Traditionally in the world of personal injury claims we are used to seeing the cost of prosthetic provision for a lower limb amputation significantly exceeding the cost for an upper limb amputation. A very basic explanation for that is because of the higher prevalence of knee, ankle and foot prosthesis with expensive components such as microprocessors. The fact that the leg is a larger limb and therefore better able to accommodate what can sometimes be quite heavy prosthetics is perhaps another reason we generally see claims with lower limb amputations costing more than claims where an upper limb has been lost. This is before we factor in additional factors such as the impact on accommodation requirements.
Another explanation is the reality that the driving force behind most prosthetic development is military injuries. The conflicts in Iraq and Afghanistan resulted in a very large of service personnel requiring amputations, but data suggests only around 14% involved upper limb amputations1. Thus there has been an understandable greater focus on the development of lower limb prosthesis over the past two decades.
Myoelectric technology
However in recent years we have seen some very interesting developments in the world of upper limb prosthesis. A recurring feature with such prosthesis is the use of myoelectric technology. In very simple terms these prosthesis use sensors which receive electric signals from muscles within the residual limb to then control the use of the elbow, wrist and hand.
This technology has been around for a while, but the difficulty has been incorporating it into a prosthesis that is functional and affordable. One success story we have seen is the partnership between Open Bionics and the Hanger Clinic which led to the "Hero Arm". This is a lightweight (340g / 12oz) myoelectric arm with multi-grip functionality. It is engineered and manufactured in the UK and, according to Open Bionics, it is now available in over 800 locations in the USA, UK, Europe, Australia and New Zealand for below-elbow amputee adults and children aged eight and above.
The Hero Arm also utilises 3D scanning technology and according to Open Bionics' own literature "the innovative socket is comfortable, adjustable and breathable, making it easy to take on and off while providing you with the best fit" 2.
The Hero Arm
We have seen the Hero Arm being trialled by claimants. In one case a claimant had undergone a below-elbow amputation and was aged 15 when trialling the Hero Arm. That particular claimant found that the Hero Arm enabled him to:
- carry light-weight objects using both hands;
- grasp and pass small items; and
- he found wearing the prosthetic was helping improve his posture when sitting.
In this case the claimant had some reluctance to wear the arm at school for fear of attracting attention, though one suspects that may not be as much of an issue amongst adult users.
In our experience the cost of the Open Bionics Hero Arm with myoelectric hand, myo-electrodes with custom adjustable socket and forearm custom finish will be in the region of £10,000 to £15,000 on a five yearly cycle. By comparison the unit cost for a multi-grip/multi-articulated myoelectric terminal device such as the Bebionic, I-Limb or Michelangelo is in the region of £15,000 to £25,000. One also needs to factor in the training with an occupational therapist with knowledge and expertise in upper limb prosthetics.
Upper limb prosthetics on the horizon
More developments in upper limb prosthetics are on the horizon. An international research team at the Cleveland Clinic have developed a novel bionic arm that they say "allows wearers to think, behave, and function as though they did not have an amputation". The prosthetic is said to combine "intuitive motor control, touch and grip kinaesthesia, and the intuitive feeling of opening and closing the hand" 3. The "touch robot system" uses technology that provides individual finger sensation to the user through a neural-machine interface.
Paul Marasco, PhD, lead investigator and associate professor at the Cleveland Clinic said "These findings are an important step towards providing people with amputation with complete restoration of natural arm function". While this technology is not yet available amongst the general population, technologies like the Hero Arm which offer something approaching normal hand function are becoming increasingly user-friendly, relatively affordable and therefore popular amongst upper limb amputees.
The days of very basic or only cosmetic upper limb prosthetic provision in the claims world are becoming a distant memory. We are seeing more research and development in this area and as a consequence the cost of claims involving an upper limb amputation are going to continue to increase.
Footnotes
1 Ten years at war: comprehensive analysis of amputation trends; Chad A Krueger 1, Joseph C Wenke, James R Ficke - https://pubmed.ncbi.nlm.nih.gov/23192067/
2 https://openbionics.com/en/hero-arm/
3 "Bionic Arm Prosthesis May Restore Natural Efforts" by The O&P EDGE September 2, 2021 - https://opedge.com/bionic-arm-prosthesis-may-restore-natural-efforts/
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