Prosthetic principles in bilateral shoulder disarticulation

•Based on a paper presented at the Second World Congress, ISPO, New York, 1977. Abstract Following a brief survey of the historic develop­ ment of pneumatic prostheses the actual prin­ ciples of prosthetic management in bilateral shoulder disarticulation or bilateral amelia are explained. The active functions are restricted to active prona t ion and supination, active gripping of the terminal device " h o o k " or " h a n d " , com­ bined with pneumatic locking of free swinging shoulder and elbow joints in one artificial a r m ; the cosmetic a rm provides only space for the power package in the resin socket of the upper a rm. Both arms are suspended on a Simpson frame. Thus optical control is concentrated on the movements of the functional a rm. The reduction of valve control makes prosthetic training and use easier. Recently hybrid systems came into use be­ cause electric power proved superior to pneu­ matic power for pronat ion and supination and gripping, whereas C 0 2 is still necessary for locking the elbow and the shoulder joint . The accumulator can be recharged daily at a plug socket, the CO2 container need only be refilled after one or two weeks ensuring more indepen­ dence for the disabled. The advantage of such a prosthesis is the better appearance in public combined with a certain functional use. However only intensive foot training without prostheses provides independence in daily acti­ vities, because even sophisticated prosthetic systems cannot make up completely for body loss.