or accessory. Similar innovations to a man who designed his limb after an Eames chair is expected and greatly anticipated.

= Conclusion = Though prosthetics have some disadvantages, such as pain and malfuntions, the advantages provide wearers with increased mobility, functionality and natural appearance. The immense benefits provided contribute to a more normal lifestyle. The future of prosthetics is promising with the innovations technology continuously provides. Reasearchers are using such technologies to improve upon the malfuntions associated with mobility and functionality of prosthetics. Eventually, all prosthetic users will find confidence in the use of their artificial body parts.

= References =

History of Prosthetics

1. http://health.howstuffworks.com/prosthetic-limb1.htm Accessed March 31, 2009

2. http://www.amputee-coalition.org/inmotion/nov_dec_07/history_prosthetics.html Accessed March 31, 2009

Types of Prosthetics

1. http://www.scienceclarified.com/Ph-Py/Prosthetics.html Accessed March 29, 2009

2. http://www.answers.com/topic/prosthesis Accessed March 28, 2009

3. http://www.merck.com/mmhe/sec25/ch307888/ch307888b.html Accessed March 28, 2009

4. http://www.amputee-coalition.org/inmotion/may_jun_04/body_electric.html Accessed March 29, 2009

5. http://science.jrank.org/pages/5527/Prosthetics.html Accessed March 31, 2009

Benefits

1. http://www.extremeprosthetics.com/finnieston_cosmetic_cover.htm Accessed March 31, 2009

2. http://www.aetna.com/cpb/medical/data/300_399/0399.html Accessed March 31, 2009

3. http://news.bbc.co.uk/1/hi/health/2975828.stm Accessed March 31, 2009

4. http://www.amputeesupply.com/ Accessed March 29, 2009

5. http://www.merck.com/mmhe/sec25/ch307888/ch307888b.html Accessed March 31, 2009

6. http://www.scottsabolich.com/randd.html Accessed April 3, 2009

7. http://www.oddshoe.org/ Accessed April 2, 2009

8. http://www.jcchoices.org/orgs/246.html Accessed April 2, 2009

9. http://www.su.ualberta.ca/services_and_businesses/services/safewalk Accessed April 2, 2009

10. http://www.dating4disabled.com/ Accessed April 2, 2009

Detriments

http://www.wonderhowto.com/how-to/video/how-to-explore-prosthetic-options-for-the-gym-as-an-amputee-267292/ Accessed March 27, 2009

http://www.scottsabolich.com/staying_in_step.html Accessed March 29, 2009

http://www.healthcentral.com/erectile-dysfunction/c/74/7552/ed Accessed March 27, 2009

http://www.amputee-coalition.org/military-instep/feet.html Accessed March 27, 2009 http://emedicine.medscape.com/article/317358-overview Accessed March 27, 2009

Aesthetics

1. Playmedesign - Immaculate Arm System

2. Joanna Hawley - Eames Prosthetic Leg

3. Prosthetic Advancements