Page 192 - Handbook of Biomechatronics

Upper-Limb Prosthetic Devices 189

Skin

Inside Outside

Muscle
Mechanical linkage

Position, velocity, and force
Fig. 6 Schematic representation of the EPP topology when used with a tunnel
cineplasty or exteriorized tendons cineplasty. The position, velocity, and force of the
prosthetic component is directly correlated with position, velocity, and force of the con-
trolling muscle. (Drawn by E.C. Grahn; From Northwestern University Prosthetics Research
Laboratory (NUPRL).)

of cineplasty procedures, was the first to suggest no more than two tunnels in
a single stump. In Germany, the German surgeon Ernst Ferdinand
Sauerbruch (1915, 1916) worked on cineplasty techniques without know-
ing the existence of the Italian team. Sauerbruch is considered to be the
father of the muscle tunnel cineplasty procedure as it is known today.
Sauerbruch who was director of surgery at the Greifswald University Hos-
pital in Zurich started working in the field after suggestion of Dr. Stodola, a
distinguished Swiss turbine engineering professor. After being Director of
Surgery in Zurich (1910–18), Sauerbruch moved to Germany where he
was Director of Surgery in Munich (1918–28) and in Berlin (1928–49).
Sauerbruch made several contributions in the field. He proposed the use
of pairs of agonist and antagonist muscles to control a single-DoF prosthesis,
in order to provide more physiological and precise control. He also moved
the muscle tunnel from distal to the bone end where Italians had it, to prox-
imal to the bone end. He stressed the necessity of an exercise program for
these muscles before and after the cineplasty procedure. He also championed
a team organization of physician, prosthetist, surgeon, and technician around
the patient. Finally, Sauerbruch’s group specially built numerous innovative
prostheses for tunnel cineplasty amputees. He was also the first to insist on
the importance of performing the tunnel cineplasty only on highly