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Prosthetic split-hooks are by far the MORE MODERN concept than prosthetic hands and they did not take long to get vilified [what you all got wrong about history]

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - Prosthetic split-hooks are by far the MORE MODERN concept than prosthetic hands and they did not take long to get vilified [what you all got wrong about history]; published March 3, 2019, 23:01; URL: https://www.swisswuff.ch/tech/?p=9423.

BibTeX: @MISC{schweitzer_wolf_1574108571, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Prosthetic split-hooks are by far the MORE MODERN concept than prosthetic hands and they did not take long to get vilified [what you all got wrong about history]}}, month = {March},year = {2019}, url = {https://www.swisswuff.ch/tech/?p=9423}}


We are told by prosthetic R&D aficionados, by film makers, fiction authors, popular culture and whatnot, that a prosthetic hook (i.e., split-hook) is "old", and a prosthetic hand is "new". Also, we get told that myoelectric arms are very modern in terms of control technology, whereas some recent media and prosthetic manufacturers even called myoelectric control "brain control".

None of that is true, quite obviously, while we realize that reality is rather different. Rather strikingly different, in fact.

Timeline overview

The timeline of events more or less looks like this:

  • for upper extremity prostheses, a prosthetic hand (and not a hook) is a type of design that predates the prosthetic split-hook by about 2000 (two thousand) years;
  • for upper extremity prosthetic control systems, cable control (first system developed ~1780, first useful system ~1860, first widely commercialized system ~1948, first technically sound cable mount design ~2016) slightly predates myoelectric control (first concept ~1919, first myoelectric prosthesis prototype ~1948, first Russian arm design to become widely popularized ~1960)
  • a split-hook is therefore more modern by at least ~2000 years than the idea of a prosthetic hand, it is ~500 years more modern than the idea of a moveable prosthetic hand and still ~100 years more modern than the idea of a body-powered or cable-controlled prosthetic hand;
  • the body-powered split-hook as well as the body-powered v/c prehensor are inventions of arm amputees; in that tradition i may add a true bowden-cable mount and a new wrist unit that is far more robust than any prior product, thus closing the circle to a truly useful device (for rehabilitation in real work, not to play piano);
  • so myoelectric control (with first inventions after ~1919 and first prototypes dating to ~1948) still has the rough charm of other inventions of that time, such as the band-aid, the electric hair-dryer, or the electric dish-washer;
  • the design of a prosthetic hand (and not a different shape of gripper) likely relates to sword fighting as cause for limb loss and as continued application domain for the prosthetic arm from 15th century onward, whereas a prosthetic split-hook only became interesting after the onset of industrialization where factory work caused amputations and required replacement, and so a prosthetic split-hook always denoted real work rather than destructive aristocratic or warlord type pastime;
  • the fictionalization of split-hooks as belonging to evil people only required about 40-50 years and it comes from a time when increasing numbers of disabled beggars started to line the streets, and when an increasing reduction of social cohesion lead to an stigmatization of the visually handicapped people; the technical proficiency of a well designed split-hook was never affected by the fairy-tale type story telling; however, the popularity of prosthetic split-hooks particularly among more immature people such as pubescent or adolescent people as well as people with reduced self-esteem was seriously impacted by the negative social connotation of hooks to this day;
  • transhumanism still has not decided whether to adopt a truly iconoclastic attitude with regard to arm amputation or whether to adhere to the same, >2000 year old anthropomorphic copy-paste-schematic for prostheses which in essence tells us that transhumanists are just as lost in time and place as a swashbuckling warlord seems to be misplaced in a modern IT driven office;

History interpretation

So really, the use of split-hooks in popular culture and public awareness is associated with poor factory workers that ultimately also constituted a population of homeless and beggars, whereas the delineation to rich people was that these did not have to deliver manual work, thus did not need reliable grip performance, and thus could rely on the far less useful designs of prosthetic hands while taking advantage of parasitic and exploitative aspects of constellation of powers.

In fact, prosthetic hands have their roots in sword fighting - an inherently unproductive activity performed by warlords and aristocrats, or those "challenged" by aristocrats to a duel or such, a destructive but not overly constructive occupation. To this day, one has to be able to afford a lifestyle where one can just sit around to parade one's "bionic" hand as a useless but promising, poorly reflected piece of design fraught with hopes and promises, that has been with us for over two thousand years.

In order to successfully wear a prosthetic hand, which by design clearly leaves a lot to be desired from view of gripping and overall comfort, and in order to avoid having to manually perform duties and tasks, it becomes necessary to find modes of income that are similar to the cleric, aristocrat or scholar or whoever else can get by without delivering what I call real work. Without surprise, we find current representational ambassadors of prosthetic "bionic" hands to mostly be "motivational" speakers, models, professors, actresses, beer drinkers and hell raisers but sure as hell no real work deliverers.

The body-powered split-hook, conversely, is a true piece of engineering that, however, requires a true engineer to be recognized as that.

Even a body powered hand that is exceptionally well crafted such as the Becker hand offers great support.

The split hook has been vilified for purely societal reasons [link, link], and in a world, where true manual ability threatens to take away glamour of the former aristocratic, cleric and scholar class, this is a real threat that is now fought with a lot of investment and energy [Cybathlon 2016; Cybathlon 2020] - but only by members of that class, by people that hate hard work, that stand above it, that do not accept it, that see no role in helping amputees for real work, for real hard work, for physically demanding work, in other words, for that type of work where the use of prosthetic arms is orthopedically necessary.

As the ability to "be unable to" perform actually menial work has been a symbolic and practical hallmark of high societal standing so far, it is that where the future of prosthetic arm development will have to address its own historical contradictions, it has to overcome itself in a domain where it has so far fought itself. How can the absence of true reliability be defended a lot longer? Who are the true beneficiaries - as sword fights as main application domain are long over?

The fact that myoelectric arms, from the very beginning, were explicitly designed to keep amputees from ever achieving any industrially useful grip success rate is clearly documented by a more or less stable error rate of myoelectric controls as academically published over 40 years. Whatever the coordination efforts were behind this outcome, even considering the total lack of oversight on such horrible results - that is absolutely extraordinary. Literally everyone else has to improve on this planet, regardless of profession or topic, subject area or focus, but for the R&D of prosthetic arms, the real developers that push the envelope for real work application are amputees that innovate the field of truly useful prosthetic technology themselves, ridiculed by academia that places all their "bets" and hype on myoelectric control, which, in its overall limitations and success, does not move even a bit over forty years. You could not even write fiction about that type of stuff, no one would believe it.

Around 210 BC: first prosthetic hand

The Roman scholar Pliny the Elder (23-79 A.D.) wrote of a Roman general in the Second Punic War (218-210 B.C.) who had a right arm amputated. He had an iron hand fashioned to hold his shield and was able to return to battle. (https://www.amputee-coalition.org/resources/a-brief-history-of-prosthetics/)

15th and 16th century: prosthetic hands for sword fighting

The design of a prosthetic hand (and not a different shape of gripper) likely relates to sword fighting as cause and application domain for the prostheses from 15th century onward. - List of "iron hands" [link]

Around 1450: first prosthetic iron hand with moveable parts

[link] The First Hand of Florence is a prosthetic hand with a stiff thumb and a moveable 4-finger block.

Around 1510: Goetz von Berlichingen - famous iron hand with moveable parts

[link] The most popular prosthesis of the Middle Ages is the so called Iron Hand of knight Götz von Berlichingen. It was constructed in 1504 by an armorer and a real sensation at that time. It looked like an iron glove and was tightened to the stump of the forearm with leather straps. With the help of gearwheels the fingers could be revolved and fixed at a certain position, so that the knight could hold his sword and continue to carry out his profession.

[link] Eiserne Hand oder Jagsthäuser Hand werden zwei dem Ritter Gottfried „Götz“ von Berlichingen zugeschriebene passive Handprothesen aus dem 16. Jahrhundert bezeichnet, deren jüngere auch wesentlich bekannter ist. Beide Eiserne Hände sind heute im Museum der Götzenburg Jagsthausen ausgestellt. Im weiteren Sinne bezeichnet der Begriff „Eiserne Hand“ eine größere Gruppe ähnlicher Prothesen aus der Zeit des späten Mittelalters beziehungsweise der frühen Neuzeit.

Around 1512: silver arm for Oruc "Barbarossa" Reis

[link] In 1510, the three brothers raided Cape Passero in Sicily and repulsed a Spanish attack on Bougie, Oran and Algiers. In August 1511 they raided the areas around Reggio Calabria in southern Italy. In August 1512 the exiled ruler of Bougie invited the brothers to drive out the Spaniards, and during the battle Oruç lost his left arm. This incident earned him the nickname Gümüş Kol (Silver Arm in Turkish), in reference to the silver prosthetic device which he used in place of his missing limb.

[link] Italian historian and physician Paolo Giovio recorded that the Turkish pirate Horuk Barbarossa lost his right hand in the Battle of Bugia (circa 1517) against Spain, and received an iron replacement that enabled him to continue in battle.

Around 1600: one of the first noncombative prosthetic hands

[link] One of the first descriptions of a noncombative hand prosthesis was in 1600 by Italian surgeon Giovanni Tommaso Minadoi, who described an amputee who could remove his hat, untie a purse and even write with a quill.

Around 1622: Duke Christian of Brunswick gets an iron hand for combat

[link] Another example of an iron hand was that created by a Dutch craftsman for Duke Christian of Brunswick, who had lost his left hand in the Battle of Fleury (circa 1622).

16th century: mechanics build increasingly powered hands

1551: first spring-loaded hand (Paré)

In 1551, French military surgeon Ambroise Paré drew the first detailed design of a spring-loaded prosthetic hand, nicknamed ‘Le Petit Lorrain’ after the craftsman who fashioned it (Figure 3). Paré also drew a prosthetic arm for an above elbow amputation.

Zuo, K. J., & Olson, J. L. (2014). The evolution of functional hand replacement: From iron prostheses to hand transplantation. Plastic Surgery, 22(1), 44-51.

Around 1780: first cable-controlled body-powered prosthetic hand (Klingert)

Cable controlled arms were known to be used since the Royal Court Mechanic Carl Heinrich Klingert in Breslau tried to imitate hand motion with his construction of a prosthesis that used 9 gut strings and a number of manually operated control switches, for an aristrocrat around 1712-1786.

Images: Kluge, Carl Alexander Ferdinand, and Hermann Eduard Fritze. Arthroplastik oder die sämmtlichen, bisher bekannt gewordenen künstlichen Hände und Füsse, zum Ersatz dieser verloren gegangenen Gliedmassen: mit 26 in Stein gravirten Tafeln. Meyer, 1842.

Betrachtet man diesen künstlichen Arm Klingerts als ein Modell zu einem Phantom, bei welchem eine beliebige Stellung der Glieder für schönkünstlerische (..) Zwecke erzielt, und von einer einzigen Stelle des Oberarmschaftes aus durch das Spielen einer Claviatur die naturgemässe Bewegung aller einzelnen Glieder bewirkt werden soll, so muss man eine solche Aufgabe durch den sinnreichen Mechanismus für vollkommen ge löst erachten ; soll hingegen der Apparat als Modell zu einem für den wirklichen Ersatz und für das Handeln im Leben bestimmten künstlichen Arm die nen, so muss das Ganze für eine allzukünstliche und darum practisch unbrauchbare Maschine erklärt werden. -- Kluge, Carl Alexander Ferdinand, and Hermann Eduard Fritze. Arthroplastik oder die sämmtlichen, bisher bekannt gewordenen künstlichen Hände und Füsse, zum Ersatz dieser verloren gegangenen Gliedmassen: mit 26 in Stein gravirten Tafeln. Meyer, 1842.


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Around 1812: improved cable-controlled body-powered prosthetic hand (Baliff)

[link] In 1812 the Berlin dentist and surgical technician Peter Baliff had a new idea: he wanted to use the remaining power of the amputated arm to move the prosthesis. Therefore, he tightened tackles round elbow and shoulder, which carried out the movement. By stretching of the elbow the thumb could also be stretched and with a certain movement of the shoulder the other fingers were stretched. For the user of the prosthesis this meant that he had to crick himself to move his artificial hand.

Around 1860: first cable-controlled body-powered prosthetic split-hook

[link] In the 1860s, the Comte de Beaufort in France adapted a design of prosthesis to enable the amputee to open and close a double spring hook, or flex and extend the thumb on a simple hand with fused fingers.

Around 1904: first fictionalized prosthetic hook as symbol of evil

Captain James Hook [link] is a fictional character, the main antagonist of Sir J. M. Barrie's play Peter Pan; or, the Boy Who Wouldn't Grow Up and its various adaptations, in which he is Peter Pan's archenemy. The character is set as a pirate captain of the brig Jolly Roger. His two principal fears are the sight of his own blood (supposedly an unnatural colour) and the crocodile who pursues him after eating the hand cut off by Pan. An iron hook replaced his severed hand, which gave the pirate his name. First appearance: Peter Pan (1904). The real story behind Peter Pan bases on Sir Barrie's real life ostensibly is so seedy that no person of taste or respect should use the story to "make hooks look bad" and "Peter Pan look good". This is not made better when one realizes that one particular Swiss company that tries to promote prosthetic arms for children also registered to produce devices for sexual activities, and they also advertise using the Captain Hook metaphor - supported by Swiss Federal Institute of Technology and others.

(C) Copyright Image Wyss Zurich, Give Children A Hand, Swiss Prosthetics, Bionicman

Generally, the Captain Hook symbol used to denigrate prosthetic split-hook prostheses mainly appears to serve as a metaphor for people that want to convey the message "look, I am deeply confused, I have no idea how metaphors or prostheses work, but I am after involving children, and I never want to grow up myself" [link]. Anyone that understands its ramifications will be very careful with this.

Around 1911: first widely commercialised cable-controlled body-powered prosthetic hand (Carnes)

The Carnes hand (1911) combined these elegant looking features with rather complex mechanism that did achieve the same as the previous inventions. It was crafted relatively well. The complex mechanics of the Carnes arm was developed from 190Carnes, W. T. (1911). U.S. Patent No. 999,484. Washington, DC: U.S. Patent and Trademark Office.

Carnes arm - history and current status [update]

Around 1912: first cable-controlled body-powered prosthetic split-hook

[link] In the early 1900s, there weren't a lot of regulations in place to protect the safety of U.S industrial workers, and terminal devices for upper-limb prostheses were somewhat limited. This is the cultural landscape that D.W. Dorrance found himself in when he underwent a traumatic amputation of his arm as a result of a workplace accident in his job as a lumber supervisor. Seeking a better solution for his own needs, he invented the split hook in 1912 and founded the company that is today known as Hosmer, Campbell, California. -- Reference: Dorrance, D. W. (1912). U.S. Patent No. 1,042,413. Washington, DC: U.S. Patent and Trademark Office.

Around 1919: first myoelectric prosthetic control systems

In 1919, a German book titled Ersatzglieder und Arbeitshilfen (Limb Substitutes and Work Aids) contained conceptual designs for the first externally powered prostheses, using pneumatic and electric power sources. Unfortunately, these revolutionary designs were too complex to be feasible with contemporary technology. -- Reference: Zuo, K. J., & Olson, J. L. (2014). The evolution of functional hand replacement: From iron prostheses to hand transplantation. Plastic Surgery, 22(1), 44-51.

Around 1948: first mobile myoelectric prosthetic control system

In 1948, Reinhold Reiter, a physics student at Munich University (Munich, Germany), created the first myoelectric prosthesis, a device that amplifies surface electromyography (EMG) potentials to power motorized parts. Although Reiter published his work, it was not widely appreciated, and this potentially ground-breaking invention did not gain commercial or clinical acceptance. --
Reference: Zuo, K. J., & Olson, J. L. (2014). The evolution of functional hand replacement: From iron prostheses to hand transplantation. Plastic Surgery, 22(1), 44-51.

Around 1948: first Bowden-cable body-powered cable-controlled prosthetic arm

In 1948, the Bowden cable body-powered prosthesis was introduced, replacing bulky straps with a sleek, sturdy cable. Despite new materials and improved craftsmanship, today’s body-powered prostheses are essentially adaptations of the Bowden design. Durable, portable and relatively affordable, body-powered prostheses allow the user an impressive range of motion, speed and force in operating a terminal device – most commonly a two-pronged hook – by changing the tension in a cable via preserved shoulder and body movements. The ability to use both hands simultaneously, rather than requiring a healthy hand to control the prosthesis, permits the user to complete tasks more efficiently. Furthermore, by sensing cable tension, the amputee is able to predict and adjust the position of the prosthesis without visual feedback. Although prolonged wearing can be uncomfortable, complicated motor tasks are limited and appearance is not human-like, body-powered prostheses are widely used. -- Reference: Zuo, K. J., & Olson, J. L. (2014). The evolution of functional hand replacement: From iron prostheses to hand transplantation. Plastic Surgery, 22(1), 44-51.

Around 1960: first politically motivated adoption of myoelectric prosthetic control technology by governments and medical systems

The first clinically significant myoelectric prosthesis was unveiled by Russian scientist Alexander Kobrinski in 1960.-- Reference: Zuo, K. J., & Olson, J. L. (2014). The evolution of functional hand replacement: From iron prostheses to hand transplantation. Plastic Surgery, 22(1), 44-51.

Russian prosthetic arm [about the history of myoelectric arms]

 

Milestones

Technical aspect Myoelectric Body-powered Passive
~210 B.C. - shape of prosthesis has to be a hand x
1551 - first spring-loaded prosthetic hand x
~1780 - first cable actuated prosthetic hand (Klingert) x
~1812 - first cable actuated body powered prosthetic hand (Baliff) x
~1860: first cable-controlled body-powered prosthetic split-hook x
~1912 - Dorrance patents body-powered split hook x
~1919 - first externally powered prosthetic arm x
~1948 - Reiter - first functioning myoelectric hand prototype x
~1948 - first widely commercialized bowden-cable powered split-hooks x
~1960 - Kobrinski introduces the myoelectric hand from Russia x
Summary Myoelectric:

first externally powered control idea 1919

Body-powered:

first body-powered prosthetic hand 1780

first body powered controls with split hook 1860

first commercalised truly useful body-powered split hook 1912 (Dorrance), widely commercialised after 1948

Passive:

first hand shapes worn passively ~200 BC

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