Prosthetics

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Prosthetics

 

(1) A form of medical care.

(2) A medical-engineering discipline concerned with the restoration of lost body parts and (in part) functions of individual organs in sick and disabled persons for the purposes of rehabilitation. In the narrower sense, prosthetics deals with the design, production, and use of prostheses and other orthopedic devices, such as corsets and footwear. From the social standpoint, prosthetics provides sick and disabled persons with special means of locomotion, including canes, crutches, compact wheelchairs, wheeled beds, and lever-controlled and motorized wheelchairs.

Prosthetics is a transitional discipline between medicine and engineering and is directly related to such fields as orthopedics and traumatology, plastic surgery, physiology, biomechanics, and electronics.

Although it did not take shape as an independent discipline until the 19th century, prosthetics is mentioned even in remote antiquity. The Greek historian Herodotus wrote about a certain Hegesistratus (500 B.C.), who made a wooden leg for himself and served in the Persian army. The Roman historian Pliny told of a commander who, having lost an arm during the Second Punic War (218–201 B.C.), was able to hold his shield with the aid of a specially made iron arm. On display in a Nuremberg museum is a metal arm made in 1509. In 1552, A. Paré made a leg prosthesis with a knee hinge and lock. In 1800 the Englishman D. Potts obtained a patent for a wooden leg with knee and ankle hinges; movements were regulated by rods. In the early 19th century, the Dutchman van Peeterssen invented an above-elbow prosthesis in which the fingers were contracted by a spring and extended by contraction of the muscles of the shoulder girdle on the other side of the body. In the 1870’s the French physician Gripouilleau made an attachment for a hand prosthesis for performing several tasks. Tool holders, such as a hook, ring, or clamp, were made for any point of amputation of the arm.

The development of prosthetics in Russia is associated with I. P. Kulibin, N. I. Pirogov, and others (seeORTHOPEDICS). In 1877 the Committee for Aid to Crippled Soldiers was formed to help military casualties obtain prostheses. In 1878 the Red Cross provided funds for the manufacture of prostheses. On the initiative of the orthopedists R. R. Vreden, G. I. Turner, G. A. Al’brekht, and V. A. Betekhtin, an organization plan for prostheses was worked out, and by 1916 shops in 12 cities were making fiber, plywood, leather, and gauze-gelatin prostheses. The development of prosthetics in the USSR was made possible by the creation of a good supply of materials and technical expertise, the training of skilled personnel, and the application of modern achievements in science and technology. Much of the credit belongs to N. N. Priorov, N. N. Burdenko, N. A. Bern-shtein, M. I. Sitenko, and B. P. Popov. In the USSR there are now more than 100 enterprises manufacturing prostheses, orthopedic devices, and semifinished products for prostheses. Hospitals for primary and complex prosthetics have been organized in plants that manufacture prosthetic and orthopedic devices. Mobile teams in vehicles outfitted with shops for working with prostheses serve disabled individuals living in remote sections of the country.

In the USSR, the fundamental principles governing prostheses are set forth in the Basic Principles of Health Legislation of the USSR and the Union Republics of 1972. The categories of individuals entitled to free prostheses or to prostheses at a reduced cost and the conditions and procedures for supplying the prostheses are specified in additional legislation enacted by the USSR and the Union republics. Public health agencies are responsible for supplying citizens with dental and ocular prostheses, while social security agencies provide other types. Directives issued by these agencies closely regulate procedures for supplying prosthetic and orthopedic devices, schedules for the manufacture, repair, and exchange of the devices, and warranty periods. Citizens being fitted with complex prostheses are placed in hospitals located in plants that manufacture prosthetic and orthopedic devices. Industrial workers, office workers, and members of kolkhozes are given an allowance for temporary incapacity for work while they are in the hospital (but not for more than 30 calendar days).

Interest among physiologists, particularly specialists in biomechanics, has led to a deeper study of the motor functions of disabled persons in relation to the movements of healthy individuals; this has given rise to new requirements in the construction of prostheses. Various materials have been approved for use in modern prosthetic devices. New approaches to research, such as biomechanical and physiological methods, are used to study individuals who wear prostheses. Soviet scientists were the first to devise and introduce artificial arms with bioelectric control. For children wearing prostheses, N. A. Shenk has proposed rigid sleeves that can be lengthened as the patient grows. L. M. Voskoboinikova has constructed prostheses for abnormally developed extremities, and A. N. Vitkovskaia has designed prostheses for young children. Important advances have been made in the clinical aspects of prosthetics. These include studies of the levels at which extremities should be amputated and methods for doing so, determination of the causes and prevention of diseases and defects of the stump, the introduction of a method of fitting a prosthesis directly on the operating table, and the identification of problems encountered by children who wear prostheses after amputations and by children suffering from anomalies in development of the extremities.

Achievements in prosthetics in the USSR are reported in the journal Ortopediia, travmatologiia iprotezirovanie (Orthopedics, Traumatology, and Prosthetics, since 1955) and in Protezirovanie i protezostroenie (Prosthetics and Prosthesis Construction), a collection of the works of the Central Scientific Research Institute of Prosthetics and Prosthesis Construction (founded 1948). The principal foreign publications are Bulletin JSPO (since 1972, Copenhagen), Orthotics and Prosthetics (1947, Washington, D.C.), Bulletin of Prosthetics Research (1964, New York), Orthopädie Technik (1949, Wiesbaden), and Orthopädie Technische Informationen (1969, Berlin). International organizations include the International Association of Orthotists and Prosthetists (INTERBOR, founded 1958) and the International Society for Prosthetics and Orthotics (ISPO, founded 1970).

REFERENCES

Kopylov, F. A., V. A. Betekhtin, and M. S. Pevzner. Meditsinskie osnovy protezirovaniia. [Leningrad] 1956.
Popov, B. P. “Protezirovanie.” In Mnogotomnoe rukovodstvopo ortopedii i travmatologii, vol. 1. Moscow, 1967.
Protezirovanie i protezostroenie: Sb. trudov, fasc. 25. Moscow, 1971.

N. I. KONDRASHIN and V. G. SANIN

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