Externally Powered Upper-Limb Prostheses
A. Bennett Wilson, Jr.
The earliest reference to externally powered upper-limb prostheses seems to be in connection with experiments that took place in Germany about 1918 in which electromagnets were used to close the fingers of an artificial hand  . The next reported effort apparently is the research and development program proposed and carried out by Alderson on electrically powered arm systems during 1946-1952 with support from International Business Machines, Inc. and the Veterans Administration.
Initial results of the Alderson-IBM project (Fig. 1) were quite impressive with respect to operation, but an extensive evaluation at UCLA in 1951 revealed that a disproportionate amount of mental effort by the wearer was required for use of the various systems. As a result of the findings of the UCLA study, and because only a limited amount of money was available for work in artificial limbs, the Advisory Committee on Artificial Limbs (later the Committee on Prosthetics Research and Development) of the National Academy of Sciences recommended that development of actuators be delayed until sufficient research could be carried out concerning the control problem so as to provide means for control of the prosthesis without conscious thought by the wearer.
A project was initiated at UCLA about 1953 to explore various control methods. Among the various studies conducted at UCLA was an evaluation of the so-called Vaduz hand (Fig. 2), a design that originated in Lichtenstein which used bulging of the residual muscles in a forearm stump to provide control of an electrically actuated artificial hand. Some rather positive findings were overshadowed by the poor quality of the one unit that was available at the time, and perhaps by the introduction by Russia in 1958 of a "thought control" electric arm. The Russian device actually consisted of an electric hand controlled by myoelectric signals from the residual forearm agonists and antagonists of a below-elbow amputee.
The "Thalidomide tragedy" in 1958-1962 prompted England and Canada to secure manufacturing rights to the Russian design, but fabrication and distribution was not successful in either country. The "Thalidomide tragedy" also encouraged work at the University of Heidelberg in the development of pneumatically powered artificial arm systems, and an agreement was obtained by Kessler and Kiessling for continuation of this work in the U.S. (Fig. 3). This project was carried out between 1960 and 1969. Again the problem of control was the primary reason for discontinuing the work.
Because of the Thalidomide tragedy, Sweden also launched a modest program in development of externally powered upper-limb prostheses about 1960. Work in this area has been carried out continuously since, but with no commercially available devices resulting, as far as is known at this time.
The Russian design caused an Austrian group, Viennatone, and the Otto Bock Company in Germany to develop and market about 1962 similar devices. A few years later Hannes Schmidl began fitting externally powered artificial arms on a relatively large scale at the INAIL Center, Budrio, Italy and continues to do so to the present time. Pneumatic models were used initially, but all designs used now are electric.
Simpson, at the Princess Margaret Rose Hospital, Edinburgh, Scotland uses routinely pneumatic prostheses for a group of "Thalidomide" children, but his design is not widely available elsewhere.
In 1960 while on Sabbatical study at the University of Southern California Tomovic from the Institute Pupin, Belgrade, suggested the use of electromechanical pressure sensitive systems to aid in solution to the control problem by introducing closed-loop feedback systems. A number of prototypes (Fig. 4) were designed and fabricated upon the return of Tomovic to Yugoslavia. Results of evaluation were also overshadowed by poor workmanship and engineering, and work on this was abandoned about 1968.
McLaurin, while at Northwestern University, designed the so-called Michigan feeding arm about 1960 which used a linkage to coordinate motions about the elbow and the wrist to make it possible for young bilateral children amputees to feed themselves. This device met with considerable success in the clinical setting, but never became a commercial success.
McLaurin continued work in electrical arms for children at the Ontario Crippled Childrens Centre, Toronto, between 1963 and 1975. Although he was able to persuade the Variety Club to develop a facility for manufacturing, at cost, some of the products of research as a philanthropic endeavor, to date only an electric elbow has been made available, but because of the low volume the cost is extremely high in spite of subsidization.
In the late sixties a number of efforts in the U.S. were directed toward the development of electric elbows. By 1969 three designs were considered ready for clinical evaluation, the "Boston" elbow developed by M.I.T. and Liberty Mutual Insurance Co., the AMBRL elbow, developed by the Army Medical Biomedical Research Laboratory, and a design by Rancho Los Amigos Hospital. The clinical evaluation program was organized and coordinated by CPRD in 1969-70.
Of 20 subjects in the study only 3 elected to retain the electric device. Two of these subjects had physical problems that made operation of the body powered prosthesis more difficult than would have been the case otherwise. Out of this experience came a revised set of design criteria and objectives.
In addition to all of these efforts, research and development programs in externally powered artificial arms have been carried out in the U.S. at Temple University - Moss Rehabilitation Hospital , Northwestern University (Fig. 5), Veterans Administration Prosthetic Center, Duke University, Rancho Los Amigos Hospital, University of California at Los Angeles, the University of Colorado, and Johns Hopkins University.
Sweden, Great Britain, Italy, Germany, Russia, and others have continued to support research and development in this field.
Yet today it is very difficult to obtain an electric or pneumatic arm in the United States, other than the electrically operated hands that are suitable for below-elbow patients. We will be pleased to hear the opinions of readers of the NEWSLETTER concerning the reasons for this.
A. Bennett Wilson, Jr.
March 16, 1978
References:
- Alderson, Samuel W., The electric arm, (Chapter 13 in Klop-steg and Wilson's "Human Limbs and Their Substitutes," McGraw-Hill, 1954, reprinted by Hafner Press, 1969).
- Battye, C.K., A. Nightingale, and J. Whillis, "The use of myoelectric currents in the operation of prostheses," J. Bone Joint Surg., 37-B, 506, Aug. 1955.
- Berger, N., and CR. Huppert, The use of electrical and mechanical muscular forces for the control of an electrical prosthesis, Amer. J. Occup. Ther., 6:110-14, 1952.
- Childress, D.S., et al., Myoelectric immediate postsurgical procedure: A concept for fitting the upper-extremity amputee, Artif. Limbs, Vol. 13, No. 2, Autumn, 1969.
- Committee on Prosthetics Research and Development, Externally powered prosthetic elbows - a clinical evaluation, Report E-4 National Academy of Sciences, 1970.
- Committee on Prosthetics Research and Development, The application of external power in prosthetics and orthotics, National Academy of Sciences, Publication 874, 1961.
- Committee on Prosthetics Research and Development, The control of external power in upper-extremity rehabilitation, National Academy of Sciences, Publication 1352, 1966.
- Dankmeyer, Charles H., Sr., Charles H. Dankmeyer, Jr., and Martin P. Massey, An externally powered modular system for upper-limb prosthesis, Orth, and Pros., 26:3, Sept. 1972.
- Frantz, CH., An evolution in the care of the child amputee, Artif. Limbs, Vol. 10, No. 1, Spring 1966.
- Kadefors, R., et al., Stryning av armprotes med myosignaler, Electronic 3:42-49, 1967.
- Kessler, H.H., and Kiessling, E.A., Pneumatic arm prosthesis, Am J. Nursing, 65:6: June 1965
- Kobrinski, A.E., Bolkhovit-in, S.V., Voskoboinikova, L.M., Ioffe, D.M., Polyan, E.P., Popov, B.P., Slavutski, Y.L., Sysin, A.Y., and Yakobson, Y.S.: Problems of bioelectric control in automatic and remote control. Proceedings of the First International Congress of the International Federation of Automatic Control, Moscow, 1960, London, Butterworth & Co. (Publishers) Ltd., 1961, Vol. 2, p. 619.
- Marquardt, E., Heidelberg pneumatic arm prosthesis, J. Bone and Joint Surgery, 47-B:3:425-434, August 1965.
- Rakic, M., Practical design of a hand prosthesis with sensory elements, Proceedings of the Interna-, tional Symposium of the Application of Automatic Control in Prosthetics Design, 103-119, August 27-31, 1962, Belgrade, Yugoslavia.
- Reiter, R., Eine neue electro-kuntshand, Grenzgeb. Med., 4, 133, 1948.
- Schlesinger, G., Der Mechanische aufbau der kunst-chanische aufbau der kunstlichen glieder, in Ersatzglieder und Arbeitshilfen, Borchartd, M., et al., Eds., J. Springer, Berlin, 1919.
- Schmeisser, Gerhard, Wood-row Seamone, and C. Howard Hoshall, Early clinical experience with the Johns Hopkins externally powered modular system for upper-limb prostheses, Orth, and Pros. 26:3, Sept. 1972.
- Schmidl, Hannes, The I.N.A.I.L. experience fitting upper-limb dysmelia patients with myoelectric control, Bull Pros. Res. 10-27, Spring 1977.
- Scott, R.N., Myo-electric control, Science J., 2-7, March 1966.
- Simpson, D.C., An experimental design for a powered prosthesis for children, Health, Scottish Home and Health Department Bulletin, 22:4:75-78, October 1964.
- Tomovic, R., and G. Boni, An adaptive artificial hand, IRE Transactions on Automatic Control, 3-10, April 1962.
- Wirta, R.W., Taylor, D.R., and Finley, F.R., Engineering principles in the control of external power by myoelectric signals. Archives of Physical Medicine, 49:294-296, 1968.
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