A growing evaluation of an improved upper and bottom extremities prosthesis has emerged due to the global prevalence of amputation. Current prosthetics are frequently inconvenient to use and control and they only give limited functional restoration. In addition, the inability to normalise anthropometric biomechanics with a prosthetic raises the risk of long-term health problems like osteoarthritis, skin damage and body pain. Recent advancements in bionic prosthesis creation hold a lot of promise for limb loss rehabilitation including improving quality of life. The present state of sophisticated prostheses, the incorporation of robotic systems in the treatment of people who have had significant limb amputations, and several novel surgical methods that are being tested for clinical practicality are all discussed in this brief review.
In 2005, there were about 1.6 million people in the USA who had lost limbs and the figure is expected nearly triple by 2050 (Zhou, 2020). Diabetes, peripheral arterial disease, injury and bone-joint cancer are all common reasons. As of May 2014, 1,645 US army personnel had major limb amputations as a consequence of combat injuries, with many losing more than one limb. Physical limitations requiring the use of prostheses or orthotic are projected to affect about 0.5% of the population in developing countries (Zhang, 2020). The impact on global health and wellbeing for people who are disabled as they age is critical to consider, and it emphasises the need for enhanced prosthetic development.
Development of artificial Limbs
Artificial limbs have become more pleasant, efficient and lifelike in recent years as a result of technological advancements. A combination of three major elements, such as amputee demands, surgical and engineering improvements and enough healthcare resources to support the formulation and deployment of technological solutions, are expected to impact future achievements. Amputee demand has fuelled significant advancements in prosthetic technology during the last two decades. Patients with a mid-calf prosthesis who would otherwise be healthy ought to be able to fulfil all of their normal responsibilities, walk without a visible limp and engage in leisure and recreational activities. The single critical angle that no prosthesis surgery can deny that the level of contact made between the left behind limb and artificial connection are always necessary. Socket, which is the portion of the prosthetics that secures the artificial limb over the remaining parts of the limbs, has an impact on the amputee’s maximal comfort.
People who were lacking organs previously had incredible difficulty moving from one location to another. They mostly used peg legs or walking crutches, which were made of wood. Metal springs and tendons are deployed to replicate the action of physiological joints, allowing for flexible motion of the specific body part (Yang, 2020). This development allowed many patients to move more regularly than with prior wooden devices, allowing them to enjoy more active lifestyles. Furthermore, other researches show that with the help of an artificial laboratory-made device, people gained the bravery to compete in physical competitions such as marathons. Since then, the gadget has been under ongoing development to make it more realistic and to mimic the precise and full range of limb functions.
Prosthetic doctors and researchers all around the world have achieved substantial breakthroughs in materials and design since the 1980s, greatly improving the connection with the socket (Mao, 2020). Silicone elastomer is now commonly used to provide elastomeric liner from inside that acts as a comfortable and flexible barrier between the amputee’s epidermal as well as the stiff (Ren, 2020), poundage components of the orthosis. These sockets liners are usually attached within the sockets through a mechanism known as a “shuttle” lock and provide assistance for the bionic arm. The amputee simply detaches the lining from the receptacles and removes the artificial limb by pressing a secret button. Researchers recently developed a series of thicker gel plastics that give more cushion and pressure absorbance while retaining the benefits of the original liners. The same gel padding technique has been used in bicycle leather seats and other non-prosthetic applications.
Uses of the Artificial limbs
The physical structures and shapes differ from one person to the next. As a result, there is no such thing as universal prostheses, which is a one-size-fits-all device that can be used by anyone. The main goal of customising this prosthesis is to make them fit and seem as natural as possible in the patient’s body. Before the amputation procedure, exact dimensions of the individuals are collected in order to offer the finest possible concord of all of the patient’s bodily parts. Artificial limbs are a laboratory-made device that duplicates the exact movement of human limbs. Initially, the limbs were used to provide support to patients and assist them in transferring from one location to another, but they were not advanced enough to be moved willingly by the user.
Types of artificial Limbs
In the 1960s, the term “bionics” was coined. It combines the word ‘bio’ which means life, with the suffix ‘nics’ meaning electronics (Shan, 2020). Bionics is the study of machine elements that operate as a living organism. In prosthetic surgery, a constant transformation from the remaining artificial limbs to the use of bionics aligning with robotic is now observed. It is able to locate inclinations in the formation of cost effective prosthetic limbs and cheap components, as well as the development of more costly prosthetic limbs, but the next propensity is obligated to bigger issues existing for a technology landscape. As a result of the work done and its applicability is discovered in the context of healthcare and game devices (Han, 2020). It is worth noting that the gaming sphere for kids was picked in consideration of market size as well as the necessity to keep product costs low. The cornerstone is a neural network-based sensing technology for electro-myographic activity gestures. Data is handled and transmitted to the processor via an electric circuit; a gripper is recognised via a neural network; further data can be transferred for regulation of any electrical gadget with the set of specialized tools within the executive mechanism.
As previously stated, the researcher is aiming to develop a technology-proof bionic limb that will outperform all prosthetic arms in terms of functionality and will also outperform foreign bionic prosthetic arms in terms of functionality by factory output. Due to a significant cost reduction in comparison to foreign bionic prosthetic limbs, the LLC “Bionic Natali” company is faced with the problem of making him available to the majority of crippled individuals (Attallah, 2020). For the record, the project’s know-how also includes the creation of a comprehensive method for reading on an enormous amount of body energy, which is wireless and built on neural network models and other algorithms. The cornerstone is the technical medium for recognising electro-myographic activity gestures using a network on neural with an analogue of the limb (Abougharbia, 2020). A bracelet is worn by a disabled person on his or her hand or a stump and additional non – invasive electrodes eliminate possible differences in neuromuscular activity. Data is handled and transmitted to the processor via an electric circuit, where a neural network recognises a gripper or a knee movement and practitioners can get additional information received from that sound from the prosthetic component.
The effectiveness of alternative socket designs and their effects on the overall prosthetic biomechanics can be evaluated quantitatively using biomechanical analysis. Energy expenditure, motion range, velocity, rhythm, step length, stride width, proportion of swing and posture are some of the variables that are being analysed in this study. At peak performance, the VO2 and VCO2 parameters can be used to determine the amount of energy used in relation to the amount of oxygen consumed per minute per kilogramme of body weight (Tamazin, 2020). Kinematic information can be obtained via motion capture technologies. Structure and standardisation are implied, but not explicitly stated as the researcher got a tight schedule of completion. As a result, the appraisal of daily activities is extremely under-investigated. The amputation may pose biomechanical problems, but a custom-made socket can alleviate those problems. As a result, the placement of the prosthetic and its suspension system are other factors to consider. Can raise the metabolic cost, incorrectly activate tissues, and finally reduce the symmetry of the gait if the prosthesis components are insufficient.
Figure 1: Cushioning Sleeve
(Source: Yang, 2018)
In order to gain a commendable apt on the know-how of prosthetic ankle-foot devices, a surgeon must work mechanically and biomechanically, numerous studies have been conducted. In order to ensure stability, prosthetic feet must be able to provide an acceptable knee flexion moment in the early gait cycle, as well as provide propulsion for the contra-lateral limb during forward locomotion. High torque can be obtained by using components with variable stiffness and an efficient power return which pays close attention to alignment difficulties (Nasser, 2020). This study has shown that dynamic foot systems that store and release power during walking reduce user calorie expenditure and enhance gait, albeit somewhat. Researcher has focused on incorporating active components into prosthetic feet in order to better imitate the natural movement of the ankle and foot. It is still limited in use because of their weight, mass and mental exertion while use. Developing control algorithms that can guarantee high reliability while minimising mental effort is the most important task in this context.
Uses for a Bionic Limb
These limbs, as previously said, rely on the muscle signal to function. For instance, after a user places on their legs, which attach to the adjunction muscle tissue, the muscles are flexed either above or beneath the limb where it was attached. Muscle relaxation as well as contractions is detected by the device’s sensor (Vonsevych, 2019). The bionic will receive the signal to flex the arm if the person wearing the arm flexes the muscles in order to prolong the arm to grab something. The identification of these muscular signals is a little more sophisticated and necessitates the use of a technology, such as a computer.
Figure 2: A pair of Bionic limbs
(Source: Wu, 2018)
Within, computers and sensors are inserted in order to give prompt and better action. If an individual with prosthetic arms thinks to stretch his or her legs, the prosthetic legs will be alerted and react by making a reaction and extending the leg. According to an empirical study, the advanced bionic limb technologies have provided prosthesis users with the greatest freedom of movement (Goethel, 2019). Individual adaptation also influences the speed with which actions are taken. For example, a faster tension reflex results in faster limb movement, whereas a slower tension reflex results in gentler movements. These can also be worn and removed depending on the patient’s needs.
Skeletal Attachments of artificial Limbs
Per Branemark, a Swedish specialist who developed a surgical approach to firmly implant prosthetic teeth in the jaw several decades ago (Makin, 2018), surprised the dental industry. Despite considerable protests at the time regarding the inefficiency of such efforts, his techniques are now widely acknowledged as a standard approach of dental restoration around the world. The stump, as a dynamic organ, begins to shrink (atrophy) with time, yet it can also inflate in response to heat or weight gain, causing chafing (Culham, 2018). Such volume variations have no effect on the prosthetic fit with osseointegration. The disadvantage of this procedure is that it necessitates two surgeries to secure the titanium implantation to the bone.
Figure 3: Skeletal attachment
(Source: Wang, 2018)
The treatment entails the danger of osteomyelitis or infections near the implant’s abutment, thus patients must maintain rigorous personal hygiene (Johansen-Berg, 2018). On a practical level, the average Westerner with a lower leg amputation, who are elderly and has bad circulation, is unlikely to be a match for such a complicated surgical treatment. This approach has the most potential for a subset of younger people who have had traumatic amputations. It is not practical to conduct comparative testing of the procedure.
Impact on the Patients
In preparation for utilising the prosthetic limb, amputees should undergo pre-prosthetic workouts to assist maintain ROM and build strength and endurance in the lumbar spine and remaining limb (Beckmann, 2018). To help manage the trunk and relieve back discomfort, abdominal muscles exercises could be explored. Prosthetic gait abnormalities can be prevented with pre-prosthetic limb training. Because of the amputation, the amputee’s centre of gravity will naturally move to the non-prosthetic side’s foot. After a surgery, the amputee will be without a prosthetic for a period of time. This is owing to the length of time required to complete the assessments necessary to determine whether or not the supply of a limbs is appropriate.
During this time, the amputee will develop accustomed to the shifted centre, making realignment of the centre of mass more difficult after they obtain a prosthetic limb. In order to assist both research and practice, the authors of a critical appraisal study looked at 18 publications to assess the information on gait training therapies in individuals with lower limb amputations. They discovered that gait retraining is required to address asymmetry, biomechanics, and subsequent effects following an amputation. The study looked at both interurban and treadmill-based rehabilitation. Over-grounded exercise with verbal, mechanical or cognitive awareness interventions, as well as treadmill-based training as a complement to over-ground, like a residential workout or on its own visual cues or body weight support, were found to be beneficial in improving gait (Slater, 2018). The exercises below can be utilised for individuals who have had a transtibial or transfemoral amputation, and should be modified as needed depending on the component.
Artificial Limb’s use and functionality are life-saving, getting acclimated to these devices is difficult. Because various people have varied skin and tissue types, the gadgets may have different levels of resistance. The amount of sweating differs from person to person, and persons who suffer from hyperhidrosis may have trouble fitting prosthetic devices. Apart from that, they can incline to skin invasion where the prosthetic limbs have been attached owing to the monture as well as antagonisms functioning together (Henderson, 2018). Although, all possible metrics of the patients are taken when the device is implanted, almost after a year, all of the tissues have settled and become accustomed to the device; however, during this positive change, the fit of the connector area can become hampered, necessitating special consideration once more. The agony connected with the entire procedure is excruciating. This intense pain, also known as Phantom limb agony, might operate as a negative catalyst, causing patients to avoid using the artificial device, resulting in less motion of body parts.
Figure 4: Advance prosthetic knee
(Source: Dong, 2018)
However, despite the potential advantages of activity monitoring, there are still limitations connected with their utilisation due to factors such as cost, availability, skill level and technical and cultural considerations. It is important to analyse the costs and benefits of commercial activity monitors in low-resource settings, particularly when it comes to widespread, real time assessment. Affordability issues may arise, if prosthesis is equipped with embedded sensors and mobile or periodic connectivity, making them unavailable to service providers and patients who need them the most In addition, those with impairments and those in low-resource situations would need easy access to information and communications technology (Duff, 2018). In low-resource settings, patients are more likely to miss follow-up appointments due to communication and transportation difficulties, as well as the inability to take an off at work. Clinics and research in low-resource areas may be particularly vulnerable to the costs associated with the loss of sensors; as of this, low-cost monitoring systems are more important than ever before.
Benefits of Artificial Limbs
While some researchers appreciate the need for robotics as a crucial medium for surgery of artificial limbs, the majority choose a lifelike and thus unnoticeable limb. External covers for both higher and lower extremity devices are made within the same silicone content that helps to socket comfort. The recent advancement is the production of a meticulously moulded match for the opposing limb, complete with distinct coloration for a genuine appearance. The cheaper production costs of such technologies may allow them to be used in underdeveloped economies where more sophisticated mechanism is prohibitively expensive (Orlov, 2018). Blatchford’s Shower Limb is a perfect illustration of this pattern. In addition, the business has created a series of plastic Atlas Prosthetic limbs that are specifically built for usage in tropical conditions. Clinically, these devices are well-received, albeit there have been occasional reports of durability issues.
Figure 5: Re-flex prosthetic shin-foot
(Source: Xing, 2018)
Only a few studies have looked into the psychological effects of wearing and using prostheses, such as the embodiment of the prosthesis, sensory preferences and community attitudes toward people with disabilities. As a result, long-term statistics on community-based activities would be beneficial, especially in regard to community involvement and isolation, which are prevalent problems among prosthesis users and have been connected to quality of life ratings. Prosthetic sockets fit for comfort, function and reduced energy usage may also be improved through community-based physical activity monitoring (Macdonald, 2018). There are no techniques to study assessed the relationship socket fit, which is a major factor in successful recovery and regaining of function and movement.
Using activity monitoring in the community to compare different populations and give doctors a more complete picture of a patient’s skills and needs than clinical measurements alone has proven to be an effective tool in the evaluation of prosthetic devices and intervention programs. For those living in low-resource situations, the authors advocate a synchronised strategy for building a framework for monitoring prosthetic use outside of the clinic which takes account daily life contexts (Van den Heiligenberg, 2018). There are many benefits to using technology to monitor prosthetic use outside of a clinical setting, including the construction of frameworks, data and evidence needed to build devices that are more suited to the demands of the user and their real-world situations. Researchers, clinicians and end-users could benefit greatly from society activity monitoring of prosthetic users, but the technology and present rehabilitation service systems are currently impeding long-term monitoring.
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