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Jump to: navigation, search This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (October 2006) Multimedia is media and content that uses a combination of different content forms. The term can be used as a noun (a medium with multiple content forms) or as an adjective describing a medium as having multiple content forms. The term is used in contrast to media which use only rudimentary computer display such as text-only, or traditional forms of printed or hand-produced material. Multimedia includes a combination of text, audio, still images, animation, video, or interactivity content forms. Multimedia is usually recorded and played, displayed or accessed by information content processing devices, such as computerized and electronic devices, but can also be part of a live performance. Multimedia (as an adjective) also describes electronic media devices used to store and experience multimedia content. Multimedia is distinguished from mixed media in fine art; by including audio, for example, it has a broader scope. The term "rich media" is synonymous for interactive multimedia. Hypermedia can be considered one particular multimedia application. Examples of individual content forms combined in multimedia:


1 Categorization of multimedia 2 Major characteristics of multimedia 3 Terminology o 3.1 History of the term o 3.2 Word usage and context 4 Usage / Application o 4.1 Creative industries 4.1.1 Commercial 4.1.2 Entertainment and fine arts 4.1.3 Education 4.1.4 Journalism 4.1.5 Engineering 4.1.6 Industry 4.1.7 Mathematical and scientific research 4.1.8 Medicine 4.1.9 Document imaging 4.1.10 Disabilities



Still Images


Video Footage


o 4.2 Miscellaneous 5 Structuring information in a multimedia form 6 Conferences 7 See also 8 References 9 External links

[edit] Categorization of multimedia

Multimedia may be broadly divided into linear and non-linear categories. Linear active content progresses without any navigational control for the viewer such as a cinema presentation. Nonlinear content offers user interactivity to control progress as used with a video game or used in self-paced computer based training. Hypermedia is an example of non-linear content. Multimedia presentations can be live or recorded. A recorded presentation may allow interactivity via a navigation system. A live multimedia presentation may allow interactivity via an interaction with the presenter or performer.

[edit] Major characteristics of multimedia

Multimedia presentations may be viewed by person on stage, projected, transmitted, or played locally with a media player. A broadcast may be a live or recorded multimedia presentation. Broadcasts and recordings can be either analog or digital electronic media technology. Digital online multimedia may be downloaded or streamed. Streaming multimedia may be live or ondemand. Multimedia games and simulations may be used in a physical environment with special effects, with multiple users in an online network, or locally with an offline computer, game system, or simulator. The various formats of technological or digital multimedia may be intended to enhance the users' experience, for example to make it easier and faster to convey information. Or in entertainment or art, to transcend everyday experience.

A lasershow is a live multimedia performance.

Enhanced levels of interactivity are made possible by combining multiple forms of media content. Online multimedia is increasingly becoming object-oriented and data-driven, enabling applications with collaborative end-user innovation and personalization on multiple forms of content over time. Examples of these range from multiple forms of content on Web sites like photo galleries with both images (pictures) and title (text) user-updated, to simulations whose coefficients, events, illustrations, animations or videos are modifiable, allowing the multimedia "experience" to be altered without reprogramming. In addition to seeing and hearing, Haptic technology enables virtual objects to be felt. Emerging technology involving illusions of taste and smell may also enhance the multimedia experience.

[edit] Terminology
[edit] History of the term
The term "multimedia" was coined[citation needed] by Bob Goldstein (later 'Bobb Goldsteinn') to promote the July 1966 opening of his "LightWorks at L'Oursin" show at Southampton, Long Island. On August 10, 1966, Richard Albarino of Variety borrowed the terminology, reporting: Brainchild of songscribe-comic Bob (Washington Square) Goldstein, the Lightworks is the latest multi-media music-cum-visuals to debut as discothque fare.[1] Two years later, in 1968, the term multimedia was re-appropriated to describe the work of a political consultant, David Sawyer, the husband of Iris Sawyerone of Goldsteins producers at LOursin.

Multimedia (multi-image) setup for the 1988 Ford New Car Announcement Show, August, 1987, Detroit, MI In the intervening forty years, the word has taken on different meanings. In the late 1970s the term was used to describe presentations consisting of multi-projector slide shows timed to an audio track.[2][3] However, by the 1990s 'multimedia' took on its current meaning. In the 1993 first edition of McGraw-Hills Multimedia: Making It Work, Tay Vaughan declared Multimedia is any combination of text, graphic art, sound, animation, and video that is delivered by computer. When you allow the user the viewer of the project to control what and when these elements are delivered, it is interactive multimedia. When you provide a structure of linked elements through which the user can navigate, interactive multimedia becomes hypermedia. [4]

The German language society, Gesellschaft fr deutsche Sprache, decided to recognize the word's significance and ubiquitousness in the 1990s by awarding it the title of 'Word of the Year' in 1995. The institute summed up its rationale by stating "[Multimedia] has become a central word in the wonderful new media world"[5] In common usage, the term multimedia refers to an electronically delivered combination of media including video, still images, audio, text in such a way that can be accessed interactively. Much of the content on the web today falls within this definition as understood by millions. Some computers which were marketed in the 1990s were called "multimedia" computers because they incorporated a CD-ROM drive, which allowed for the delivery of several hundred megabytes of video, picture, and audio data.

[edit] Word usage and context

Since media is the plural of medium, the term "multimedia" is a pleonasm if "multi" is used to describe multiple occurrences of only one form of media such as a collection of audio CDs. This is why it's important that the word "multimedia" is used exclusively to describe multiple forms of media and content. The term "multimedia" is also ambiguous. Static content (such as a paper book) may be considered multimedia if it contains both pictures and text or may be considered interactive if the user interacts by turning pages at will. Books may also be considered non-linear if the pages are accessed non-sequentially. The term "video", if not used exclusively to describe motion photography, is ambiguous in multimedia terminology. Video is often used to describe the file format, delivery format, or presentation format instead of "footage" which is used to distinguish motion photography from "animation" of rendered motion imagery. Multiple forms of information content are often not considered modern forms of presentation such as audio or video. Likewise, single forms of information content with single methods of information processing (e.g. non-interactive audio) are often called multimedia, perhaps to distinguish static media from active media. In the Fine arts, for example, Leda Luss Luyken's ModulArt brings two key elements of musical composition and film into the world of painting: variation of a theme and movement of and within a picture, making ModulArt an interactive multimedia form of art. Performing arts may also be considered multimedia considering that performers and props are multiple forms of both content and media.

[edit] Usage / Application

A presentation using Powerpoint. Corporate presentations may combine all forms of media content.

Virtual reality uses multimedia content. Applications and delivery platforms of multimedia are virtually limitless.

VVO Multimedia-Terminal in Dresden WTC (Germany) Multimedia finds its application in various areas including, but not limited to, advertisements, art, education, entertainment, engineering, medicine, mathematics, business, scientific research and spatial temporal applications. Several examples are as follows:

[edit] Creative industries

Creative industries use multimedia for a variety of purposes ranging from fine arts, to entertainment, to commercial art, to journalism, to media and software services provided for any of the industries listed below. An individual multimedia designer may cover the spectrum throughout their career. Request for their skills range from technical, to analytical, to creative.

[edit] Commercial Much of the electronic old and new media used by commercial artists is multimedia. Exciting presentations are used to grab and keep attention in advertising. Business to business, and interoffice communications are often developed by creative services firms for advanced multimedia presentations beyond simple slide shows to sell ideas or liven-up training. Commercial multimedia developers may be hired to design for governmental services and nonprofit services applications as well. [edit] Entertainment and fine arts In addition, multimedia is heavily used in the entertainment industry, especially to develop special effects in movies and animations. Multimedia games are a popular pastime and are software programs available either as CD-ROMs or online. Some video games also use multimedia features. Multimedia applications that allow users to actively participate instead of just sitting by as passive recipients of information are called Interactive Multimedia. In the Arts there are multimedia artists, whose minds are able to blend techniques using different media that in some way incorporates interaction with the viewer. One of the most relevant could be Peter Greenaway who is melding Cinema with Opera and all sorts of digital media. Another approach entails the creation of multimedia that can be displayed in a traditional fine arts arena, such as an art gallery. Although multimedia display material may be volatile, the survivability of the content is as strong as any traditional media. Digital recording material may be just as durable and infinitely reproducible with perfect copies every time. [edit] Education In Education, multimedia is used to produce computer-based training courses (popularly called CBTs) and reference books like encyclopedia and almanacs. A CBT lets the user go through a series of presentations, text about a particular topic, and associated illustrations in various information formats. Edutainment is an informal term used to describe combining education with entertainment, especially multimedia entertainment. Learning theory in the past decade has expanded dramatically because of the introduction of multimedia. Several lines of research have evolved (e.g. Cognitive load, Multimedia learning, and the list goes on). The possibilities for learning and instruction are nearly endless. The idea of media convergence is also becoming a major factor in education, particularly higher education. Defined as separate technologies such as voice (and telephony features), data (and productivity applications) and video that now share resources and interact with each other, synergistically creating new efficiencies, media convergence is rapidly changing the curriculum in universities all over the world. Likewise, it is changing the availability, or lack thereof, of jobs requiring this savvy technological skill. [edit] Journalism

Newspaper companies all over are also trying to embrace the new phenomenon by implementing its practices in their work. While some have been slow to come around, other major newspapers like The New York Times, USA Today and The Washington Post are setting the precedent for the positioning of the newspaper industry in a globalized world. News reporting is not limited to traditional media outlets. Freelance journalists can make use of different new media to produce multimedia pieces for their news stories. It engages global audiences and tells stories with technology, which develops new communication techniques for both media producers and consumers. Common Language Project is an example of this type of multimedia journalism production. Multimedia reporters who are mobile (usually driving around a community with cameras, audio and video recorders, and wifi-equipped laptop computers) are often referred to as Mojos, from mobile journalist. [edit] Engineering Software engineers may use multimedia in Computer Simulations for anything from entertainment to training such as military or industrial training. Multimedia for software interfaces are often done as a collaboration between creative professionals and software engineers. [edit] Industry In the Industrial sector, multimedia is used as a way to help present information to shareholders, superiors and coworkers. Multimedia is also helpful for providing employee training, advertising and selling products all over the world via virtually unlimited web-based technology [edit] Mathematical and scientific research In mathematical and scientific research, multimedia is mainly used for modeling and simulation. For example, a scientist can look at a molecular model of a particular substance and manipulate it to arrive at a new substance. Representative research can be found in journals such as the Journal of Multimedia. [edit] Medicine In Medicine, doctors can get trained by looking at a virtual surgery or they can simulate how the human body is affected by diseases spread by viruses and bacteria and then develop techniques to prevent it. [edit] Document imaging Document imaging is a technique that takes hard copy of an image/document and converts it into a digital format (for example, scanners).

[edit] Disabilities Ability Media allows those with disabilities to gain qualifications in the multimedia field so they can pursue careers that give them access to a wide array of powerful communication forms.

[edit] Miscellaneous
In Europe, the reference organisation for Multimedia industry is the European Multimedia Associations Convention (EMMAC).

[edit] Structuring information in a multimedia form

Multimedia represents the convergence of text, pictures, video and sound into a single form. The power of multimedia and the Internet lies in the way in which information is linked. Multimedia and the Internet require a completely new approach to writing. The style of writing that is appropriate for the 'on-line world' is highly optimized and designed to be able to be quickly scanned by readers.[6] A good site must be made with a specific purpose in mind and a site with good interactivity and new technology can also be useful for attracting visitors. The site must be attractive and innovative in its design, function in terms of its purpose, easy to navigate, frequently updated and fast to download.[7] When users view a page, they can only view one page at a time. As a result, multimedia users must create a mental model of information structure.

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A 2008 study published in the New England Journal of Medicine tested the effect of using gene therapy to help restore the sight of patients with a rare form of inherited blindness, known as Leber's congenital amaurosis or LCA. Leber's Congenital Amaurosis damages the light receptors in the retina and usually begins affecting sight in early childhood, with worsening vision until complete blindness around the age of 30. The study used a common cold virus to deliver a normal version of the gene called RPE65 directly into the eyes of affected patients. Remarkably all 3 patients aged 19, 22 and 25 responded well to the treatment and reported improved vision following the procedure. Due to the age of the patients and the degenerative nature of LCA the improvement of vision in gene therapy patients is encouraging for researchers. It is hoped that gene therapy may be even more effective in younger LCA patients who have experienced limited vision loss as well as in other blind or partially blind individuals. Two experimental treatments for retinal problems include a cybernetic replacement and transplant of fetal retinal [23] cells. [edit]Mobility

Folded long cane.

Many people with serious visual impairments can travel independently, using a wide range of tools and techniques. Orientation and mobility specialists are professionals who are specifically trained to teach people with visual impairments how to travel safely, confidently, and independently in the home and the community. These professionals can also help blind people to practice travelling on specific routes which they may use often, such as the route from one's house to a convenience store. Becoming familiar with an environment or route can make it much easier for a blind person to navigate successfully. Tools such as the white cane with a red tip - the international symbol of blindness - may also be used to improve mobility. A long cane is used to extend the user's range of touch sensation. It is usually swung in a low sweeping motion, across the intended path of travel, to detect obstacles. However, techniques for cane travel can vary depending on the user and/or the situation. Some visually impaired persons do not carry these kinds of canes, opting instead for the shorter, lighter identification (ID) cane. Still others require a support cane. The choice depends on the individual's vision, motivation, and other factors. A small number of people employ guide dogs to assist in mobility. These dogs are trained to navigate around various obstacles, and to indicate when it becomes necessary to go up or down a step. However, the helpfulness of guide dogs is limited by the inability of dogs to understand complex directions. The human half of the guide dog team does the directing, based upon skills acquired through previous mobility training. In this sense, the handler might be likened to an aircraft's navigator, who must know how to get from one place to another, and the dog to the pilot, who gets them there safely.

Some blind people use GPS for the visually impaired as a mobility aid. Such software can assist blind people with orientation and navigation, but it is not a replacement for traditional mobility tools such as white canes and guide dogs. Technology to allow blind people to drive motor vehicles is currently being developed.

Government actions are sometimes taken to make public places more accessible to blind people. Public transportation is freely available to the blind in many cities. Tactile paving and audible traffic signals can make it easier and safer for visually impaired pedestrians to cross streets. In addition to making rules about who can and cannot use a cane, some governments mandate the right-of-way be given to users of white canes or guide dogs. [edit]Reading

and magnification

Braille watch

Most visually impaired people who are not totally blind read print, either of a regular size or enlarged by magnification devices. Many also read large-print, which is easier for them to read without such devices. A variety of magnifying glasses, some handheld, and some on desktops, can make reading easier for them. Others read Braille (or the infrequently used Moon type), or rely on talking books and readers orreading machines, which convert printed text to speech or Braille. They use computers with special hardware such as scanners and refreshable Braille displays as well as software written specifically for the blind, such as optical character recognition applications and screen readers. Some people access these materials through agencies for the blind, such as the National Library Service for the Blind and Physically Handicapped in the United States, the National Library for the Blind or the RNIB in the United Kingdom. Closed-circuit televisions, equipment that enlarges and contrasts textual items, are a more high-tech alternative to traditional magnification devices. There are also over 100 radio reading services throughout the world that provide people with vision impairments with readings from periodicals over the radio. The International Association of Audio Information Services provides links to all of these organizations.

[edit]Computers Access technology such as screen readers, screen magnifiers and refreshable Braille displays enable the blind to use mainstream computer applications and mobile phones. The availability of assistive technology is increasing, accompanied by concerted efforts to ensure the accessibility of information technology to all potential users, including the blind. Later versions of Microsoft Windows include an Accessibility Wizard & Magnifier for those with partial vision, and Microsoft Narrator, a simple screen reader. Linux distributions (as live CDs) for the blind include Oralux and Adriane Knoppix, the latter developed in part by Adriane Knopper who has a visual impairment. Mac OS also comes with a built-in screen reader, called VoiceOver. The movement towards greater web accessibility is opening a far wider number of websites to adaptive technology, making the web a more inviting place for visually impaired surfers. Experimental approaches in sensory substitution are beginning to provide access to arbitrary live views from a camera. Modified visual output that includes large print and/or clear simple graphics can be of benefit to users with some [25] residual vision. [edit]Other

aids and techniques

A tactile feature on a Canadian banknote.

Blind people may use talking equipment such as thermometers, watches, clocks, scales,calculators, and compasses. They may also enlarge or mark dials on devices such as ovens and thermostats to make them usable. Other techniques used by blind people to assist them in daily activities include:

Adaptations of coins and banknotes so that the value can be determined by touch. For example:

In some currencies, such as the euro, the pound sterling and the Indian rupee, the size of a note increases with its value.

On US coins, pennies and dimes, and nickels and quarters are similar in size. The larger denominations (dimes and quarters) have ridges along the sides (historically used to prevent the "shaving" of precious metals from the coins), which can now be used for identification.

Some currencies' banknotes have a tactile feature to indicate denomination. For example, the Canadian currency tactile feature is a system of raised dots in one corner, based on Braille cells but not standard Braille.

It is also possible to fold notes in different ways to assist recognition.

Labeling and tagging clothing and other personal items Placing different types of food at different positions on a dinner plate Marking controls of household appliances

Most people, once they have been visually impaired for long enough, devise their own adaptive strategies in all areas of personal and professional management.

Letters and numbers

a or 1 (dot 1)

b or 2 (dots 1-2)

c or 3 (dots 1-4)

d or 4 (dots 1-4-5)

e or 5 (dots 1-5)

f or 6 (dots 1-2-4)

g or 7 (dots 1-2-4-5)

h or 8 (dots 1-2-5)

i or 9 (dots 2-4)

j or 0 (dots 2-4-5)

k (dots 1-3)

l (dots 1-2-3)

m (dots 1-3-4)

n (dots 1-3-4-5)

o (dots 1-3-5)

p (dots 1-2-3-4)

q (dots 1-2-3-4-5)

r (dots 1-2-3-5)

s (dots 2-3-4)

t (dots 2-3-4-5)

u (dots 1-3-6)

v (dots 1-2-3-6)

w (dots 2-4-5-6)

x (dots 1-3-4-6)

y (dots 1-3-4-5-6)

z (dots 1-3-5-6)

Writing Braille
Braille may be produced using a slate and stylus in which each dot is created from the back of the page, writing in mirror image, by hand, or it may be produced on a Braille typewriter or Perkins Brailler, or produced by a Braille embosser attached to a computer. It may also be rendered using a refreshable Braille display. Braille has been extended to an 8-dot code, particularly for use with Braille embossers and refreshable Braille displays. In 8-dot Braille the additional dots are added at the bottom of the cell, giving a matrix 4 dots high by 2 dots wide. The additional dots are given the numbers 7 (for the lower-left dot) and 8 (for the lower-right dot). Eight-dot Braille has the advantages that the case of an individual letter is directly coded in the cell containing the letter and 8 that all the printable ASCII characters can be represented in a single cell. All 256 (2 ) possible combinations of 8 dots are encoded by the Unicode standard. Braille with six dots is frequently stored as Braille ASCII. The first ten letters of the alphabet are formed using only the top four dots (1, 2, 4, and 5). Reminiscent of Greek [4] numerals, these symbols also represent the digits 1 through 9 and 0 (preceded by the symbol [number follows]; [5] [number follows]j also stands for 10, within context). Adding dot 3 forms the next ten letters, and adding dot 6 forms the last six letters (except w) and the words and, for, of, the, andwith. Omitting dot 3 from the letters U-Z and the five word symbols form nine digraphs (ch, gh, sh, th, wh, ed, er, ou, and ow) and the letter w.

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It has been suggested that Wheelchair support surface be merged into this article or section. (Discuss) Proposed since March 2011. This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (June 2009)

Wheelchair seating in a theater (i.e. giving a dedicated, convenient space left free for a user to position his own wheelchair in the cinema).

A typical modern battery powered chair.

A wheelchair is a chair with wheels, designed to be a replacement for walking. The device comes in variations where it is propelled by motors or by the seated occupant turning the rear wheels by hand. Often there are handles behind the seat for someone else to do the pushing. Wheelchairs are used by people for whom walking is difficult or impossible due to illness (physiological or physical), injury, or disability. People with both sitting and walking disability often need to use awheelbench.


1 History 2 Types

o o o o o o o

2.1 Manually powered 2.2 Electric-powered 2.3 Other variants 2.4 Sports variants 2.5 Transfer, stretcher, or mechanical 2.6 All terrain variants 2.7 Recent developments

3 Mobility and access

o o

3.1 Buildings 3.2 Vehicles

4 User organizations 5 See also 6 References


The earliest record of wheelchairs dates back to the 6th century, as an inscription found on a stone slate in China. Later dates relate to Europeans using this technology during the German Renaissance. The invalid carriage or Bath Chair seems to date from around 1760.[1] Harry Jennings and his disabled friend Herbert Everest, both mechanical engineers, invented the first lightweight, steel, collapsible wheelchair[2] in 1933. Mr Everest had broken his back in a mining accident. The two saw the business potential of the invention and went on to become the first mass-manufacturers of wheelchairs: Everest and Jennings. Their "x-brace" design is still in common use, albeit with updated materials and other improvements.

Depiction of Confucius in a wheelchair, dating to ca. 1680. The artist may have been thinking of methods of transport common in his own day.


A basic manual wheelchair incorporates a seat, foot rests and four wheels: two, caster wheels at the front and two large wheels at the back. The two larger wheels in the back usually have handrims; two metal or plastic circles approximately 3/4" thick. The handrims have a diameter normally only slightly smaller than the wheels they are attached to. Most wheelchairs have two push handles at the top of the back to allow for manual propulsion by a second person. Other varieties of wheelchair are often variations on this basic design, but can be highly customised for the user's needs. Such customisations may encompass the seat dimensions, height, seat angle (also called seat dump or squeeze), footrests, leg rests, front caster outriggers, adjustable backrests and controls.

Wooden wheelchair dating to the early part of the 20th century

Everyday manual wheelchairs come in two major designsfolding or rigid. The rigid chairs, which are increasingly preferred by active users, have permanently welded joints and many fewer moving parts. This reduces the energy required to push the chair by eliminating many points where the chair would flex as it moves. Welding the joints also reduces the overall weight of the chair. Rigid chairs typically feature instantrelease rear wheels and backrests that fold down flat, allowing the user to dismantle the chair quickly for storage in a car. Many rigid models are now made with ultralight materials such as aircraft aluminium and titanium. One major manufacturer, Tilite, builds only ultralights. Another innovation in rigid chair design is the installation of polymer shock absorbers, such as FrogLegs, which cushion the bumps over which the chair rolls. These shock absorbers may be added to the front wheels or to the rear wheels, or both. Rigid chairs also have the option for their rear wheels to have a camber. Wheels can have a camber, or tilt, which angles the tops of the wheels in toward the chair. This allows for better propulsion by the user which is desired by long-term users and users who race wheelchairs/ Various optional accessories are available, such as anti-tip bars or wheels, safety belts, adjustable backrests, tilt and/or recline features, extra support for limbs or neck, mounts or carrying devices for crutches, walkers or oxygen tanks, drink holders, and clothing protectors. Transport wheelchairs are usually light, folding chairs with four small wheels. These chairs are designed to be pushed by a caregiver to provide mobility for patients outside the home or more common medical settings. Experiments have also been made with unusual variant wheels, like the omniwheel or the mecanum wheel. These allow for a broader spectrum of movement.

Wheelchair fitted with Mecanum wheels, taken at an exhibition in the early 1980s.

The electric wheelchair shown on the right is fitted with Mecanum wheels (sometimes known as Ilon wheels) which give it complete freedom of movement. It can be driven forwards, backwards, sideways, and diagonally, and also turned round on the spot or turned around while moving, all operated from a simple joystick.


An antique wheelchair

Manual wheelchairs are those that require human power to move them. Many manual wheelchairs can be folded for storage or placement into a vehicle, although modern wheelchairs are just as likely to be rigid framed. Manual or self-propelled wheelchairs are propelled by the occupant, usually by turning the large rear wheels, from 20-26 inches (5166 cm)in average diameter, and resembling bicycle wheels. The user moves the chair

by pushing on the handrims, which are made of circular tubing attached to the outside of the large wheels. The handrims have a diameter that is slightly less than that of the rear wheels. Skilled users can control speed and turning and often learn to balance the chair on its rear wheels do a wheelie. The wheelie is not just for show a rider who can control the chair in this manner can climb and descend curbs and move over small obstacles. Foot propulsion of the wheelchair by the occupant is also common for patients who have limited hand movement capabilities or simply do not wish to use their hands for propulsion. Foot propulsion also allows patients to exercise their legs to increase blood flow and limit further disability. One-arm drive enables a user to guide and propel a wheelchair from one side. Two handrims, one smaller than the other, are located on one side of the chair, left or right. On most models the outer, or smaller rim, is connected to the opposite wheel by a folding axle. When both handrims are grasped together, the chair may be propelled forward or backward in a straight line. When either handrim is moved independently, the chair will turn left or right in response to the handrim used. Another alternative is a LeverDrive chair that propels the chair forwards by using a lever that is pumped back and forth. Some chairs are also configured to allow the occupant to propel using one or both feet instead of using the rims. Attendant-propelled chairs (or transport wheelchairs) are designed to be propelled by an attendant using the handles, and thus the back wheels are rimless and often smaller. These chairs are often used as 'transfer chairs' to move a patient when a better alternative is unavailable, possibly within a hospital, as a temporary option, or in areas where a user's standard chair is unavailable. These chairs are commonly seen in airports. Special airplane transfer chairs are available on most airlines, designed to fit narrow airplane aisles and transfer wheelchair-using passengers to and from their seats on the plane. Wheelbase chairs are wheeled platforms with specially molded seating systems interfaced with them for users with a more complicatedposture. A molded seating system involves taking a cast of a person's best achievable seated position and then either carving the shape frommemory foam or forming a plastic mesh around it. This seat is then covered, framed, and attached to a wheelbase. Light weight and high cost are related in the manual wheelchairs market. At the low-cost end, heavy, tubular steel chairs with sling seats and little adaptability dominate. Users may be temporarily disabled, or using such a chair as a loaner, or simply unable to afford better. Heavy unmodified manual chairs are common as "loaners" at large facilities such as airports, amusement parks and shopping centers. In a higher price range, and more commonly used by persons with long-term disabilities, are major manufacturer lightweight chairs with more options. The high end of the market contains ultra-light models, extensive seating options and accessories, allterrain features, and so forth. Reclining wheelchairs have handbrake-like controls attached to the push handles or posts supporting the backrest which, when pressed by the caregiver, allow the backrest to recline from is normal upright position (at 90 degrees) to varying angles up to 180 degrees.


Main article: Motorized wheelchair An electric-powered wheelchair is a wheelchair that is moved via the means of an electric motor and navigational controls, usually a small joystick mounted on the armrest, rather than manual power. For users who cannot manage a manual joystick, headswitches, chin-operated joysticks, sip-and-puff or other specialist controls may allow independent operation of the wheelchair


A Standing wheelchair is one that supports the user in a nearly standing position. They can be used as both a wheelchair and a standing frame, allowing the user to sit or stand in the wheelchair as they wish. They often go from sitting to standing with a hydraulic pump or electric-powered assist. A mobility scooter is a motorized assist device similar to an EPW, but with a steering 'tiller' or bar instead of the joystick, and fewer medical support options. Mobility scooters are available without a prescription in some markets, and range from large, powerful models to lightweight folding ones intended for travel. A bariatric wheelchair is one designed to support larger weights; most standard chairs are designed to support no more than 250 lbs. (113 kg) on average. Pediatric wheelchairs are another available subset of wheelchairs. Hemi wheelchairs have lower seats which are designed for easy foot propulsion. The decreased seat height also allows them to be used by children and shorter individuals. A knee scooter is a related device which may be substituted for a wheelchair when an injury has occurred to only one leg, below the knee. The patient rests the injured leg on the scooter, grasps the handlebars, and pushes with the uninjured leg. A power-assisted wheelchair is a recent development that uses the frame & seating of a typical manual chair while replacing the standard rear wheels with wheels that have small battery-powered motors in the hubs. A floating rim design senses the pressure applied by the users push & activates the motors proportionately. This results in the convenience, small size & light-weight of a manual chair while providing motorised assistance for rough/uneven terrain & steep slopes that would otherwise be difficult or impossible to navigate, especially by those with limited upper-body function.


A modern racing wheelchair

Athletes with a disability use sport wheelchairs for disabled sports that require speed and agility, such as basketball, rugby, tennis and racing. Each wheelchair sport tends to use specific types of wheelchairs, and these no longer look like their everyday cousins. They are usually non-folding (in order to increase rigidity), with a pronounced negative camber for the wheels (which provides stability during a sharp turn), and made of composite, lightweight materials. Sport wheelchairs are not generally for everyday use, and are often a 'second' chair specifically for sport use, although some users prefer the sport options for everyday.

US versus France, FIPFA World Cup, Tokyo, Japan, October 2007.

Powerchair Football/Power Soccer A new sport has been developed for powerchair users called powerchair football or power soccer. It is the only competitive team sport for powerchair users. The Federation Internationale de Powerchair Football Associations (FIPFA)[3] governs the sport and is located in Paris, France with country affiliates around the world.

stretcher, or mechanical

Stretcher (or transfer) chairs are mobile chairs that can be adjusted to lay flat like a stretcher to help in the lateral (or supine) transfer of a patient from a bed to the chair. Once transferred, the stretcher can be adjusted to allow the patient to assume a sitting position. Transfer chairs often use sliding sheets or inflatable sliding mats with air bearings to facilitate the movement of the patient from the bed to the chair. The patient in bed is rolled onto the transfer sheet or mat, and the sheet slides between the bed and the chair (configured as a flat

stretcher), carrying the patient with it. Transfer chairs sometimes have separate manual cranks or electric winches which attach to the sliding sheet and pull (or drag) the patient off the bed and onto the chair. Such devices can also be used to transfer patients to standard gurneys. Alternately nurses can lift or slide the transfer sheet and patient manually. Transfer chairs are usually much more expensive than common wheelchairs. This is because of the complex engineering required to be able of change the chair's configuration from a stretcher to a mobile chair. This kind of lateral patient transfer requires a stable platform to prevent injury (i.e., avoid patient falls). This stability requirement makes transfer chairs larger, heavier, and less mobile than standard wheelchairs.

terrain variants

This wheelchair allow users to enter the water and provide a better mobility in the sand and on uneven terrain. There are lots of different models available both manual and battery driven. In many countries in Europe where the Accessible Tourism is well set, many beaches are wheelchair accessible and provide this kind of wheelchairs to clients free of charge.


Recent technological advances are slowly improving wheelchair and EPW technology. Some wheelchairs, such as the iBOT, incorporate gyroscopic technology and other advances, enabling the chair to balance and run on only two of its four wheels on some surfaces, thus raising the user to a height comparable to a standing person. They can also incorporate stair-climbing and four-wheel-drive feature motorized assists for hand-powered chairs are becoming more available and advanced. The popular Segway Personal Transporter is a mobility device that was a direct outgrowth of the development of the iBOT wheelchair. The Segway, which is basically an iBOT with two wheels removed, was developed explicitly to increase the number of units produced and take advantage of the economies of scale to make the iBOT affordable to wheelchair users. The $25,000 iBot, which was developed as a joint venture between Johnson and Johnson's Independence Technology and Dean Kamen's DEKA Research, was discontinued in January 2009. The addition of geared, all-mechanical wheels for manual wheelchairs is a new development incorporating a hypocycloidal reduction gear into the wheel design. The 2-gear wheels can be added to a manual wheelchair. The geared wheels provide a user with additional assistance by providing leverage through gearing (like a bicycle, not a motor). The two-gear wheels offer two speed ratios- 1:1 (no help, no extra torque) and 2:1, providing 100% more hill climbing force. The low gear incorporates an automatic "hill hold" function which holds the wheelchair in place on a hill between pushes, but will allow the user to override the hill hold to roll the wheels backwards if needed. The low gear also provides downhill control when descending. A recent development related to wheelchairs is the handcycle. They come in a variety of forms, from road and track racing models to off-road types modelled after mountain bikes.

There have been significant efforts over the past 20 years to develop stationary wheelchair trainer platforms that could enable wheelchair users to exercise as one would on a treadmill or bicycle trainer.[4][5] Some devices have been created that could be used in conjunction with virtual travel and interactive gaming similar to an omnidirectional treadmill.[citation needed] In 2011, British inventor Andrew Slorance developed Carbon Black the first wheelchair to be made almost entirely out of carbon fibre[6] The chair was launched at Naidex in October 2011.[7] Working alongside Andrew Slorance as a collaborative National Health Service development partner, A National Health Technology Cooperative Devices for Dignity (D4D) provided Andrew with funding and expert guidance to support him taking the product to market.

and access

The examples and perspective in this section deal primarily with the United States and do not represent a worldwide view of the subject. Please improve this article and discuss the issue on the talk page. (May 2010)

Wheelchair ramp and disabled parking space

A gate for wheelchairs in Hiroshima

A wheelchair-swing on a playground in New Zealand


Adapting the built environment to make it more accessible to wheelchair users is one of the keycampaigns of disability rights movements and the Americans with Disabilities Act of 1990 (ADA). The most important principle is Universal design - that all people regardless of disability are entitled to equal access to all parts of society like public transportation and buildings. A wheelchair user is less disabled in an environment without stairs.

Wheelchair elevator located outdoors

Sometimes it is necessary to add structures like ramps or elevators in order to permit people in wheelchairs (and those using crutches, canes, walkers and so forth, or those with unsupported walking disabilities) to use a particular building. Other important adaptations are powered doors, lowered fixtures such as sinks and water fountains, and toilets with adequate space and grab bars to allow the person to maneuver himself or herself out

of the wheelchair onto the fixture. In the United States, most new construction for public use must be built to ADA standards of accessibility. With the aging of the population, architects are seeking to design wheelchair ramps for private homes that are less obtrusive and harmonize better with the overall design of the home's structure. Other important adaptations to private homes are larger bathroom doors that can accommodate wheelchairs, and showers and bathtubs that are designed for accessibility. These designs can permit the use of mobile shower chairs or transfer benches to facilitate bathing for people with disabilities. Wet rooms are bathrooms where the shower floor space and bathroom floor are one continuous surface. Such floor designs allow a patient in a shower chair to be pushed directly into the shower without needing to overcome a barrier or lip. The construction of low floor trams and buses is being encouraged, whereas the use ofpaternosters in public buildings without any alternative method of transportation has been criticized due to the lack of access for wheelchair users. Modern urban architecture now incorporates better accessibility for people with disabilities. In many countries, such as the UK, the owners of inaccessible buildings are advised to keep a lightweight portable wheelchair or scooter access ramp on hand to make premises disabled-friendly.

Public transit accessible vehicles are public transportation revenue vehicles which do not restrict access, are usable and provide allocated space and/or priority seating for people who use wheelchairs. In Los Angeles there is a program to remove a small amount of seating on some trains to make more room for bicycles and wheel chairs.[8] New York City's entire bus system is wheelchair-accessible, and a multi-million-dollar renovation program is underway to provide elevator access to many of the city's 485 subway stations. In Adelaide, Australia, all public transport has provision for at least two wheelchairs per bus, tram or train. In addition all trains have space available for bicycles. The Washington, D.C. Metro system features complete accessibility on all its subways and buses. A wheelchair that has been designed and tested for use as a seat in motor vehicles are often referred to as a "WC19 Wheelchair" or a "transit wheelchair". ANSI-RESNA WC19 (officially, SECTION 19 ANSI/RESNA WC/VOL. 1 Wheelchairs for use in Motor Vehicles)is a voluntary standard for wheelchairs designed for use when traveling facing forward in a motor vehicle. ISO 7176/19 is an international transit wheelchair standard that specifies similar design and performance requirements as ANSI/RESNA WC19. Thus, a WC19 Wheelchair is a crash-tested wheelchair with four clearly identified securing points that meets the design and performance requirements of ANSI-RESNA WC19 Wheelchairs Used as Seats in Motor Vehicles, and is sometimes called a transit wheelchair.



Several organizations exist that help to give and receive wheelchair equipment. Organizations that accept wheelchair equipment donations typically attempt to identify recipients and match them with the donated equipment they have received. Organizations that accept donations in the form of money for wheelchairs typically have the wheelchairs manufactured and distributed in large numbers, often in developing countries. Organizations focusing on wheelchairs include Direct Relief International, the Free Wheelchair Mission, Hope Haven, Personal Energy Transportation, the Wheelchair Foundation and WheelPower.

From Wikipedia, the free encyclopedia
(Redirected from Artificial leg)

For other uses, see Prosthesis (disambiguation). Not to be confused with Orthotic.
This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (October 2010)

A man with two prosthetic arms playing table football.


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Societal implications

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Personal / physical assistance

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In medicine, a prosthesis, prosthetic, or prosthetic limb (from Greek , "application, attachment"[1]) is an artificial device extension that replaces a missing bodypart. It is part of the field of biomechatronics, the science of using mechanical devices with human muscle, skeleton, and nervous systems to assist or enhance motor control lost bytrauma, disease, or defect. Prostheses are typically used to replace parts lost by injury (traumatic) or missing from birth (congenital) or to supplement defective body parts. Inside the body, artificial heart valves are in common use with artificial hearts and lungs seeing less common use but under active technology development. Other medical devices and aids that can be considered prosthetics include hearing aids, artificial eyes, palatal obturator, gastric bands, and dentures. Prosthetics are specifically not orthotics, although given certain circumstances a prosthetic might end up performing some or all of the same functionary benefits as an orthotic. Prostheses (or "A" prosthesis) are technically the complete finished item. For instance, a C-Leg knee alone is not a prosthesis, but only a prosthetic part. The complete prosthesis would consist of the stump attachment system - usually a "socket",

and all the attachment hardware parts all the way down to and including the foot. Keep this in mind as often nomenclature is interchanged.

1 History 2 Lower extremity prosthetics

2.1 Lower extremity modern history

2.1.1 C-Leg knee prosthesis

3 Robotic prostheses 4 Cosmesis 5 Cognition 6 Prosthetic enhancement

o o o o o

6.1 Types 6.2 Transtibial prosthesis 6.3 Transfemoral prosthesis 6.4 Transradial prosthesis 6.5 Transhumeral prosthesis

7 Current technology/manufacturing

o o o

7.1 Body-powered arms 7.2 Myoelectric 7.3 Robotic limbs

8 Direct bone attachment / osseointegration 9 Cost 10 Design considerations

o o

10.1 Performance 10.2 Other

11 References 12 External links


Prosthetic toe from ancient Egypt

Prosthetics have been mentioned throughout history. The earliest recorded mention is the warrior queen Vishpala in the Rigveda.[2] Egyptians were early pioneers of the idea, such as a wooden toe found on a body from the New Kingdom.[3] Roman bronze crowns have also been found, but their use could have been more aesthetic than medical.[4] Another early recorded mention of a prosthetic was done by the Greek historian Herodotus, who tells the story of Hegesistratus, a Greek diviner who cut off his own foot to escape his Spartancaptors and replaced it with a wooden one.[5] Pliny the Elder also recorded that a Roman general who had his arm cut off had an iron one made to hold his shield up when he returned to battle. A famous and quite refined[6] historical prosthetic arm was that of Gtz von Berlichingen, made in the beginning of the 16th century. Around the same time, Franois de la Noue is also reported to have had an iron hand, as is, in the 17th century, Ren-Robert Cavalier de la Salle.[7] During the Dark Ages, prosthetics remained quite basic in form. Debilitated knights would be fitted with prosthetics so they could be fitted with a shield. Only the wealthy were able to afford anything that would assist in daily function. During the Renaissance, prosthetics also underwent a rebirth. Prosthetics development using iron, steel, copper, and wood started. Functional prosthetics began to make an appearance in the 1500s. Gotz von Berlichingen, a German mercenary, developed a pair of iron hands that could be moved by relaxing a series of releases and springs. Record written by an Italian surgeon also notes the existence of amputee who had an arm that allowed him to remove his hat, open his purse, and sign his name. Improvement in amputation surgery and prosthetic design came at the hands of Ambroise Par. Among his inventions was an above-knee device that was a kneeling peg leg and foot prosthesis that had a fixed position, adjustable harness, and knee lock control. The functionality of his advancements showed what future prosthetics would function. Other major improvements before the modern era:

Pieter Verduyn - First nonlocking below-knee (BK) prosthesis.

James Potts - Prosthesis made of a wooden shank and socket, a steel knee joint and an articulated foot that was controlled by catgut tendons from the knee to the ankle. Came to be known as Anglesey Leg or Selpho Leg.

Sir James Syme - A new method of ankle amputation that did not involve amputating at the thigh. Benjamin Palmer - Improved upon the Selpho leg. Added an anterior spring and concealed tendons to simulate natural-looking movement.

Dubois Parmlee Created prosthetic with a suction socket, polycentric knee, and multi-articulated foot. Marcel Desoutter & Charles Desoutter First aluminum prosthesis[8]

At the end of World War II, the NAS (National Academy of Sciences) began to advocate better research and development of prosthetics. Through government funding, a research and development program was developed within the Army, Navy, Air Force, and the Veterans Administration. The following organizations have been created to help and inform the general publics about prosthetics:

American Orthotics and Prosthetic Association, American Board for Certification in Prosthetics and Orthotics, American Academy of Orthotics and Prosthetics These three groups work together to take responsibility for the academic side of orthotics and prosthetics and provide certification of individuals and facilities working with orthotics and prosthetics.

The International Society for Prosthetics and Orthotics Founded in 1970 and headquartered in Copenhagen, this association helps with the progression in research and clinical practice worldwide. They hold an international conference every three years and publish their own technical journal.

Association of Childrens Orthotic-Prosthetic Clinics The organization was started in 1950s to advocate research and development of childrens prosthetics. They meet annually and have their own publication.

Amputee Coalition of America The organization was created in 1990 to improve the lives of amputees. Advocate the improvement of amputee lifestyle through education and also have their own publication, inMotion.


extremity prosthetics

Lower extremity prosthetics describes artificially replaced limbs located at the hip level or lower. The two main subcategories of lower extremity prosthetic devices are 1.trans-tibial (any amputation transecting the tibia bone or a congenital anomaly resulting in a tibial deficiency) and 2.trans-femoral (any amputation transecting the

femur bone or a congenital anomaly resulting in a femural deficiency). In the prosthetic industry a trans-tibial prosthetic leg is often referred to as a "BK" or below the knee prosthesis while the trans-femoral prosthetic leg is often referred to as an "AK" or above the knee prosthesis. Other, less prevalent lower extremity cases include the following: 1. Hip disarticulations - This usually refers to when an amputee or congenitally challenged patient has either an amputation or anomaly at or in close proximity to the hip joint. 2. Knee disarticulations - This usually refers to an amputation through the knee disarticulating the femur from the tibia. 3. Symes - This is an ankle disarticulation while preserving the heel pad.

extremity modern history

Socket technology for lower extremity limbs saw a revolution of advancement during the 1980s when Sabolich Prosthetics, John Sabolich C.P.O., invented the Contoured Adducted Trochanteric-Controlled Alignment Method (CATCAM) socket, later to evolve into the Sabolich Socket. He followed the steps of science led by Ivan Long and Ossur Christensen as they developed alternatives to the scientifically developed quadrilateral socket, which followed the open ended plug socket created from wood. The advancement was due to the difference in the socket to patient contact model. Prior, sockets were made in the shape of a square bucket with no specialized containment for either the patient's bony prominences' or muscular tissue. Sabolich's design held the patient's limb like a glove, locking it into place and distributing the weight evenly over the existing limb as well as the bone structure of the patient. This was the first instance of ischial containment and led to an extreme advancement in patient accomplishment. Because of Sabolich's dedication to research and development in lower extremity prosthetics, Sabolich Prosthetics saw the first above the knee prosthetic patients walk and run step over step with both one leg and two legs missing, walking down stairs, suction sockets, modern plastic and bio elastic sockets, sense of feel technology, and numerous other inventions in the prosthetic field. Others who contributed to socket development include Tim Staats, Chris Hoyt, Frank Gottschalk(who undermined in a scientific article the efficacy of the CAT-CAM socket- indicating the surgical procedure done by the amputation surgeon was most important to prepare the amputee for good use of a prosthesis of any type socket design. The first microprocessor-controlled prosthetic knees became available in the early 1990s. The Intelligent Prosthesis was first commercially available microprocessor controlled prosthetic knee. It was released by Chas. A. Blatchford & Sons, Ltd., of Great Britain, in 1993 and made walking with the prosthesis feel and look more natural.[9] An improved version was released in 1995 by the name Intelligent Prosthesis Plus. Blatchford released another prosthesis, the Adaptive Prosthesis, in 1998. The Adaptive Prosthesis utilized hydraulic controls, pneumatic controls, and a microprocessor to provide the amputee with a gait that was more responsive to changes in walking speed. Little evidence exists to support the tremendous financial burden to

third parties who pay essentially the cost of a cheap home for the microprocessor knee, ischial containment socket, flexfoot leg. Some amputees from the Iraq and Afghanistan conflicts have returned to service with sophisticated prostheses. Cost analysis reveals that a sophisticated above knee prosthesis will be in the neighborhood of $1 million in 45 years, given only annual cost of living adjustments.
[edit]C-Leg knee prosthesis

Two different models of the C-Leg prosthesis

The Otto Bock Orthopedic Industry introduced the C-Leg during the World Congress on Orthopedics in Nuremberg in 1997. The company began marketing the C-Leg in the United States in 1999.[11] Other microprocessor-controlled knee prostheses include Ossur's Rheo Knee, released in 2005, the Power Knee by Ossur, introduced in 2006, the Pli Knee from Freedom Innovations[12] and DAW Industries Self Learning Knee (SLK).[13] The idea was originally developed by Kelly James, a Canadian engineer, at the University of Alberta.[14] The CLeg uses hydraulic cylinders to control the flexing of the knee. Sensors send signals to the microprocessor that analyzes these signals, and communicates what resistance the hydraulic cylinders should supply. C-Leg is an abbreviation of 3C100, the model number of the original prosthesis, but has continued to be applied to all Otto Bock microprocessor-controlled knee prostheses. The C-Leg functions through various technological devices incorporated into the components of the prosthesis. The C-Leg uses a knee-angle sensor to measure the angular position andangular velocity of the flexing joint. Measurements are taken up to fifty times a second. The knee-angle sensor is located directly at the axis of rotation of the knee.[15] Moment sensors are located in the tube adapter at the base of the C-Leg. These moment sensors use multiple strain gauges to determine where the force is being applied to the knee, from the foot, and the magnitude of that force.[15] The C-Leg controls the resistance to rotation and extension of the knee using a hydraulic cylinder. Small valves control the amount ofhydraulic fluid that can pass into and out of the cylinder, thus regulating the extension and

compression of a piston connected to the upper section of the knee. [10] The microprocessor receives signals from its sensors to determine the type of motion being employed by the amputee. The microprocessor then signals the hydraulic cylinder to act accordingly. The microprocessor also records information concerning the motion of the amputee that can be downloaded onto a computer and analyzed. This information allows the user to make better use of the prosthetic.[15] The C-Leg is powered by a lithium-ion battery housed inside the prosthesis below the knee joint. (cell is actually located within the axis of the joint) On a full charge, the C-leg can operate for up to 45 hours, depending on the intensity of use. A charging port located on the front of the knee joint can be connected to a charging cable plugged directly into a standard outlet.[16] A "pigtail" charging port adapter permits the relocation of the charging port to a location more accessible when the prosthesis has a cosmetic cover applied. The charger cord has lights that allow the user to observe the level of charge when connected to the knee. A 12 volt car charger adapter can also be purchased. The C-Leg provides certain advantages over conventional mechanical knee prostheses. It provides an approximation to an amputees natural gait. The C-Leg allows amputees to walk at near walking speed. Variations in speed are also possible and are taken into account by sensors and communicated to the microprocessor, which adjusts to these changes accordingly. It also enables the amputees to walk down stairs with a step-over-step approach, rather than the one step at a time approach used with mechanical knees.[11] The C-Legs ability to respond to sensor readings can help amputees recover from stumbles without the knee buckling.[17] However, the C-Leg has some significant drawbacks that impair its use. The C-Leg is susceptible to water damage and thus great care must be taken to ensure that the prosthesis remains dry. Otto Bock recommends that each amputee use the C-Leg for up to two months before the system can fully become accustomed to the individuals unique gait. Becoming accustomed to the C-Leg is especially difficult when walking downhill, and amputees should seek help while becoming familiar with the system to avoid injury. [11] A wide range of amputees can make use of the C-Leg; however, some people are more suited to this prosthesis than others. The C-Leg is designed for use on people who have undergone transfemoral amputation, or amputation above the knee. The C-Leg can be used by amputees with either single or bilateral limb amputations. In the case of bilateral amputations, the application of C-Legs must be closely monitored. In some cases, those who have undergone hip disarticulation amputations can be candidates for a C-Leg.[18] The prosthesis is recommended for amputees that vary their walking speeds and can reach over 3 miles per hour; however, it cannot be used for running. The C-Leg is practical for upwards of 3 miles daily, and can be used on uneven ground, slopes, or stairs. Active amputees, such as bikers and rollerbladers may find the C-Leg suited to their needs.

Certain physical requirements must be met for C-Leg use. The amputee must have satisfactory cardiovascular and pulmonary health. The balance and strength of the amputee must be sufficient to take strides while using prosthesis. The C-Leg is designed to support amputees weighing up to 275 pounds.[18]


Further information: Robotics#Touch In order for a robotic prosthetic limb to work, it must have several components to integrate it into the body's function: Biosensors detect signals from the user's nervous or muscular systems. It then relays this information to a controller located inside the device, and processes feedback from the limb and actuator (e.g., position, force) and sends it to the controller. Examples include wires that detect electrical activity on the skin, needle electrodes implanted in muscle, or solid-state electrode arrays with nerves growing through them. One type of these biosensors are employed in myoelectric prosthesis. Mechanical sensors process aspects affecting the device (e.g., limb position, applied force, load) and relay this information to the biosensor or controller. Examples include force meters and accelerometers. The controller is connected to the user's nerve and muscular systems and the device itself. It sends intention commands from the user to the actuators of the device, and interprets feedback from the mechanical and biosensors to the user. The controller is also responsible for the monitoring and control of the movements of the device. An actuator mimics the actions of a muscle in producing force and movement. Examples include a motor that aids or replaces original muscle tissue.

Cosmetic prosthesis has long been used to disguise injuries and disfigurements. With advances in modern technology, cosmesis, the creation of lifelike limbs made from silicone or PVC has been made possible. Such prosthetics, such as artificial hands, can now be made to mimic the appearance of real hands, complete with freckles, veins, hair, fingerprints and even tattoos. Custom-made cosmeses are generally more expensive (costing thousands of US dollars, depending on the level of detail), while standard cosmeses come ready-made in various sizes, although they are often not as realistic as their custom-made counterparts. Another option is the custom-made silicone cover, which can be made to match a person's skin tone but not details such as freckles or wrinkles. Cosmeses are attached to the body in any number of ways, using an adhesive, suction, form-fitting, stretchable skin, or a skin sleeve.

Main article: Neuroprosthetics

Unlike neuromotor prostheses, neurocognitive prostheses would sense or modulate neural function in order to physically reconstitute or augment cognitive processes such as executive function, attention, language, and memory. No neurocognitive prostheses are currently available but the development of implantable neurocognitive brain-computer interfaces has been proposed to help treat conditions such asstroke, traumatic brain injury, cerebral palsy, autism, and Alzheimer's disease.[19] The recent field of Assistive Technology for Cognitionconcerns the development of technologies to augment human cognition. Scheduling devices such as Neuropage remind users with memory impairments when to perform certain activities, such as visiting the doctor. Micro-prompting devices such as PEAT, AbleLink and Guidehave been used to aid users with memory and executive function problems perform activities of daily living.


Further information: Powered exoskeleton#Research In addition to the standard artificial limb for everyday use, many amputees or congenital patients have special limbs and devices to aid in the participation of sports and recreational activities. Within science fiction, and, more recently, within the scientific community, there has been consideration given to using advanced prostheses to replace healthy body parts with artificial mechanisms and systems to improve function. The morality and desirability of such technologies are being debated. Body parts such as legs, arms, hands, feet, and others can be replaced. The first experiment with a healthy individual appears to have been that by the British scientist Kevin Warwick. In 2002, an implant was interfaced directly into Warwick's nervous system. The electrode array, which contained around a hundred electrodes, was placed in themedian nerve. The signals produced were detailed enough that a robot arm was able to mimic the actions of Warwick's own arm and provide a form of touch feedback again via the implant.[20]

In 2008, Oscar Pistorius was briefly ruled ineligible for the 2008 Summer Olympics due to an alleged mechanical advantage over runners who have ankles.

In early 2008, Oscar Pistorius, the "Blade Runner" of South Africa, was briefly ruled ineligible to compete in the 2008 Summer Olympics because his prosthetic limbs were said to give him an unfair advantage over runners who had ankles. One researcher found that his limbs used twenty-five percent less energy than those of an able-bodied runner moving at the same speed. This ruling was overturned on appeal, with the appellate court stating that the overall set of advantages and disadvantages of Pistorius' limbs had not been considered. Pistorius did not qualify for the South African team for the Olympics, but went on to sweep the2008 Summer Paralympics, and has been ruled eligible to qualify for any future Olympics. He qualified for the 2011 World Championship in South Korea and reached the semifinal where he ended last timewise, he was 14th in the first round, his personal best at 400m would have given him 5th place in the finals. Dean Kamen's company DEKA developed the "Luke arm", an advanced prosthesis currently under trials as of 2008.[21]

A United States Marine with bilateral prosthetic legs leads a formation run.

There are four main types of artificial limbs. These include thetranstibial, transfemoral, transradial, and transhumeralprostheses. The type of prosthesis depends on what part of the limb is missing.



A transtibial prosthesis is an artificial limb that replaces a leg missing below the knee. Transtibial amputees are usually able to regain normal movement more readily than someone with a transfemoral amputation, due in large part to retaining the knee, which allows for easier movement. In the prosthetic industry a trans-tibial prosthetic leg is often referred to as a "BK" or below the knee prosthesis.


A transfemoral prosthesis is an artificial limb that replaces a leg missing above the knee. Transfemoral amputees can have a very difficult time regaining normal movement. In general, a transfemoral amputee must use approximately 80% more energy to walk than a person with two whole legs.[22] This is due to the complexities in movement associated with the knee. In newer and more improved designs, after employing hydraulics, carbon fibre, mechanical linkages, motors, computer microprocessors, and innovative combinations of these technologies to give more control to the user. In the prosthetic industry a trans-femoral prosthetic leg is often referred to as an "AK" or above the knee prosthesis.[23]


A transradial prosthesis is an artificial limb that replaces an arm missing below the elbow. Two main types of prosthetics are available. Cable operated limbs work by attaching a harness and cable around the opposite shoulder of the damaged arm. The other form of prosthetics available are myoelectric arms. These work by sensing, via electrodes, when the muscles in the upper arm moves, causing an artificial hand to open or close. In the prosthetic industry a trans-radial prosthetic arm is often referred to as a "BE" or below elbow prosthesis.


A transhumeral prosthesis is an artificial limb that replaces an arm missing above the elbow. Transhumeral amputees experience some of the same problems as transfemoral amputees, due to the similar complexities associated with the movement of the elbow. This makes mimicking the correct motion with an artificial limb very difficult. In the prosthetic industry a trans-humeral prosthesis is often referred to as a "AE" or above the elbow prothesis.


Knee prosthesis manufactured using WorkNCComputer Aided Manufacturing software

In recent years there have been significant advancements in artificial limbs. New plastics and other materials, such as carbon fiber, have allowed artificial limbs to be stronger and lighter, limiting the amount of extra energy necessary to operate the limb. This is especially important for transfemoral amputees. Additional materials have allowed artificial limbs to look much more realistic, which is important to transradial and transhumeral amputees because they are more likely to have the artificial limb exposed.[24]

Manufacturing a prosthetic finger

In addition to new materials, the use of electronics has become very common in artificial limbs. Myoelectric limbs, which control the limbs by converting muscle movements to electrical signals, have become much more common than cable operated limbs. Myoelectric signals are picked up by electrodes, the signal gets integrated and once it exceeds a certain threshold, the prosthetic limb control signal is triggered which is why inherently, all myoelectric controls lag. Conversely, cable control is immediate and physical, and through that offers a certain degree of direct force feedback that myoelectric control does not. Computers are also used extensively in the manufacturing of limbs. Computer Aided Design and Computer Aided Manufacturing are often used to assist in the design and manufacture of artificial limbs.[24] Most modern artificial limbs are attached to the stump of the amputee by belts and cuffs or bysuction. The stump either directly fits into a socket on the prosthetic, ormore commonly todaya liner is used that then is fixed to the socket either by vacuum (suction sockets) or a pin lock. Liners are soft and by that, they can create a far better suction fit than hard sockets. Silicone liners can be obtained in standard sizes, mostly with a circular (round) cross section, but for any other stump shape, custom liners can be made. The socket is custom made to fit the residual limb and to distribute the forces of the artificial limb across the area of the stump (rather than just one small spot), which helps reduce wear on the stump. The custom socket is created by taking a plaster cast of the stump or, more commonly today, of the liner worn over the stump, and then making a mold from the

plaster cast. Newer methods include laser guided measuring which can be input directly to a computer allowing for a more sophisticated design. One problems with the stump and socket attachment is that a bad fit will reduce the area of contact between the stump and socket or liner, and increase pockets between stump skin and socket or liner. Pressure then is higher, which can be painful. Air pockets can allow sweat to accumulate that can soften the skin. Ultimately, this is a frequent cause for itchy skin rashes. Further down the road, it can cause breakdown of the skin. [22] Artificial limbs are typically manufactured using the following steps:[24] 1. Measurement of the stump 2. Measurement of the body to determine the size required for the artificial limb 3. Fitting of a silicone liner 4. Creation of a model of the liner worn over the stump 5. Formation of thermoplastic sheet around the model This is then used to test the fit of the prosthetic 6. Formation of permanent socket 7. Formation of plastic parts of the artificial limb Different methods are used, including vacuum forming and injection molding 8. Creation of metal parts of the artificial limb using die casting 9. Assembly of entire limb


Current body powered arms contain sockets that are built from hard epoxy or carbon fiber. Wrist units are either screw-on connectors featuring the UNF 1/2-20 thread (USA) or quick release connector, of which there are different models. Terminal devices contain a range of hooks, hands or other devices. Hands require a large activation force, which is often uncomfortable. Hooks require a much lower force. [25]Hosmer and Otto Bock are major commercial hook providers. Mechanical hands are sold by Hosmer and Otto Bock as well; the Becker Hand is still manufactured by the Becker family. Prosthetic hands may be fitted with standard stock or custom made cosmetic looking silicone gloves. But regular work gloves may be worn as well. Other terminal devices include the V2P Prehensor, a versatile robust gripper that allows customers to modify aspects of it, Texas Assist Devices (with a whole assortment of tools) and TRS that offers a range of terminal devices for sports. Cable harnesses can be built using aircraft steel cables, ball hinges and self lubricating cable sheaths. Current high tech allows body powered arms to weigh around half to only a third of the weight that a myoelectric arm has.

Actor Owen Wilson gripping the myoelectric prosthetic arm of a United States Marine


A myoelectric prosthesis uses electromyography signals or potentials from voluntarily contracted muscles within a person's residual limb on the surface of the skin to control the movements of the prosthesis, such as elbow flexion/extension, wrist supination/pronation (rotation) or hand opening/closing of the fingers. A prosthesis of this type utilizes the residual neuro-muscular system of the human body to control the functions of an electric powered prosthetic hand, wrist or elbow. This is as opposed to an electric switch prosthesis, which requires straps and/or cables actuated by body movements to actuate or operate switches that control the movements of a prosthesis or one that is totally mechanical. It is not clear whether those few prostheses that provide feedback signals to those muscles are also myoelectric in nature. It has a self suspending socket with pick up electrodes placed over flexors and extensors for the movement of flexion and extension respectively. The first commercial myoelectric arm was developed in 1964 by the Central Prosthetic Research Institute of the USSR, and distributed by the Hangar Limb Factory of the UK.[26][27]


Main article: Neural prosthetics Further information: Robotics#Touch Advancements in the processors used in myoelectric arms has allowed for artificial limbs to make gains in fine tuned control of the prosthetic. The Boston Digital Arm is a recent artificial limb that has taken advantage of these more advanced processors. The arm allows movement in five axes and allows the arm to be programmed for a more customized feel. Recently the i-Limb hand, invented in Edinburgh, Scotland, by David Gow has become the first commercially available hand prosthesis with five individually powered digits. The hand also possesses a manually rotatable thumb which is operated passively by the user and allows the hand

to grip in precision, power and key grip modes.[28] Raymond Edwards, Limbless Association Acting CEO, was the first amputee to be fitted with the i-LIMB by the National Health Service in the UK.[29] The hand, manufactured by "Touch Bionics"[30] of Scotland (a Livingston company), went on sale on 18 July 2007 in Britain.[31] It was named alongside the Large Hadron Collider in Time magazine's top fifty innovations.[32] Another robotic hand is theRSLSteeper bebionic [33] Another neural prosthetic is Johns Hopkins University Applied Physics Laboratory Proto 1. Besides the Proto 1, the university also finished the Proto 2 in 2010.[34] Robotic legs exist too: the Argo Medical Technologies ReWalk is an example or a recent robotic leg, targeted to replace the wheelchair. It is marketed as a "robotic pants".[35] Targeted muscle reinnervation (TMR) is a technique in which motor nerves which previously controlled muscles on an amputated limb aresurgically rerouted such that they reinnervate a small region of a large, intact muscle, such as the pectoralis major. As a result, when a patient thinks about moving the thumb of his missing hand, a small area of muscle on his chest will contract instead. By placing sensors over the reinervated muscle, these contractions can be made to control movement of an appropriate part of the robotic prosthesis.[36][37] An emerging variant of this technique is called targeted sensory reinnervation (TSR). This procedure is similar to TMR, except that sensory nerves are surgically rerouted to skin on the chest, rather than motor nerves rerouted to muscle. The patient then feels any sensory stimulus on that area of the chest, such as pressure or temperature, as if it were occurring on the area of the amputated limb which the nerve originally innervated. In the future, artificial limbs could be built with sensors on fingertips or other important areas. When a stimulus, such as pressure or temperature, activated these sensors, an electrical signal would be sent to an actuator, which would produce a similar stimulus on the "rewired" area of chest skin. The user would then feel that stimulus as if it were occurring on an appropriate part of the artificial limb. [36] Recently, robotic limbs have improved in their ability to take signals from the human brain and translate those signals into motion in the artificial limb. DARPA, the Pentagons research division, is working to make even more advancements in this area. Their desire is to create an artificial limb that ties directly into the nervous system.[38]

bone attachment / osseointegration

Main article: Osseointegration Osseointegration is a new method of attaching the artificial limb to the body. This method is also sometimes referred to as exoprosthesis(attaching an artificial limb to the bone), or endo-exoprosthesis.

The stump and socket method can cause significant pain in the amputee, which is why the direct bone attachment has been explored extensively. The method works by inserting a titanium bolt into the bone at the end of the stump. After several months the bone attaches itself to the titanium bolt and an abutment is attached to the titanium bolt. The abutment extends out of the stump and the artificial limb is then attached to the abutment. Some of the benefits of this method include the following:

Better muscle control of the prosthetic. The ability to wear the prosthetic for an extended period of time; with the stump and socket method this is not possible.

The ability for transfemoral amputees to drive a car.

The main disadvantage of this method is that amputees with the direct bone attachment cannot have large impacts on the limb, such as those experienced during jogging, because of the potential for the bone to break.[22]
[edit]Cost This section has multiple issues. Please help improve it or discuss these issues on the talk page.

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Transradial and transtibial prostheses typically cost between US $6,000 and $8,000. Transfemoral and transhumeral prosthetics cost approximately twice as much with a range of $10,000 to $15,000 and can sometimes reach costs of $35,000. The cost of an artificial limb does recur because artificial limbs are usually replaced every 34 years due to wear and tear. In addition, if the socket has fit issues, the socket must be replaced within several months. If height is an issue components can be changed, such as the pylons. [39] [40] Low cost above knee prostheses often provide only basic structural support with limited function. This function is often achieved with crude, non-articulating, unstable, or manually locking knee joints. A limited number of organizations, such as the International Committee of the Red Cross (ICRC), create devices for developing countries. Their device which is manufactured by CR Equipments is a single-axis, manually operated locking polymer prosthetic knee joint.[41] Table. List of knee joint technologies based on the literature review. [42]
Name of technology (country of origin) Brief description Highest level of

evidence ICRC knee (Switzerland) ATLAS knee (UK) POF/OTRC knee (US) DAV/Seattle knee (US) LEGS M1 knee (US) JaipurKnee (US) LCKnee (Canada) None provided (Nepal) None provided (New Zealand) None provided (India) Friction knee (US) Wedgelock knee (Australia) SATHI friction knee (India) Single-axis with manual lock Weigh-activated friction Single-axis with ext. assist Compliant polycentric Four-bar Four-bar Independent field Independent field Field Field Field Field

Single-axis with automatic lock Field Single-axis Roto-molded single-axis Six-bar with squatting Weigh-activated friction Weigh-activated friction Weigh-activated friction Field Field Technical development Technical development Technical development Limited data available

Low Cost Above Knee Prosthetic Limbs: ICRC Knee (left) and LC Knee (right)

There is currently an open Prosthetics design forum known as the "Open Prosthetics Project". The group employs collaborators and volunteers to advance Prosthetics technology while attempting to lower the costs of these necessary devices.[43] A plan for a low-cost artificial leg, designed by Sbastien Dubois, was featured at the 2007 International Design Exhibition and award show in Copenhagen, Denmark, where it won the Index: Award. It would be able to create an energy-return prosthetic leg for US $8.00, composed primarily of fiberglass.[44] Prior to the 1980s, foot prostheses merely restored basic walking capabilities. These early devices can be characterized by a simple artificial attachment connecting one's residual limb to the ground. The introduction of the Seattle Foot (Seattle Limb Systems) in 1981 revolutionized the field, bringing the concept of an Energy Storing Prosthetic Foot (ESPF) to the fore. Other companies soon followed suit, and before long, there were multiple models of energy storing prostheses on the market. Each model utilized some

variation of a compressible heel. The heel is compressed during initial ground contact, storing energy which is then returned during the latter phase of ground contact to help propel the body forward. Since then, the foot prosthetics industry has been dominated by steady, small improvements in performance, comfort, and marketability.Jaipur Foot, an artificial limb from Jaipur, India, costs about US$ 40.


There are multiple factors to consider when designing a transtibial prosthesis. Manufacturers must make choices about their priorities regarding these factors.

Nonetheless, there are certain elements of foot mechanics that are invaluable for the athlete, and these are the focus of todays high-tech prosthetics companies:

Energy storage and return storage of energy acquired through ground contact and utilization of that stored energy for propulsion

Energy absorption minimizing the effect of high impact on the musculoskeletal system Ground compliance stability independent of terrain type and angle Rotation ease of changing direction Weight maximizing comfort, balance and speed Suspension - how the socket will join and fit to the limb