Transcript PLL5 Prosthetics Slides

+
Prosthetics
Courtney Berg
Jess Farland
Meggie Ferrari
Ben Moruzzi
+
Prosthetics

History
A brief timeline, the creators, relation to war

Need-to-know basics
The parts of a prosthetic , materials used, cost and health
insurance coverage, the fitting process

Issues/Concerns that occur
Skin breakdown, infection, stump swelling, loss of suction

Future of Prosthetics: Robotics
The makeup, necessary surgeries, current problems, solutions

Success Stories
Andrew Lourake, Sgt. Juan Arredando, Kristen Shineberger, A
Dolphin Tale: Winter
+
Learning Objectives

The significance of prosthetics in war

The materials used for each part of a prosthetic

The fitting process

Issues that can occur with prosthetics

The general makeup of robotic prosthetics
+
History

First prosthetics around 1500 B.C

Egyptians were the pioneers

Dark Ages

Renaissance is the rebirth of prosthetics
http://www.amputeecoalition.org/inmotion/nov_dec_07/history_prosthetics.html
+
The Creators

Ambroise Paré

Lorrain

Pieter Verduyn

Sir James Syme

Benjamin Palmer
http://biomed.brown.edu/Courses/BI108/BI108_2003_Groups
/Hand_Prosthetics/history.html
+
Significance in America

Civil War

WWI

WWII
http://biomed.brown.edu/Courses/BI108/BI108_2003_Groups
/Hand_Prosthetics/history.html
+ “Wounded In Action” at NMHM
https://farm4.staticflickr.com/3509/3239854538_3ca14203f9.jp
g
+
Under the Prosthetic



Socks: directly on the skin

wool

Cotton

synthetics
Nylon Sheath

Provides a moisture barrier

Reduces friction between sock and prosthetic
An additional option is a Gel Sock, which is a sock attached to
a nylon sheath, separated by a gel (silicone usually).
+
The Prosthetic Itself

Wood

Plastic


Thermosets

Thermoplastics
Metal
+
Thermoplastics


Used for prosthetic interfaces as well as structural
components

Efficient to create

Efficient to fabricate

Remain permanently fusible (unlike thermosets)
One of the few cons - decreased durability because of
material tears or splits and imprecise fit because of
shrinkage of thermoplastic materials
http://www.oandp.org/jpo/library/1991_01_001.asp
+
Over the Prosthetic (liner)

Pelite: is a polyethylene closed cell foam used as an interface
material.

Most commonly used soft socket liner

Thermoformable: meaning that it can be heated and formed over
the plaster cast

Easily adjusted by adding additional material when the residual
limb shrinks
http://www.amputee-coalition.org/inmotion/nov_dec_98/primer.html
http://www.oandplibrary.org/alp/chap04-01.asp
+
Pricing of Prosthetics

A lower extremity prosthesis (leg) can range in cost from
$5,000.00 to $50,000

An upper extremity device (arm) can range from $3,000.00 to
$30,000.

Need to be replaced every 3-5 years
+
Health Insurance?

K0 (Level 0) - Does not have the ability or potential to ambulate or transfer safely with
or without assistance, and a prosthesis does not enhance the quality of life or mobility.

K1 (Level 1) - Has the ability or potential to use a prosthesis for transfers or ambulation
on level surfaces at fixed cadence — typical of the limited and unlimited household
walker.

K2 (Level 2) - Has the ability or potential for ambulation with the ability to traverse lowlevel environmental barriers such as curbs, stairs, or uneven surfaces — typical of the
limited community walker.

K3 (Level 3) - Has the ability or potential for walking with variable cadence — typical
of the community walker who is able to traverse most environmental barriers and may
have vocational, therapeutic or exercise activity that demands prosthetic use beyond
simple walking.

K4 (Level 4) - Has the ability or potential for prosthetic use that exceeds basic walking
skills, exhibiting high impact, stress or energy levels — typical of the prosthetic
demands of the child, active adult, or athlete.
+
The Fitting Process

Prepatory prosthesis (temporary)

Definitive prosthesis
1. Casting the residual limb so a custom socket can be made.
2. The cast is then used to modify and design a model that is custom to you and your
particular needs.
3. Using the design model a clear socket is formed and this clear socket is used for a
diagnostic test socket to make minor alterations. This clear socket allows the prosthetist to
see the contour, fit and alignment of the socket.
4. Once the clear test socket is fabricated then the necessary components are added,
and a foot is added to the prosthesis making it ready for the fitting.
+
Skin Breakdown

Pressure on skin causes moisture
collection

Redness, cuts, blisters, sores

Easily preventable
http://dermnetnz.org/common/image.php?path=/reactions/img/amputati
on-stump-06.jpg
+
Normal vs. Broken Down Skin
http://2.bp.blogspot.com/-7ldLZil9alI/T7jA6h1FxI/AAAAAAAAC58/B7W8QdN4_70/s1600/DSC_1007.JPG
http://dermnetnz.org/common/image.php?path=/re
actions/img/amputation-stump-02.jpg
+
Infection

Natural oils and body sweat collect

Reddening, sores, discharge of pus, tender, bad odor

Life threatening

Easily preventable
+
http://www.worldwidewounds.com/2006/september/Harker/images/FIg_
2necrosis.jpg
+
Stump Swelling

When liner isn’t worn

Causing difficulty wearing prosthetic

Shrinker or elastic bandage can prevent
+
http://forum.ispo.ir/wp-content/uploads/2013/08/edema.jpg
http://www.mccleveop.com/wp-content/uploads/2013/04/StumpShrinker.png
+
Loss of Suction

Prosthetic malfunction

Stump shrinkage

Loss of weight

Sock worn
+
http://www.victoryop.com/Images/Prx/BK_Vol_VerticalNoTitl
e.jpg
+
Psychological Issues

Depression: 21% - 35%

Posttradumatic stress disorder (PTSD)

Phantom Sensation and Pain
80% - 100% non painful
46% - 90% painful
+
Robotic Prosthetics
http://blogs.indiewire.com/thompsononhollywood/the-terminator-trailersfrom-hell
+
Robotic Prosthetics make up

Biosensors

Mechanical Sensors

Controllers

Actuators
http://bioengineering.epfl.ch/labs
+
Types of Biosensors

Surface electrodes

Needle electrodes

Solid State electrode arrays
http://neurogadget.com/2014/05/12/segway-inventors-star-wars-inspiredrobotic-arm-earns-fda-approval-gives-new-hope-amputees/10276
+
Mechanical Sensors
 Pressure
Gauge’s
 Accelerometers
 Force
meters
 Gyroscopes

https://www.youtube.com/watch?v=
W_O-u9PNUMU
+
Reinnervation Surgeries

Target Muscle reinnervation (TMR)


developed by Dr. Todd Kuiken at the Rehabilitation
Institute of Chicago
Target Sensory reinnervation (TSR)
http://www.livescience.com/39951robotic-leg-thought-control.html
http://kin450-neurophysiology.wikispaces.com/Bionic+Limbs
+
Control and Actuation
•
EMG sensing
•
Control
•
Feedback
http://www.rehab.research.va.gov/jour/11/486/page
719.html
+
Current Problems

User Acceptance

Awkward Control (lack of
feedback)

Difficulty training the user

Price: Robotic Leg is about
$100,000
Solution
• Grasps preprogrammed
• Prosthetic modes that are manually
adjusted
• Bebionic “Terminator”- $11,000
http://neurogadget.com/2014/05/12/segway-inventors-starwars-inspired-robotic-arm-earns-fda-approval-gives-newhope-amputees/10276
+
Other Advancements

Bomb Disabling robots
Developed at John’s Hopkins University

equipped with with two modular prosthetic
arms
john-hopkins-bomb-disposal-robot-7.jpg

Quadriplegic uses arm which connects
directly to brain
robot-arm-upmc.jpg

BigDog

Robotic dog uses prosthetic legs to maneuver

Legged squad support system
+
Andrew Lourake
 Motocross
accident got launched 15 feet in the air
 Tibial plateau fracture led to an infection
 First
Air Force pilot with an
above-knee amputation to
return to active duty
https://www.google.com/search?q=andrew+and+the+X3+prosthetic&newwindow=1&biw=1242&bih=568&tbm=isch&source=lnms&sa=X&ei=UldcVJqEFcyAygSs9YGwCA&ved=0CAoQ_AUoAw&dpr=1.1#facrc=_&imgdii=_&imgrc=PsMkxCdghM24qM%253A%3BS3RXkavShnIwRM%3Bhtt
p%253A%252F%252Fmedia.ottobock.com%252F_web-site%252Fprosthetics%252Flower-limb%252Fx3%252Fx3_prosthetic_leg169_v2c_16_9_video_preview_one_column.jpg%3Bhttp%253A%252F%252Fwww.ottobockus.com%252Fprosthetics%252Fsuccess-stories%252Fandrew's-x3story%252F%3B960%3B540
+
Sgt. Juan Arredando
 An
Iraq veteran who lost his hand on patrol
 The
arm contains a tiny computer chip that
translates electrical signals made by the
arm’s nerves into physical movement.
 Depending
on the length of the
amputation, tarms like this can cost
from $60,000 to $15,000
http://usatoday30.usatoday.com/tech/news/techinnovations/2007-07-19-bionic-hand-amputee_N.htm
+
Kristen Shineberger

Ewing's Sarcoma: a rare disease in
which cancer cells are found in the
bone or in soft tissue

On September 11, 2012, Kristen’s leg
was amputated.

As she grows, she needs to continually buy a bigger
prosthetic leg.
 The money that is raised for her goes to this cause
http://www.youtube.com/watch?v=K3q_Se8d45k
k0.pinimg.com%252F236x%252Faf%252F29%252F05%252Faf2905aa6acbe7bda4649a6c915afa1e.jpg%3Bhttp%253A%252F%252Fwww.pinterest.com%252Ftkimf%252Fseriousf
un%252F%3B236%3B354
+
Cieran Kelso

Lost both his legs below the knee as a result of meningitis as
a baby

At age 8 his biggest concern was that he could swim with his
friends, so his parents raised £1,000 to create prosthetic
flippers for him
http://www.dailymail.co.uk/health/article-2288914/Brave-boy-lost-legs-meningitis-swim-friendsthanks-amazing-custom-legs-fitted-FLIPPERS.html
+
Winter


She was found stranded in Mosquito Lagoon (Florida),
tangled in a crab trap line
missing her entire tail fluke and joint


Tail flukes are the powerhouse of the dolphin and are attached to
the peduncle, the muscular part of the dolphin
When she’s not wearing the tail she swims by propelling her
body forward in a side to side motion. But when the
prosthetic is on, she swims with the up and down motion that
is normal for dolphins.
+
Winter

She was fitted for a plastic stretchy sleeve. When the sleeve is
in place, we can put the prosthetic on top of it and attach the
fluke to her peduncle.

Winter weighed just
over 270 pounds and
had tried over 50 tails.
In general, adult
bottlenose dolphins can
weigh up to about
1,400 pounds.
https://www.youtube.com/watch?v=qXZMYs-Q3RI
+
Learning Objectives

The significance of prosthetics in war

The materials used for each part of a prosthetic

The fitting process

Issues that can occur with prosthetics

The general makeup of robotic prosthetics