What are Prosthetics?

Prosthetics are artificial devices that serve to replace a missing body part, which may be lost through trauma, disease, or a condition present at birth. They are made using a range of materials that have progressively become lighter, more hygienic, and more functional.

 

History Timeline of Prosthetics:

 

710 BC
710 BC

Cairo Toe

 

The first prosthetic toe is estimated to have been created between 950-710 BC. These prosthetic toes were made of wood and leather in the burial chambers of an Egyptian tomb (Smithsonian Mag 2017). The Cairo toe was particularly well-preserved and found in 2000. The first prosthetic toe was found in the 1800s. The Greville Chester toe was found in 600 BC. It was also created by the Egyptians with cartonnage: a paper mache material that uses linen, glue, and plaster (CBS News 2011).

 

300 BC
300 BC

Capua leg

In 300 BC, the Capua Leg  is the oldest prosthetic leg known. It is made with bronze and iron with a wooden core by the Romans. The leg was destroyed during the WW2 bombings, but a replica can be found at the Science Museum in London (Wikipedia 2022). 

1508 AD
1508 AD

Iron Hand of Knight

From 476 to 1000 AD, development of prostheses were categorized by peg legs and hand hooks. Knights used prosthesis for shields and fit stirrups (AALOS 2022).

During the Renaissance period (1400s to 1700s), prostheses were made of copper, iron, steel, and wood. In 1508, Gotz Von Berlinchen made the first pair of advanced iron hands called the Iron Hand of Knight. In 1529, Ambroise Parè introduced modern amputation procedures (1529) to the medical community and made prostheses (1536) for upper and lower-extremity amputees. “Ambroise Paré was one of the first military surgeons to encourage primary amputation for the treatment for gunshot wounds; he was also one of the first to choose an amputation site well above the gangrenous area” (Hernigou). Prior, cauterisation, the closing of wound using burned (in this case boiling oil), caused infection and heamorrhage until Paré introduced “the use of ligatures, using a thread-like or wire material to constrict a patient’s blood vessels” (Hernigou).

1966
1966

Stunted Limbs Extension Prosthesis

At the beginning of the 20th century came metal limbs. In 1919, the introduction of a light copper-aluminum alloy made the production of a lighter, less bulky leg possible.

The refashioning of the knee socket for amputees allowed for artificial legs with bending knee joints to be widely distributed to amputees (Science Museum Group). Despite earlier developments of lighter metal prosthetics, most prosthetics after World War 2 in 1945 were still made of wood and leather. The combination was heavy, ugly, and also unhygienic.

For those with stunted limbs, the extension prosthesis created in 1966 attached one piece of aluminum legs using pelvic bands (UPMC 2015).

2005 AD
2005 AD

Ottobock Knee Shin System C-Leg

The Quantum Leap of the 21st century began with the efforts of Ottobock Healthcare. The introduction of the microprocessor controlled knee shin system C-Leg in the US drove production and technological advancement (NIH 2005). This shift manifested in the focus on prioritizing high-performance, lightweight running blades, responsible legs, and motorized hands using sensors and microprocessors. 

More about Ottoblock and AI
2006 & 2009 AD
2006 & 2009 AD

First Bionic Foot and Knee

In 2006, the first bionic foot used artificial intelligence to adjust to different ground surfaces and changes in activity. The first bionic knee was developed in 2009 and was  a motor-powered (TimeToast). The way in which it worked is that the artificial intelligence closely simulates human muscle activity, allowing the wearer to almost seamlessly adjust to differing gradients when climbing stairs

2011 AD
2011 AD

First use of 3D-Printing for Prothesis

The development of 3D printing prosthetics came from a need for cheaper prosthetics with a faster turn around. The World Health Organization says that there is a shortage of 40,000 trained prosthetists in poorer countries (BBC Science 2017). Scientists attempted to use earl 3D printing technology from 1990-1999 to create prosthetics. Though they successfully created organs and dental implants, it was not until 2011 that there was a significant break through. American artist, Ivan Owen can be attributed with creating the first 3D printed prosthetic hand. The project was to help a little boy whose mom made a request to Owen after seeing his steampunk mechanical hand on a video online. A properly manufactured prosthetic can last from 3-5 years at a fifth of the cost of a normal prosthetic ($2,000 versus $395), reducing a 3-6 week process to only a single day. 

Owen’s development has led to programs like Enabling the Future, a network with 7,000 members in dozens of countries and access to 2,000 printers for those who need it. After hearing about this project, Jorge Zuniga, a research scientist of biomechanics at the University of Nebraska in Omaha with a son of his own, developed Cyborg Beast. Backed by the University of Nebraska’s biomechanics department, the group developed futuristic-looking low-cost prosthetic hands. There are 500 Cyborg Beasts designs in worldwide use having been downloaded almost 50,000 times. Zuniga even took this project to his native Chile, running a pediatric orthopedic 3D-printing laboratory. He next plans to move to Nigeria (XOMetry 2022).

More about 3D-Printing

What are Prosthetics?

Prosthetics are artificial devices that serve to replace a missing body part, which may be lost through trauma, disease, or a condition present at birth. They are made using a range of materials that have progressively become lighter, more hygienic, and more functional.

BC History

The first prosthetic toe is estimated to have been created between 950-710 BC. These prosthetic toes were made of wood and leather in the burial chambers of an Egyptian tomb (Smithsonian Mag 2017). The Cairo toe was particularly well-preserved and found in 2000. The first prosthetic toe was found in the 1800s. The Greville Chester toe was found in 600 BC. It was also created by the Egyptians with cartonnage: a paper mache material that uses linen, glue, and plaster (CBS News 2011).

Egyptian Toe (Live Science 2017)
Greville Chester Toe (The Lancet 2011)

In 300 BC, the Capua Leg  is the oldest prosthetic leg known. It is made with bronze and iron with a wooden core by the Romans. The leg was destroyed during the WW2 bombings, but a replica can be found at the Science Museum in London (Wikipedia 2022). During the Second Punic War from 218 BC-201 BC, General Marcus Sergius lost his right hand. He was given a prosthesis fashioned from iron to hold his shield (O&P News 2015).

Capua Leg (MDPI 2021)
General Marcus Sergius Prosthetic (Harney 2022)

Middle Ages – Renaissance

From 476 to 1000 AD, development of prostheses were categorized by peg legs and hand hooks. Knights used prosthesis for shields and fit stirrups (AALOS 2022).

During the Renaissance period (1400s to 1700s), prostheses were made of copper, iron, steel, and wood. In 1508, Gotz Von Berlinchen made the first pair of advanced iron hands called the Iron Hand of Knight. In 1529, Ambroise Parè introduced modern amputation procedures (1529) to the medical community and made prostheses (1536) for upper and lower-extremity amputees. “Ambroise Paré was one of the first military surgeons to encourage primary amputation for the treatment for gunshot wounds; he was also one of the first to choose an amputation site well above the gangrenous area” (Hernigou). Prior, cauterisation, the closing of wound using burned (in this case boiling oil), caused infection and heamorrhage until Paré introduced “the use of ligatures, using a thread-like or wire material to constrict a patient’s blood vessels” (Hernigou). In 1629, Pieter Verduyn made the first non-locking below-knee prosthesis. This prosthetic has been the blueprint for current joint and corset devices (Britannica 2022).

Iron Hand of Knight (Atlas Obscura 2015)

US development in the 1800s

In 1800, the Anglesey Leg was made by James Potts. The prosthetic leg was a wooden shank and socket with a steel knee joint and an articulated foot (National Trust Collections).

A new method ankle amputation emerged in 1843. Sir James Syme discovered a new method of ankle amputation that did not involve amputating at the thigh (Wikipedia 2022). This means that only a prosthetic foot is necessary and a jointing knee could be maintained.

Anglesey Leg (Science Museum Group Collection 1920)

Adding to design and aesthetic, Benjamin Palmer received a patent for prosthetic legs with an improved, smooth appearance and concealed tendons for natural-looking movement (Yale Library).

The improvement upon the pre-existing model of a prosthetic leg emerged from the addition of an anterior spring. In 1858, Doctor Douglas Bly’s Anatomical Leg was pronounced to be the “most complete and successful invention ever attained in artificial limbs.” Fundamental, to this patented invention was the ball and socket ankle: made of an ivory ball resting within a rubber socket (Harvard Library 2014). The ankle allowed for mobility in terms of pronation and intonation of the foot, but also served a smoother support system. In 1863, Cosmetic Rubber Hand with fingers that could move and attachments like brushes and hooks – During American Civil War (UPMC 2015).

Dr. Douglas Bly’s Anatomical Leg (Harvard 2014)
Cosmetic Rubber Hand (ASME 2011)

20th century

At the beginning of the 20th century came metal limbs. In 1919, the introduction of a light copper-aluminum alloy made the production of a lighter, less bulky leg possible.

The refashioning of the knee socket for amputees allowed for artificial legs with bending knee joints to be widely distributed to amputees (Science Museum Group). Despite earlier developments of lighter metal prosthetics, most prosthetics after World War 2 in 1945 were still made of wood and leather. The combination was heavy, ugly, and also unhygienic.

For those with stunted limbs, the extension prosthesis created in 1966 attached one piece of aluminum legs using pelvic bands (UPMC 2015).

From the 1970s through the 1990s, new developments in materials came in the form of plastics, polycarbonates, resins, and laminates. These carbon fiber materials were light, easy to clean, and individualized: making them comfortable and hygienic.

Extenuating circumstances forced additional production of newer plastic limbs. In 1979, children in  Cambodia were stepping on old landmines left over from war (NY Times 1997). The results was widespread use of small, lightweight plastic limbs in the country for the first time.

Extension Prosthesis (Science Museum Collective Group 1964)

Quantum Leap/21st century

The Quantum Leap of the 21st century began with the efforts of Ottobock Healthcare. The introduction of the microprocessor controlled knee shin system C-Leg in the US drove production and technological advancement (NIH 2005). This shift manifested in the focus on prioritizing high-performance, lightweight running blades, responsible legs, and motorized hands using sensors and microprocessors. A way in which this can be seen is in 2006, the first bionic foot used artificial intelligence to adjust to different ground surfaces and changes in activity. The first bionic knee was developed in 2009 and was  a motor-powered (TimeToast). The way in which it worked is that the artificial intelligence closely simulates human muscle activity, allowing the wearer to almost seamlessly adjust to differing gradients when climbing stairs

Most recent Ottobock C-Leg model (Ottobock 2022)

More recent developments came in 2018 from the collaboration between John Hopkins University and the Icelandic company Ossur. Their modular prosthesis limb promises to deliver “humanlike” strength, thought-controlled dexterity and sensation. The project is currently in preclinical trials on mind-controlled leg and foot prostheses (JHU APL 2022).

John Hopkins Modular Prosthesis Limb (JHU Applied Physics Laboratory)

Artificial Intelligence

In 1993, Chas A. Blatchford & Sons, Ltd. developed the first intelligent prosthesis. They later improved on that version in 1995 and named it the Intelligent Prosthesis Plus using hydraulic, pneumatics and a microprocessor. In 1997, Ottobock developed the C-leg, a fully microprocessor control knee. From 2005 to 2006, Ossur released the Rheo knee and power knee that used onboarding AI mechanisms. Continuing, in 2011, Ossur developed the first bionic leg called the symbiotic leg. During the same time period, Ottobock released the Genius X3 that allowed for backward walking and a smoother motion when walking. In 2015, the Blatchford group introduced the Line, the first fully integrated limp with seven sensor and four CPU. This allowed for coordination of the entire leg between the knee and ankle joint. This was only possible from the sensors and user data on movement.

Ottobock Genius X3 Recent Model (Ottobock)

In 2011, Dr. Hugh Herr developed the walk BiOM, the world’s first bionic foot with calf system using robotic mechanism to imitate the muscle and tendon action. Currently, the most commonly available microprocessing prosthetics are Meridium (OttoBock, Germany), Elan (Blatchford, UK), Pro-prio (Össur, Iceland), Triton Smart Ankle (hereinafter referred as TSA) (Otto Bock, Germany), and Raize (Fil-lauer, USA) etc. (Nayak and Des 2020). 

Walk BiOM (MCOPRO)

In 2007, the first commercially available bionic hand was produced by Touch bionics. The hand had individually powered fingers and a rotating thumb. Developed by Ottobock in 2010, the Michelangelo hand was a fully articulated robotic hand electronically started. In 2017, Bebionic, manufactured by RSL steeper and the World Congress, was released. It allowed for 14 different hand positions and two thumb positions. From here, begins the sift to brain computer interface (BCI) that allows for neuroprosthesis (aka. Mind-control). This would allow a prosthesis to attain immediate brain data and function accordingly. The EEG based mind controlled smart prosthetic arm was presented in 2016 IEEE conference but till now this concept is not commercialized. (Nayak and Des 2020).

Michelangelo Hand (Ottobock 2022)

In 2019, The Imperial College London and the University of Göttingen teamed up to create a “next generation” bionic hand. Published in Science Robotics, the team’s findings show that machine learning (AI) is the key to fluid motion. Normally controlled through motors stimulated by stimuluses, the new bionic hand uses a human-machine interface which sends a signal to the prosthetic. The hand uses eight electrodes to pick up electric signals from the stump of the amputee. This then send signals to a miniature computer and then to the prosthetic. This programs instructions that accurately do what the person wants. There is also an initial training phase in which the patient can train the machine learning algorithm to understand their own signals (Forbes 2018).

BeBionic Hand (Ottobock 2022)

Though not available to the market yet, the future is bright. Continued pursuits are being made to implement wireless technology, add range of motion, have greater control of individual fingers, etc. Although not available commercially, the group looks to soon take that leap in 2022 (AIM 2019).

3D Printing

The development of 3D printing prosthetics came from a need for cheaper prosthetics with a faster turn around. The World Health Organization says that there is a shortage of 40,000 trained prosthetists in poorer countries (BBC Science 2017). Scientists attempted to use earl 3D printing technology from 1990-1999 to create prosthetics. Though they successfully created organs and dental implants, it was not until 2011 that there was a significant break through. American artist, Ivan Owen can be attributed with creating the first 3D printed prosthetic hand. The project was to help a little boy whose mom made a request to Owen after seeing his steampunk mechanical hand on a video online. A properly manufactured prosthetic can last from 3-5 years at a fifth of the cost of a normal prosthetic ($2,000 versus $395), reducing a 3-6 week process to only a single day. 

Owen’s development has led to programs like Enabling the Future, a network with 7,000 members in dozens of countries and access to 2,000 printers for those who need it. After hearing about this project, Jorge Zuniga, a research scientist of biomechanics at the University of Nebraska in Omaha with a son of his own, developed Cyborg Beast. Backed by the University of Nebraska’s biomechanics department, the group developed futuristic-looking low-cost prosthetic hands. There are 500 Cyborg Beasts designs in worldwide use having been downloaded almost 50,000 times. Zuniga even took this project to his native Chile, running a pediatric orthopedic 3D-printing laboratory. He next plans to move to Nigeria (XOMetry 2022).

(Enabling the Future 2022)

Manufacturers

Timeline

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