Biotechnology

Prosthetics

Imagine an artificial arm that moves naturally in

response to your thoughts, that allows you to feel both
the outside world and your own movements, and that
is as strong and graceful as an intact, biological limb.

What are prostheses?

An artificial extension that replaces a missing body part.
Usually replace parts lost by injury or missing from birth
or to supplement defective body parts.
An artificial limb is a type of prosthesis

A United States Army soldier plays table football with two prosthetic arms

Jon Comer, professional skateboarder with a prosthetic leg.

The Numbers

Trauma is the second leading cause of

amputation in the U.S.

About 30,000 traumatic amputations occur
in this country every year.
Four of every five traumatic amputation
victims are male, and most of them are
between the ages of 1530.
Traumatic amputation most often affects
limbs and appendages like the arms, ears,
feet, fingers, hands, legs, and nose.
More than 90% of amputations performed in
the United States are due to circulatory
complications of diabetes, the most
common cause of non-traumatic leg and
foot amputations.

The Numbers

In the United States, the most common causes of

lower-extremity amputation are:
Disease (70%)
Trauma (22%)
Congenital or Birth Defects (4%)
Tumors (4%)

Diseases that can cause amputation are varied, but

the most common ones are vascular disease and
diabetes. Vascular disease limits the circulation to
the extremities. Diabetes, which affects blood sugar,
can decrease the body's ability to heal itself.

Trauma resulting in amputation is most frequently

related to motor vehicle accidents and industrial
accidents.

Congenital malformation or birth defects can

result in either the person having no limb or a very
short limb that is treated as an amputation, for which
a prosthetic device is made.

Tumors of the bone, called osteosarcoma, can

sometimes be treated by amputation of the limb.

History

EGYPTIAN TIMES: mummies found

with prosthetic limbs made of fiber
THE DARK AGES: basic peg legs and
hand hooks

Prostheses were more cosmetic than

functional; meant to hide disgrace and
weakness of defeat from other battles.

RENAISSANCE: Ambroise Pare

(contributed to amp. Surgery and
prosthetics)

invented "Le Petit Lorrain" (a hand

operated by springs and catches)
Armorers in the 15th and 16th centuries
made artificial limbs out of iron for soldiers
who lost limbs. Over the next several
centuries, craftsmen began to develop
artificial limbs from wood instead of metal
because of the lighter weight of the material.
http://www.ottobockus.com/products/upper_limb_prosthetics/bo
dy_powered_hooks_wrist_units.asp
http://www.ampulove.com/amputee/proshistory/proshistory.htm

History continued

1600's - 1800's: refinements of the prosthetic and

surgical principles; invention of the tourniquet,
anesthesia, analeptics, blood clotting styptics,
and disease fighting drugs
Late 19th century: artificial limbs became more
widespread due to the large number of amputees
from the Civil War.
Technology improved primarily for two
reasons: the availability of government
funding and the discovery of anesthetics.
After World War II, the Artificial Limb Program
was started in 1945 by the National Academy of
Sciences. This program helped improve artificial
limbs by promoting and coordinating scientific
research on prosthetic devices.
In 1962 the government guaranteed prostheses
for veterans who lost them in the war.

Presently

20th Century: Modern plastics are stronger

and more lightweight. The most exciting
development has been the development of
myoelectric prosthetic limbs (uses
electrical signals from arm muscles to move
limb).
RECENTLY: Computers have been used to
help fit amputees with prosthetic limbs.
Eighty-five percent of private prosthetic
facilities use a CAD/CAM to design a model of
the patient's arm or leg, which can be used to
prepare a mold from which the new limb can
be shaped.
A great deal of emphasis has been placed on
developing artificial limbs that look and move
more like actual human limbs.
Advances in biomechanical understanding,
the development of new plastics, and the use
of computer aided design and computer aided
manufacturing have all contributed in the
development of more realistic artificial limbs

http://illumin.usc.edu/article.php?articleID=6
http://www.madehow.com/Volume-1/Artificial-Limb.html

What are they made of?

The typical prosthetic device consists of a custom fitted

socket, an internal structure (also called a pylon), knee cuffs
and belts that attach it to the body, prosthetic socks that
cushion the area of contact, and, in some cases, realisticlooking skin.
Should be lightweight; hence, much of it is made from plastic.
The socket is usually made from polypropylene.
Lightweight metals such as titanium and aluminum have
replaced much of the steel in the pylon.
Newest development in prosthesis manufacture has been the
use of carbon fiber to form a lightweight pylon.
The feet are made from urethane foam with a wooden inner
keel construction. Other materials commonly used are plastics
such as polyethylene, polypropylene, acrylics, and
polyurethane.
Prosthetic socks are made from a number of soft yet strong
fabrics.
Physical appearance of the prosthetic limb is important to the
amputee. The majority of endoskeletal prostheses (pylons)
are covered with a soft polyurethane foam cover that has
been designed to match the shape of the patient's sound limb.
This foam cover is then covered with a sock or artificial skin
that is painted to match the patient's skin color.

How are they made?

Must be prescribed first, and then fitted.
Measuring and casting

1 Accuracy and attention to detail; comfortable and useful; Prosthetist evaluates the amputee.

2 Prosthetist measures the lengths of body segments and determines location of bones and
tendons in the remaining part of the limb. A plaster cast of the stump is made.
Making the socket

3 A sheet of clear thermoplastic is heated and then vacuum-formed around the positive mold.
This thermoplastic sheet is now the test socket; it is transparent so that the prosthetist can
check the fit.

4 Ensure that the test socket fits properly. (if it is a leg, then the prosthetist studies the gait);
explain how the fit feels; comfort comes first.

5 The permanent socket is then formed; usually made of polypropylene and is vacuum-formed
over a mold in the same way as the test socket.
Fabrication of the prosthesis

6 Plastic pieces are made in the usual plastic forming methods: vacuum-forming, injecting
moldingforcing molten plastic into a mold and letting it cooland extruding, in which the
plastic is pulled through a shaped die. Pylons that are made of titanium or aluminum can be diecast; in this process, liquid metal is forced into a steel die of the proper shape. The wooden
pieces can be planed, sawed, and drilled. The various components are put together using
bolts, adhesives, and laminating.

7 The entire limb is assembled by the prosthetist's technician; uses a torque wrench and
screwdriver to bolt the prosthetic device together. Prosthetist fits the permanent socket to the
patient, this time with the completed custom-made limb attached. Final adjustments are then
made.
http://www.madehow.com/Volume-1/Artificial-Limb.html

Types of Artificial Limbs

The type of prosthesis depends on what part of the limb is

missing.
Transtibial Prosthesis : an artificial limb that replaces a leg
missing below the knee.
Usually able to regain normal movement because of knee
(allows for easier movement)
Transfemoral Prostheses: an artificial limb that replaces a leg
missing above the knee.
very difficult regaining normal movement; must use 80%
more energy to walk than a person with two whole legs (due
to the complexities in movement associated with the knee)
Transradial Prostheses: an artificial limb that replaces an arm
missing below the elbow.
Cable operated limbs (attaching a harness and cable around
the opposite shoulder of the damaged arm)
Myoelectric arms
Transhumeral Prostheses: an artificial limb that replaces an
arm missing above the elbow.
same problems as transfemoral amputees because of
complexities of the elbow. Makes mimicking the correct
motion with an artificial limb very difficult.

How do they work?

-Artificial Arms
If you are an arm amputee, your choices range from a passive
to a more functional prosthesis.
Passive arms have no grasping function but have a
good cosmetic appearance.
Functional arms can either be body-powered or electric
(most often myoelectric). Cable-operated hands and
hooks are known as "body-powered" prostheses and are
operated by means of a cable and harness system. By
using the back and shoulder muscles, the cable is pulled
which either opens ("voluntary opening") or closes
("voluntary closing") the hand.
A "myoelectric" prosthesis is operated when the
electrodes pick up muscle impulses from your residual
limb. They are translated into electrical signals that are
sent to the electric hand to open or close it. Power is
provided by a battery.

www.waramps.ca

Myoelectric Arm

http://www.cnn.com/HEALTH/9806/1
0/artificial.hand/index.html

Gait Cycle

-the series of movements of the leg and foot between one touch of the
heel on the ground and the next time the same heel touches.

C-Leg
The C-Leg allows the wearer to:
seamlessly speed up or slow down
take on hills or slopes
recover from stumbles
go down stairs step-over-step
The science behind the knee is revolutionary. It anticipates
what the wearer is doing and accommodates every change,
in real time... by utilizing microprocessors to control the
knee's hydraulic function 50 times a second.
http://www.ottobockus.com/PRODUCTS/LOWER_LIMB_PROSTHETICS/c-legvideos.asp

How do they work?

on preference, activity level, some
-Feet Depend
are more flexible than others
The Trias+ foot was modeled after
the anatomical function of the
human foot. It was engineered to
ensure effortless, unified function.
The design combines dual spring
elements in the heel and forefoot.
Made of carbon fiber that can
support for patients who weigh up
to 275 pounds.

http://www.ottobockus.com/PRODUCTS/LOWER_LIMB_PROS
THETICS/feet.asp

Cost
Transradial and transtibial prostheses typically
cost between US $6,000 and $8,000.
Transfemoral and transhumeral prosthetics cost
approximately twice much with a range of
$10,000 to $15,000 and can sometimes reach
costs of $35,000.
The cost of an artificial limb does recur because
artificial limbs are usually replaced every 3-4
years due to wear and tear on the artificial limb.
In addition, if the artificial limb has fit issues, the
limb must be replaced within several months

Future

Continue to develop limbs whose function is

more and more similar to the real thing
Direct bone attachment (osseointegration)
attaching prosthetic legs to a titanium bolt
placed directly in the bone
(+) may avoid skin sores, sweating, and pain
(+) Amputees have better muscle control of the
prosthetic.
(+) Amputees can wear the prosthetic for an
extended period of time - with the stump and
socket method this is not possible.
(+)Transfemoral amputees are more able to drive a
car.
(-) cannot have large impacts on the limb, such as
those experienced during jogging

Biohybrid limbs
Insert microchips into muscles to pick up signals
from the brain
Two-way talk (send and receive)
Sensitive to touch and heat

Jesse Sullivan demonstrates one of his prosthetic

arms by using a paint roller on the side of his
house in Dayton, Tenn., July 20, 2006. His left arm
is a bionic device wired directly into his brain.
Sullivan lost his arms in May 2001, while working
as a utility lineman.

http://www.cbsnews.com/stories/2006/09/14/tech/main2008317.shtml

THE END