PD-3-03-01
New Surgeries, New Technologies, New Thinking: Another Sauerbruch
Dudley S. Childress, Richard F. Weir & Craig W. Heckathorne (Northwerstern Univ, Chicago, IL USA)
Tunnel cineplasty was introduced in Italy around 1900 but it was Ernst-Ferdinand Sauerbruch, who developed the concept into a practical method for the control of arm prostheses. In many ways Sauerbruch was a progenitor of interdisciplinary activities in rehabilitation. Speaking in 1916 about his successful collaboration with physiologists, and with Aurel Stodola, a professor of engineering, he said, "Henceforth, surgeon, physiologist, and technician (engineer) will have to work to together." This control approach, modified by Lebsche and brought to the USA after World War II was used successfully by many American veterans but was discontinued in the 1970s. Many users believe the procedure provides exceptional control. We have determined through engineering tests that user's control is at least as good as body-powered methods. We believe direct muscle control may be a practical way to achieve natural multi-functional control of multi-finger hand prostheses. To achieve this goal we need surgeons, working together with engineers and prosthetists, to apply new surgical techniques to bring about direct muscle control in completely new ways (e.g. musculo-dermal-cineplasties) that are effective, practical, and have a nice appearance. We need a new Sauerbruch and a new Stodola to design and demonstrate how today's new surgical approaches can be combined with our modern control technologies. Results using Beasley's tendon-exteriorization approach are demonstrated. Utilization with direct skeletal attachment appears feasible.
PD-3-03-02
UPPER LIMB AMPUTEE REHABILITATION BODY VS EXTERNAL POWER PROSTHESES.
A, Esquenazi. MD MossRehab Hospital and Temple University School of Medicine Philadelphia PA 19141 USA
Abstract: Simple hooks or stuffed leader gloves were commonly available for the prosthetic restoration of the upper limb amputee. Over the years efforts were made to make moving hands to provide improved function. The use of body powered prosthesis with hand or hook terminal device (TD), was intensified after the 2nd World War. Its relative simplicity, lower cost, durability and ease of use promoted their use. During the 1960's and 70's new techniques for improved prosthetic restoration were sought. The use of external power sources, such as compressed gas and battery power became available. Work on switches and sensors lead to the development of myoelectric control systems. These external powered devices utilize battery technology and multi-function pattern-recognition myoelectric, proportional controls. In addition improved suspension techniques and external power sources allowed the fitting of patients with more proximal amputation. These two prosthetic restoration approaches have significant differences. Not only those related to cost, durability, maintenance, weight, speed of action, TD force and cosmesis. But also the very different control strategy used and their potential effect on the physiological use of the residual limb and the sensory-motor cortex. These differences have become major points of controversy in the field of amputee rehabilitation. This presentation will discuss the differences in the control mechanisms, and review and compare their effects on patient selection.
