The Evolution of Prosthetic Devices: A Patent History

A prosthesis (also called a prosthetic limb, artificial limb, or limb "replacement"—

though natural limbs are irreplaceable) is an artificially made substitute for a limb
lost through a congenital defect (present at birth), accident, illness, or wartime
injury. A type of prosthesis called a cosmesis is designed to be purely cosmetic and
has little or no function; artificial hands often fall into this category.

Artificial limb

An artificial limb is a type of prosthesis that replaces a missing extremity, such as

arms or legs. The type of artificial limb used is determined largely by the extent of
an amputation or loss and location of the missing extremity. Artificial limbs may
be needed for a variety of reasons, including disease, accidents, and congenital
defects. Inside the body, artificial heart valves are in common use with artificial
hearts and lungs seeing less common use but under active technology
development. Other medical devices and aids that can be considered prosthetics
include artificial eyes, palatal obturator, gastric bands, and dentures.

In recent years there have been significant advancements in artificial limbs. New
plastics and other materials, such as carbon fiber, have allowed artificial limbs to
be stronger and lighter, limiting the amount of extra energy necessary to operate
the limb. With advances in modem technology, cosmesis, the creation of life-like
limbs made from silicone or PVC, has been made possible. Such prosthetics, such
as artificial hands, can now be made to mimic the appearance of real hands,
complete with freckles, veins, hair, fingerprints and even tattoos. Cosmesesare
attached to the body in any number of ways, using an adhesive, suction,
formfitting, stretchable skin, or a skin sleeve.

There are four main types of artificial limbs:

These include the transtibial, transfemoral, transradial, and transhumeral

prostheses. The type of prosthesis depends on what part of the limb is missing.
• Transradial Prosthesis - A transradial prosthesis is an artificial limb that replaces
an arm missing below the elbow. Two main types of prosthetics are available.
Cable operated limbs work by attaching a harness and cable around the opposite
shoulder of the damaged arm. The other form of prosthetics available are
myoelectric arms. These work by sensing, via electrodes, when the muscles in the
upper arm moves, causing an artificial hand to open or close.

• Transhumeral Prosthesis - A transhumeral prosthesis is an artificial limb that

replaces an arm missing above the elbow.

Transhumeral amputees experience some of the same problems as transfemoral

amputees, due to the similar complexities associated with the movement of the
elbow. This makes mimicking the correct motion with an artificial limb very
difficult.

• Transtibial Prosthesis - A transtibial prosthesis is an artificial limb that replaces a

leg missing below the knee. Transtibial amputees are usually able to regain normal
movement more readily than someone with a transfemoral amputation, due in large
part to retaining the knee, which allows for easier movement.

•Transfemoral Prosthesis - A transfemoral prosthesis is an C-leg prosthesis

artificial limb that replaces a leg missing above the knee.

Transfemoral amputees can have a very difficult time regaining normal movement.
In general, a transfemoral amputee must use approximately 80% more energy to
walk than a person with two whole legs. This is due to the complexities in
movement associated with the knee. In newer and more improved designs, after
employing hydraulics, carbon fiber, mechanical linkages, motors, computer
microprocessors, and innovative combinations of these technologies to give more
control to the user.

Microprocessor controlled movement.

The first artificial knee with an “on board” computer to improve the symmetry of
amputees' gait across a wide range of walking speeds was developed by Blatchford
in the early 1990s. Studies have confirmed that these “intelligent prostheses” offer
amputees a more reliable gait pattern during the swing phase of the gait cycle,
permitting them to walk with more confidence and in a more energy efficient
manner.

The Otto Bock C-Leg takes this a stage further, offering not only symmetry in the
swing phase but also markedly improved security in the stance phase—that is, the
knee will not buckle unintentionally during standing .Sensors in the ankle and shin
of the prosthesis continually assess the position of the leg in space as the amputee
is walking. The data are fed into two microprocessors inside the knee, and the
resistance from a hydraulic damper is adjusted up to 50 times a second, optimising
knee stiffness throughout the entire gait cycle. The ability of this knee to
automatically increase knee stability within microseconds makes it much easier
and safer for amputees to traverse uneven ground, to walk on sloped surfaces, and
to walk down stairs.

Myoelectric limbs are externally powered, using a battery and electronic system to
control movement. Each prosthesis is custom made, attaching to the residual limb
using suction technology.

Once the device has been securely attached, it uses electronic sensors to detect
even the smallest traces of muscle, nerve and electrical activity in the remaining
limb. This muscle activity is transmitted to the surface of the skin where it is
amplified and sent to microprocessors, which use the information to control the
movements of the artificial limb.

Based on the mental and physical stimulus provided by the user, the limb moves
and acts much like a natural appendage. By varying the intensity of the movement
of their existing functional muscles the user can control aspects such as strength,
speed and grip in the bionic limb. If muscle signals cannot be used to control the
prosthesis, switches with a rocker, pull-push or touch pad can be used. Improved
dexterity is achieved via the addition of sensors and motorised controls, thus
enabling users to perform tasks such as using a key to open a door or getting cards
out of a wallet.

One of the features of this technology is the ‘autograsp’ function, which

automatically adjusts tension when it detects a change in circumstance (such as
holding a glass that is then filled with water). An added bonus of the myoelectric
limb is that, like traditional body-powered devices, it can be made to replicate the
appearance of a natural limb.

The disadvantages of this technology are that the battery and motor inside it makes
it heavy, it’s expensive, and there’s a slight time delay between the user sending a
command and the computer processing that command and turning it into action.

World's first thought-controlled bionic leg

So how exactly does TMR work with respect to Vawter's condition?

"We take nerves that would have gone down to his ankle and rewire them to his
hamstring," said Dr. Annie Simon, a biomedical engineer on Hargrove's team at
the RIC.

That means that when Vawter, post surgery, thinks of moving his ankle, the
rewired nerves force his hamstring muscle to contract. Over-the-skin electrodes
that are placed within the molded plastic that connects the bionic leg to the residual
limb pick up on that contraction and translate it, through RIC's algorithms, into
precise movement below the knee.

"It learns and performs activities unprecedented for any leg amputee, including
seamless transitions between sitting, walking, ascending and descending stairs and
ramps, and repositioning the leg while seated," Hargrove said.