A United States soldier demonstrates table football with two transradial prosthetic limbs.

An artificial limb is a type of prosthesis that replaces a missing extremity, such as arms and 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. A congenital defect can create the need for an artificial limb when a person is born with a missing or damaged limb. Industrial, vehicular, and war related accidents are the leading cause of amputations in developing areas, such as large portions of Africa. In more developed areas, such as North America and Europe, disease is the leading cause of amputations.^[1] Cancer, infection and circulatory disease are the leading diseases that may lead to amputation.^[2] Download high resolution version (2400x1800, 671 KB)A soldier plays Foosball with two prosthetic limbs. ... Download high resolution version (2400x1800, 671 KB)A soldier plays Foosball with two prosthetic limbs. ... Table football (Bonzini style table). ... A United States soldier playing Foosball. ... A United States Army soldier plays table football with two prosthetic arms Jon Comer, professional skateboarder with a prosthetic leg. ... Look up Limb in Wiktionary, the free dictionary. ... Partial hand amputation Amputation is the removal of a body extremity by trauma or surgery. ... A congenital disorder is any medical condition that is present at birth, as contrasted with an acquired disorder. ... A world map showing the continent of Africa Africa is the worlds second-largest and second most-populous continent, after Asia. ... North America North America is a continent[1] in the Earths northern hemisphere and (chiefly) western hemisphere. ... For other uses, see Europe (disambiguation). ... Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). ...

History

The iron prosthetic hand worn by Götz von Berlichingen from 1508 (1861 etching).

Wooden leg of Gen. Józef Sowiński; from early 19th century

An artificial limb is mythologically referred to in the Rigveda, the "iron leg" given to Vishpala by the Ashvins. The first specimen discovered archaeologically, known as the Roman Capua Leg, was found in a tomb in Capua, Italy, dating to 300 BC, and was made of copper and wood.^[3] Two artificial toes found on Egyptian mummies are even older, dating to 1295–664 BC; these are being tested (as of July 2007) to determine whether they could have been used in life.^[3] 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. Image File history File links No higher resolution available. ... Image File history File links No higher resolution available. ... An 18th Century engraving of Götz von Berlichingen. ... Image File history File links MWP_Sowinski. ... Image File history File links MWP_Sowinski. ... Józef SowiÅ„ski Józef SowiÅ„ski (1777–1831) was a Polish artillery general and one of the heroes of Polands November 1830 Uprising. ... Rig veda is the oldest text in the world. ... Vishpala () is a woman mentioned in the Rigveda (RV 1. ... The Ashvins ( possessor of horses, horse tamer, cavalier, dual ) are divine twin horsemen in the Rigveda, sons of Saranya, a goddess of the clouds and wife of either Surya in his form as Vivasvat. ... The Roman Capua Leg is an artificial leg, found in a grave in Capua, Italy. ... Centuries: 4th century BC - 3rd century BC - 2nd century BC Decades: 350s BC 340s BC 330s BC 320s BC 310s BC - 300s BC - 290s BC 280s BC 270s BC 260s BC 250s BC Years: 305 BC 304 BC 303 BC 302 BC 301 BC - 300 BC - 299 BC 298 BC... An armorer or armourer (see spelling differences) was in former times a smith who specialized in manufacturing and repairing arms and armour. ... (15th century - 16th century - 17th century - more centuries) As a means of recording the passage of time, the 16th century was that century which lasted from 1501 to 1600. ...

In the 19th century, artificial limbs became more widespread due to the large number of amputees from wars such as the Napoleonic Wars in Europe and the American Civil War in the U.S. 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. Combatants Austria[a] Portugal Prussia[a] Russia[b] Sicily[c] Sardinia  Spain[d]  Sweden[e] United Kingdom French Empire Holland[f] Italy Etruria[g] Naples[h] Duchy of Warsaw[i] Confederation of the Rhine[j] Bavaria Saxony Westphalia Württemberg Denmark-Norway[k] Commanders Archduke Charles Prince Schwarzenberg Karl Mack... Combatants United States of America (Union) Confederate States of America (Confederacy) Commanders Abraham Lincoln, Ulysses S. Grant Jefferson Davis, Robert E. Lee Strength 2,200,000 1,064,000 Casualties 110,000 killed in action, 360,000 total dead, 275,200 wounded 93,000 killed in action, 258,000 total... Anesthesia (AE), also anaesthesia (BE), is the process of blocking the perception of pain and other sensations. ... Combatants Allied powers: China France Great Britain Soviet Union United States and others Axis powers: Germany Italy Japan and others Commanders Chiang Kai-shek Charles de Gaulle Winston Churchill Joseph Stalin Franklin Roosevelt Adolf Hitler Benito Mussolini Hideki Tōjō Casualties Military dead: 17,000,000 Civilian dead: 33,000... President Harding and the National Academy of Sciences at the White House, Washington, DC, April 1921 The National Academy of Sciences (NAS) is a corporation in the United States whose members serve pro bono as advisers to the nation on science, engineering, and medicine. ... Scientific method is a body of techniques for investigating phenomena, acquiring new knowledge, or correcting and integrating previous knowledge. ...

In recent years, 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, through the combined work of doctors and engineers, 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.^[2][4] Biomechanical is a English Metalband. ... Look up engineer in Wiktionary, the free dictionary. ... For other uses, see Plastic (disambiguation). ... This article is about computer-aided design. ... Integrating computer-aided manufacturing (CAM) with computer-aided design systems produces quicker and more efficient manufacturing processes. ...

Types

A United States Marine with bilateral prosthetic legs leads a formation run.

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. Image File history File links Metadata Size of this preview: 388 × 599 pixelsFull resolution (982 × 1516 pixel, file size: 970 KB, MIME type: image/jpeg) From left: Gunnery Sgt. ... Image File history File links Metadata Size of this preview: 388 × 599 pixelsFull resolution (982 × 1516 pixel, file size: 970 KB, MIME type: image/jpeg) From left: Gunnery Sgt. ... The United States Marine Corps (USMC) is a branch of the United States military responsible for providing power projection from the sea,[1] utilizing the mobility of the U.S. Navy to rapidly deliver combined-arms task forces. ... A transtibial amputation (sometimes one sees transtibal amputation) is an amputation above the foot but below the knee. ... Please wikify (format) this article or section as suggested in the Guide to layout and the Manual of Style. ... A United States soldier playing Foosball. ... A Transhumeral prosthesis is degin for above elbow amputee it is available in electronic,mechanical and etc. ...

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. A transtibial amputation (sometimes one sees transtibal amputation) is an amputation above the foot but below the knee. ...

Transfemoral Prostheses

A transfemoral prosthesis is an 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.^[5] This is due to the complexities in movement associated with the knee. Please wikify (format) this article or section as suggested in the Guide to layout and the Manual of Style. ...

Transradial Prostheses

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. A United States soldier playing Foosball. ... For other uses, see Electrode (disambiguation). ... Look up ARM in Wiktionary, the free dictionary. ...

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. A Transhumeral prosthesis is degin for above elbow amputee it is available in electronic,mechanical and etc. ...

Current Technology/Manufacturing

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. This is especially important for transfemoral amputees. Additional materials have allowed artificial limbs to look much more realistic, which is important to transradial and transhumeral amputees because they are more likely to have the artificial limb exposed.^[4] Carbon fiber composite is a strong, light and very expensive material. ...

In addition to new materials, the use of electronics has become very common in artificial limbs. Myoelectric limbs, which control the limbs by converting muscle movements to electrical signals, have become much more common than cable operated limbs. Myoelectric limbs allow the amputees to more directly control the artificial limb. Computers are also used extensively in the manufacturing of limbs. Computer Aided Design and Computer Aided Manufacturing are often used to assist in the design and manufacture of artificial limbs.^[4] CAD/CAM is an abbrieviation of computer-aided design and computer-aided manufacturing. ...

Most modern artificial limbs are attached to the stump of the amputee by belts and cuffs or by suction. The stump usually fits into a socket on the prosthetic. The socket is custom made to create a better fit between the leg and the artificial limb, which helps reduce wear on the stump. The custom socket is created by taking a plaster cast of the stump and then making a mold from the plaster cast. Newer methods include laser guided measuring which can be input directly to a computer allowing for a more sophisticated design. Suction is the creation of a partial vacuum, or region of low pressure. ...

One of the biggest problems with the stump and socket attachment is that there is a large amount of rubbing between the stump and socket. This can be painful and can cause breakdown of tissue.^[5]

Artificial limbs are typically manufactured using the following steps:^[4]

1. Measurement of the stump
2. Measurement of the body to determine the size required for the artificial limb
3. Creation of a model of the stump
4. Formation of thermoplastic sheet around the model of the stump – This is then used to test the fit of the prosthetic
5. Formation of permanent socket
6. Formation of plastic parts of the artificial limb – Different methods are used, including vacuum forming and injection molding
7. Creation of metal parts of the artificial limb using die casting
8. Assembly of entire limb

For other uses, see Plastic (disambiguation). ... Vacuum forming is a simplified version of thermoforming, whereby a sheet of plastic is heated to a forming temperature, stretched onto or into a single-surface mold, and held against the mold by applying vacuum between the mold surface and the sheet. ... Injection molding is a manufacturing technique for making parts from thermoplastic material in production. ... This article is about the manufacturing process. ...

Emerging Technology

There are several areas of technology that have advanced significantly in recent years and are showing considerable potential. Robotic limbs and direct bone attachment are two new technologies that have made tremendous gains recently.

Robotic Limbs

Advancements in the processors used in myoelectric arms has allowed for artificial limbs to make gains in fine tuned control of the prosthetic. The Boston Digital Arm is a recent artificial limb that has taken advantage of these more advanced processors. The arm allows movement in five axes and allows the arm to be programmed for a more customized feel.^[6]

Targeted muscle reinnervation (TMR) is a technique in which motor nerves which previously controlled muscles on an amputated limb are surgically rerouted such that they reinnervate a small region of a large, intact muscle, such as the pectoralis major. As a result, when a patient thinks about moving the thumb of his missing hand, a small area of muscle on his chest will contract instead. By placing sensors over the reinervated muscle, these contractions can be made to control movement of an appropriate part of the robotic prosthesis.^[7] Motor nerves allow the brain to stimulate muscle contraction. ... For other uses of Muscles, see Muscles (disambiguation). ... “Surgeon” redirects here. ... Location The clavicular head of the pectoralis major takes its origin from the anterior surface of the medial half of the clavicle. ...

An emerging variant of this technique is called targeted sensory reinnervation (TSR). This procedure is similar to TMR, except that sensory nerves are surgically rerouted to skin on the chest, rather than motor nerves rerouted to muscle. The patient then feels any sensory stimulus on that area of the chest, such as pressure or temperature, as if it were occurring on the area of the amputated limb which the nerve originally innervated. In the future, artificial limbs could be built with sensors on fingertips or other important areas. When a stimulus, such as pressure or temperature, activated these sensors, an electrical signal would be sent to an actuator, which would produce a similar stimulus on the "rewired" area of chest skin. The user would then feel that stimulus as if it were occurring on an appropriate part of the artificial limb.^[7] The mechanism of the reflex arc Sensory neurons (or neurones) are nerve cells within the nervous system responsible for converting external stimuli from the organisms environment into internal electrical impulses. ... For other uses, see Skin (disambiguation). ...

Recently, robotic limbs have improved in their ability to take signals from the human brain and translate those signals into motion in the artificial limb. DARPA, the Pentagon’s research division, is working to make even more advancements in this area. Their desire is to create an artificial limb that ties directly into the nervous system.^[8] The human brain controls the central nervous system (CNS), by way of the cranial nerves and spinal cord, the peripheral nervous system (PNS) and regulates virtually all human activity. ... The Defense Advanced Research Projects Agency (DARPA) is an agency of the United States Department of Defense responsible for the development of new technology for use by the military. ... The Human Nervous System. ...

Direct Bone Attachment

Direct bone attachment is a new method of attaching the artificial limb to the body. The stump and socket method can cause significant pain in the amputee which is why the direct bone attachment has been explored extensively. The method works by inserting a titanium bolt into the bone at the end of the stump. After several months the bone attaches itself to the titanium bolt and an abutment is attached to the titanium bolt. The abutment extends out of the stump and the artificial limb is then attached to the abutment. Some of the benefits of this method include: This article or section does not cite its references or sources. ...

• 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.

The main disadvantage of this method is that amputees with the direct bone attachment cannot have large impacts on the limb, such as those experienced during jogging, because of the potential for the bone to break.^[5]

Cost

Transradial and transtibial prostheses typically cost between US $6,000 and $8,000. Transfemoral and transhumeral prosthetics cost approximately twice as 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.^[9] Wear and tear is a term for damage that naturally and inevitably occurs due to normal use or aging. ...

Jaipur Foot, an artificial limb from Jaipur, India, costs about US$ 40. The Jaipur leg is a rubber-based prosthetic leg produced by Dr. P. K . ... , Jaipur   (Hindi: जयपुर, Rajasthan Capital), also popularly known as the Pink City, historically sometimes rendered as Jeypore, is the capital of Rajasthan state, India. ...

There is currently an open Prosthetics design forum known as the "Open Prosthetics Project". The group employs collaborators and volunteers to advance Prosthetics technology while attempting to lower the costs of these necessary devices. Visit their site at http://OpenProsthetics.org.

A plan for a low-cost artificial leg, designed by Sébastien Dubois, featured at the 2007 Indernational Design Exhibition award show in Copenhagen, Denmark. It plans to be able to create an energy-return prosthetic leg for US 8 dollars, composed primarily of fiberglass.^[10] Bundle of fiberglass Fiberglass (also called fibreglass and glass fibre) is material made from extremely fine fibers of glass. ...

Footnotes

1. ^ "Science, Medicine, and the Future: Artificial Limbs", BMJ, 29 September 2001. Retrieved 11 February 2007.
2. ^ ^{a b} "History of Prostheses", University of Iowa, 5 June 2006. Retrieved 11 February 2007.
3. ^ ^{a b} "Cairo toe earliest fake body bit", BBC News, 27 July 2007. Retrieved 27 July 2007.
4. ^ ^{a b c d} "Artificial Limb", How Products are Made, 2007. Retrieved 11 February 2007.
5. ^ ^{a b c} "Getting an Artificial Leg Up", Australian Broadcasting Corporation, 2000. Retrieved 11 February 2007.
6. ^ Recently the i-Limb hand, invented in Edinburgh, Scotland, by David Gow has become the first commercially available hand prosthesis with five individually powered digits. The hand also possesses a manually rotatable thumb which is operated passively by the user and allows the hand to grip in precision, power and key grip modes. "Advanced Signal Processing Dramatically Improves Capability of Artificial Limbs", SIGMO Technology, 2005. Retrieved 11 February 2007.
7. ^ ^{a b} Kuiken TA, Miller LA, Lipschutz RD, Lock BA, Stubblefield K, Marasco PD, Zhou P, Dumanian GA (Feb 2007). "Targeted reinnervation for enhanced prosthetic arm function in a woman with a proximal amputation: a case study". Lancet 369 (9559): 371-80. PMID 17276777. 
8. ^ "Replacement Arm, Good as New", DefenseTech.org, 11 April 2005. Retrieved 11 February 2007.
9. ^ "Cost of Prosthetics Stirs Debate", The Boston Globe, 5 July 2005. Retrieved 11 February 2007.
10. ^ http://www.indexaward.dk/2007/default.asp?id=706&show=nomination&nominationid=163&playmovie=wmv

The British Medical Journal (BMJ) is a medical journal published weekly in the United Kingdom by the British Medical Association (BMA). ... The University of Iowa, also commonly called Iowa or locally UI, is a major coeducational research university located on a 1,900 acre (8 km²) campus in Iowa City, Iowa, US, on the banks of the Iowa River in East Central Iowa. ... The Australian Broadcasting Corporation or ABC is Australias national non-profit public broadcaster. ... The Boston Globe (and Boston Sunday Globe) is the most widely circulated daily newspaper in Boston, Massachusetts and New England. ...

External links

• http://www.direct.gov.uk/disability Directgov disabled people - UK govt information
• Amputee Coalition of America
• National Academy of Sciences
• OandPCare.org has an extensive glossary of terms relating to artificial limbs, prostheses and the field of prosthetics
• Prosthetic Suppliers and Manufacturers
• The Open Prosthetics Project