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Prosthetics · Living Loud and Proud: Disability Conversations

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Welcome to the Living Loud and Proud podcast,
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brought to you by Disability Pride Pennsylvania.
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If you need a link to the transcript for this
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episode, please visit our accessible website
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at www.disabilitypridepa.org/podcast.
00:00:23.120 --> 00:00:28.859 And now, here is your host. Hey folks! Welcome
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to Season 2, Episode 3 of the Living Loud and
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Proud podcast. Today's topic is centered around
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the development of prosthetic limbs from ancient
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times to now. I'm your host and producer, Phill
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Rosen, today, and I'm joined once more by my
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co -producer, Ray 'DECA' Horton. Ray, how's it going?
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Hello, folks. How's everybody doing today? I'm
00:00:49.479 --> 00:00:52.619 doing great, Phill. Oh, that's awesome. So to
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get started here, I want to preface this by saying
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that this is distilled from my research into
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this topic. This is a very broad topic. And I
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cannot give a full history here in one 30 to
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60 minute episode. And I'm honestly no expert
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in any of this. So please take all of this with
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a grain of salt. But I think for the purposes
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of our podcast and like learning about the history
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and some of the people who have developed these.
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devices over time, this is going to be really
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fascinating and interesting. So without further
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ado, oh, let's press on and learn a little bit
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more about the history of prosthetic limbs throughout
00:01:34.780 --> 00:01:38.680 history. Are you ready, Ray? Yeah. All right.
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So the first like historical record of prosthetics,
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like any mention of them. originate from the
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ancient Near East, circa 3000 BCE. Now, when
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I refer to the ancient Near East, you know, we're
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talking Iran, Mesopotamia, Egypt, Anatolia, the
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Armenian highlands, Levant, and the Arabian Peninsula,
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basically the Middle East and Northern Africa.
00:02:03.140 --> 00:02:08.139 Right, got it. So the earliest evidence or earliest
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record are from ancient Egypt and Iran. Specifically,
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the Eye of Horus story from ancient Egyptian
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mythology is one of the earliest recorded mentions
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of eye prostheses. That's circa 3000 BCE or so.
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And in this story, real quick, it's just the
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left eye of Horus was plucked out and restored
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by Thoth. Or Thoth. I'm not sure how to pronounce
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that. I'm so sorry to any ancient Egyptian scholars
00:02:39.080 --> 00:02:43.099 out there. Oh, there's, trust me, it's almost
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subjective, depending on who you're talking to.
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But, wait, so are we saying that there might
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have been actual glass eyes going on as far back
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as 3000 BCE? Or just a thought or referencing
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of, you know, eventually someday doing something
00:03:01.060 --> 00:03:03.599 like this? So there's no, like, archaeological
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evidence in ancient Egypt that I found record
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of in my research, but... I have a feeling that
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they probably had access to, like, maybe, you
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know, enameled metal or wood, something like
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that. And they would probably fashion these....
00:03:24.750 --> 00:03:27.810 They probably did it with some of the mummies. Oh,
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yeah. Oh, for sure. I'm sure they did. So, you
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know, they did have, like, some ability to at
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least think about this and probably. did actually
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practice this but we don't have any evidence
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of anything physical okay the earliest archaeological
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evidence was from ancient Iran circa 3000
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to 2800 BCE so this is still you know what five
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thousand years ago at this point a crazy long
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time ago and it was an eye prosthetic that
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was buried with a woman in Shahr-i Sukhteh likely
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made of bitumen paste covered with a thin layer
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of gold. I assume the bitumen paste probably
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deteriorated to a point that they were unable
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to, you know, find it. But there was gold in
00:04:21.259 --> 00:04:26.079 the eye socket, I guess. Got it. So, you know,
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really fascinating stuff. Egyptians were pioneers
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of, like, foot prostheses. There was a mummy.
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that was found that had a toe made from wood
00:04:37.250 --> 00:04:40.509 and leather. Wow. In the New Kingdom, that's
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circa 1000 BCE or so. It has been reproduced
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by biomechanical engineers in 2011. And it was
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found to allow both the use of sandals and walking
00:04:52.930 --> 00:04:58.029 barefoot in ancient Egypt. Oh, wow. Yeah. Really,
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really interesting. And then the oldest discovered
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prosthetic limb was an artificial leg from a
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grave found in Capua circa 300 BCE so like this
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is like you know ancient Rome or the Etruscans
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somewhere around that probably ancient Rome actually
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the Etruscans were a little bit earlier and
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then there's no sign of an artificial foot
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but there's some speculation that it was made
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out of like say gold or silver or some other
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like precious metal at the time and it probably
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got stolen by grave robbers or taken off the
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body whoever was digging the grave now the original
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limb was destroyed in World War II during a German
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air raid of London that destroyed The Royal
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College of Surgeons in London it was housed right
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there. And unfortunately, the blitzkrieg and the
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air raids was really destructive and horrible.
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The Nazis weren't stealing it, they were blowing
00:06:11.759 --> 00:06:18.980 it up. Right, exactly. And then I want to kind
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of jump back a little bit in time to go to South
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Asia for a moment, India. And circa 1200 BCE,
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the Rigveda mentions Vishpala. Now the Rigveda
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is a Sanskrit hymnal. Like it's a collection
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of poems and like mythologies. Got it. And Vishpala
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in this text lost her leg "in the time of night
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in Khela's battle", or there's an alternate translation
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of "in Khela's race, eager for a decision, they..."
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which is referring to the Ashvins, who were the
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Hindu twin gods associated with medicine, health,
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dawn, and the sciences, "gave her a leg of iron
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so she could keep running." Now, the reason why
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I mentioned the two different translations is
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because Ralph Griffith interpreted it as a female
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warrior in battle. And then later, Karl Friedrich
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Geldner interpreted the horse race instead of
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the battle. There's not really any additional
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information that survived about the characters
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or events mentioned as typical of many of the
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poems and hymns in the Rigveda. So, you know,
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all we have is just this mention of it and that's
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it. But I thought that was an interesting thing
00:07:46.430 --> 00:07:49.040 to kind of put in there. Yeah, there'll be a
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Netflix anime with Bollywood that'll come out
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probably in the next few years. So we don't have
00:07:54.079 --> 00:07:55.779 to worry about it. Are we sure it hasn't already
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happened? I'm not a huge fan of Bollywood movies
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myself. So let's move on to ancient Rome. And
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we're going to really just quick talk about dental
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implants and dental prostheses. So there were
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bronze crowns that have been found from ancient
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Rome. There's some debate as to whether they
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were aesthetic or if they were like medically
00:08:22.350 --> 00:08:28.470 necessary crowns. Got it. You know. Right. Ancient
00:08:28.470 --> 00:08:31.470 Rome equivalents of having a grill. Basically.
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Yeah. They were likely attached to the tooth
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using a paste that contained phosphorus, carbon
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and calcium. And the reason we know that is because
00:08:39.950 --> 00:08:44.169 these crowns were covered in this paste. Right.
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So. that leads us to believe that. And then,
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there's also a mention in The Histories.
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This is ancient Greece, by the way, 430 BCE by
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Herodotus that mentions Hegesistratus, a Greek diviner for Mardonius
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during the Greco-Persian wars. Now, Hegesistratus
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was, originally an Elean, he had been captured
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by the Spartans and bound, you know, basically
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kept as a prisoner of war, right? And he escaped
00:09:28.070 --> 00:09:32.610 by cutting off his own foot. Oh, okay. And he
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later replaced it with a wooden foot. Later,
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he got captured and executed by the Spartans.
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So his life did not end well, you know, but again,
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this was ancient Greece. There was a lot of war.
00:09:46.679 --> 00:09:49.600 on the Aegean peninsula at the time. Right. You
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know, so, and all around the Peloponnesian sea,
00:09:53.059 --> 00:09:59.399 honestly, but, or Aegean. So. Roman Empire version
00:09:59.399 --> 00:10:04.200 of Saw. Basically, well, Greek, but anyways.
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And now we, I want to kind of talk a little bit
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more about like the development of wooden and
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metal prosthetics. So we're going to go back
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to ancient Rome. And we're going to talk about
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the Second Punic War. So Marcus Sergius Silus
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fought in the Second Punic War. This was a war
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that lasted between 218 to 201 BCE. Anybody who
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knows about Hannibal and the Alps, this is that
00:10:33.070 --> 00:10:35.789 war. This is the one with the elephants and everything.
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Yes, they're crossing the Alps in the winter.
00:10:38.470 --> 00:10:44.690 Okay. And I'm going to read a little. Quick passage
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from Pliny the Elder in Natural History, published
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in AD 77. "Nobody, at least in my opinion, can
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rightly rank any man above Marcus Sergius, although
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his great grandson, Catiline, shames his name.
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In his second campaign, Sergius lost his right
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hand. Although disabled, Sergius served in many
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subsequent campaigns....He had a hand made of iron
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for him, and going into battle with his bound
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to his arm, raised the siege of Cremona, saved
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Placentia, and captured 12 enemy camps in Gaul,
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all of which exploits were confirmed by the speech
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he made as Praetor when his colleagues tried
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to debar him as infirm from the sacrifices. There's
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more discussion of his exploits in battle. as
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well as his imprisonment by Hannibal for 20 months.
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But, you know, not really relevant to what we're
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talking about here today, but interesting guy.
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If you want to learn more about, you know, the
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Punic Wars, fascinating read, you should do it.
00:11:48.289 --> 00:11:53.129 Right. And now we're going to kind of jump into
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the sixth and eighth or sixth to eighth century
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AD. So there was an Italian man who was found.
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There was a skeleton found with a knife in a
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Longobard cemetery in Povegliano Veronese. Man,
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I am butchering all these names, I'm sure. This
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man was estimated to have lived in the 6th or
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8th century, somewhere in that region A .D. And
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he had an amputated hand and he replaced it with
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a knife. And materials suggested that the knife
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was a replacement for his right hand, attached
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with a leather strap that he tightened with his
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teeth many times. So there was a lot of bite
00:12:41.840 --> 00:12:46.679 marks in the leather. Right. Okay. Got it. And
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now we're going to move forward several centuries
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to Götz von Berlichingen. But in 1504, during the
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War of the Succession of Landshut, Burlichingen
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lost his right arm at the wrist when cannon fire
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forced his sword against him. What I interpret
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that to mean is his sword basically was cut off
00:13:10.460 --> 00:13:17.279 his hand. Yeah, yeah, yeah. So there were two
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mechanical iron hands that were made for him.
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One was made by a local blacksmith. And it was
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like a very, very simple. Like, you know, just
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enough to like kind of grasp a couple of things
00:13:28.840 --> 00:13:31.879 here and there. Not too much articulation. Right.
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And then there was a second that was capable
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of holding a shield of reins. I believe this
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one was made for him by a mechanic in his army.
00:13:40.980 --> 00:13:44.399 Okay. And he continued his military exploits
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after losing his hand until 1544. And then he
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died in relative peace in 1544. In the 1560s,
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I don't have the actual date at 81 or 82 in Hornburg
00:13:58.039 --> 00:14:01.220 Castle. Okay. Now, are we to understand that
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this was somebody back in the 1500s that lived
00:14:04.720 --> 00:14:12.460 to age 81 or 82? Yes. Man. I mean, he was a noble,
00:14:12.620 --> 00:14:18.340 right? He was a knight. He still lived long even
00:14:18.340 --> 00:14:22.470 for them. I understand, but if you get past the
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diseases and you're relatively wealthy and well
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taken care of, you're going to live pretty long
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regardless. But yeah, so he's a really, really
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interesting figure. He was a mercenary too, so
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he would pick and choose battles based on what
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lords wanted his favor or needed his services.
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Now we're going to move on to a couple of Frenchmen.
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François de la Noue, who was nicknamed 'Bras-de-
00:14:56.960 --> 00:15:03.039 Fer, which means iron arm. All right. Yeah. He
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was a Huguenot captain injured at the siege of
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Fontenay in 1570 by a bullet that shattered his
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arm. The arm was amputated later. And a mechanic
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of La Rochelle, his army. made him an artificial
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iron arm with a hook for holding his reins. And
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then we're going to also talk about Henri de
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Tonti, who is nicknamed Main-de-Fer, Iron Hand.
00:15:30.990 --> 00:15:34.509 Okay. He was a captain lieutenant of the Matre
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de Camp in Messina, losing his hand in a grenade
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explosion, later replacing it with a metal hook
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covered by a glove. Interesting little tidbit
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about him. He was tasked with exploring North
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America by the French government. And he did
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it with René-Robert Cavalier, Sieur de La Salle,
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who was supposedly reported to have an iron hand.
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But, you know, outside of the Wikipedia page
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that I found that on, I could not find any evidence
00:16:13.440 --> 00:16:18.200 of it. Okay. He did not have any injuries requiring
00:16:18.200 --> 00:16:22.240 the use of prosthetics, I guess. Got it. Also,
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fun fact about Rene-Robert Cavalier is the La Salle
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Explorers are named after Robert Cavalier, despite
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the university being named after a Jesuit Priest
00:16:35.360 --> 00:16:38.220 That's pretty cool. Fun fact about
00:16:38.220 --> 00:16:44.509 Philly institutions. Well, that worked out in
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favor. And, you know, I mean, come on. I mean,
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dude, I mean, these guys had superhero names
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back before they existed. So that makes it even
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better for, you know, the explorers, you know.
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"Hey, we were named after the first superheroes,
00:16:58.889 --> 00:17:03.929 all right?" I do want to mention that, you know,
00:17:03.950 --> 00:17:09.720 these men all had hook hands. Right. I just want
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to mention, because there might be some people
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out there thinking about Captain Hook. I certainly
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was when I was researching this. Not commonly
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attributed to inspiring J .M. Barrie with the
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character of Captain Hook. But when I did research
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this, I did find a portrait of Henri included
00:17:28.240 --> 00:17:32.400 in a blog post about this. So maybe. Yeah, yeah,
00:17:32.460 --> 00:17:35.700 yeah, definitely. There's a lot of references
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to Captain Cooks in J .M. Barrie's. discussions
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of the play that he wrote. So, you know, I presume
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he was probably more inspired by British people,
00:17:49.750 --> 00:17:53.490 but you never know. But that leads right into,
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you know, basically like what the next point
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that you were getting ready to point out, you
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know, how most of these prosthetics, well, they
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were built for holding weapons, shields, and,
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you know, well, in your notes, it's talking about
00:18:11.000 --> 00:18:13.759 shields or stabilizing mounted warriors. Yeah,
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like you said, the reins of the... As you were
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mentioning to guys earlier, I'm like, "hey, everybody
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made sure they still were riding their horses.'
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Well, I mean, you know, horses were a very important
00:18:25.559 --> 00:18:27.579 part of battle. Yeah, I mean, yeah, you know.
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So, of course. And, you know, I mean, they had,
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you know, legs that would, you know, connect
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to the saddles as well for those who needed it.
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And only the wealthy could really afford functional
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prosthetics that have like real articulable like
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fingers and other joints that really are useful
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in daily life. But all of these first appeared
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in the 1500s. So, you know, at least in terms
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of the more modern articulable ones. And then
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we're going to kind of move on to like some of
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the other pre-20th century ones. I don't have
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dates for these listed in my notes here, but
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only because it just would take too long to talk
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about all of them. So there was an Italian surgeon
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who recorded the existence of an amputee with
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a functional prosthetic. The arm that he mentioned
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in his notes allowed the man to remove his hat,
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open his purse and sign his name. All things
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that were very important at the time. You know,
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for anyone in Renaissance, like this was early
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Renaissance Italy at that point. So, you know,
19:39
those are all important things to do. And then
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there were improvements in amputation surgery
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and prosthetic design that came from French barber
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surgeon Ambrose Paré during the mid 16th century.
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This guy's fascinating, by the way. He's kind
00:19:57.829 --> 00:20:02.029 of like a mad scientist surgeon almost. Oh, my
00:20:02.029 --> 00:20:06.269 favorite. Well, he actually had all sorts of
20:06
different things that had nothing to do with
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the amputations as well. He came up with certain
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things that had to do with Obstetrics and Gynecology.
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And he was using the scientific method before
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it was really functionally talked about in science.
00:20:23.390 --> 00:20:27.119 Yeah, I got it. But he championed the move away
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from using boiling elder oil and cauterization
20:29
to clean amputation sites during surgery to using
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a mixture of egg yolk, oil of roses and turpentine
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left overnight on the wound. And this was because
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turpentine has properties that allow the wound
20:48
to stay cleaner, whereas the boiling oil and
20:51
cauterization. would often lead to shock in the
00:20:56.529 --> 00:21:01.109 patients. Got it. And he reintroduced the ligature
21:01
of arteries in place of cauterization. So I guess
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from what I was reading that like in the Middle
21:11
East there, when they would amputate limbs, they
21:15
would tie off the arteries to staunch the blood
00:21:20.450 --> 00:21:24.440 flow. Right. And we lost that during the Middle
21:24
Ages, essentially. So he created the Bec de Corbeau,
21:28
which is a crow's beak, which is a predecessor
21:30
to modern haemostats. So he documented phantom
21:37
pains in amputees. So he's like the first person
21:41
to really kind of talk about Phantom Limb Syndrome.
00:21:44.940 --> 00:21:49.759 Right. And he also developed a kneeling peg leg
21:49
and foot prosthetic. with a fixed position, adjustable
21:53
harness, and knee lock control, as well as some
21:55
ocular prostheses made from enameled gold, silver,
21:58
porcelain, and glass. So this guy was like a
22:02
crazy inventor, constantly innovating in medicine
00:22:07.150 --> 00:22:10.450 and surgery. Yeah, I see. And by the way, this
22:10
was all in the 16th and 17th century. So a long
22:17
time ago, long before we even think about modern
00:22:20.210 --> 00:22:22.539 medicine. in a lot of ways. And he helped pimp
22:22
out pirates too, evidently. Because, you know,
22:27
I mean, now we're finally hearing about the peg
00:22:29.359 --> 00:22:36.240 leg. Exactly. So other major improvements pre
22:36
20th century, and I'm just going to go bullet
22:39
point on this. Peter Verduyn created the first
22:42
non-locking below-knee prosthetic, prosthetic
00:22:45.779 --> 00:22:49.589 limb. What do you mean by non-locking? So instead
22:49
of with with regards to Paré's prosthetic, it
22:59
would have locking joints so that, you know,
00:23:02.309 --> 00:23:04.349 there would be stability in the limb. I got it.
23:04
It doesn't lock necessarily or doesn't need
00:23:08.490 --> 00:23:13.549 to lock. Right. Stability. James Potts created
23:13
a prosthesis made of a wooden shank and socket,
23:16
steel, a knee joint, and articulated foot, foot
23:20
controlled by cat gut tendons from knee to ankle.
00:23:24.609 --> 00:23:27.970 Okay. And this became known as the "Anglesey Leg"
23:27
or "Selpho Leg". Now these were pretty crude.
23:33
The tendons were actually on the outside of the
23:37
limb, which I'm sure anyone listening can understand
23:41
how that might be non-ideal for the durability
23:45
of the device. But, you know, later that got
00:23:50.849 --> 00:23:56.109 reworked by someone else. Sorry. No, I was saying,
00:23:56.130 --> 00:23:58.630 was this the one that was using cat guts? Yes.
00:23:59.470 --> 00:24:04.650 I guess dogs really love that one. You know,
24:04
it wasn't unusual at the time, too, to have cat
24:07
gut strings for stringed instruments as well.
24:09
So, you know, a little bit of music history there.
24:14
As well. Sir James Syme developed a method of
24:19
ankle amputation that did not involve amputating
24:21
at the thigh. So basically he pioneered below
00:24:28.190 --> 00:24:32.130 the knee amputations. I didn't know that was
00:24:32.130 --> 00:24:40.680 a problem. So, oh, wow. Okay. Yeah. Benjamin
24:40
Palmer improved the Selpho Leg that we just
24:43
mentioned earlier with the cat gut tendons on
24:45
the outside by adding an interior spring. So
24:48
there's a spring on the back and concealing the
24:52
tendons to simulate more natural looking movement.
24:56
This is a big deal because up until that point,
24:59
I mean, we've seen all the pirate movies with
25:01
the peg legs and they're limping around. You know,
25:05
this allows people who are using these devices.
25:08
to more easily blend in and not necessarily have
25:13
people know, "Oh, you are injured in some way."
00:25:16.309 --> 00:25:19.789 Right. Which that really helps with the stigma
25:19
that a lot of people feel when they have devices
25:22
like this. Dubois Parmlee created a prosthetic
25:29
with a suction socket, polycentric knee and multi-
25:32
articulated foot. Now the suction socket, you
25:36
know, is important because this is like the first
25:39
like real sort of change in how prosthetics were
25:44
attached to the limb and it allowed for more
00:25:46.299 --> 00:25:51.859 comfort. Okay. And the multi-articulating foot,
25:51
I don't think I need to explain that one to anyone.
25:54
It makes a more natural looking ankle movement.
00:25:56.839 --> 00:26:01.140 Right. Marcel Desoutter and Charles Desoutter
26:01
developed the first aluminum prosthesis. So this
26:03
is like the first like real reduction in weight.
00:26:07.420 --> 00:26:12.519 of a prosthetic limb. Got it. And Henry Heather
26:12
Bigg and his son, Henry Robert Heather Bigg,
26:15
were commanded by Queen Victoria to provide surgical
26:19
appliances to wounded soldiers after the Crimean
26:22
War. Now, the Crimean War was like mid-19th century.
26:29
They developed arms that allowed double arm amputees
00:26:33.440 --> 00:26:37.339 to crochet. Wow. And a hand that felt natural
26:37
to others out of ivory felt and leather among
26:40
other prosthetic limbs. And they also developed
26:44
an early mechanical treatment of limbs in the
26:46
spine. So like when we're talking about that,
26:49
think about like, you know, rods to support the
00:26:54.440 --> 00:26:57.900 spine. Right. You know, for like scoliosis or
26:57
something like that. And then like, you know,
27:01
screws and metal plates for like. other parts
27:04
of the body that you know need a little more
27:06
support yeah injury so this is like the first
27:10
real modern sort of like medical devices that
27:15
were starting to be created at that time in terms
00:27:18.029 --> 00:27:21.549 of things that get left in the body. And i always
27:21
thought the concept for these didn't come until
00:27:23.769 --> 00:27:28.529 the 20th century but here it is! Yeah no this
27:28
is very fascinating stuff that we're all talking
27:32
about here. So I couldn't really find too much
27:36
new developments until post World War II in
27:39
terms of the way in which prosthetics were attached
27:45
to the body or put together, created, manufactured.
27:49
So we're going to just jump right ahead to the
00:27:51.960 --> 00:27:55.579 1940s. And just as a footnote, it's not surprising
27:55
because looking at how all these advancements
27:57
were happening so early, In the previous millennia,
28:02
I mean, my God, we should have been well past
28:08
that. I'm noticing a trend here where it seemed
28:11
like they seemed to stop thinking about the development
00:28:16.240 --> 00:28:21.220 of it for long stretches of human history. Or
28:21
our records about it are incomplete, potentially.
28:25
Also, no pun intended on the footnote, right?
00:28:29.579 --> 00:28:35.079 Oh, wow. How about that? Okay. Anyways, the National
28:35
Academy of Sciences here in the U.S. advocated
28:41
for better research and development of prosthetics
28:43
after World War II ended, which led to the development
28:47
of a research and development program within
28:49
the Army, Navy, Air Force, and the Veterans Administration
28:53
that helped to fund improvements in prosthetic
28:56
technologies. And the Veterans Administration,
28:59
by the way, was fairly newly created at this
00:29:01.960 --> 00:29:06.599 point. Right. I believe FDR, don't quote me on
29:06
that, but I believe FDR was instrumental in the
29:10
creation of the VA. You know, obviously, any
29:15
Army historians are going to come at me with
00:29:18.460 --> 00:29:24.160 pitchforks and bayonets, if I'm wrong. But they
29:24
definitely will, you know, co-sign with you
29:28
on it it wasn't around as early as it should
00:29:33.250 --> 00:29:37.829 have been. Yeah a team at UC Berkeley including
29:37
James Foort and C.W. Radcliffe helped to develop
29:41
the quadrilateral socket which was like developing
29:44
a jig fitting system for amputations above the
29:46
knee and and just a quick note about sockets
29:51
we're not going to go in depth on sockets that
29:53
we could talk for five episodes about sockets
29:56
alone. So like, there's a lot of stuff about
30:00
this out there, but really we're just going to
30:03
talk very quickly about a few of them that are
30:05
very notable and are still used today. So this
30:09
particular socket, the quadrilateral socket is
30:15
a rectangular shape to help distribute weight
30:17
bearing across the ischial tuberosity, which
30:21
is the lower back pelvis or lower back butt bone.
00:30:25.079 --> 00:30:29.119 Got it. Okay. And the gluteal muscles, your butt.
30:30
The socket was attributed by Foort to Eberhart
30:35
and his team from Germany in 1949. Now, unfortunately,
30:38
I don't know who Eberhart is. I could not find
30:41
any record of him outside of the paper that James
00:30:44.460 --> 00:30:49.359 Foort published. Ass-tounding. So, yeah, it really
30:49
is. Another pun there, too. We got, what is that,
00:30:56.119 --> 00:30:59.880 two now? Okay, that one was intentional. Yeah.
31:01
Now, socket technology improved further in the
31:04
1980s when John Sabolich, CPO, invented the Contoured
31:10
Adducted Trochanteric-Controlled Alignment
31:14
Method. What a mouthful that is. Or the CATCAM
31:18
socket. It evolved into the Sabolich socket.
31:23
This kind of followed a direction from some previous
31:26
pioneers in socket technology, Ivan Long and
31:33
Ossur Christensen, who were developing alternatives
31:36
to the quadrilateral socket in the 1970s. And
31:40
I actually read a little bit of one of their
00:31:41.720 --> 00:31:45.799 papers from 1974 talking about this. Right. So,
31:46
you know, they were doing research from the 60s
31:49
into the 70s about this. They created an open
31:53
ended plug socket, basically, that was made
31:55
from wood that helped to better distribute the
31:58
weight evenly over the existing limb and lock
32:01
in the bony anatomy containing the muscular tissue.
32:05
So basically, this is something that helped with
32:10
things like pressure sores and comfort, as well
32:14
as allowing for better articulation of the muscles
00:32:17.339 --> 00:32:21.299 that is still there. Yeah, yeah. And better support
32:21
the bones that, you know, didn't necessarily
32:24
have the weight distribution the way that it
32:27
normally would be stay in place a little bit
32:30
more. So, and as we all know, that's huge when
00:32:36.059 --> 00:32:38.460 it comes to anything disability related. Yeah.
32:38
But especially with something like this. So.
32:44
And all of these developments, by the way, they
32:47
led to the broad adoption of ischial containment
32:50
to help better support lower limb amputees if
00:32:53.880 --> 00:32:57.880 needed. Again, supporting the butt bone. Right.
32:58
And other notable contributors to socket development
33:02
include Tim Staats, Chris Hoyt, and Frank Gottschalk.
33:07
And Gottschalk in particular disputed the efficacy
33:11
of the CATCAM socket alone. insisting that the
33:14
surgical procedure done by the amputation surgeon
33:17
was most important to prepare the amputee for
33:20
any type of socket design. So this is really
33:24
just from what I gathered here, it was just essentially
33:32
it's more comfortable based on how things are
33:37
cut. It's kind of like, you know, in the sound.
33:41
design world, garbage in, garbage out. Same concept
33:44
here. So there are several types of socket designs.
33:49
We don't really have time to talk about all of
33:51
them here in this episode today. There's so much
33:55
detail here that we could literally have an episode
33:57
on each type of socket if we wanted to, just
34:01
talking about the differences about it. So we're
34:03
just going to go real quick through the categories.
34:05
So we have the transfemoral socket, which is
34:09
above-knee. The femur, as many might understand.
34:15
The transtibial, below-knee, socket. The Syme
34:20
Socket, which that goes back to talking about
00:34:22.579 --> 00:34:30.119 James Syme. Right. The knee disarticulation prostheses,
34:30
which those are like through the knee. So like
34:32
anyone who has a partial knee amputation, they'll
34:39
probably get something like that. There's
34:42
also a below-elbow prostheses. So there's the
34:46
Transradial Prosthetics is like a category of
34:49
that. There's the Transhumeral Prostheses,
00:34:52.599 --> 00:34:55.860 not funny, but it's above the elbow. Oh God.
34:56
The Partial Foot Prostheses. So that's like,
35:00
you know, anyone who, who had like a partial
35:06
foot. Actually, historically, an NFL kicker
35:14
who, for the longest time, had the longest field
35:17
goal of all time, Tom Dempsey, I believe his
00:35:21.409 --> 00:35:26.849 name was, had a partial foot. I did not know
00:35:26.849 --> 00:35:30.829 about that. Was that considered illegal? Well,
35:30
so what happened was he kicks that long field
35:35
goal. He had a half shoe basically with a steel
35:39
plate at the front. And the owner, I believe
35:44
it was the owner of the Cowboys at the time.
35:46
I don't know if it was Jerry Jones yet. Went
35:50
on this whole crusade about how that was super
35:52
illegal. And they made a rule that required that
35:57
any shoe that was used by a kicker had some sort
36:02
of like natural, like more natural prosthetic.
00:36:06.119 --> 00:36:08.900 Right. Got it. Okay. Because he was like, "Oh,
36:09
there's no way he would have kicked that far
00:36:10.739 --> 00:36:12.679 if he didn't have a steel plate there!" Yeah.
36:12
You know what? I might have to agree with that,
00:36:14.679 --> 00:36:18.300 you know? You know, my problem with that is he's
36:18
actually at a huge disadvantage because when
36:20
you don't have half your foot, your balance is
00:36:21.940 --> 00:36:25.579 off. Yeah, yeah, but he was kicking with the
00:36:25.579 --> 00:36:29.679 foot that had the metal, right? He was, but again...
36:30
he didn't have any of the feeling of like, say
36:32
the toes or, or any of that. So it, that actually
36:35
would be a huge issue from, from that perspective.
36:38
So I, I don't know. I think it might be a wash.
36:40
He might not be a football kicker, but he was
00:36:43.059 --> 00:36:48.860 definitely golf kicking. Well, they also were
36:48
kicking. in a different way than they do now...
36:52
you know what i'm not even going to get into
00:36:53.940 --> 00:36:59.320 that right now, that's too far off-topic. That's a whole other podcast. Where did you leave off at? Kicking has changed
36:59
since then. All right, so now we're at the Hip
37:03
Disarticulation and Hemipelvectomy Prostheses
37:07
so these are like they take out your pelvis essentially...
00:37:10.659 --> 00:37:16.500 Yeah, yeah. ...and they put a fake pelvis in there.
37:18
Hybrid prostheses, so these combine socket and
37:21
suspension methods. So like, you know, I don't
37:26
know when this would be useful. I'm not an Amputational
37:29
Surgeon or an Orthopedist by any means. But, I
37:35
imagine this is when someone has like a very
37:38
complicated, like amputation that requires a couple of
37:44
different things to allow for the better functionality
00:37:46.659 --> 00:37:51.980 and comfort. Right. Then there's Suction Sockets,
00:37:52.039 --> 00:37:55.059 which I feel that's self-explanatory. Yeah,
00:37:55.099 --> 00:37:57.880 yeah, we've already got, yeah. Pin Lock Sockets,
37:58
self-explanatory again. And then Copolymer Liners,
38:01
which those are like soft liners that improve
38:04
fit and comfort. Again, big thing to deal with
38:07
pressure sores, to deal with swelling in the
38:10
limb. Especially lower limbs because lower limbs
38:13
are more prone to the swelling than upper limbs
00:38:17.210 --> 00:38:21.469 just by way of gravity. Yeah. You know what?
38:21
It's so funny because, all right, and all this
38:24
was just basic mechanics. It's so crazy because
38:29
I'm realizing this is probably, especially for
38:33
those of you who are into sci-fi and fantasy
38:36
and all that other stuff. You could definitely
38:38
comfortably say that steampunk design and art
38:46
was definitely influenced by this. It's so funny
38:50
because as Phill was rifling off all these different
38:53
terms, names, developers, and all that, I realized
38:57
I actually was familiar with some of this because
39:02
early exoskeleton designs were developed from
39:08
this stuff, like the early mechanical ones, not
39:11
the ones that have servo motors, just straight
39:15
mechanical design. Some of you may have been
39:20
privy to see it throughout the last century,
39:23
especially the latter half. like with the 60s
39:28
70s and 80s and everything but they weren't usually
39:31
that very practical plus you also had to be practically
39:34
an athlete you know not a full athlete but practically
39:37
an athlete because they were mechanically driven
39:41
which meant they also were powered by whatever
39:43
muscle tension you had. But yeah, these were like
39:46
a lot of the designs there and some of them I,
39:49
I dare say probably were, some of these different
39:55
types of socket designs probably sprung from
39:57
those earlier exosuit or exoframes or influenced
00:40:04.750 --> 00:40:08.969 them too you know. Yeah, yeah for sure and I
40:08
actually want to just mention here real quick
40:10
I did not have time to really get into like athletic
00:40:14.329 --> 00:40:17.489 prosthetics because that's a whole 'nother can of worms. Another,
00:40:17.489 --> 00:40:23.690 yeah. But there's a lot of fascinating stuff in
40:23
the development of all of those types of limbs
40:25
and other devices to help athletes better perform.
40:31
But anyways, let's move on to the 1990s to today.
40:36
And as Ray was kind of alluding to, this is when
40:39
we first start getting like computer chips, microprocessors,
40:42
in limbs. The first microprocessor-controlled prosthetic
40:48
knees became available in 1993. The first one
40:55
that was mass-marketed and commercially available
40:59
was called the Intelligent Prosthesis. It was
41:03
released by Chas A. Blatchford & Sons, Ltd., of
41:07
Great Britain. And it made walking feel and look
41:11
more natural than previous prosthetic designs.
41:15
And this gave way to their next model, the Intelligent
41:19
Prosthesis Plus, which was an improved version
41:22
released two years later in 1999. And then the
41:26
Adaptive Prosthesis also released by Blatchford
41:30
and Sons was released in 1998. This one utilized
41:35
hydraulic controls, pneumatic controls, and a
41:39
microprocessor to allow better response to changes
41:42
in walking speed, basically allowing for more
41:45
natural movement. So it's not as jerky when you're
41:51
changing speeds. And this all led to kind of an
41:57
evolution of the prosthetics program here in
42:02
America. The Evolutionizing Prosthetics Program
42:07
is what it was called, funny enough. It was created
42:10
by DARPA in 2005, the same people that gave us
42:13
the internet, y'all. And the goal is to "develop
42:18
an advanced electromechanical prosthetic upper
42:22
limb with near natural control that would dramatically
42:25
enhance independence and quality of life for
42:28
amputees." That is a direct quote from the FDA's
42:31
website. Or from the FDA, by the way, on this
42:34
program. So very important, as we can all see
42:39
based on that. And in 2014, the LUKE Arm was
42:45
developed. And our friend Dean Kamen is back.
42:49
Say hi to Dean, everyone! His team at DEKA Research
42:53
and Development Corporation. created the first
42:57
prosthetic arm approved by the FDA that translates
43:01
signals from a person's muscles to perform complex
43:04
tasks. In the 20th century, there had been very
43:14
many mechanical developments that had allowed
43:18
for better articulation of fingers and limbs,
43:21
like small digits. But this was like the first
43:26
real leap forward into something that was more
43:28
natural and allowed for better grasping of objects,
43:32
especially, you know, to make sure that they
43:36
don't drop out of the hand randomly. Exactly.
43:42
And Johns Hopkins University and the U .S. Veterans
43:46
Administration also participated in this program.
43:52
there's been a lot of collaboration on this to
43:55
try and make these prosthetics better for especially
43:58
veterans, but for anyone who needs them. 'Scuse
44:03
me. And then in 2019, we start seeing the development
44:10
of the Amparo Confidence Socket, which is made
44:14
of thermoplastics rather than like using a plaster
44:18
cast. like for metal or whatever material that
44:23
they were made out of before. This is a project
44:26
launched under AT2030. I'm not sure exactly
44:31
what that stands for, but I assume that has something
44:36
to do with accessible technology given the AT.
44:40
And this is a huge leap forward because the fact
44:46
of the matter is that the technology that was
44:51
first created with the microprocessors and the
44:54
better articulable legs and joints were estimated
44:58
from 1999 to be up to a million dollars per prosthetic
45:05
limb in 45 years from 1999. So that would be
45:11
2044. So this is something that allows for a much
45:19
faster development of each individual limb, and
45:25
they're significantly less expensive to produce.
45:28
Yeah, I just looked up AT2030, and that is their
45:31
goal. Yeah, life-changing assistive technology
00:45:37.079 --> 00:45:44.599 for all. Yeah. Yeah. So, yeah, huge leap forward.
45:45
huge leap forward here and, and this is just
45:49
going warp speed now I think. And, and now we
45:53
have kind of we're moving on to future development
45:55
and design trends. So of course the lighter,
46:00
more durable flexible materials. You know if we
46:04
want to talk about like our previous episode
46:06
on wheelchairs you know carbon fiber, you know
00:46:10.650 --> 00:46:14.699 for the lightweight...Right...kind of material. Silicone,
46:14
which like makes for a better skin, more natural
46:18
feeling skin. And then advanced polymers that
46:22
also improve the look and feel of the limbs in
46:25
the skin. The polymers would be the outer layer,
46:28
the silicone would be more like the muscles inside
46:32
from what I could gather. And like I said, in
46:38
tandem, these improve weight, look, feel of natural
46:41
limbs and the skin. And this allows for the reduction
46:45
of stigma because it's more comfortable and helps
46:49
people blend in. So less eyes staring at people
46:54
and whatnot. And then we also have bionics and
46:59
myoelectrics. These are kind of robotic arms,
47:02
right? Utilize sensors to detect electrical signals
47:06
from muscles. These are converted into motions
47:09
to allow users to control the limb using their
47:12
natural muscle contractions with greater control
47:17
over it compared to the mechanical solutions
47:19
in the past, which improves the functionality,
47:24
improving the range and fluidity of movements
47:26
available to users. This is especially important
47:29
with regards to grasping fragile objects or walking
47:32
more naturally. And, like, when we talk about grasping
47:38
fragile objects, I have seen videos of people
47:42
with these bionic arms trying to hold eggs. And
47:46
sometimes the arms, they fail and it is not pretty.
00:47:50.139 --> 00:47:54.219 Yeah. A lot of egg on your face. Yeah, yeah,
00:47:54.219 --> 00:47:58.159 yeah. And pun intended. Well, no, I mean, literally,
00:47:58.219 --> 00:48:02.079 I'm not even joking. Yeah, literally. And then
48:02
the last kind of development that we can think
48:05
of for the future would be integrating AI into
48:08
these limbs. So this is like machine learning,
48:12
you know, very basic AI. They learn the habits
48:17
of the user over time, improving the functionality,
48:20
and they can provide real-time adjustments based
48:25
on the movement that someone is using at the
48:28
time based on their past history. So this would
48:32
allow for more natural motions. From analyzing
48:35
the gait, grip, and other patterns of movement.
00:48:38.780 --> 00:48:42.260 Yeah. So like we're, we're really in a place
48:42
where like prosthetics may not look all that
48:47
different in the very near future from a natural
00:48:51.840 --> 00:48:56.679 limb. Yeah. And it's so funny because, you know,
48:56
going back to like what you've talked about,
48:59
you know, with these last few points, you know
49:03
well, I wanted to talk about 3D printers. But
49:07
before I get to that, I was reading something
49:09
where one of the things with AI integration with
49:14
this is they're trying to come up with a new
49:17
data set or something where it's more subjective
49:20
towards the individual and the learning localized
49:25
specifically. The AI portion becomes a part of
49:31
your brain. Not necessarily your...I don't think
49:34
they mean that they want to install a chip in
49:37
there, you know, that is used standalone. But
49:39
something damn near close to it that's standing
49:42
right next to you, you know, figuratively standing
00:49:44.400 --> 00:49:46.480 right next to you. Don't give Elon Musk any ideas
00:49:46.480 --> 00:49:51.139 for Neuralink. Yeah, right, no. And going back
49:51
to about 3D printing, you know, it's so crazy
49:54
because about four years ago, I can't remember
49:59
if you got the chance to meet the guy. We met
50:03
at Gay Pride and Philly (Disability) Pride. A gentleman who
50:09
actually 3D prints his own prosthetics. Well,
50:14
he doesn't have an arm. And he's kind of like
50:20
into cyberpunk and everything. So he's been literally
50:25
3D printing regular static and also slightly
50:31
mechanical. you know, arm, forearm and hands
50:35
for itself, you know, and his designs are great.
50:38
You know, I, I don't know if it, if I should
50:40
be concentrating on the science of it or the
50:43
art of it, but yeah, you know, like, and it's
50:46
so crazy because these things actually exist,
50:50
the, you know, uh, what they call it for 3d printing,
50:52
the, the designs that you download for the...
00:50:57.070 --> 00:51:03.349 Oh, oh, gosh. I can't remember. I forget
00:51:03.349 --> 00:51:05.849 what the name is, but yeah. It's not SCAD, is it? The
51:05
designs, the plans. I mean, there are like tons
51:09
of groups out here, you know, forums where you
51:12
could go and, you know, collaborate or download
51:15
these designs that someone's given, you know,
51:18
and just make the proper adjustments for, you
51:23
know, size and fit, you know. And it's like so
51:26
crazy. If you've got the money or access. You
51:32
know, and you don't need something that's like,
51:34
you know, in the microprocessor range. You know,
00:51:39.119 --> 00:51:42.340 hey. Well, and assuming Star Wars is correct,
51:42
we're going to be very close to having a Luke
00:51:44.360 --> 00:51:47.840 Skywalker-style hand soon. Oh, right. How about
00:51:47.840 --> 00:51:52.280 that? Again. Yeah. A long time ago in a galaxy...
51:52
OK, I can't do that anymore. You get the point,
00:51:55.760 --> 00:52:00.940 everyone. The final remake, the final reboot
52:00
for Six Million Dollar Man, Sixty Billion Dollar
00:52:03.219 --> 00:52:10.079 Man. So, yeah, you know, this is really interesting
52:10
to talk about. And honestly, go out there and
52:14
research more of this, people, if you really
52:17
are enjoying this discussion, because there's
52:20
so much to learn here. There's so much to mine.
52:24
Maybe you could be the next person to design
52:28
something new or to change the way this design
00:52:30.460 --> 00:52:34.800 is. Yeah, we now have the technology where the
52:34
average person can do it. Like I was mentioning
52:36
the gentleman whose name I wish I could remember.
52:40
Yeah, yeah. Well, everyone, thanks for listening
52:45
in. This has been such a great topic to talk
52:49
about and research the history of prosthetic
52:51
limbs specifically. If you liked our show, please
52:56
share it with your friends and family, anyone
52:59
you think might enjoy it. And, you know, let
53:02
us know how we're doing. Tell us. Anything else
53:09
you want to talk about, Ray, before I fully sign
00:53:11.679 --> 00:53:15.820 off? Nah, okay. Good luck, everybody. Well, that's
53:15
it, everyone. Thanks for listening in. Until
00:53:18.940 --> 00:53:24.780 next time, have a good life. Yeah, what he said.
00:53:24.940 --> 00:53:28.260 All right, folks. All right. Please visit our
53:28
accessible website at www.disabilitypridepa.org.
53:33
You can find us on social media @DisabilityPridePA
53:38
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