Prosthetics through the ages | NIH MedlinePlus Magazine

Millions of people in the United States are currently living with limb loss. This number is expected to grow as the population ages and the prevalence of diseases such as diabetes increases, leading to conditions like dysvascularity (poor blood circulation in the legs).

Visit Wonderfu for more information.

For individuals with limb loss, prosthetic devices significantly enhance quality of life by fostering movement and independence. Although early prosthetics were often uncomfortable, they enabled users to return to work and participate in daily activities. In this article, we will trace the evolution of these devices from rudimentary designs and materials to modern innovations, many of which are currently being developed by NIH-supported researchers.

When were prosthetics invented, and what were they used for?

Historians remain uncertain whether the first prosthetics were functional or merely cosmetic. Katherine Ott, Ph.D., curator for the Division of Medicine and Science at the Smithsonian Institution's National Museum of American History, attributes this ambiguity to the diverse cultural perceptions of what constitutes wholeness in a person.

The oldest known prosthetics are two artificial toes from ancient Egypt. One, known as the "Greville Chester toe," was crafted from cartonnage, a material made from glue, linen, and plaster. This toe is believed to be between 2,600 and 3,400 years old, although its exact age remains unknown. Researchers consider it to be cosmetic since it lacks the ability to bend.

The other prosthetic, the "Cairo toe," is a wooden and leather toe estimated to be between 2,700 and 3,000 years old. Its design suggests it was the earliest known practical artificial limb, given its flexibility and the fact that it was modified multiple times to suit the wearer.

About 300 years later, around 300 B.C. in Italy, a Roman nobleman used a prosthetic leg known as the "Capua leg," made of bronze and hollowed wood and secured with leather straps.

Additional early examples of prosthetics include artificial feet from Switzerland and Germany, created between the 5th and 8th centuries. These feet were constructed from wood, iron, or bronze and were likely strapped to the remaining limb of the amputee.

 A wood and aluminum prosthetic arm invented by William Robert Grossmith in the mid-19th century.

War and the U.S. military inspire prosthetic advances

Soldiers who lost limbs in battle frequently used early artificial limbs crafted from wood or iron. Approximately 2,200 years ago, Roman general Marcus Sergius Silus lost his right hand during the Second Punic War and replaced it with an iron prosthetic designed to hold his shield. Knights during the Middle Ages sometimes employed wooden limbs for battle or horseback riding. In the 16th century, French surgeon Ambroise Paré created some of the first purely functional prosthetics for soldiers returning from combat, also publishing the earliest written references to prosthetics.

The American Civil War brought about another advance. The war's unprecedented number of amputees led to a near quadrupling of patents for prosthetics. Among these was a wooden leg called the "Hanger limb," the first to incorporate rubber in the ankle and cushioning in the heel. This demonstrated the realization that prosthetics should be made less painful for amputees.

 An artificial leg from the American Civil War.

Today, the U.S. Department of Veterans Affairs serves as a significant provider of prosthetics and leads rehabilitation efforts for veterans who have lost limbs during their service. These veterans often experience polytrauma, which involves injuries to multiple body parts, usually from blast-related incidents.

When polytrauma occurs, veterans require comprehensive clinical care and strong support networks. The Rehabilitation Medicine division at the NIH Clinical Center, alongside the National Center for Medical Rehabilitation Research at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, is committed to providing treatment for prosthetic users and conducting research on limb loss.

Improvements in design

While prosthetics well into the 20th century were constructed from combinations of wood, metal, glue, and leather, their functionality improved. Between the late 15th and 19th centuries, France and Switzerland produced artificial limbs equipped with cables, gears, cranks, and springs that allowed for rotation and bending. Nonetheless, these devices still required manual adjustment; for example, an artificial hand could be cranked shut around a fork, yet another hand was needed to operate the crank.

In the following century, manufacturers began using plastics and various artificial materials to create more functional prosthetics. However, many of the best prosthetic devices remained unaffordable for most individuals, including veterans. Typically, these prosthetics were designed for specific tasks, such as piano playing. Accessibility increased post-World War I when Great Britain saw a surge in prosthetic manufacturing for returning soldiers. Jeffrey S. Reznick, Ph.D., Chief of the National Library of Medicine History of Medicine Division, notes that wartime manufacturing often took place in military hospitals, where recovering soldiers were fitted with artificial limbs as part of their rehabilitation.

If you're interested in learning more about prosthetic tools, contact us today for an expert consultation!

Today’s prosthetics are vastly different from those made prior to the late 20th century. Modern devices commonly utilize lightweight and durable materials, such as plastic, aluminum, titanium, and silicone, allowing for a more precise fit to the user's remaining limb. The Walter Reed National Military Medical Center even offers tattoo services for service members' prosthetics, enhancing their natural appearance.

The next generation of artificial limbs seeks to move without conscious control from the user—an exciting frontier in prosthetic technology.

 An example of a modern bionic prosthetic arm.

NIH-supported innovations in prosthetics

Researchers are developing technologies such as robotics, 3D printing, artificial intelligence, and motion-sensing systems for prosthetics. Over the last decade, NIH has funded various projects focused on leveraging the brain's electrical activity to facilitate the movement of prosthetic limbs through electrodes implanted in the user's remaining muscles. These electrodes transmit signals to the brain, enabling freer movement for the prosthetic limbs.

One notable example funded by the National Institute of Biomedical Imaging and Bioengineering is a robotic lower leg prosthesis designed to promote more natural walking motions. Researchers at Vanderbilt University created the device with powered knee and ankle joints, alongside software capable of anticipating the user’s desired movements.

In addition to these technological advances, tracking the number of prosthetic users and identifying effective treatments is essential. Therefore, the NIH, in collaboration with the U.S. Department of Defense and the Mayo Clinic, established the Limb Loss and Preservation Registry, which uses electronic health records to assess the prevalence of limb loss in the United States and evaluate treatment costs and outcomes.

Alternative accessible version (pdf)

Extensive technological and neurological advancements remain necessary to create prosthetics that closely mimic natural body parts and seamlessly integrate into a person's sense of self. Some of today's most advanced prosthetics stimulate brain neurons to replicate real sensations; however, they only engage a small fraction of the billions of cells in the brain, suggesting that current technology has only scratched the surface of sensory experience. The full restoration of sensation through prosthetics remains a distant goal.

Longevity is another challenge; eventually, components such as electrodes wear out and require replacement. This raises ethical and philosophical questions. For instance, what happens if someone begins to view a prosthetic as part of their identity, and it eventually fails?

This is just one of the many unresolved questions stemming from rapid prosthetic advancements. A comprehensive review by researchers in the Netherlands identified 169 ethical implications related to neuroprosthetics (van Velthoven, E. A. M., et al., Journal of Neural Engineering, Vol. 19, No. , ). Issues include health risks associated with electrode implantation in the brain, uncertainties regarding long-term safety, autonomy concerns, and the evolving relationship between humans and machines. Furthermore, while many studies aim to improve well-being and life satisfaction through neuroprosthetic innovations, the devices do not always perform flawlessly, which can result in user dissatisfaction.

Hearing aids, in particular, encounter acceptance barriers, primarily due to lack of awareness. Alarmingly, 1 in 8 U.S. adults experiences hearing challenges, particularly among those over 70; yet, over 90% of these adults could not identify what constitutes a normal hearing range during a survey conducted among 1,250 individuals aged 50 to 80 (Carlson, M. L., et al., Otology & Neurotology, Vol. 43, No. 3, ). Many people remain unaware of the long-term health implications of untreated hearing loss, including cognitive decline and available treatments.

As technology progresses, rehabilitation psychologists play a crucial role in interdisciplinary teams comprising prosthetists, physical therapists, engineers, and others. Together, they help individuals learn to use and adapt to prosthetics, according to Scherer. However, rehabilitation psychologists are currently in short supply. Even with the establishment of APA Division 22 (Rehabilitation Psychology) in , fewer than 1% of psychologists today report specializing in rehabilitation psychology, according to recent APA data, and only 4% possess American Board of Professional Psychology certification in this specialty.

Many rehabilitation patients receive assistance from psychologists who lack specialization in this field, as revealed by an analysis of postdoctoral rehabilitation psychology training in the United States and Canada (Stiers, W., & Stucky, K., Rehabilitation Psychology, Vol. 67, No. 3, ). Addressing these concerns will require outreach and advocacy to enhance visibility and expand the pipeline for the profession, as indicated by researchers in a recent report—the first of its kind addressing the state of the field (Baker, L. N., et al., Rehabilitation Psychology, Vol. 67, No. 2, ).

A rehabilitation psychologist focuses on coping, adaptation, maximizing functioning, enhancing quality of life, and assisting individuals in achieving their goals, Scherer explained. However, there simply aren’t enough of them.

If prosthetics advance to the point where they can genuinely replicate or enhance sensory perception and performance, further ethical dilemmas will emerge. For instance, should prosthetics be restricted to individuals with paralysis, or should they be available as performance enhancers for healthy individuals or even high-performing athletes? "When we reach the point of genuinely enhancing people's capabilities, even those without spinal cord injuries, there will undoubtedly be ethical considerations," he stated.

For more information, please visit our website at Prosthetic equipment speed Socket Router.