Physical Medicine and Rehabilitation Clinics of North America
Advances in Lower-limb Prosthetic Technology
Section snippets
History
Prostheses were developed out of necessity to replace the function of lost limbs, and to return individuals to a productive state within the social structure. There is evidence for the use of prostheses from as early as the fifteenth century BC. One of the earliest examples of prosthetic usage was found in the eighteenth dynasty of ancient Egypt in the reign of Amenhotep II. A mummy on display in the Cairo Museum had his right great toe amputated and replaced with a prosthesis manufactured from
Amputation Surgery
Amputation surgery was once revered as a surgery for only the highly skilled surgeon; before the Civil War, only 500 of the 11,000 northern physicians and 27 of the 3000 southern physicians had performed surgery. The mortality rate from a primary amputation was 28%; if a second amputation was performed, it rose to 58%, and if an infection such as pyemia occurred, the mortality rate was more than 90%.1 During WWI, the concept of debridement with antiseptic technique and delayed primary closure
Suspension sleeves and liners
Some of the most significant developments in recent years have occurred with the interface systems between the residual limb and the socket. The 2 most common interface systems are suspension sleeves and liners. The primary function of the suspension sleeve is to hold the socket in place or suspend the socket, whereas the liner is designed to provide padding or cushioning for the residuum. The properties of suspension sleeves and liners may be combined to create suspension liners, an interface
Socket
The prosthetic socket is generally considered the most important component of a prosthesis. As a human-prosthesis interface, the socket should be designed properly to achieve satisfactory load transmission, stability, and efficient control for mobility.26 The functionality of a socket extends beyond simply accommodating the load or forces of the anatomy of the residuum in a comfortable manner. For example, when an able-bodied person takes a step, signals from the central nervous system (CNS)
The Microprocessor Knee
The development of microprocessor technology in prosthetics dates back to the late 1940s when Professor John Lyman at University of California Los Angeles introduced the first microprocessor prosthesis with integrated circuits for upper limb prosthetics. Upper limb amputees have commonly used myoelectric prosthetics, but not until the 1990s was microprocessor technology successfully transferred to lower-limb amputees. Microprocessor controls used in prosthetic knees use sensors to continuously
Foot and ankle systems
In the summer of 1945, Howard Eberhart, a military engineer, was setting up a research project on the landing gear of B-29s when his left leg was crushed beneath one of the testing trucks. The Naval Surgeon, Dr Verne Inman, who performed his amputation suggested that, as part of Eberhart's occupational therapy, he join another engineer, Eugene Murphy, to help design a new prosthetic foot.41, 42 Together with a team of notable researchers, they made many contributions to the science of
Sport prosthetic components
There are few sport specific prosthetic feet, as most sports do not require a specialized prosthesis. A well-fitting everyday prosthesis that either offers the dynamic response or the required mobility will allow participation in most sports with few limitations. The source and degree of mobility available in prosthetic feet have changed greatly through the years. The motion no longer comes from only the ankle, the “split toe” found in some foot plates permits frontal motions, yet do not absorb
Outcomes
There is a dilemma with advanced prosthetic technology when trying to determine what the best prosthetic components are for each individual amputee. Common indictors such as materials, time of fabrication, complexity of design, and cost do not dictate the “best” components for each individual. Matching functional ability with the proper prosthetic components is the solution for optimizing physical performance. Most clinicians would suggest that coupling the correct prosthetic components for the
Future directions
Research is being conducted across multiple disciplines to improve functionality of residual limb and lower-limb prosthetics. The CRRM is actively conducting research in several areas to improve the human-prosthesis interface. Options are being explored for augmentation of limb-lengthening techniques by using physical agents, such as electromagnetic fields (EMFs), to reduce distal bone loss to decrease the risk of fracture, and ultrasound to speed callus formation and decrease rehabilitation
Summary
The boundaries once faced by individuals with amputations are quickly being overcome through biotechnology. Although there are currently no prosthetics capable of replicating anatomic function, there have been radical advancements in prosthetic technology, medical science, and rehabilitation in the past 30 years, vastly improving functional mobility and quality of life for individuals with lower-limb amputations. What once seemed impossible is rapidly becoming reality. The future seems
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