Upper-Limb Prosthetics Current Status And Future Needs
Maurice A. LeBlanc, C.P.
This paper is an attempt not so much to give the current status of upper-limb prosthetics but to develop the direction where research and development efforts should be pointed in the next few years to solve the most pressing clinical needs for patients.
Current Status
The history (Fig. 1 and Reference  ) and development of upper-limb prosthetics is presented in the Orthopaedic Appliances Atlas of 1960 and will be updated by the revision to that volume now in progress and expected in 1978. In addition to the 1960 "Atlas," the Manual of Upper Extremity Prosthetics and Prosthetic Principles—Upper Extremity Amputations have been used as teaching manuals and resource books to provide state-of-the-art service to amputees.
Background
The 1971 report Rehabilitation Engineering—A Plan for Continued Progress made specific recommendations for future research and development in arm prosthetics. Subsequent efforts since that time also have tried to answer the question "What research work should we be doing to best help arm amputees?" Past recommendations centered mostly on the areas listed below:
- Restudy of body powered prostheses
- Continuation of development of externally powered prostheses
- Improvement in appearance of hooks, hands, and arms
- Surveys of the upper-limb amputee population
- Formation of specialized centers for severely disabled arm amputees
- Increased emphasis on control and sensory feedback
Recent Progress
In the last several years, accomplishments have been made in the following areas:
- Sockets: OCCC1 open shoulder socket for above-elbow amputees (Fig. 2 and Reference ). Northwestern University self-suspension socket for below-elbow amputees (Fig. 3 and Reference ). Northwestern University atmosphere-pressure suspension socket for above-elbow amputees (Fig. 4 and Reference ).
- Components: Externally powered hands and hooks (Fig. 5 and Reference
). Externally powered elbows (Reference ). Otto Bock wrist rotator (Fig. 6 ).
- Control: EMG Control (Reference and ). Hybrid body/electric control (Reference ). Sensory feedback (Reference ).
- Cosmesis: Endoskeletal prostheses (Fig. 7 and Reference ).
- High Bilaterals: Coordinated feeder arms (Fig. 8 ).
Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7, Fig. 8
- Ontario Cripple Children's Centre, Toronto, Canada
Future Needs
There are several old but good and yet undone ideas for improvement of upper-limb prostheses. Considering recent accomplishments as well, I see future needs for the field as falling into two major items:
- Packaging: Only an estimated 50 percent of arm amputees wear prostheses. Ned Sharpies' study (20) revealed that whatever we can do mechanically (functionally) for unilateral arm amputees is not nearly as important as what we can do for them cosmetically (socially). With this in mind, it seems to me that we have to "package" prostheses better to achieve greater amputee acceptance. This includes work 1) on improved prosthetic skin material, 2) self-suspension, 3) self-containment, and 4) general aesthetics.
- High Bilateral Prostheses: It is readily acknowledged that high bilaterals—children and adults—present a most serious and difficult problem. In contrast to unilateral arm amputees and some low level bilateral amputees, the challenge to increase function of these people is a large one. I see future needs including 1) assistance in enabling them to use their feet wherever possible, 2) increase in function of components, 3) increase in control capability without added encumbrance in mental work necessary by the amputee, and 4) commercial availability of components and systems.
Goals
It seems to me that the goals are difficult to achieve, but can be stated simply as:
- For unilateral arm amputees: making them feel good about themselves!
- For bilateral arm amputees: giving them a measure of independence!
References:
- Orthopaedic Appliances Atlas, Volume 2, Artificial Limbs, American Academy of Orthopaedic Surgeons, 1960.
- Manual of Upper Extremity Prosthetics, Edited by William R. Santschi, Department of Engineering, University of California at Los Angeles, 1958.
- Prosthetic Principles-Upper Extremity Amputations, Prepared by John J. Bray, Published by the Prosthetics-orthotics Education Program, Division of Orthopedic Surgery, University of California at Los Angeles, 1975.
- Rehabilitation Engineering, A Plan for Continued Progress, Committee on Prosthetics Research and Development, National Academy of Sciences, Washington, D.C., April 1971.
- The Child with an Orthopaedic Disability-His Orthotic Needs and How to Meet them, Committee on Prosthetics Research and Development, National Academy of Sciences. Washington, D.C., 1973.
- Unpublished report of meeting held in Annapolis, Maryland on ]une 19-20, on Prosthetics Research and Development, by the National Academy of Sciences.
- "Externally Powered Prosthetics/Orthotics Systems for Children: Present United States Status," Inter-Clinic Information Bulletin, August 1973, John Lyman.
- "Fabrication Procedures for the Open-Shoulder Above-Elbow Socket," Artificial Limbs, Autumn 1969, C.A. McLaurin, et. al.
- "The Northwestern University Supracondylar Suspension Technique for Below-Elbow Amputations, "Orthotics and Prosthetics, December 1972, J. N. Billock.
- Report on Ninth Workshop Panel on Upper-Limb Prosthetics, Committee on Prosthetics Research and Development, National Academy of Sciences, held on October 25-27, 1971.
- Report of Seventh Workshop Panel on Upper-Limb Prosthetics-Externally Powered Terminal Devices, Committee on Prosthetics Research and Development, National Academy of Sciences, held on July 30-31, 1969.
- Report of Sixth Workshop Panel on Upper-Extremity Prosthetic Components-Externally Powered Elbows, Committee on Prosthetics Research and Development, National Academy of Sciences, held on October 21-23, 1968.
- "Myoelectric Immediate Postsurgical Procedure: A Concept for Fitting the Upper-Extremity Amputee." Artificial Limbs. Autumn 1969. D.S. Childress, et. al.
- "A Myoelectrically Controlled Powered Elbow," Artificial Limbs. Autumn 1969, Herbert M. Hartman. et. al.
- "Hybrid System: Electric Elbow-Body Powered Hook," Report of Eighth Workshop Panel on Upper-Extremity Prosthetics-Control of Externally Powered Devices, Committee on Prosthetics Research and Development, National Academy of Sciences, held on March 31-April 2,1970.
- "A Sensory Feedback System for an Upper Limb Amputation Prosthesis," Bulletin of Prosthetics Research, Fall 1974, Frank W. Clippinger, et. al.
- Cosmesis and Modular Limb Prostheses, Committee on Prosthetics Research, National Academy of Sciences, Report of Workshop held on March 3-7, 1971.
- Child Amputees: Disability Outcomes and Antecedents, University of Michigan, Department of Health Development, Circa 1970, Ned Sharpies.
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