prosthesis prosthesis in medicine, a prosthesis (plural: prostheses; from ancient greek: πρόσθεσις, romanized: prósthesis, lit. 'addition, application, attachment'), or a prosthetic implant, is an artificial device that replaces a missing body part, which may be lost through trauma, disease, or a condition present at birth (congenital disorder). prostheses are intended to restore the normal functions of the missing body part. amputee rehabilitation is primarily coordinated by a physiatrist as part of an inter-disciplinary team consisting of physiatrists, prosthetists, nurses, physical therapists, and occupational therapists. prostheses can be created by hand or with computer-aided design (cad), a software interface that helps creators design and analyze the creation with computer-generated 2-d and 3-d graphics as well as analysis and optimization tools. not to be confused with orthotic. a man with a lower-extremity prosthesis disability theory and models disability theory ableism / disablism medical model social model education mainstreaming individualized education program (iep) special needs special school special education learning disability therapy physical occupational speech societal implications disability rights movement inclusion normalization people-first language pejorative terms sexuality and disability personal assistance unlicensed assistive personnel (adls) orthotics and braces prosthetics assistive technology assisted living mobility aid physical accessibility universal design web accessibility socioeconomic assistance social security disability insurance supplemental security income ticket to work disability living allowance disabled students allowance disabled persons railcard freedom pass assured income forthe severely handicapped groupsorganizations national telecommuting institute society for disability studies disabled peoples' international (dpi) visitability wethe15 parasports special olympics paralympic games deaflympics invictus games culture disability in the arts disability art disability in the media disabilitylists types a person's prosthesis should be designed and assembled according to the person's appearance and functional needs. for instance, a person may need a transradial prosthesis, but the person needs to choose between an aesthetic functional device, a myoelectric device, a body-powered device, or an activity specific device. the person's future goals and economical capabilities may help them choose between one or more devices. craniofacial prostheses include intra-oral and extra-oral prostheses. extra-oral prostheses are further divided into hemifacial, auricular (ear), nasal, orbital and ocular. intra-oral prostheses include dental prostheses, such as dentures, obturators, and dental implants. prostheses of the neck include larynx substitutes, trachea and upper esophageal replacements, somato prostheses of the torso include breast prostheses which may be either single or bilateral, full breast devices or nipple prostheses. penile prostheses are used to treat erectile dysfunction, correct penile deformity, perform phalloplasty and metoidioplasty procedures in biological men, and to build a new penis in female-to-male gender reassignment surgeries. limb prostheses limb prostheses include both upper- and lower-extremity prostheses. upper-extremity prostheses are used at varying levels of amputation: forequarter, shoulder disarticulation, transhumeral prosthesis, elbow disarticulation, transradial prosthesis, wrist disarticulation, full hand, partial hand, finger, partial finger. a transradial prosthesis is an artificial limb that replaces an arm missing below the elbow. upper limb prostheses can be categorized in three main categories: passive devices, body powered devices, and externally powered (myoelectric) devices. passive devices can either be passive hands, mainly used for cosmetic purposes, or passive tools, mainly used for specific activities (e.g. leisure or vocational). an extensive overview and classification of passive devices can be found in a literature review by maat et.al. a passive device can be static, meaning the device has no movable parts, or it can be adjustable, meaning its configuration can be adjusted (e.g. adjustable hand opening). despite the absence of active grasping, passive devices are very useful in bimanual tasks that require fixation or support of an object, or for gesticulation in social interaction. according to scientific data a third of the upper limb amputees worldwide use a passive prosthetic hand. body powered or cable-operated limbs work by attaching a harness and cable around the opposite shoulder of the damaged arm. a recent body-powered approach has explored the utilization of the user's breathing to power and control the prosthetic hand to help eliminate actuation cable and harness. the third category of prosthetic devices available is myoelectric arms. these work by sensing, via electrodes, when the muscles in the upper arm move, causing an artificial hand to open or close. in the prosthetics industry, a trans-radial prosthetic arm is often referred to as a "be" or below elbow prosthesis. lower-extremity prostheses provide replacements at varying levels of amputation. these include hip disarticulation, transfemoral prosthesis, knee disarticulation, transtibial prosthesis, syme's amputation, foot, partial foot, and toe. the two main subcategories of lower extremity prosthetic devices are trans-tibial (any amputation transecting the tibia bone or a congenital anomaly resulting in a tibial deficiency) and trans-femoral (any amputation transecting the femur bone or a congenital anomaly resulting in a femoral deficiency). 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. this is due to the complexities in movement associated with the knee. in newer and more improved designs, hydraulics, carbon fiber, mechanical linkages, motors, computer microprocessors, and innovative combinations of these technologies are employed to give more control to the user. in the prosthetics industry, a trans-femoral prosthetic leg is often referred to as an "ak" or above the knee prosthesis. a transtibial prosthesis is an artificial limb that replaces a leg missing below the knee. a transtibial amputee is 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. lower extremity prosthetics describe artificially replaced limbs located at the hip level or lower. in the prosthetics industry, a trans-tibial prosthetic leg is often referred to as a "bk" or below the knee prosthesis. prostheses are manufactured and fit by clinical prosthetists. prosthetists are healthcare professionals responsible for making, fitting, and adjusting prostheses and for lower limb prostheses will assess both gait and prosthetic alignment. once a prosthesis has been fit and adjusted by a prosthetist, a rehabilitation physiotherapist (called physical therapist in america) will help teach a new prosthetic user to walk with a leg prosthesis. to do so, the physical therapist may provide verbal instructions and may also help guide the person using touch or tactile cues. this may be done in a clinic or home. there is some research suggesting that such training in the home may be more successful if the treatment includes the use of a treadmill. using a treadmill, along with the physical therapy treatment, helps the person to experience many of the challenges of walking with a prosthesis. in the united kingdom, 75% of lower limb amputations are performed due to inadequate circulation (dysvascularity). this condition is often associated with many other medical conditions (co-morbidities) including diabetes and heart disease that may make it a challenge to recover and use a prosthetic limb to regain mobility and independence. for people who have inadequate circulation and have lost a lower limb, there is insufficient evidence due to a lack of research, to inform them regarding their choice of prosthetic rehabilitation approaches. types of prosthesis used for replacing joints in the human body lower extremity prostheses are often categorized by the level of amputation or after the name of a surgeon: transfemoral (above-knee) transtibial (below-knee) ankle disarticulation (more commonly known as syme's amputation) knee disarticulation hip disarticulation hemi-pelvictomy partial foot amputations (pirogoff, talo-navicular and calcaneo-cuboid (chopart), tarso-metatarsal (lisfranc), trans-metatarsal, metatarsal-phalangeal, ray amputations, toe amputations). van nes rotationplasty prosthetic raw materials prosthetic are made lightweight for better convenience for the amputee. some of these materials include: plastics: polyethylene polypropylene acrylics polyurethane wood (early prosthetics) rubber (early prosthetics) lightweight metals: titanium aluminum composites: carbon fiber reinforced polymers wheeled prostheses have also been used extensively in the rehabilitation of injured domestic animals, including dogs, cats, pigs, rabbits, and turtles. history prosthetic toe from ancient egypt prosthetics originate from the ancient near east circa 3000 bce, with the earliest evidence of prosthetics appearing in ancient egypt and iran. the earliest recorded mention of eye prosthetics is from the egyptian story of the eye of horus dates circa 3000 bc, which involves the left eye of horus being plucked out and then restored by thoth. circa 3000-2800 bc, the earliest archaeological evidence of prosthetics is found in ancient iran, where an eye prosthetic is found buried with a woman in shahr-i shōkhta. it was likely made of bitumen paste that was covered with a thin layer of gold. the egyptians were also early pioneers of foot prosthetics, as shown by the wooden toe found on a body from the new kingdom circa 1000 bc. another early textual mention is found in south asia circa 1200 bc, involving the warrior queen vishpala in the rigveda. roman bronze crowns have also been found, but their use could have been more aesthetic than medical. an early mention of a prosthetic comes from the greek historian herodotus, who tells the story of hegesistratus, a greek diviner who cut off his own foot to escape his spartan captors and replaced it with a wooden one. wood and metal prosthetics the capua leg (replica) iron prosthetic hand believed to have been owned by götz von berlichingen (1480–1562) "illustration of mechanical hand", c. 1564 artificial iron hand believed to date from 1560 to 1600 pliny the elder also recorded the tale of a roman general, marcus sergius, whose right hand was cut off while campaigning and had an iron hand made to hold his shield so that he could return to battle. a famous and quite refined historical prosthetic arm was that of götz von berlichingen, made at the beginning of the 16th century. the first confirmed use of a prosthetic device, however, is from 950 to 710 bc. in 2000, research pathologists discovered a mummy from this period buried in the egyptian necropolis near ancient thebes that possessed an artificial big toe. this toe, consisting of wood and leather, exhibited evidence of use. when reproduced by bio-mechanical engineers in 2011, researchers discovered that this ancient prosthetic enabled its wearer to walk both barefoot and in egyptian style sandals. previously, the earliest discovered prosthetic was an artificial leg from capua. around the same time, françois de la noue is also reported to have had an iron hand, as is, in the 17th century, rené-robert cavalier de la salle. henri de tonti had a prosthetic hook for a hand. during the middle ages, prosthetic remained quite basic in form. debilitated knights would be fitted with prosthetics so they could hold up a shield, grasp a lance or a sword, or stabilize a mounted warrior. only the wealthy could afford anything that would assist in daily life. one notable prosthesis was that belonging to an italian man, who scientists estimate replaced his amputated right hand with a knife. scientists investigating the skeleton, which was found in a longobard cemetery in povegliano veronese, estimated that the man had lived sometime between the 6th and 8th centuries ad. materials found near the man's body suggest that the knife prosthesis was attached with a leather strap, which he repeatedly tightened with his teeth. during the renaissance, prosthetics developed with the use of iron, steel, copper, and wood. functional prosthetics began to make an appearance in the 1500s. technology progress before the 20th century an italian surgeon recorded the existence of an 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 paré. among his inventions was an above-knee device that was a kneeling peg leg and foot prosthesis with a fixed position, adjustable harness, and knee lock control. the functionality of his advancements showed how future prosthetics could develop. other major improvements before the modern era: pieter verduyn – first non-locking 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