Glossary
Amputation: the surgical removal of a limb or body part.
Recreational: Activity involving movement done outside of actually being considered working out for example surfing, rollerblading, dancing, etc.
Prosthesis: another word for a prosthetic.
Residual Limb: the "stump" or what is left over of a limb after an amputation surgery has occurred.
Myoelectric: the most expensive and high based technology prosthetic in modern day times.
Electrodes: Also commonly referred to as microprocessors, they receive signals from the muscles attached to the residual limb and help the prosthetic function in the way the patient is hoping.
Orthotics: a branch in medicine that deals with artificial devices such as braces, splints, etc.
CAD/CAM: when computer software helps with the making and manufacturing of prosthetics.
Why do people want/get prosthetics?
People get prosthetics to regain function in that area of their body to make everyday activities easier for them. Thousands of years ago prosthetics were used for simplicity reasons of bringing a feeling of “wholeness” back to a person with a missing limb. Now, people want prosthetics for a high variety of reasons. The main reason people receive a prosthetic is due to an amputation. According to Michael Marriott, a writer from New York Times, amputations happen because they had cancer in that region of their body, got into a bad accident, are born without etc. and about 200,000 people in the U.S. have had to go through the surgery in the past decade. In our modern world people have multiple options for types of prosthetics. According to the article “Challenges and Benefits of Modern Day Prosthetics” expert Robert Virtue stated, everyone has their own set of needs, such as wanting to continue an activity like running, surfing, cooking, dancing, etc. This leaves the option of wanting a prosthetic just to show fullness, or wanting it to perform recreational activities. Orthotic specialists are mainly making above/below the knee, and above/below the elbow prosthetics. With today’s technology options and knowledge only growing in orthotics, this is allowing patients to attain custom fit prosthetics to continue functioning the way they did before that loss. This means they can now be able to walk, cook a meal, pick up a glass, and much more. Most people are fine without a prosthetic and have adapted to life without a limb, but a functioning prosthetic custom made for a patient and their daily activities is something doctors are capable of providing to millions of people today. Something the doctors can’t control however, is the cost for these prosthetics.
What is the price for prosthetics?
When it comes to people purchasing their prosthetics, the government has a system in place to help the first time amputees out; after that it starts depending on what special functions you want the prosthetic to attain. Robert Virtue, an expert on prosthetics and orthotics, stated that when an amputee is getting their first prosthetic, the government Health and Support Service provides the first one with no costs attached. However, the government has a set of rules in place that make certain aged people unable to get their first prosthetics as they want it. They only supply recreational advanced prosthetics to people under the age of 18(waterproofed, able to handle sports, etc.), leaving many adults having to pay full price with loans in order to get a prosthetic they want that fits their needs. With high demand for people wanting more out of their new limbs, orthotics specialists have tried adding new technologies into prosthetics resulting in much higher prices. A typical prosthetic costs around $5,000-$50,000 and now with all of our added technology features they can cost up to millions(Marriott). For example, in an experiment with a former military soldier a man was granted $120 million dollars to have a school put together a high tech below the elbow hand prosthetic. This prosthetic was based off of brain waves put through bluetooth miobands to send signals to the parts of the hand and arm that his mind was trying to move, and it worked. With that in mind, because he’s a veteran of the military he had that funding supported. Not all people are so fortunate. Along with the cost of the actual prosthetic comes the cost of the surgeries involved to getting it. With his specialized miobands, he had to have a nerve reroute operation done($20,000-$150,000) so that his brain signals went to the right places on the prosthetic. In reality, most people don’t have this kind of money sitting around but currently the National Disability Insurance System is working on fixing that. The NDIS takes the money when people buy prosthetics and pool it together. They are trying to find a better way to take that pool of money and distribute it in a way so adults can also get recreational prosthetics, not just kids. Although the cost of an actual prosthetic is trying to be supported by the government systems, something not a lot of people get financial support on is the surgeries previous to getting their prosthetic.
What surgeries happen before getting a prosthetic?
Before actually needing or receiving a prosthetic, a patient has to have either gone through a amputation surgery or an osseointegration surgery. A person has no need for a prosthetic unless they go through one of these procedures. The first, most common surgery is an amputation. Amputation surgeries can cost anywhere from $20,000-$60,000(Resnick). Amputations are most commonly done above or below the knee and elbow. The process of a amputation surgery involves clearing the diseased and damaged tissue and bones in that area, then sealing off nerves and blood vessels and smoothing out bones and muscle so the residual limb can be nicely joined to a prosthetic(Norton). Although this is the most common surgery when it comes to prosthetics and orthotics, the second most common is Osseointegration. Osseointegration allows patients to surgically attach prosthetics to the body through a screw being joined into the bone. The downfall to this kind of surgery is it’s much more fragile when it comes to accidents where you could get hurt and could result in another open wound if you’re not careful. Therefore, if it was just a normal attach everyday prosthetic and you fell off your bike really hard, the prosthetic could just pop off and you’d be fine, but if you had osseointegration done, it could rip it off your body from being so fragile unlike a real bone(Resnick). The only difference between the two is after shaping the bone and muscle, amputation surgeries would close up the skin around that wound, but osseointegration would place a metal rod and then close it up in hopes that it would form into your bone for a more secure fit from prosthetics. Surgeries are pretty straightforward when it comes to the procedures, but procedures for fabricating someone's custom prosthetic is not.
What is the process for design of prosthetics?
When custom making a prosthetic for a patient, there are 3 steps; consulting with patient on comfort and structure, casting and scanning, and repeating until the patient is satisfied with the feel and performance of the prosthetic. When professionals are consulting about someone’s residual limb, the main important part of the prosthetic is based around the socket. The socket is the part of the prosthetic that is attached to the residual limb, and it is formed with a plaster cast followed by laser cut plastics to form the correct shape. Some parts of the residual limb will be more sensitive to pressure meaning you have to find the parts to take pressure and the parts to relieve pressure. This is called rectification(Smith). These molding sessions require multiple consultations and appointments to assure the bone won’t slip into the socket uncomfortably causing pain to the fragile skin. After the socket portion of the prosthetic has gone through the consultations and fittings, then comes the rest of the prosthetic. The rest of the prosthetic is highly based on preferences and the types of functioning wanting to be performed by an individual. The same consultations and fittings apply to the rest of the prosthetic, but these are where most of the modern technologies and costs become involved. When casting molds for baseline, normal prosthetics, the main portion of the prosthetic is based on matching shape and size to the other limb(left leg/right leg, right arm/left arm). If you involve moving parts to the interior it becomes more about molding a case around the micro compressors and hydraulics you could have to help function it. These factors is what mainly bases the price range going from $5,000 - 1 million (Bloomberg). Trial and error is one of the top things taught to students in the fields of orthotics so they understand that not everyone has the same hopes from a prosthetic. Developers for the prosthetics start at the socket, move to the interior of the main portion of the limb and then put a covering, to the rubber skin on the outside which can then be water proofed, heat resistant, etc.(Smith). The fabrication of prosthetics can seem like it’s one of the most time consuming parts to getting one, but with modern technology they are progressing in almost every aspect of getting, creating and receiving a prosthetic.
How is modern technology helping benefit prosthetics?
Modern technology is making it so prosthetics are capable of many more functions than before; they are also making the turnaround time of receiving and fabricating a custom prosthetic much more efficient and timely. Looking back a few years ago there is already drastic changes that have been made in specialization features in prosthetics. The program that is allowing this to happen is a computer software being taught to students in the field of orthotics and prosthetics called CAD/CAM. CAD/CAM is a computer program that takes measurements and stores them in the program along with graphic designs of what a patient's asks for in it’s function abilities(Smith). With storing designs on a database like this, that means the odds of people wanting similar functions out of a prosthetic are high. Therefore, they can bring up previous files and tweak the design to custom fit the look for a patient, while keeping the hydraulics and electrodes inside already setup for fabrication. This means turn around time for patients getting their prosthetics is turning into about 1 week. Turn around time 10 years ago meant a patient had to wait a minimum of 1 month to 3 months to receive theirs(Norton). Dr. Courtney Moran from the John Hopkins Laboratory for Prosthetics and Design stated, “with CAD/CAM technology only advancing by the day, we are expecting that the next step to be that we will be able to find a way to have the socket adjust to physiologic changes and volume changes during physical activity so that people don’t need separate prosthetics for activity and everyday functions”. Many doctors have stated that the most challening part of a prosthetic is the socket, simply because that is the attachment between fragile skin of the residual limb to the prosthetic. Another goal for the future of prosthetics with CAD/CAM technology stated by Dr.Moran is, “instead of the person only communicating with the limb, the limb will communicate back and indicate an object's texture, hardness, temperature, etc.”(Bloomberg). With all these aspirations from doctors and experts still comes the costs, research, and experimentation for any of these ideas to come to life. That only means in the future there will be lots of trial and error to keep progressing prosthetics in the positive way they’ve been going for decades.
Technology is going far and beyond what we ever saw possible a few years ago. This video shows just that. With prosthetics excelling through technology we are starting to the thought to be impossible, become possible. If you watch this video you will see how with the minds of specialists in orthotics and prosthetics, they have been able to come up with a brain wave transmitting signal system that sends waves from your brain to the prosthetic. The man in the video explains that he's tried multiple different kinds of prosthetics and that this new trial with these electrodes and miobands really shows how far designers have developed and how much more can be developed.
Credits:
Created with images by familymwr - "Saul Bosquez" • Nadya Peek - "With Jaipur foot, ankle block sort of high" • University of Salford - "Prosthetics student" • University of Salford - "Prosthetics student"