Prostheses are commonly used to replace parts of the body that are malformed, lost due to trauma, or never formed due to congenital defect. This paper will examine the use of prostheses throughout history and their advancement.

The most common use of prostheses in history was replacement of a limb due to trauma.¹ Throughout history, children who were born with congenital defects or malformed limbs were unfortunately viewed as ‘defective’ or ‘demonic’ and were not often allowed to live long enough to have need for prostheses.¹

The first record of a functioning prosthetic limb in history was found in the book of Vedas from Sanskrit, India. This book, believed to have been written between 3,500 and 1,800 B.C. was a historical record of the time period. One entry stated that during a battle with a neighboring territory Queen Vishpla, a warrior queen in ancient India, received a blow that amputated one of her legs. After a time, having healed, she was fitted with an iron leg in order to be able to return to the battle field in defense of her kingdom once more.¹ While there is written record of the limb, there has been no discovery of the iron leg used by Queen Vishpla, or one like it, in that area of the world.

The ancient Egyptians also made false limbs during the burial process of their nobles and monarchs.^{2, 3} It was believed that if a body was not made whole during the burial ritual, the spirit of the individual would not have the missing appendage in the afterlife. In order to afford their kings and queens every advantage possible in the afterlife, “feet, legs, noses, ears—and even penises” ^{2(p. 1)} were replicated using wood or ceramic and buried with mummified bodies.² These limbs were purely aesthetic, and showed no signs of ever being used by the bodies they were attached to.^{2, 3}

In the year 2000, archeologists in ancient Egypt unearthed what was believed to be the oldest functioning artificial body part ever found.^2-4 The device was estimated to be 3,000 years old (circa1065–740 B.C.).³ It was a replacement big toe that was found attached to the mummy of a woman estimated to be 50-60 years old at the time of her death.^2-4 Unlike the replacement limbs that had been previously found, this one was laced to the foot with a leather sleeve, not just placed with the body.^{2, 4} The toe also had three bendable joints and showed signs of wear on the bottom and sides suggesting it had actually been used during the woman’s lifetime.^2-4 This early prosthesis was far more sophisticated than prostheses that have been found and dated after the fall of ancient Egypt.

Archeologists have found evidence of prostheses in ancient Rome that were made to replace missing lower legs.^{5, 6} These devices date back to 300 B.C. and were made from a wooden core coated with hammered metal plates.^{5, 6} The replacement limb was then strapped with leather to the remaining stump and used to replicate normal ambulation.⁵ These devices were formed by blacksmiths, metalworkers, and armor makers because they were skilled in the blending of wood, metal and leather.⁵ The limbs found in ancient Rome lacked the sophistication of joints found in those developed by the Egyptians.

Blacksmiths and armor makers continued to be the creators of prostheses through the Middle Ages. During this time, the loss of a limb was considered embarrassing and unsightly, yet little was done to aid these people.⁵ Knights who were injured in battle were often the only members of the population who were afforded any method of concealment. A knight would go to the same man who constructed their armor, and request a replacement limb made to attach to their armor, so as to hide the embarrassment. However, these prosthetic limbs were heavy, solid pieces that only served to disguise the fact that a limb was missing as they weighed far too much to be of use in combat..⁵

The most frequently recognized forms of early prostheses were made common by seafaring men. Popular culture has often labeled theses men ‘pirates,’ but any man who served on a ship frequently faced the same risks. The use of rope drawn sails often led to tangles in the line that could ensnare a sailor with a strong gust of wind. If an arm or leg was caught in that rope, the sailor, more often than not, lost that limb.⁴ Sailors spent the majority of their lives at sea, so when a catastrophic injury occurred and a sailor lost a limb, they made do with whatever they could find on the boat. For that reason, wooden shafts for legs and metal hooks for hands became common forms of limb replacement.⁴

In the 16th century, a French surgeon named Ambroise Paré contributed major advances in prosthetics such as mechanical, hinged hands, and locking knee joints. These implements were made of metal, but unlike those utilized by the Knights of the Middle Ages, these devices could be used in activities of daily life. A century later, a Dutch surgeon by the name of Pieter Verduyn created a lower-leg prosthesis that involved “specialized hinges and a leather cuff for improved attachment to the body.” ⁴ (p 2) These drastic advances are still utilized today as some of the basic features of modern prosthetics.⁴ While these devices were highly useful, they were complicated and expensive, and few could afford them. However, by the 1700’s, metal hooks and wooden legs attached with leather straps had became commonplace for individuals with amputations.⁵

The Civil War in America (1861–1865) served to make the need for prostheses commonplace among formerly able-bodied young men.⁵ Surgeons working on surviving soldiers who fought for the north conducted 300,000 amputations over the course of the war.⁵ It is unknown how many amputations were conducted on soldiers who fought for the south.

The high demand for prostheses due to the Civil War encouraged manufacturers to make advancements. Prior to the war, in 1818, a German dentist named Peter Ballif developed a full arm prosthesis that was designed to be controlled by the movements of the opposite shoulder and the torso.^{1, 4} In 1844, a Dutch sculptor proposed a similar device that was designed for use with above the elbow amputations.¹ In 1863, Dubois Parmelee invented a socket to attach both arm and leg prostheses that employed suction to keep the prosthetic in place.¹ The split-hook hand, which is still used in modern day prostheses with a few modification, was created in 1912, by a man named Dorrance. Despite the plethora of advancements available, the metal hooks and wooden legs that were developed centuries earlier were still used. They became less common however as government funding to support those who had suffered amputations improved.⁶ There were also improvements in surgical techniques, which enabled the residual portion of the limb to be better shaped to accept a prosthetic limb.⁶

Following World War I and II in 1945, the National Academy of Sciences, an agency funded by the United States government, established the Artificial Limb Program.^{4, 6} This program was designed to improve the design of prosthetic devices through the funding and coordination of research.^{4, 6} The U.S. Veterans Association funded research that developed mechanical arms with a hook on the end that could open and close by shrugging the shoulder.⁵ This gave the individual wearing it the ability to grasp things. The agencies combined funding to improve leg prostheses, ushering in improvements in both above and below-the-knee. Emphasis began to be placed on how lifelike the replacement limb appeared.⁶ Doctors and engineers worked together to improve both the function and the appearance of prosthetic limbs. Creation of new materials such as plastic, the advent of computer aided design, and further improvement in surgical techniques all served to make prosthetic limbs more functional and lifelike.^{5, 6} Following the Vietnam War, electronic control of prosthetic limbs was introduced.⁵

Today the number of people living with an amputation is estimated to be between 400,000 and 1,000,000 in the United States alone.5 Technology is advancing to meet the demand for better devices. The combination of plastic and carbon fiber is becoming commonplace, making these devices lighter, stronger, and more durable.⁵ For prosthetic arms, silicone based materials are being used that make the limb more comfortable to wear, and more lifelike in appearance, even having a softer texture to the skin.⁵ It is also becoming commonplace to have a mold made of the remaining limb and then have it mirrored to create a replica that looks just like the individual’s other arm.⁵ Advancements in computer technology enables modern prosthetic limbs to adapt their function during tasks like gripping or walking.⁴

The most drastic difference between modern prostheses and those of the past, is in the interface between the prosthetic device and the patient’s limb.⁴ This portion of the prosthesis is a combination of the suspension system and the socket.⁴ In the past the suspension system for a prosthetic limb was made from straps of leather and buckles, and the socket was wooden or metal lined with fabric. Most modern prostheses combine the socket and suspension system into a molded plastic socket that uses suction to remain attached. It must be carefully molded and padded to prevent damage to the limb it is attached to.^4-7

This socket also makes the prosthesis easier to put on and take off. This is particularly helpful when the individual has multiple prosthetic limbs. Having multiple prosthetics is particularly common in athletes. These athletes may have separate prosthetics for activities like running, skiing, or biking. The prosthetics available to athletes are considered state of the art, and have some of the most extreme advances in prosthetic technology. Those prosthetics used by athletes for running hardly resemble human limbs. They are carefully crafted combinations of plastic, rubber, and carbon fiber that are proportionally fitted to the body.⁴ They are carefully regulated during competition to ensure that no advantage such as extra limb length is being used.

Modern lower limb prosthetics for the general population are much more versatile than those of the past, however further advances are still being examined. For example, in 2007, research was conducted to determine the benefits of adding a motorized ankle to leg orthotics.⁸ This motorized ankle unit is designed to mimic a normal gait. Current leg prostheses are fixed at the ankle causing uneven gait and possible lack of stability during standing. The units created in this study combined sensors to detect minute movements at the ankle, and micro-motors to adjust the ankle in response to instabilities.⁸ These units are still strictly experimental, but have shown promise in a laboratory setting.⁸

In upper body prosthetics, there have been numerous recent developments as well. Todd Kuiken, known as the pioneer of prostheses, specializes in upper limb prostheses.^{9, 10} His research has yielded a replacement upper limb, attached at the shoulder, that can be controlled by thought alone.^{9, 11, 12} Commonly used arm prostheses can only accomplish one movement at a time.¹² This new prosthetic utilizes a process called targeted muscle reinnervation (TMR).^{4, 12} TMR “uses the residual nerves from an amputated limb and transfers them onto alternative muscle groups that are not biomechanically functional since they are no longer attached to the missing arm.” ^12(pl) This procedure had success in a 2007 case study, indicating promise for the device’s future use.

The most recent advancement in prosthetics occurred in the U.K. and is being called a ‘bionic hand.’¹³ It started as a project to help children with congenital amputations in 1963, and has evolved into a prosthetic hand with five individually functioning digits.¹³ The device came into its own in the year 2007 when a company called Touch Bionics agreed to produce and sell what they call the i-LIMB. Since its debut in 2007, over 200 people have been fitted with the device, including injured soldiers returning from Iraq. The company is currently working on models for a full arm.¹³ This device raised the expectations for prosthetic devices, and will be able to improve the lives of so many who have been disadvantaged for too long.

The use of prosthetic implements has always been with the intent of helping someone with a disability to live a more normal life. The advancement throughout history has been paramount in making this possible. Prostheses today help people with amputations tackle the necessities of life; ambulation, exercise, the ability to grasp objects, and open doors on their own. There are even special prosthetic legs for women attending formal occasions that are designed to wear heels.⁴ One of the first to be fitted with an i-LIMB, an individual who had suffered quadruple amputations, was able to see a hand that was attached to him open for the first time in 21 years.¹³ Improvements in prostheses are constantly being made, between the athlete who desires to run faster, and the mother who wants to be able to brush the hair of her child, demands for improvements have been heard, answered, and will continue to be for years to come.

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