Prosthetic Limbs Limitations

Medical Prosthetics
The Benefits and Limitations of Prosthetic limbs.
By Elisha Turner
Introduction
“Prosthetic” is a term that refers to devices designed to re-place a missing part of the body. (Stefania Sansoni, 2014)
Prosthetic limbs are an invention which have both come from the mind of people in the medical profession treating amputees but also from amputees themselves who recognise the need for technical advances and use of new materials as well as specialisation of design (Norton, 2007; Park, 2015).
Prosthetics has become a regular necessity because people need them for different reasons such as illness, mobility purposes and disfigurement.
The main topic of this essay will be about the in-depth research into medical prosthetics

that has been carried out, not only reflecting back on the past but how it has and will evolve in the future.
Through investigating the social and historical impacts of medical prosthetics including public perceptions it is clear that prosthetics has been around for thousands of years but has recently seen increasing demand since the rise of injuries within the military combined with birth defects.

Review Literature
History
Over the years many prosthetic devices have been created and tested out.

Some are successful, whereas “some fail miserably…some are just miserable!” (Enabling the Future, 2014). The success of prosthetics is often due to quality of life, self-confidence, ability to have the use of a high functioning devices and regaining motion. However, prosthetics don’t work when the prosthetic does not look realistic, lack of mobility, poor fitting and a financial implication.

Prosthetics were first created by the Egyptians and date back to 950-710 BC. (Kim M. Norton, (2007) These were originally made from wood and leather and then moved onto more solid products such as whale bone. A man called Corporal Coles was gifted a prosthetic hand made from whale bone when he lost both of his hands whilst priming a cannon (Enabling the Future, 2014). The oldest artificial leg that was discovered and excavated, dates back to 300bc but was later destroyed during air raids that took place in World War 2. It was made of bronze and iron, with a wooden core, apparently for a below-knee

amputee.
During Victorian times, prosthetics were made out of steel and brass and were used for people who lost limbs during the war. These artificial hands could be moved at the elbow, wrists and fingers. They were often covered by clothes so that they didn’t scare anyone who saw them.( Enabling the Future, 2014 )
As prosthetics developed the type of materials used changed to try and modernise the look of prosthetics.

In the 1950’s and 60’s a drug called Thalidomide was given to pregnant women to ease morning sickness and aid sleep. It was believed that this drug caused a lot of babies to be born with severe birth defects including one of the case studies considered later in this essay. Following considerable numbers of birth defects from Thalidomide, CO2 powered prosthetic limbs were made with the idea that CO2 canisters would enable the prosthetics to make gas powered fine movements. (Enabling the Future, 2014) (Fig.2)

This prosthetic toe was made from wood and leather and was discovered in an Egyptian tomb of a female mummy. Dating back to this time, prosthetics would have been almost unheard of and would have only be made for the wealthy if needed. It was known as the ‘Cairo Toe’ consisted of two wooden pieces which were lashed together by leather thread through holes bored into the wood; the toe also had a leather strap which secured the toe to the foot through more leather threads. (IP

Watchdog,2016)

This prosthetic was made from CO2 gas limbs. These devices used a system of gas canisters that worked with various movements of the body to operate them. They were created out of a need to try to help children born due to birth defects from a drug called Thalidomide.

This Prosthetic is what is known as the “Capula Leg” it was discovered within Italy and dates back to 300 BC.

This Prosthetic arm was modified and created between 1840 and 1940 and made from steel and brass. It can be articulated by the elbow, wrist and fingers. Most amputations within this time was as a result of war.

This Prosthetic is what is known as the hammer arm it has been designed for working within a factory and has a various other range of tools that can be changed to suit each job.

The following prosthetic legs were believed to
have been create by a bootmaker dating back between the times of 1839-1924.

This prosthetic is the acoustic headband that had fixtures of ear trumpets attached. It is known to have been created between 1901 and 1930.

Over the years that had been a drastic change in the way that prosthetics are made and measured. The materials used are now a lot lighter and more comfortable, and the movement of the limbs are almost life like.
From reviewing all of the prosthetics and how they have developed throughout history, the technological advances have dramatically changed the capabilities of prosthetics.( (IMP,BBC 2011). From viewing a documentary it is known that the prosthetics are becoming so technological that they can mimic how the real muscles and cartilages work within a human limb. (IMP,BBC, 2011)

“It is amazing what we are able to do now with 3D printing. All of these devices can now not only be thought of, prototyped, printed and tested in a matter of days (and sometimes hours!) – but they can be shared around the World with a simple click of a button.”
“Someone with a need for new fingers after an industrial accident – can now simply go online in a matter of minutes and find a group of people that can design, 3d print and mail him a new hand in no time at all.”
“The future is here.
And it is amazing.” (Enabling the future ,2014)

The Process of Availability has expanded over time due to the rise and demand of prosthetics from people and military usage from amputation. (IMP,BBC 2011)

Theory
As a result of medical prosthetics there are a number of physical and physiological issues that can occur. For example,
“An approximate number of 1.6 million persons was recorded as living with a limb loss in the United States in the year 2005. Forty percent of these individuals underwent a major amputation of the lower limb (excluding the toes). It is projected that the number of amputees will more than double by the year 2050. Some of the factors or complications that lead to amputation include cancer, trauma, and congenital limb deficiency; however, the most common factor is peripheral vascular disease (PVD) complications, generally found in the elderly population. After a limb loss, the amputees face major adjustments in their emotional, social, and physical lives”. (Stephan R. Manucharian, 2013)
According to Nicholas et al (1993) the investigators have compared the loss of a limb with the loss of a spouse and studied the progression of psychological responses, patients' feelings after an amputation, depression among amputees, psychiatric symptoms, social and psychological adjustment following amputation, psychosocial factors affecting rehabilitation outcome, the effects of age and time, the effects of activities of daily living (ADL) changes, the effects of depression on phantom pain and reasons for psychiatric consultation following amputation (3-11). (Nicholas et al,1993).

There are many different physical aspects to wearing/not wearing medical prosthetics for some the impact can be life changing

Social Aspect
Within the general society there are a relative amount of social implications with someone who may have a prosthetic limb because to some degree they feel they are treated differently as opposed to a fully limbed person. For example there are certain jobs that limb differenced people cannot participate in due things like needing full control or stability within certain work areas. (Nicholas et al,1993).
This can add a hit on effect to their self-esteem or confidence/anxiety pressures resulting in feeling inadequate or not equal.

Psychological aspect
With regarding physical changes to one’s self after prosthetics there is also a psychological aspect that has to be considered as this can also be impacted when limb differences occur from non-congenital limb difficulties.
Counselling with regard to development of realistic rehabilitation expectations and methods of coping with personal concerns or social difficulties, should form an integral part of this preparation. While some researchers have reported significantlevels of clinical depression, anxiety, grief and social isolation.. (D. DESMOND and M. MacLACHLAN, 2002)
“No-one comes out unscathed by an amputation and a pros-thesis may act as a security, a guarantee or a mechanism for requiring the integrity of one's physical appearance, which validates one's psychological integrity.” (Pillet & Didierjean-Pillet, 2001).

Perceptions of disability
A subject that has been a matter in present and past time is the perception of Disability, how over the years people with disabilities or differences have become more accepted within the public eye has had a dramatic rise since the launch of the Paralympics. I feel Paralympics has brought a positive view to prosthetics and their perceptions in this country because of the influential role models that have been brought forward as the Paralympic games was televised. “Three-quarters of Britons feel more positive about the role of people with disabilities in the UK following the Paralympics” (BBC, 2012)

Methodology
For Part of my Primary research 3 Case studies have been included. These have asked a number of questions about the implications of prosthetics and the difference between some non-users and users of prosthesis. I carried out this research by creating a closed questionnaire through email, the case studies I used were people I had within my contact database who may or may not use prosthetics. From including this research within an email format the advantages are that the individual answers can be clearly identified and a comparison between each case studies can also be included. But unfortunately the disadvantages are that the questions cannot be broadened out or taken further for increase of knowledge and understanding.
Although the Results from case studies are not generalizable but give an in depth in sight into individual experiences. Therefore, it is expected that responses will help understand how prosthetic users and non-users really feel coping with everyday life and the impact it has on them as individuals past and present.

Results
Case Studies
3 case were carried out the following highlights the nature of each disability and whether the participants questioned were born with their limb loss or it is a result of a medical condition or physical injury. Each case study summarises the answers given by participants from the questionnaire (appendix 1) and aims to provide an accurate description of how each participant responds to the use of prosthetics and their personal views around the social and physical benefits and impacts of using prosthetic limbs.
Case Study A (see full response in appendix 2)
Case Study A, Born with upper limb disfigurement and has used a prosthetic arm in the past made out of silicon.
Case Study A describes his prosthetic arm as very realistic saying, "no body would be able to tell unless they knew me"...
Probably made from "silicon" and "moulded" around the disfigured limb
However despite being very realsitic, the prosthetic was not always comfortable... Case Study A refers to how medical professionals helped improve comfort "if I found it sore they'd find ways to work around the problem to make it comfortable" and later goes on to say "not wearing it...made it a lot easier and comfortable"
Case Study A used to wear their prosthetic all the time but in recent years has decided not to wear the prosthetic at all because now