A System of Powered Prostheses for Severe Bilateral Upper Limb Deficiency.

Twenty children attending the Princess Margaret Rose Orthopaedic Hospital, Edinburgh, need a powered upper limb prosthesis. These children have the now familiar range of upper limb disabilities, from bilateral amelia to bilateral phocomelia, due to thalidomide. They were born between 1960 and 1962. Before the task of fitting the first children was begun, the main centres in Germany were visited. The skill shown by small children in operating powered prostheses was impressive and the system advocated by Marquardt (1962) was convincing and essentially practical. Unfortunately the only prosthetic components for this system which were then available in the United Kingdom were the “pat-a-cake” arms, the powered hooks and the control valves and tubing; the more advanced devices such as those providing elbow flexion or pronation and supination could not be obtained. Accordingly, in July 1963, two children were fitted with the pat-a-cake arms. For reasons which will be given later the control valves were not controlled by chest movements as recommended, but an attempt was made to get the children to work them with what digits they had. Little functional benefit was obtained with this type of prosthesis, perhaps because the children were more than a year old. In order to advance the training of the children it was necessary to design and develop a new prosthesis.