Abstract:
An upper extremity prosthetic device is provided that comprises three main components, namely, an arm cuff, a forearm section and a distal connector. The arm cuff is adjustable to accommodate lower arms of different sizes. The forearm section may be constructed in certain limited sizes to accommodate different sized forearm residual limbs. The distal connector is designed to connect to any of the forearm section configurations, and the distal connector enables any terminal device to be attached to the connector. The components may be mixed and matched in various combinations to fit the physical dimensions of virtually any amputee. The interchangeable parts will accommodate a wide range of residual limb geometries, overall sizes and lengths. Embodiments of the present invention minimize the need for time and resource-intensive customized fitting and create an affordable, relatively low-cost prosthetic interface.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
       [0001]    The present application claims the benefits of U.S. Provisional Application Ser. No. 61/101,892 filed Oct. 1, 2008 entitled “Anatomically-Configured Adjustable Upper Extremity Prosthetic Interface,” which is incorporated herein by this reference in its entirety. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention relates to an upper extremity prosthetic device for persons with upper extremity transradial (i.e., below elbow) amputations. 
       BACKGROUND OF THE INVENTION 
       [0003]    Presently, many upper extremity prosthetic devices are custom made. In a typical manufacturing process, a cast is made of the amputee&#39;s residual limb. A prosthetic device is then molded from the casting. This process is time-consuming and costly. It further requires highly trained individuals to build and fit the devices. As a result, persons with low income and people in most developing countries have no access to such custom fitted devices much less the ability to pay for such devices. Thus, many people are deprived of the benefit of a prosthetic device. In addition, even those persons who can afford an expensive, customized prosthetic device do not participate in a wide variety of activities, such as sporting events, due to concerns over damage to their prosthetic device. 
         [0004]    One example of an upper extremity prosthetic device is disclosed in the U.S. Pat. No. 5,888,235. The invention is a prosthetic arm mountable on a socket attached to the residual limb of a person. The prosthetic arm includes a base for attachment to the socket, a forearm section or adapter having a proximal end and a distal end, a terminal device such as a hook or anthropomorphic hand, and attached to the distal end of the forearm section or adapter for selectively opening or closing. An elbow joint interconnects the proximal end of the forearm section to the base, the elbow joint being pivotable to enable moving the forearm section upwardly or downwardly. Control straps and cables fitted on the person are responsive to body movements of the person for selectively locking the elbow joint to prevent it from pivoting while allowing the terminal device to open or close or locking the terminal device to prevent it from opening or closing while allowing the elbow joint to pivot. 
         [0005]    Another example of a prosthetic arm is disclosed in the U.S. Patent Application Publication No. 20070213842. This invention comprises a forearm section adapted to mount to the arm of a patient, a hand section including a thumb and at least one finger, and a wrist section connected between the forearm section and said hand section. Movement of the prosthesis is achieved by a combination of pressurized air bladders and return springs. The prosthetic device is structurally and functionally interconnected to simulate a large number of the movements performed by the corresponding natural skeletal structures. 
         [0006]    Although there may be a number of differing constructions for arm prosthetic devices, there is still a need to provide an upper extremity prosthetic device that is adjustable to fit persons of different sizes, provides an adjustable fit for a wearer over time, yet provides superior ability for the device to act as a functional prosthesis. There is also a need to provide a prosthetic device for the arm that is relatively inexpensive, yet provides a comfortable and durable solution for the amputee. There is yet another need to provide a prosthetic device that is non-obtrusive to the amputee and provides a natural appearance of a substitute limb. 
       SUMMARY 
       [0007]    In one preferred embodiment of the present invention, the upper extremity prosthetic device, also known as a Johnson Veatch Device, comprises three main components, namely, a lower arm cuff or humeral cuff, a forearm section and a distal connector. The lower arm cuff is adjustable to accommodate lower arms of different sizes. Similarly, the forearm section may be constructed in certain limited sizes, for example, small, medium and large, to accommodate different sized forearm residual limbs. The distal connector is designed to connect to any of the forearm section configurations. 
         [0008]    The lower arm cuff comprises two opposed condyle contacts, an olecranon contact, and a posterior humeral contact. A pair of curved rods interconnects the condyle contacts to opposing sides of a base of the cuff. The base can be defined as the olecranon contact and posterior humeral contact that form one integral piece. Four shaft collars are provided in which one shaft collar is disposed on the end of each condyle contact and one each on opposite sides of the olecranon contact. A pair of cable or rod connections interconnects the lower arm cuff to the forearm section. 
         [0009]    The forearm section comprises two symmetrically opposed half-shells, a tongue disposed between one side of the half shells, a rear sizing plate disposed between the other side of the half shells, and a plurality of adjustment straps. 
         [0010]    The distal connector includes a pair of arms that extend outwardly and interface with matching ends of the forearm section. The distal connector further includes an angled lower surface with a threaded boss for interconnection with a variety of terminal devices. The lower surface may be angled to facilitate positioning of terminal devices relative to the user&#39;s body. 
         [0011]    The components may be mixed and matched in various combinations to fit the physical dimensions of virtually any amputee. The interchangeable parts will accommodate a wide range of residual limb geometries, overall sizes and lengths. By doing so, embodiments of the present invention will minimize the need for time and resource-intensive customized fitting and, as a result, will create an affordable, relatively low-cost prosthetic interface. 
         [0012]    In another aspect of the invention, means are provided for attaching to an arm a plurality of supporting contacts to interconnect the arm to the prosthetic device. The means for attaching comprises a pair of opposing condyle contacts, an olecranon contact, and a posterior humeral contact, said contacts each making contact with the arm thereby providing a suspended configuration for the prosthetic device. 
         [0013]    In yet another aspect of the invention, the invention has utility in sub-combination in that the group of four contacts provides an effective device to attach a number of different forearm extensions and terminal devices. 
         [0014]    Other features and advantages of the present invention will become apparent from a review of the following Detailed Description taken in conjunction with the Drawings. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0015]      FIG. 1  is front plan view of one embodiment of the lower arm prosthetic device of the present invention. 
           [0016]      FIG. 2  is an exploded view of the embodiment shown in  FIG. 1 . 
           [0017]      FIG. 3  is a perspective view of a distal connector and exemplary terminal devices. 
           [0018]      FIG. 4  is a side plan view of the embodiment of  FIG. 1 . 
           [0019]      FIG. 5  is an opposite side view of the embodiment of  FIG. 1 . 
           [0020]      FIG. 6  is a front plan view of the lower arm or humeral cuff of one embodiment of the present invention positioned on a user arm and further showing as environment the skeletal structure of the user&#39;s arm and forearm. 
           [0021]      FIG. 7  is a side view of one embodiment of the prosthetic device of the present invention further showing as environment the skeletal structure of the user&#39;s arm and forearm. 
           [0022]      FIG. 8  is a perspective view of a shaft collar of the present invention. 
           [0023]      FIG. 9  is a front plan view of a condyle contact of the present invention. 
           [0024]      FIG. 10  is a rear elevation view of an olecranon contact of the present invention. 
           [0025]      FIG. 11  is a side view of an olecranon contact of the present invention. 
           [0026]      FIG. 12  is a side view of a posterior humeral contact of the present invention. 
           [0027]      FIG. 13  is a rear perspective view of the embodiment of  FIG. 1 . 
           [0028]      FIG. 14  is a section view of a portion of the forearm adapter including a contact pad. 
           [0029]      FIG. 15  is a perspective view of an embodiment of the lower arm cuff of the present invention further showing a security strap in association therewith. 
       
    
    
       [0030]    While the following disclosure describes the invention in connection with those embodiments presented, one should understand that the invention is not strictly limited to these embodiments. Furthermore, one should understand that the drawings are not necessarily to scale, and that in certain instances, the disclosure may not include details which are not necessary for an understanding of the present invention, such as conventional details of fabrication and assembly. 
       DETAILED DESCRIPTION OF THE INVENTION 
       [0031]    With reference to  FIG. 1 , a first embodiment of the upper extremity prosthetic device  10  of the present invention is shown. The upper extremity prosthetic device comprises three portions: A lower arm cuff  12 , a forearm section or adapter  14 , and a distal connector  16 . The prosthetic device  10  is designed to secure to the residual limb of a below-elbow amputee as discussed in more detail below. 
         [0032]    As seen in  FIG. 2 , the lower arm cuff comprises two opposed condyle contacts  18 , an olecranon contact  20 , a posterior humeral contact  22 , a pair of curved rods  24 , four shaft collars  26  (one shaft collar disposed on the end of each condyle contact  18  and one each on opposite sides of the olecranon contact), and a pair of cable or rod connectors  28  associated with the condyle contacts  18 . 
         [0033]    The forearm section  14  comprises two symmetrically opposed half-shells  40  and  42 , a tongue  44 , a rear sizing plate  46 , and a plurality of adjustment straps  48 . Each forearm half-shell  40 ,  42  further include a cable or rod connector  50  mounted on proximal ends of the half-shells. A pair of cables or rods  130  interconnects the lower arm cuff to the forearm section in which the cables  130  are secured at their respective ends to the connectors  28  and  50 . 
         [0034]    The distal connector  16  includes a pair of arms  60  and  62  which extend outwardly and interface with distal ends  43  and  45  of the forearm half shells  40  and  42 , respectively. The distal connector further includes an angled lower surface  64  with a universally sized threaded boss  66  for interconnection with a variety of terminal devices, exemplary versions of which are shown in  FIG. 3 . The lower surface  64  extends at an angle, as shown in  FIGS. 4 and 5 , to facilitate positioning of terminal devices  70  relative to the user&#39;s body. For example, the angled lower surface  64  orients a terminal device in a more favorable position for the wearer of the lower arm prosthetic device by orienting the terminal device toward the centerline of the wearer&#39;s body. This orientation of the terminal device facilitates, for example, better positioning of grasping food in which the wearer can move the prosthesis to the mouth without undue movement of the head.  FIG. 4  is representative of the lower arm prosthetic device  10  as worn on a user&#39;s left arm, and  FIG. 5  is representative of a lower arm prosthetic device that is worn on a user&#39;s right arm, noting how the angled lower surfaces orient the terminal devices. 
         [0035]    Turning to  FIGS. 6 and 7 , the lower arm cuff  12  is shown as it would generally be positioned relative to the anatomy of an arm. The upper cuff  12  provides a suspension mount for the attached forearm section. As shown, the cuff  12  is worn on the lower arm so that the condyle contacts  18  are positioned to rest against and are thereby held in position against the distal humeral epicondyles of the elbow. More specifically as shown in  FIG. 6 , one of the condyle contacts  18  is positioned proximate the medial epicondyle, and the second opposed condyle contact  18  is positioned proximate the lateral epicondyle. 
         [0036]    As best seen in  FIG. 7 , the posterior humeral contact  22  rests on the flared distal end of the humerus bone. The olecranon contact  20  is positioned to rest against the olecranon. This four-point contact provides a semi-rigid cuff which effectively creates a mechanical lock on the user&#39;s arm through an interference fit. The shape and adjustability of the components of the lower arm cuff prevents skin pinch and binding of adipose tissue during elbow flexion so as to maximize functionality and comfort. 
         [0037]    As previously noted, there are four shaft collars  26  associated with the lower arm cuff  12 . An example of a shaft collar is shown in  FIG. 8 . The shaft collar comprises a generally c-shaped body and includes a threaded opening  72  extending through both halves or portions of the c-shaped body to receive a complementary threaded screw  74 . The opening  76  in the center of the c-shaped body receives the bent rod  24 , and by tightening of the threaded screw  74 , the shaft collar may clamp and rigidly hold one end of the bent rod  24 . Each shaft collar  26  further includes passages  78  to receive a threaded screw to interconnect the shaft collar  26  to the condyle contacts  18  and the olecranon contact  20 . A representative example of this connection is shown in  FIG. 9 . As also shown in  FIG. 9 , each condyle contact  18  includes a bore or passage  80  to receive one end of the bent rod  24 . Similarly, as shown in  FIG. 10 , the olecranon contact  20  includes a passageway  82  extending completely through the olecranon contact  20 . Each passage  80  in the condyle contacts  18  has a length L 1 , and the total length of the passage  82  in the olecranon contact has a length L 2 . The passages  80  and  82  permit adjustable relative positioning of the condyle contacts  18  relative to the olecranon contact  20  by both adjusting the length of the bent rod within the respective passages  80  and  82 , as well as permitting rotation of the bent rod  24  relative to the olecranon contact  20 , and rotation of the condyle contacts  18  relative to the bent rods  24  to provide substantial adjustability relative to the size and shape of a residual limb. In addition, each of the condyle contacts is provided with a pad or cushion surface  18  for engagement with the arm of a wearer. Similarly, as shown in  FIGS. 11 and 12 , the olecranon contact  20  includes a padded portion  92 , and the post-humeral contact  22  includes a padded portion  94 . With reference back to  FIG. 2 , in a preferred embodiment, the padded portion  94  of the post-humeral contact  22  may further comprise a central raised and angled pad  96  for improved stability and engagement with the wearer&#39;s arm. 
         [0038]    The shaft collars  26  affixed to the condyle contacts and olecranon contact allow for rotation and positioning for optimal adjustability, but are sufficiently strong to resist loading forces without movement. The medial and lateral condyle contact elements  18  rest upon the epicondyles on their respective sides of the wearer&#39;s arm as mentioned. The olecranon contact  20  presses on the posterior surface of the arm and down on the olecranon, and the posterior humeral contact  22  presses against the humeral bone. In combination the four contacts provide a stable and strong cuff for engagement with the residual limb. The cuff  12  can be adjusted to locate the position and orientation of the epicondyle contact points and to locate the position and orientation of the olecranon contact  20  and posterior humeral contact  22 . The epicondyle feature locations may be varied in the sagittal, coronal and transverse planes in the following directions: ventral-dorsal, medial-lateral, and caudal-cranial. They may also be rotated about the axis of the olecranon contact  20 . The performance of the cuff  12  is improved when these contacts are positioned to press mildly into the fossae (i.e., indentations) on either side of the bicep muscle. Adjusted in this manner, the cuff  12  provides maximum suspension-fixation, stability and comfort. Importantly, this adjustability also allows a single cuff design to be adjusted to operate on either a user&#39;s left hand or right hand side, meaning separate versions for opposite arms/hands are not necessary. This saves substantially on manufacturing costs and makes delivery and sizing easier. 
         [0039]    Humeral fixation may also be modified by rotating the olecranon contact  20 . This allows for increased or decreased contact with the humerus. As for example shown in  FIG. 7 , the olecranon contact  20  can be rotated either upward or downward to raise or lower the contact  20  along the humerus by adjusting the angular orientation of the curved rods  24 . Axial downward loading of the cuff  12  produces a resultant torque that rotates the posterior humeral pad  94 ,  96  into the arm, further stabilizing the cuff  12  and giving rise to reaction forces at the condyles and the olecranon. 
         [0040]    The condyle contacts  18 , olecranon contact  20  and posterior humeral contact  22  may also be provided in different sizes, for example, small, medium and large. They may be interchanged to provide further flexibility. Further, these members may be interchanged with more compliant members as needed for individual applications. Similarly, the padded surfaces  90 ,  92  and  94  may be altered to provide contact members with a range of softness/hardness. In this way the rigidity of the cuff  12  may be modified to meet the sensitivity of each prospective user. The posterior humeral contact  22  may also be varied about the olecranon by adjusting the rods  24  into or out of the passageways  80  and  82 . When suitably positioned, the shaft collars  26  may be set, causing the entire cuff to hold its preferred and functional shape in contact with the user&#39;s residual limb. Condyle contacts  18  are also interchangeable. The condyle contacts  18  in one embodiment are shaped similarly to large finger pads on the distal phalanges of the hands. In this manner, the condyle contacts  18  mimic grabbing hold of the arm with the hand, providing the mechanical equivalent of two fingers grasping the distal humerus. When the cuff  12  is used with a gauze sleeve or cloth padding, the pads  90  function as fingers with friction ridges. The contact portion  92  of the olecranon contact  20  and the contact portion  94 ,  96  of the posterior humeral contact  22  may be similarly shaped. The posterior contact  22  is shaped as a large thumb pad in the illustrated embodiment and the olecranon contact  20  is shaped as a pad and a humeral cup located at the elbow. 
         [0041]    The cuff  12  may be adjusted to conform to work on residual limbs having different geometries (for example, varying radial and axial dimensions, varying curvature and varying combinations of hard and soft tissue). Compression can also be increased with healthy limits as desired for comfort, utility (varying weighted loads), and stability on the residual limb. 
         [0042]    Turning now to  FIGS. 1 ,  2  and  13 , the forearm section  14  will be described in greater detail. The forearm section  14  grasps a forearm along its length following the radius and ulna bones. In use, the forearm half-shells  40 ,  42  are positioned and clamped about the residual limb below the elbow using perforated straps  48  having a series of spaced openings  100  which engage posts  102  formed on the surface of the half-shell forearm pieces  40 ,  42 . Tension may be controlled by the user to ensure comfort which may be modified throughout the time period the prosthetic device is worn. A rear sizing plate  46  is further provided to secure the half-shells  40 ,  42  together. As illustrated, the rear sizing plate is provided with four elongated slots  104  which are positioned to overlie apertures  106  formed in the half-shells  40  and  42 . A threaded boss and screw are positioned through the overlying apertures  106  and slots  104  and secured together to interconnect the half-shells  40  and  42  with the rear sizing plate  46 . The threaded boss and screw (not shown) may be adjustably positioned along the length of the slots  104  to accommodate different sizes of a user&#39;s forearm. 
         [0043]    As shown in  FIGS. 1 and 13 , the two half-shells  40  and  42  do not completely enclose the user&#39;s forearm. Rather, the half shells are shaped to provide an opening  108  to allow for heat dissipation as well as evaporation of sweat and moisture. As shown in  FIG. 1 , part of the opening  108  may be covered by the tongue  44 . Similarly, additional openings may be formed in the half-shells  40  and  42  to provide further cooling and evaporative functionality. Further still, cutouts and outwardly formed bulges or reliefs may be formed in the half-shells  40  and  42  to provide contact pressure relief for arteries, veins and nerves, and to provide relief for adipose tissue to move with movement of the prosthetic device  12  without painful pinching. Indentations may also be located within the forearm half-shells  40  and  42  to provide specific contact points on the forearm. These indentations grasp remaining musculature and soft tissue. With reference to  FIGS. 1 ,  2  and  13 , a tongue  44  is shown as part of the forearm section assembly. The tongue  44  acts similar to the tongue on a shoe to facilitate placement of the forearm section  14  on the residual limb of a user and to act as a pad as needed. The tongue  44  as best shown in  FIG. 13  opposes the rear sizing plate  46  and therefore provides additional surface area in contact with the limb for support. 
         [0044]    The forearm half-shells  40  and  42  in preferred embodiments may include pockets for boney proximal and distal ulna extrusion and for soft tissue to move when compressed. The half-shells  40  and  42  are shaped to compress as a living hinge, with the axis along the posterior surface. The adjustable straps  48  are positioned along the anterior surface. As an alternative to adjustable straps, laces may be utilized or other means of adjustable securement as known to those of skill in the art. All of these methods allow for variable tension along the length of the forearm. 
         [0045]    The forearm section  14  interfaces with the distal connector  16  in an adjustable manner. As best illustrated in  FIG. 13 , the outwardly projecting extensions or arms  60  and  62  of the distal connector include a series of axially aligned apertures that line up with axially aligned apertures formed in the half-shell forearm adapters  40  and  42 . Accordingly, using a threaded boss and screw  120 , the distal connector  16  may be interconnected to the forearm section  14  and the relative position between the two components may be adjusted to accommodate different axial lengths as needed. The slanted surface  64  of the distal connector  16  includes a standard 1/2-20 UNF threaded terminal attachment boss. The forearm section  14  and distal connector, in one embodiment, may be fabricated from polymer sheets, such as Kydex®, polypropylene, ABS or other thermal-formable polymer materials. The forearm section  14  and distal connector  16  are in one embodiment generally configured in a conical shape to permit accommodation over defined size ranges and allows the system to fit easily onto amputees without extensive customization. Anthropometric principles and data from the garment and clothing industry can be used to create basic interface designs over a family of sizes that will accommodate a majority of the population, for example, extra small, small, medium, large and extra large. The prosthetic device  10  can be used with a fabric sock or sleeve if desired and is either a permanent socket or temporary socket used for compressing residual limbs to substantially reduce post-trauma edema and foster wound healing. The open structure of the forearm section  14  and distal connector  16 , together with the reduced interface afforded by the lower arm cuff  12 , provides a structure which does not trap moisture, water, dirt, dust or other irritants against the skin, but rather permits them to be washed, wiped or evaporated away readily. 
         [0046]    With reference to  FIGS. 1 ,  4 ,  5  and  13 , interconnection between the lower arm cuff  12  and the forearm section  14  will be described. As previously noted, each of the condyle contacts include a cable or rod connector  28  and each of the forearm half-shells  40  and  42  also include a cable or rod connector  50 . The cables or rods  130  are affixed between the connectors to provide mechanical support and suspension for the forearm section  14  and distal connector  16 . The cable  130  may be a flexible cable or a rigid rod. The connectors  28  and  50  are designed to rotate freely about their pivot attachment points through 360 degrees of motion. The connectors  50  in one embodiment are fabricated as a slotted receiver that engages the cable or rod  130  to clamp it while allowing for axial adjustment. The length of the cable bridging the user&#39;s elbow between the upper cuff  12  and the forearm section  14  may be shortened or lengthened as desired. The lateral and medial cable or rods  130  may be adjusted independently. The interface allows elbow flexion/extension of greater than 120 degrees and supination/pronation dependent on the user&#39;s remaining residual limb range of motion. Multiple candidate connection points, other than shown in the accompanying figures, are available at the proximal end of the forearm section  14  to permit positioning of the cable or rod between the lower arm cuff  12  and forearm section  14  as required by the needs of the individual user. Both the lower arm cuff  12  and the forearm section  14  contribute to the overall suspension of the device to hold the device securely and comfortably affixed to the user&#39;s residual limb under normal dynamic motion and loading. The components articulate around the user&#39;s elbow joint through mechanical cables or rods  130  that act together as a joint while supporting axial loading. Because of the adjustability of the prosthetic device, the user may adjust the device as necessary to facilitate different tasks throughout the day, including adjustments to accommodate light, moderate and heavy loading. The forearm section may also be fitted with cable guides to accommodate cables commonly used to operate body-powered hooks and terminal devices. The forearm section itself may be customized to allow for best fitting for the user. In  FIG. 4  for example, a pair of holes  130  are formed to alleviate pressure at that location, and a bulge  140  is formed to have the section better conform to the shape of the wearer&#39;s residual limb. 
         [0047]    Referring to  FIG. 14 , it is also contemplated that pads can be added to the interior surface of the forearm section in order have the section provide a most comfortable and supportive fit for the user. As shown in  FIG. 14 , a pad  142  is provided in which an aperture formed through the forearm section  14  facilitates attachment by a connecting tab  144  disposed on the opposite side of the forearm section. Alternatively, pads may be adhesively attached or attached by other mechanisms known to those of skill in the art. 
         [0048]    As an alternative embodiment, a security strap may be secured between the condyle contacts  18 .  FIG. 15  illustrates one embodiment of such a security strap. Tabs  140  may be formed on the condyle contacts and used to secure a strap  142  having a plurality of slots  143  that are fitted over the tabs to secure the strap  142 . The slotted strap would extend around the user&#39;s arm such that the upper cuff  12  is secured about the entire circumference of the user&#39;s lower arm. 
         [0049]    Each component of the prosthetic device can be changed to provide equivalent function. Using materials with different properties allows performance to be enhanced to suit specific needs. Varying the geometry of the components will change the deflection of the prosthetic device  10  when it is tensioned. This deflection can be optimized to grasp the residual limb while achieving suspension and fixation. The interface or contact points between the condyle contacts, olecranon contacts and posterior humeral contacts can be changed and contoured to improve stability, suspension and fit. 
         [0050]    Further still, the entire prosthetic device  10  may be encapsulated into an outer housing such that the components are not exposed to assist in keeping the unit clean. Such a housing could be produced with a more aesthetic or human-looking design. The upper extremity cuff  12  could be modified to grasp any structure on the human body. The contours and size of the component pieces can be shaped to grasp any extremity and provide suspension and fixation, under static and dynamic loads. The cable or rod  130  may be replaced with textile swathes to distribute loading and aid or replicate normal motion. These variations could be used to provide suspension at the shoulder for above-elbow amputees, at the hip for above-knee amputees, and at the knee for below-knee amputees. The interface provided by the prosthetic device described herein may also be modified to facilitate miniature motors or actuators and appropriate control methods to replace the manual means of adjusting the orientation and position of the components, for example, the medial lateral condyle contacts, cable or rod tension and posterior humeral contact. Included within the inventive concept is the use of more active components, for example, the use of servo-motors to move the condyle contacts  18  or the contact point for the olecranon. This could also include the use of active powered pneumatic or hydraulic systems that move features of the design to achieve comfort and stability, or inflating or deflating bladders to control how soft tissues are directed, contacted or pushed into relief areas, or to regulate how contact pressure is applied to the user&#39;s body. The embodiments described herein are also appropriate for veterinary applications. 
         [0051]    The foregoing discussion of the invention has been presented for purposes of illustration and description. The foregoing is not intended to limit the invention to the form or forms disclosed herein. In the foregoing Detailed Description of the Invention for example, various features of the invention are grouped together in one or more embodiments for the purpose of streamlining the disclosure. This method of disclosure is not to be interpreted as reflecting an intention that the claimed invention requires more features than are expressly recited in each claim. Rather, as the following claims reflect, inventive aspects lie in less than all features of a single foregoing disclosed embodiment. Thus, the following claims are hereby incorporated into this Detailed Description of the Invention, with each claim standing on its own as a separate preferred embodiment of the invention. 
         [0052]    Moreover though the description of the invention has included description of one or more embodiments and certain variations and modifications, other variations and modifications are within the scope of the invention, e.g., as may be within the skill and knowledge of those in the art, after understanding the present disclosure. It is intended to obtain rights that include alternative embodiments to the extent permitted, including alternate, interchangeable and/or equivalent structures, functions, ranges or steps to those claimed.