Artificial Limbs (Hansard, 19 June 1978)

§ Mr. Alfred Morris

My hon. Friend will know that myoelectric hands are not new. They have been available throughout the world for many years. They were carefully examined by my Department in the late 1960s. It was then found in Britain, as in other countries, that the number of adults accepting them was very low. Most found them to be somewhat slow in operation, limited in function and incapable of the dexterity that can be achieved by the available range of body-operated mechanical devices.

Experience with gas-powered arms for thalidomide children, among others, was also disappointing. Initially, 60 children used the arms but, over the years, all but two ceased to use them. Thus, ultimate rejection was almost total.

Research efforts in this country, undertaken in conjunction with the manufacturers, have concentrated on the extension 3W and improvement of manually operated prosthesis. We have a substantial programme of research into both artificial arms and legs. The cost in 1977–78 was about £500,000. In this field, as in other areas of research, no country has a monopoly of good ideas or successful developments. We can all learn from each other.

Dr. Sörbye adopted the theory that, by fitting a myoelectric hand to very young children, some of the problems of rejection might be overcome. He took the view that, despite the problems of learning to use a complicated prosthesis, children might adapt to the use of the hand more readily than adults by accepting it as part of the body image, he believed that they would continue to use the myoelectric hand into adult life.

Many clinical and other factors were taken into account by Dr. Sörbye before he came to the conclusion that it was early fitting to young children that offered the best chance of permanent acceptance. He then designed, in collaboration with a Swedish firm, a miniaturised version of the myoelectric hand for children under five years of age. As far as we are aware, this development has not been clinically evaluated outside Sweden.

My hon. Friend may like to know that, in Sweden itself, about 30 children so far have been fitted. Although Dr. Sörbye has been working on his project for some years, only recently did he feel that he had achieved sufficient success to publish his research. And it is only within the last few months that a commercially produced version of the hand has become available.

Notwithstanding the recency of this development we have studied its progress very carefully. After announcing to the House in my reply to my hon. Friend's Question on 21st March—[Vol. 946, c. 502]—that the hand would be tried in this country, I sent a team to Sweden comprising a doctor and an engineer from my Department, together with a prosthetist and an engineer from the company which will supply the hand here. They had discussions with Dr. Sörbye and also with the Swedish and German companies that manufacture the hand and its associated equipment. Their discussions were necessary to gain as much information as possible on fitting and training, so as to ensure the best chance of success.

I am very pleased to say that as a direct result of our early interest the manufacturers have reserved a batch of their very limited current production for my Department. I expect delivery to begin later next week. The cost of each hand and its associated components is about £1,000. There will be substantial further costs in fitting and maintenance. My Department's medical staff are now assessing children for inclusion in our trial. This will involve difficult decisions but, with the aim of helping other children in the future, we must work on the basis of Dr. Sorbye's experience and the criteria he has established as offering the best prospect.

Our trial will be aimed, therefore, at children whose level of limb deficiency is in the middle-third of the forearm and who are between the ages of 3½ and 4½. Children initially selected will have a full clinical assessment at either Roehampton or Manchester. Once this is complete, the children will be fitted as quickly as possible with the hand. My hon. Friend may like to know that I expect fitting to start next month.

Once experience has been gained in fitting the prosthesis, in the training required and the extent of maintenance problems, it may be possible to extend the trial to other children. This is why I am not yet able to say how many children will ultimately be included. Nevertheless I can assure parents that they will be informed as quickly as possible of the outcome of the assessments and of future possibilities for their children.

If the trial establishes that this prosthesis provides worthwile long-term benefits for children it will be made generally available. I am aware that a number of local fund-raising activities, aimed at purchasing the new hand for individual disabled children, have been organised. It may be helpful, therefore, for me to make it quite clear that the hand will be free under the National Health Service both for the trial and any future extension of supply.

Future treatment under the National Health Service has already been offered to Joanne Brennan, who recently had the hand fitted privately in Sweden. A letter inviting her parents to attend Roehampton to assess this future treatment was sent as as soon as she returned. I am happy to 5W say that this invitation was accepted and that Joanne was examined on 14th June.

I am asked by Dr. Sörbye to say that his commitments preclude his from treating any further private patients from this country for the foreseeable future. All inquiries about the hand should be directed, therefore, to my Department and not to Dr. Sörbye. I take this opportunity of thanking Dr. Sorbye very much indeed for the help and co-operation he has given to my Department over recent weeks.