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Ortiz-Catalan et al., NEJM, 2020


Motors & motion control


At your fingertips


Prosthetics are among the original medical wearables, but technological advances haven’t necessarily made them more popular. What’s holding them back? Tim Gunn asks


Max Ortiz Catalan, head of the bionics research unit at Chalmers University of Technology, Sweden, and the founding director of the Center for Bionics and Pain Research; and Jacob Segil, director of the Center for Translational Research at the University of Colorado, Boulder.


A


dvanced prosthetics have a people problem. Cyborgian engineering wonders, they’re great conversation starters and inspiring fodder for online videos, but, for a significant portion of their intended market, they don’t have much else to recommend them. There’s been a lot of technological progress in the 75 years since someone was first strapped into one (it was non-portable), but prostheses controlled by the electrical activity of users’ muscles still aren’t widespread. It’s not just that they’re expensive: a recent Disability and Rehabilitation study found that, once the party’s over and the cameras are gone, 44% of advanced upper-limb prosthetics are rejected.


The most commonly cited issues with myoelectric prosthetics are fragility, weight, fit and control. Users of the current generation of ‘dual-site’ myoelectric upper-arm prosthetics have to flex their muscles to cycle through preprogrammed grips until they find the one they want, as if daily tasks were carnival games. The mechanical attachment is another sticking point –


70


shoving one’s arm into a socket for hours on end can be extremely uncomfortable. Often, it simply isn’t worth the hassle: in the American Journal of Physical Medicine & Rehabilitation in 2007, 60% of individuals who frequently used an upper-limb prosthetic reported that they are just as or more functional without it, as did 98% of those who had rejected one. In these cases, an uncomfortable or unreliable prosthetic turns a neutral part of the user’s body into a problem or vulnerability that would not otherwise exist. As Britt H Young, an owner, if not a regular user, of an Ottobock Bebionic, put it in the online publication Input in March 2021, “Prosthetic arm technology is still so limited that I become more disabled when I wear one.” “Prosthetics are meant to restore function,” stresses Max Ortiz Catalan, head of the bionics research unit at Chalmers University of Technology in Sweden, and the founding director of the Center for Bionics and Pain Research. In that regard, they’re underperforming. “It’s quite useless to have a very sophisticated hand or a very sophisticated leg if you can only wear it for one


Medical Device Developments / www.nsmedicaldevices.com


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