Have you ever been fined for prosthetics?

Prosthetics. The chance for new mobility and quality of life

content

1 Introduction

2 The development of prosthetics from ancient times to modern times
2.1 Ancient prostheses
2.2 Prostheses in the Middle Ages
2.2.1 Prostheses for the lower class of the population
2.2.2 Prostheses for the upper class of the population
2.3 Prostheses in the Sixteenth Century
2.4 Sour fracture hand

3 MOBIS® - Individual degrees of mobility
3.1 Explanation of the MOBIS® system
3.2 Degrees of mobility and therapy goals

4 leg prostheses of the current generation
4.1 High quality lower limb prostheses as a new start for patients and out-
requirement for manufacturers
4.2 The human leg and gait cycle
4.3 Leg prosthesis as a “replacement part” for the human body
4.3.1 The amputation height as a "unit of measurement"
4.3.2 Structure of a prosthetic leg
4.3.2.1 Shank systems
4.3.2.2 The artificial knee joint for above-knee amputees
4.3.2.3 Prosthetic feet
4.3.2.4 Hip joint systems
4.3.3 Compilation and mutual influence of individuals
Prosthetic components

5 Improvement of mobility and quality of life using the example of leg prostheses
5.1 Swimming with the Aqua-Line product line
5.1.1 Presentation of the prosthesis
5.1.2 Special features of the swimming prosthesis
5.2 Mastering everyday life with the Genium and C-Leg prosthesis
5.2.1 The Genium in Daily Life
5.2.2 Everyday uses of the C-Leg and the C-Leg compact

6 final part

attachment

List of figures

bibliography

1 Introduction

In the present work we analyze the historical development of prostheses from antiquity to the present day. The focus will be on the comparison and presentation of the health effects of a prosthesis. Furthermore, we show the changes in the possibilities for manufacturing a prosthesis over the course of time and the resulting innovations. In order to keep the scope of this work within a manageable framework, we limit ourselves mainly to the products of the Otto Bock company. We mainly limit ourselves to prostheses for the lower extremities and hand prostheses. For a better understanding of the functionality and structure of a modern lower leg prosthesis, we refer to the leg and the gait cycle of a healthy person. The respective prosthesis components are explained on the basis of various criteria, such as the degree of mobility, the amputation height and the technical possibilities. The individual prosthesis wearers each have different demands in terms of performance in everyday life. The MOBIS® system was developed in order to produce a prosthesis suitable for the degree of mobility of the person, which is also analyzed in our work. In addition, we provide an overview of the individual specifications of the Genium and C-Legs, which the wearer can use in everyday life. This also includes the Aqua-Line prosthesis, which enables wet areas such as swimming pools or showers to be safely entered.

In order to collect information material, we visited the Otto Bock company exhibition in Duderstadt. An employee of the company gave us an overview of the development of the Otto Bock company and of outstanding technical achievements of the past. Since we needed further practical examples for the preparation of the seminar paper, we visited the orthopedic and rehabilitation technology fair in Leipzig.

2 The development of prosthetics from ancient times to modern times

Today's generation of prostheses are now able to replace healthy parts of the body in almost all of their functions. Walking, running and sprinting are activities in everyday life which, thanks to the latest technology, are no longer a problem for prosthesis wearers. But these achievements of modern prosthetics would not have been possible without the inventions of antiquity, since the technical status of the modern age has been built on the knowledge of the past. In order to be able to understand the technology and functionality of modern prostheses, we first present the development of prosthetics from antiquity to modern times. In doing so, we go into the discoveries made in history, which were trend-setting for the development of prosthetics.

2.1 Ancient prostheses

The oldest known leg prosthesis comes from the 4th-3rd centuries. Century BC (see Figure 1). It is a lower leg prosthesis and was found in a Roman tomb in Capua, a town south of Italy. The inside of the prosthesis is made of wood, is covered with bronze sheet metal and shows signs of use, which suggests that it was used in everyday life as well as in combat. The prosthesis was attached to the thigh with iron holders[1]. It probably belonged to a rich Roman soldier who had the prosthesis made so that he could continue to practice his profession. This prosthesis was probably made by a Roman blacksmith who accompanied the soldiers on their campaigns of conquest through the country.

There is also a story in literature by Herodotus, a Greek historian, geographer and ethnologist, who tells of Hegesistratos. Hegesistratos was captured and was wearing an ankle bracelet. To get free again, he amputated his foot. His escape succeeded. Then he had a wooden prosthesis made for the missing foot, which is said to have even made him ready for battle again (see Fig. 2). Herodotus mentions the prosthesis in his stories without further explanation, from which it can be concluded that the construction must have been known at the time[2].

Stick stilts (see Fig. 3) were also not uncommon in antiquity. They were particularly widespread in Africa. But since the Romans were not satisfied with the stick stilts because they were considered prostheses for the slaves, they were rather a rarity around the Mediterranean area. In general, only a few details about prosthesis fittings from antiquity are known today. One reason for this is that the operations were very painful and many had already lost their lives amputating the body part. There were also penalties for doctors, e.g. in Mesopotamia, if their patient died during an operation. Then their hands or fingers, for example, were chopped off. The development of prosthetics was not very advanced, so a lower limb prosthesis usually only served the purpose of allowing the person affected to stand. Walking quickly and comfortably was not possible. Ancient prosthetics relate almost exclusively to the lower extremities, which is due to the fact that a hand prosthesis was far too complicated to make and in most cases could not serve its purpose. So there were already prostheses in antiquity, but they were not yet mature enough to be able to replace a healthy part of the body.

2.2 Prostheses in the Middle Ages

2.2.1 Prostheses for the lower class of the population

From ancient times to the Middle Ages, the standard of living of the common population fell sharply. This also had an impact on the development of prosthetics. In the Middle Ages, the poor mostly had only simple supports, which allowed them to stand up only briefly and not to walk at all (see Fig. 4). Proper prostheses that could replace a body part did not exist for the lower class of the population because they did not have the financial means to have a prosthesis made. The supports were mostly carved by the arms themselves and were very poor, as nobody had the knowledge to make a stable prosthesis.

As in ancient times, medical options were limited during this period. The chances of survival in operations were still very slim. Since there were still no anesthetics in the Middle Ages, the patient experienced the operation with full consciousness and suffered from unimaginably great pain[3]. On the other hand, the blood loss during such an operation was usually much too great that the body could not compensate for it, and the patients died during the operation. This also explains why there has been no technical progress in prosthetics for a long time, because there was hardly any demand for expensive prostheses that could really make things easier. The lack of an arm or leg was always associated with social decline in the Middle Ages. In most cases the job could not be carried out any further, so begging was often the only way to get some money. Because at that time there was no insurance that could save a worker from social decline in the event of incapacity for work through monetary payments. People with disabilities had to live their lives on the edge of society without the prospect that this situation could ever change again.

A person who had lost one of their body parts in the war, on the other hand, was provided for by a monastery, a noble house or the population[4]. The disabled were mostly to be found where the daily life of many people took place. Thus, marketplaces and churches were among the most popular spots in a city, where the disabled also stayed. In exchange for money they prayed for the donor and offered him salvation in return.

Infants, on the other hand, who were born with a disability, were considered cursed by the devil in the Middle Ages. They were viewed as a punishment for the parents and were killed immediately after birth[5].

As already mentioned, the prostheses were made by the handicapped themselves. They were made of wood, as other, more stable and better materials, such as iron, were so scarce at that time that a beggar could not afford them. The prostheses were made by hand. Mostly only a simple carving knife served as a tool. The template for one's own prosthesis was usually that of another handicapped person whom one saw on the street every day. There were no construction drawings of a prosthesis, especially since there was no possibility for the poor to produce a more complex prosthesis. So there was no central place, such as a factory where new prostheses were developed and manufactured. As a result of the fact that everyone manufactured their own prosthesis, it was not possible for centuries to develop a professional company specializing in the development of prosthetics. Due to the lack of financial resources for most of the disabled, there was no market demand for custom-made prostheses.

2.2.2 Prostheses for the upper class of the population

The prostheses of the rich are usually not very different from the prostheses of the poor[6]. The development of prosthetics was not so advanced in the Middle Ages, so that there were no opportunities even for handicapped people with a lot of money to have a prosthesis made that would have contributed to an improvement in their living situation. Mostly the only difference between the prostheses of the poor and the rich was that the prostheses of the upper class of the population compensated for the length[7] gave. The materials from which the prostheses were made were also mostly the same. As with the prostheses of the poor, wood was predominantly used in prostheses for the rich. A normal gait was also not possible with the prostheses worn by the rich. In addition to the prosthesis, the wealthy usually had walking aids or supports, because only with these were they able to keep their balance. Moving over longer distances and over uneven ground, such as fields or swamps, was also not possible, as moving with a prosthesis required a lot of strength and the pointed end of the prosthesis sank slightly on muddy ground. In addition, the prostheses did not have great stability, and it was easy to slip away when walking due to the small contact surface. Furthermore, the prosthesis did not allow the patient to unroll, which meant that even normal walking was so force-intensive that only short distances could be covered.

The great exception and innovation of prosthetics in the Middle Ages is the arm prosthesis by Götz von Berlichingen (see Fig. 5). Gottfried "Götz" von Berlichingen zu Hornberg was born around 1480 and died on July 23, 1562. He was a Frankish imperial knight who lost his right hand on June 23, 1504 during the siege of Landshut[8]. Since he could not continue his profession as a knight with just one hand, he had a prosthesis made from over 200 individual parts in a watchmaker's workshop. The place of manufacture was probably Augsburg or Nuremberg[9]. Nothing is known about the developer of this prosthesis, not even about the manufacturing process. The prosthesis weighed 1.5kg and was made of leather and metal. It enabled Götz von Berlichingen to grab and hold objects such as his sword. It is said that the prosthesis even allowed the knight to take part in fights and tournaments again. An object was gripped using a mechanical grid. If he wanted to hold a sword with his artificial hand, he put it with his sound hand on the fingers of the prosthesis and pulled them up to the prosthetic arm, whereby the artificial fingers together with the artificial arm encircled the sword. The sword was firmly in his hand. If the knight wanted to let go of the sword that he was holding in the prosthetic hand, he had to press a button on the prosthesis with his healthy left arm, whereupon the catch loosened and the sword was dropped (see Fig. 6 ). This representation of the procedure shows that Götz von Berlichingen could not use his artificial hand alone, he always needed his second, healthy hand to be able to operate the prosthesis. It can therefore be assumed that von Berlichingen only held the shield or the reins of his horse with his artificial hand in a battle, because he did not have to use his sound arm to help.

Based on the prosthesis of Götz von Berlichingen, it is shown what technical performance prosthesis manufacturers of the Middle Ages were capable of. But the prosthesis probably remained unique, as there are no records of the manufacture or use of another artificial hand of this type.

The prosthesis was considered a technical masterpiece by watchmakers and was a sensation. She was talked about all over Central Europe and sparked heated discussions about whether a person could have body parts reproduced. Because in the Middle Ages people, and especially the church, were of the opinion that the loss of a part of the body was willed by God, and that by replacing the part of the body one acted against the will of God. The development and manufacture of the prosthesis probably took more than half a year, as Götz von Berlichingen lost his hand in June 1504, and he got his artificial hand when he returned to Jagsthausen, after he could not leave his hospital bed until Mardi Gras 1505[10]. The prosthesis was made from over 200 individual parts and was so detailed that even punched fingernails adorned the prosthesis. Since hardly any prostheses for hands were made before in the Middle Ages because they were more complicated to manufacture than prostheses for the lower extremities, this makes the prosthesis even more unique. Götz von Berlichingen's prosthesis was also the first hand prosthesis that was movable and not only served to visually beautify the body. In my opinion, the prosthesis was the greatest revolution in prosthetics in the Middle Ages.

2.3 Prostheses in the Sixteenth Century

In the sixteenth century, prosthetic legs were revolutionized by Ambroise Paré. Ambroise Paré (around 1510-1590) was the royal surgeon who oversaw the French army[11]. At that time the soldiers had to cover long distances on foot during the battles and on the routes to the theaters of war. Knights who had lost a leg in battle were no longer able to take part in the battles. However, since it was very expensive to keep hiring new warriors, the King of France Ambroise Paré provided the financial means to develop new, more advanced prostheses. The aim was to optimize the prostheses so that knights with disabilities could again take part in combat. Then Paré developed a prosthesis, which is the cornerstone for all prostheses today. After the prostheses were usually only simply attached to the stump of the severed leg, and so wobbled and fell off, the stump was now embedded in the prosthesis . With the previous leg prostheses, the material often chafed on the leg of the injured person, repeatedly causing new, open wounds. By embedding the leg stump in the prosthesis, this could now be largely avoided (see Fig. 7). The prosthesis was then fastened to the garment covering the upper body, usually a doublet, with buckles. The ankle joint of the prosthesis was a hinge joint (see Fig. 7), which enabled the foot to roll more easily.As a result of this renewal, walking with a prosthesis was no longer as strenuous as before, and longer distances could be covered. In addition, the prosthesis was then given an iron coating, which made it even more similar to a knight's armor, so that the prosthesis was hardly recognizable in combat. Dr. Franz Schede suspects about the prosthesis: "The high weight has greatly reduced the practical value of this prosthesis."[12]. Assuming that the entire prosthesis and the coating consisted entirely of iron, in my opinion it must have been very heavy, much heavier than a normal leg. This should have prevented the wearer of this prosthesis from walking almost normally. Walking with two legs of different weight is very complicated, very strenuous in the long run and requires good balance. If the prosthesis had consisted of a lighter material on the inside and then an iron coating, the prosthesis might not have been quite as robust, but it would have enabled the wearer to walk more easily and naturally and would have been able to cover longer distances with the prosthesis . The heavy weight of the prosthesis is probably the main reason why it was so quickly forgotten. Another reason that this prosthetic technique has been used for the right short duration is that it was not very widespread. This could be due to the fact that this prosthesis was only intended for the royal army and was therefore only produced for the army. The prosthesis was too heavy for a normal gait and was therefore difficult or impossible to use for combat. Nevertheless, the implementation of a hinge joint on the foot of a prosthesis was revolutionary, as it was the first time in the history of prosthetics that a springy gait was possible.

From the 16th century in Florence there are other prostheses that were only made for the royal army (see Fig. 8). They were also made of iron and, like the Paré prostheses, were made for the army by the armory. With this prosthesis, the knee joint and the ankle are movable. The shaft into which the stump was inserted is covered with leather, which makes wearing the prosthesis more comfortable, as the skin does not rub off the iron when walking[13]. Thanks to a new structure that looks like a kind of leg frame, which is hollow on the inside, comparatively less iron was used for these prostheses than for the prostheses that Paré had made. The prostheses weighed an average of 3 kilograms, which is as much as today's prostheses. The Federal College for Orthopedic Technology copied the prosthesis from Florence and said about their work: “The production was relatively complex. The rounding of the lower shaft posed a great challenge. It was only the modern technique of electric welding that enabled us to close the sheet metal ends and thus complete the prosthesis. "[14]From this statement it can be concluded that the prostheses were probably not yet closed at the sheet metal ends in the 16th century. This in turn meant that the prostheses bent more easily, as the construction only gains most of its stability when the circle is closed and is thus able to bear the weight of the body. But this is only a guess, because today there are no more prostheses from this time, and it is no longer possible to clearly determine whether the sheet metal ends were closed in the 16th century or not. The tips of the prostheses are made of wood. This can be explained by the fact that this area of ​​a prosthesis wears out the fastest and therefore has to be replaced every now and then. Wood was a cheap alternative to iron. You couldn't afford to keep ironing the prostheses up. Wood wore out even faster, but it was also cheaper to repair. The knee joint of the prosthesis was composed of 3 lamellas. If the thigh was exactly on the lower leg, i.e. the upper and lower leg formed a straight line, the 3 lamellas were on top of each other. As soon as the thigh and lower leg were at an angle of 90 degrees to each other, for example if the wearer of the prosthesis was sitting on a bench, then all 3 lamellas pushed apart so that they simulated the knee.

2.4 Sour fracture hand

The Sauerbruchhand (see Fig. 9) was first produced in 1915 and named after its developer Ernst Ferdinand Sauerbruch. At the beginning of the 20th century, he was one of the most important surgeons and was involved in numerous innovations in medicine and prosthetics[15]. Due to the First World War (1914-1918) there were numerous injuries who had lost some of their body parts during the battle and were dependent on the help of prostheses. This opened up a market niche that had never existed to this extent before. This enabled Sauerbruch to experiment with many disabled people in order to optimize his prostheses.

The result of his research and technological developments was the first artificial hand that could be controlled at will by the wearer using muscle power. During the operation on the patient, a canal was placed from the prosthesis into the upper arm. This enabled the prosthesis to be moved by tensing the muscles. With this novelty, the prosthesis wearer was able to close and open the hand by tensing the muscles.

Ferdinand Sauerbruch's best-known patient was Hubert Weber, an artist who lost both hands in World War II. Through several operations, the artist was placed two prosthetic hands on his stumps, which even enabled him to draw again[16]. But the Sauerbruchhand could not last long on the market. The main reason for this was that the prosthesis was very expensive and most war invalids could not afford the prosthesis. Furthermore, the operation for attaching it to the arm was so complicated that few doctors were able to surgically attach the prosthesis to a patient. In addition, inflammations often formed in the canal, which was placed on the muscle through the arm, which led to such great pain that the prosthesis usually had to be removed again[17]. All of these aspects were mostly the reasons why the interested party decided against the Sauerbruchhand, whereby the sales of this prosthesis fell sharply, and the production was discontinued in the process. Nevertheless, the Sauerbruchhand was a revolution in the field of prosthetics, as it was the first prosthesis that could be moved by mere muscle power.

[...]



[1] Wilfried Knoche, Stefan Bieringer, Beat Rüttimann: Prostheses of the Lower Extremity - The Development from Antiquity to 1930, Dortmund 2006, p. 48

[2] Wilfried Knoche, Stefan Bieringer, Beat Rüttimann: Prostheses of the Lower Extremity - The Development from Antiquity to 1930, Dortmund 2006, p. 49

[3] Wilfried Knoche, Stefan Bieringer, Beat Rüttimann: Prostheses of the lower extremity - The development from antiquity to 1930, Dortmund 2006, p. 52

[4] http://www.itgoberfranken.de/gensler/www.Mittelalter/behi/behinderte_im_mittelalter.htm; 08/14/2012

[5] http://www.itg-oberfranken.de/gensler/www.Mittelalter/behi/behinderte_im_mittelalter.htm; 08/14/2012

[6] Wilfried Knoche, Stefan Bieringer, Beat Rüttimann: Prostheses of the Lower Extremity - The Development from Antiquity to 1930, Dortmund 2006, p. 55

[7] Length compensation: The prosthesis is so long that both legs are the same length

[8] http://de.wikipedia.org/wiki/G%C3%B6tz_von_Berlichingen; 09/21/2012

[9] Own picture from a timeline, exhibition at Otto Bock, Duderstadt

[10] http://de.wikipedia.org/wiki/G%C3%B6tz_von_Berlichingen; 09/22/2012

[11] Wilfried Knoche, Stefan Bieringer, Beat Rüttimann: Prostheses of the lower extremity - The development from antiquity to 1930; Dortmund 2006; P. 56/57

[12] Wilfried Knoche, Stefan Bieringer, Beat Rüttimann: Prostheses of the lower extremity - The development from antiquity to 1930; Dortmund 2006; P. 56/57

[13] Wilfried Knoche, Stefan Bieringer, Beat Rüttimann: Prostheses of the lower extremity - The development from antiquity to 1930; Dortmund 2006; Pp. 58/59

[14] Wilfried Knoche, Stefan Bieringer, Beat Rüttimann: Prostheses of the lower extremity - The development from antiquity to 1930; Dortmund 2006; Pp. 58/59

[15] http://de.wikipedia.org/wiki/Ferdinand_Sauerbruch; 09/30/2012

[16] Own picture from a timeline, exhibition at Otto Bock, Duderstadt

[17] http://de.wikipedia.org/wiki/Sauerbruch-Arm; 03/10/2012

End of the reading sample from 45 pages