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Development of an Affordable Prosthetic Finger from Natural Rubber: A Pilot

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Conference Paper · November 2021

DOI: 10.1109/BMEiCON53485.2021.9745225

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 The 2021 Biomedical Engineering International Conference (BMEiCON-2021)

Development of an Affordable Prosthetic Finger

from Natural Rubber: A Pilot Study

Sreyleak Chan, Kazuhiko Sasaki, Gary Guerra, Jutamanee Poonsiri, Thanatat Charatrungolan
2021 13th Biomedical Engineering International Conference (BMEiCON) | 978-1-6654-2627-5/21/$31.00 ©2021 IEEE | DOI: 10.1109/BMEiCON53485.2021.9745225

Sirindhorn School of Prosthetics and Orthotics,

Faculty of Medicine Siriraj Hospital, Mahidol University
Bangkok, Thailand
sreyleak.chn@student.mahidol.edu, kazuhiko.sas@mahidol.edu, gary.gue@mahidol.edu, jutamanee.poo@mahidol.edu,
thanatat.cha@mahidol.edu

Abstract—Objectives: To evaluate and compare the I. INTRODUCTION

appearance between silicone, natural rubber, and ethylene-vinyl
acetate (EVA) finger prostheses.
Methodology: Twenty participants were invited to participate
in this study. The mean age was 30.20±5.53, 11 (55%) were
female, and 9 (45%) were male. Thirteen (65%) were prosthetic
and orthotic students, and seven (35%) were other professional
students at Siriraj Hospital. All participants were healthy with no
color and visual impairments. Participants were asked to
evaluate the appearance of finger prostheses by Likert scale for
three finger prostheses. Silicone, natural rubber, and EVA finger
prosthesis compared with the nonamputated finger as a
reference. Scores were 1 worst, 2 poor, 3 fair, 4 good, 5 excellent
in four different categories: skin tone, outward appearance,
detail of prosthesis, and shape. For improvement, additional
comments from the participants were recorded.
Results: The silicone finger prosthesis’s total scores ranged
from 80.00% excellent to 1.25% fair across all four categories.
The natural rubber finger prosthesis scored from 13.75%
excellent to 3.75% poor, a score of 13.75% good to 10.00% worst
in EVA finger prosthesis was seen. The skin tone of silicone,
natural rubber, EVA finger prosthesis were 4.65±0.59, 3.60±0.60,
and 2.45±0.76, respectively. The outward appearance were
4.75±0.44, 3.90±0.64, and 2.20±0.83, respectively. The detail of
the prosthetic finger were 4.85±0.37, 4.05±0.76, and 2.85±0.87,
respectively. The shape were 4.90±0.31, 3.75±0.79, and 2.40±0.88,
respectively.
Discussion and Conclusion: These results evidenced the natural
rubber appearance was between excellent to poor. The detail of
natural rubber prosthetic finger were from excellent to fair,
while other categories results were good. The detail category for
EVA finger scored from good to poor, while other categories
scores ranged from fair to poor. The silicone finger prosthesis
had a better appearance than the natural finger prosthesis, with
the EVA finger prosthesis scoring lowest.
Index Terms—Finger amputee, Finger prosthesis, Natural
rubber finger prosthesis, Prosthesis satisfaction
The human hand is composed of five fingers, one thumb,
plus four fingers. Fingers are essential organs that provide vital
function and cosmesis [1]. In the 1950s, Jean Pillet, a Frence
physician, noted that any amputation on the digits could affect
the patient’s body appearance, self-esteem, and psychology. He
encouraged the use of silicone prostheses worldwide to
enhance appearances and improve psychological confidence
[2]. Shanmuganathan N et al. 2011, noted that silicone rubber
is the most acceptable prosthesis, providing high satisfaction to
the user [3].
There are many advantages of the silicone finger
prosthesis; high cosmesis, good suspension, elasticity, stain-
resistant, close fit, good appearance, and improved patient
psychological and social acceptance. However, a silicone
finger prosthesis has some disadvantages; degradation after
long-term exposure to high temperatures. Thus, prolonged
sunlight should be avoided. Moreover, skin allergies may occur
when using silicone adhesive, and this device is a passive
prosthesis, which is nonfunctional [4]. Moreover, the price of a
silicone finger prosthesis can range from $250-$500 USD [5],
[6].
In Cambodia and Myanmar, the cosmetic prosthetic hand
or finger is made from ethylene-vinyl acetate (EVA). The EVA
finger prosthesis is delivered to the amputees free of charge.
Although EVA is a local material and cheap, the shape is
bulky, alignment and suspension poor, and color does not
match the nonamputated side during prosthesis fabrication [7].
Most of the patients, upon receiving the finger prosthesis, note
abandonment.
A silicone finger prosthesis consists of a customized socket
design integrated with an anatomical finger shape. The silicone
finger prosthesis can be made in three different versions. The
basic version is fabricated with little structure and a single
silicone color. The classic version is fabricated with more
detailed structures, several silicone colors, and an additional
color for the fingernail tip. The natural version is an alternative
to the classic version and fabricates fingernails from acrylic to
provide a more natural appearance [8].

978-1-6654-2627-5/21/$31.00 ©2021 IEEE

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 A pilot study published in 2014 from the Sirindhorn School drying at room temperature. After being completely set, de-
of Prosthetics and Orthotics developed a prosthetic finger by moulding occurred, and the natural rubber finger prosthesis
using a locally sourced (Thai) natural rubber which provided was obtained. Finally, the PVC artificial nail was trimmed and
suitable properties to fabricate the finger prosthesis. The placed on the finger prosthesis (Fig. 2).
natural rubber was 1.20 MPa higher than polyvinylchloride
(PVC) gloves and was tested with a tensile strength test. TABLE I. THE PROPORTION FORMULA FOR RUBBER PROSTHESIS FINGER
Fabrication of a finger prosthesis from natural rubber costs Ingredients Ratio (g)
around 100 Thai baht without labor costs. However, the finger
Natural rubber latex 60% 167.0
prosthesis was fabricated in a mono color with three different
skin tones: light, medium-light, and dark, and then evaluated. K-laurate 20% 1.0
Also, the study did not evaluate patient satisfaction with the KOH 10% 4.0
finger prosthesis [9]. Sulfur in water 50% 3.5
The data from the National Statistical Office in Thailand, ZDEC in water 50% 1.0
report in 2007 and 2012 showed that nearly 20,000 people in ZMBT in water 50% 1.0
the entire Kingdom of Thailand have a finger amputation [10].
ZnO in water 50% 1.0
In contrast, the number of artificial fingers used was 94 or
WSL in water 35% 2.0
0.49% of the total population.
Although the silicone finger prosthesis provides high Water 10.0
satisfaction for the patient, it is expensive. The EVA finger Abbreviation: K-laurate: Potassium laurate, KOH: Potassium hydroxide,
prosthesis given to amputees, particularly in Cambodia and ZDEC: Zinc Diethyl Dithiocarbamate, ZMBT: Zinc-2-mercaptobenzothiazole,
ZnO: Zinc Oxide, WSL: Wingstay L
Myanmar, is free of charge but may not provide a good
appearance. Natural rubber can be an alternate affordable
resource to fabricate the finger prosthesis for amputees.
Therefore, this study aimed to evaluate and compare the
appearance between silicone, natural rubber, and EVA finger
prosthesis. The EVA finger prosthesis was also evaluated as
well as the natural rubber and currently used silicone finger
prosthesis.
II. METHODOLOGY
A. Participants
Twenty healthy adults, eleven female, and nine male, were
invited as participants in this pilot study. All participants
volunteered to participate in this pilot study. The mean age was
30.20±5.53, Thirteen (65%) were prosthetic and orthotic
students, and seven (35%) were other professional students at
Siriraj Hospital. All participants were healthy with no color and
visual impairments.
B. Natural rubber fabrication. Fig.1. Silicone finger prosthesis
The natural rubber finger prosthesis was made with a
proportion formula for a rubber prosthesis finger (Table I) [11].
First, the silicone finger prosthesis was selected as a model
(Fig. 1), the silicone finger model was measured for the
modification process. Alginate was then used to copy the
silicone finger model to obtain a negative cast. Then the
paraffin wax was melted at 150oC and poured into the negative
cast. After that, the wax cooled down until it was completely
set. After the wax was set, the negative cast was removed to get
a positive wax mould. Modification of the wax mould followed
the silicone finger model’s measurement. After modification,
the plaster of Paris (POP) powder was used to copy the positive
wax mould, heated at 150oC to de-mould the wax, and then the
finger positive mould from POP was obtained then using
silicone spray to spray on the surface of the positive mould.
Following the formula, the natural rubber was mixed and
poured inside the positive mould. The natural rubber was
poured layer by layer, and each layer required 24 hours for Fig. 2. Natural rubber finger prosthesis

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 III. RESULTS
A. Likert scale
Twenty participants evaluated the appearance of the finger
prostheses. The frequencies and percentage of evaluations of
each finger prosthesis are shown in tables II, III, IV. The
silicone finger prosthesis’s total score ranged from 80.00%
excellent to 1.25% fair across all four categories. The natural
rubber finger prosthesis score from 13.75% excellent to 3.75%
poor and a score of 13.75% good to 10.00% worst for the
EVA finger prosthesis was seen. The results evidenced that
the natural rubber appearance was between excellent to poor.
The detail category of natural rubber prosthetic finger results
were from excellent to fair, while other categories results were
good. The detail of EVA finger score ranged from good to
poor, and other categories results ranged from fair to poor
(Fig. 4).

Fig.3. Ethylene-vinyl acetate (EVA) finger prosthesis TABLE II. THE FREQUENCIES AND PERCENTAGE OF EVALUATORS OF THE
SILICONE FINGER PROSTHESIS
C. EVA fabrication
Categories/ Excellent Good Fair Poor Worst
The POP powder was used to copy the residuum shape of Scores (5) (4) (3) (2) (1)
the silicone finger model and modified to match the silicone Skin tone 14 5 1 0 0
finger model’s measurement from the positive mould. During (70%) (25%) (5%)
fabrication, a distal cup over the stump positive mould end was Outward 15 5 0 0 0
appearance (75%) (25%)
made with 3 millimetres (mm) EVA. The finger length was Detail of 17 3 0 0 0
extended by 12 mm EVA. The final layer was covered with 3 prosthesis (85%) (15%)
mm EVA across the palmar and dorsal sides. After that, the Shape 18 2 0 0 0
lines of each knuckle were made. Finally, the PVC artificial (90%) (10%)
Total 64 15 1 0 0
nail was trimmed and applied to the finger prosthesis (Fig. 3). (80.00%) (18.75%) (1.25%)
D. Likert scale
TABLE III. THE FREQUENCIES AND PERCENTAGE OF EVALUATORS OF THE
Prosthetic satisfaction was evaluated by the appearance of NATURAL RUBBER FINGER PROSTHESIS
the finger prosthesis using a Likert scale which allowed
Categories/ Excellent Good Fair Poor Worst
comparisons between three finger prostheses. Silicone, natural Scores (5) (4) (3) (2) (1)
rubber, and EVA finger prosthesis were compared with the Skin tone 0 13 6 1 0
nonamputated finger as a reference. Scores ranged from one (65%) (30%) (5%)
(worst), two (poor), three (fair), four (good), and five Outward 3 12 5 0 0
appearance (15%) (60%) (25%)
(excellent) across four different categories: skin tone, outward
Detail of 6 9 5 0 0
appearance, detail of prosthesis, and shape. Additional prosthesis (30%) (45%) (25%)
comments from participants for later improvement of the finger Shape 2 13 3 2 0
prosthesis were also recorded. (10%) (65%) (15%) (10%)
Total 11 47 19 3 0
E. Data collection and analysis (13.75%) (58.75%) (23.75%) (3.75%)
The finger prosthesis was evaluated using an evaluation
form adapted from a validated and used questionnaire from TABLE IV. THE FREQUENCIES AND PERCENTAGE OF EVALUATORS OF THE
EVA FINGER PROSTHESIS
another study [9]. The age, gender, and demographics of
participants were collected. All participant’s information was Categories/ Excellent Good Fair Poor Worst
Scores (5) (4) (3) (2) (1)
kept confidential, and data were analyzed using Microsoft Skin tone 0 2 6 11 1
Excel 2016. (10%) (30%) (55%) (5%)
Outward 0 1 6 9 4
appearance (5%) (30%) (45%) (20%)
Detail of 0 6 5 9 0
prosthesis (30%) (25%) (45%)
Shape 0 2 7 8 3
(10%) (35%) (40%) (15%)
Total 0 11 24 37 8
(13.75%) (30.00%) (46.25%) (10.00%)

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Fig.4. Prosthetic finger appearance satisfaction in Silicone, Natural rubber, and
EVA in all categories from twenty participants
IV. DISCUSSION
Finger amputation leads to loss of hand function, limited
daily activities could affect the body appearance, social and
psychological confidence which can lead to having a negative
impact on the quality of life [12]. Traumatic is the most
common cause of finger amputation [12], [13]. Followed by
malignancy (tumors), diseases (peripheral arterial occlusive
disease), and congenital deficiency [14]. Upper limb
amputation is classified depending on the level of amputation.
There are three different types of upper limb prostheses such as
electronic, body-powered, and cosmetic. Cosmetic prosthesis
aim at enhancing appearance, and emphasis “life-like” shape
and color that mimics the remaining sound limb. Finger
prostheses are typically used as a cosmetic device and are
commonly made from silicone or PVC [15]. The finger
prosthesis should be life-like with realistic surface detail,
matching skin tone, thin margins similar to the skin, fingernails
with a natural appearance, wrinkles, and coloration [16].
Various methods have been used for replacing the missing
finger, and silicone rubber has the highest acceptance rate for
making the prosthesis [17]. However, the silicone finger
prosthesis is quite expensive, which is not affordable for the
patient residing in resource-limited environments [18].
Natural rubber was introduced in the health care field
around 1840 to produce suitable and flexible natural rubber
materials for medical products [19]. Natural rubber is used in
more than 400 medical devices, including medical rubber
gloves, which give a close fit, and are not easy to break. This
glove provides good sensation and is pathogen resistant. The
natural rubber exhibits properties such as resilience, elasticity,
abrasion resistance, and efficient heat dispersion [20], which is
similar to silicone rubber [21].
The natural rubber used in the Prosthetics and Orthotics
field. Such as the Insole for the diabetic foot is equipped with
pressure control and tissue neoformation induction systems.
This material and model are of high quality, affordable, and
can aid treatment and prevention for the diabetic foot [22].
Microcellular rubber (MRC) insoles for leprosy patients with
aesthetic feet have prevented secondary impairments and are
manufactured using natural rubber and several other chemicals
[23]. The modified natural rubber CR solid ankle-cushion heel
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(SACH) prosthetic foot enhances foot characteristics and
reduces the current CR (SACH) costs [24].
A pilot study in 2014 from the Sirindhorn School of
Prosthetics and Orthotics identified the natural rubber as
having suitable properties to fabricate the finger prosthesis.
These authors evaluated types of color that can be mixed with
rubber and compared different kinds of molds to determine a
better detail of the outside appearance of the prosthesis [9].
This present study aimed to evaluate and compare the
appearance between silicone, natural rubber, and EVA finger
prosthesis. Natural rubber is available and cheap, which can be
purchased in Thailand. The possible benefit of a natural rubber
finger prosthesis is the prosthesis can provide a good
appearance and affordable price for the patient to purchase.
The skin tone of silicone, natural rubber, EVA finger prosthesis
were 4.65±0.59, 3.60±0.60, and 2.45±0.76, respectively. The
outward appearance were 4.75±0.44, 3.90±0.64, and
2.20±0.83, respectively. The detail of the prosthetic finger were
4.85±0.37, 4.05±0.76, and 2.85±0.87, respectively. The shape
were 4.90±0.31, 3.75±0.79, and 2.40±0.88, respectively.
Therefore, the silicone finger prosthesis has a better appearance
than the natural finger prosthesis, after that, the EVA finger
prosthesis.
Additional comments from all participants were that the
silicone finger prosthesis looked natural, excellent, suitable
thickness, and smoothly shaped. The natural rubber finger
prosthesis was suitable and could thus be used as an alternative
to higher costing options. The shape, material thickness, and
color could still improve. The EVA finger prosthesis is not
natural, rigid, bulky, does not match skin color, and needs
improvement in finger alignment. Fabrication of the prosthesis
to match the human skin color is always a problem. Thus,
several methods have been used to achieve such a problem
[25].
V. CONCLUSION
This study evaluated and compared the appearance between
silicone, natural rubber, and EVA finger prostheses. The
silicone finger prosthesis provided the best appearance, and the
natural rubber finger prosthesis provided a better appearance
than the EVA finger prosthesis. Future work should consider
the usage and durability of the natural rubber finger prosthesis
with the finger amputees in free-living settings.
ACKNOWLEDGMENT
The authors would like to thank Sirindhorn School of
Prosthetics and Orthotics (SSPO), Faculty of Medicine Siriraj
Hospital, Mahidol University, and Research Development
Grants that supported this study. Special thanks and
appreciation to all participants for spending their valuable time,
help, and kindness to make this study successful.
REFERENCES
[1] R. K. Reddy, “Acrylic Finger Prosthesis: A Case Report,” J.
Clin. DIAGNOSTIC Res., 2014. [Online]. Available:
http://www.jcdr.net/article_fulltext.asp?issn=0973709x&year=2
014&volume=8&issue=8&page=ZD07&issn=0973-
709x&id=4658
[2] C. Joseph Ivan Krajbich M.D., Michael S. Pinzur M.D., LTC
Benjamin K. Potter M.D., Phillip M. Stevens Med, Atlas of
Amputations and Limb Deficiencies: surgical, prosthetic, and
rehabilitation principles. 4th ed. American Academy of
Orthopaedic Surgeons, 2016, pp. 379-387
[3] N. Shanmuganathan, M. Uma Maheswari, V. Anandkumar, T.
V. Padmanabhan, S. Swarup, and A. H. Jibran, “Aesthetic finger
prosthesis,” J. Indian Prosthodont. Soc., vol. 11, no. 4, pp. 232–
237, 2011.
[4] M. Dhillon, “Rehabilitation of Digital Defect with Silicone
Finger Prosthesis: A Case Report,” J. Clin. DIAGNOSTIC Res.,
2014. [Online]. Available:
http://www.jcdr.net/article_fulltext.asp?issn=0973709x&year=2
014&volume=8&issue=8&page=ZD25&issn=0973-
709x&id=4708
[5] Ottobock TH, [Online]. Available: https://www.ottobock.co.th/
[6] Regal Prosthesis, [Online]. Available:
http://www.regalprosthesis.com/
[7] Cambodian School of Prosthetics and Orthotics, “Upper Limb
Prosthetics Training Course Manual,” Cambodia. 2013.
[8] Otto Bock healthCare GmbH, “Impression Taking &
Measurement Technique for Silicone Finger and Partial Hand
Prostheses,” Germany. [Online]. Available: www.ottobock.com
[9] Vinai Kumpakdee, Jiraphorn Rimworaluk, Nattakarn Supat,
Pimporn Srivuddhirattanin, Wasinee Kittisuntharakul,
Jutamanee Poonsiri, Nattawan Sudthison “Pilot study:
Development of Prosthetic Finger By Using Thai Natural
Rubber,” Sirindhorn School of Prosthetics and Orthotics,
Faculty of Medicine Siriraj Hospital, Mahidol University.
Undergraduate Research Academic Year 2014. Book 2/2 (WE
20 S619u Bk.2 2014)
[10] TNSO: Information and Communication Technology, [Online].
Available: http://web.nso.go.th/en/survey/disabi/disabi07.htm
[11] Pattara Gantasilp, Waraporn Kajornchaikoon, Ponchit Buakaew,
Pansa Chouyplong, Nutchanart Na Ranong, “Study of prosthetic
hand,” Rubber research data and article, Rubber Research
Institute of Thailand, Department of Agriculture, Ministry of
Agriculture and Cooperatives, 1991.
[12] Z. Kuret, H. Burger, G. Vidmar, and T. Maver, “Adjustment to
finger amputation and silicone finger prosthesis use,” Disabil.
Rehabil., vol. 41, no. 11, pp. 1307–1312, May 2019.
[13] D. B. C. Reid, K. N. Shah, A. E. M. Eltorai, C. C. Got, and A.
H. Daniels, “Epidemiology of Finger Amputations in the United
Authorized licensed use limited to: Mahidol University provided by UniNet. Downloaded on April 07,2022 at 07:48:03 UTC from IEEE Xplore. Restrictions apply.
View publication stats
States From 1997 to 2016,” J. Hand Surg. Glob. Online, vol. 1,
no. 2, pp. 45–51, 2019.
[14] I. Imbinto et al., “Treatment of the partial hand amputation: An
engineering perspective,” IEEE Rev. Biomed. Eng., vol. 9, pp.
32–48, 2016.
[15] S. Watve, G. Dodd, R. MacDonald, and E. R. Stoppard, “Upper
limb prosthetic rehabilitation,” Orthop. Trauma, vol. 25, no. 2,
pp. 135–142, 2011.
[16] S. Mehta, B. Leela, A. Karanjkar, and A. Halani, “Prosthetic
rehabilitation of a partially amputated finger using a customized
ring-wire substructure,” J. Indian Prosthodont. Soc., vol. 18, no.
1, pp. 82–85, Jan. 2018.
[17] A. Goyal and H. Goel, “Prosthetic rehabilitation of a patient
with finger amputation using silicone material,” Prosthet.
Orthot. Int., vol. 39, no. 4, pp. 333–337, Jan. 2015.
[18] G. Manivannan, G. Karthikeyan, P. Das, and G. Babu, “Cost
effective cosmetic prosthesis for lost digits.,” Lepr. Rev., vol.
86, no. 1, pp. 117–23, Mar. 2015.
[19] M. Raulf, “The latex story,” Chem. Immunol. Allergy, vol. 100,
pp. 248–255, 2014.
[20] H. Mooibroek and K. Cornish, “Alternative sources of natural
rubber,” Appl. Microbiol. Biotechnol., vol. 53, no. 4, pp. 355–
365, Apr. 2000.
[21] F. Liravi and E. Toyserkani, “Additive manufacturing of
silicone structures: A review and prospective,” Addit. Manuf.,
vol. 24, no. October, pp. 232–242, 2018.
[22] M. D. C. Dos Reis, F. A. Soares, A. F. Da Rocha, J. L. A.
Carvalho, and S. S. F. R. Rodrigues, “Insole with pressure
control and tissue neoformation induction systems for diabetic
foot,” 2010 Annu. Int. Conf. IEEE Eng. Med. Biol. Soc.
EMBC’10, pp. 5748–5751, 2010.
[23] S. K. Paul, E. Rajkumar, and T. Mendis, “Micro Cellular Rubber
(MCR) - a boon for leprosy affected patients with anesthetic feet
in preventing secondary impairments,” J. Foot Ankle Res., vol.
7, no. S1, p. 531230, 2014.
[24] K. Sasaki et al., “The development and testing of a modified
natural rubber CR solid ankle–cushion heel prosthetic foot for
developing countries,” J. Rehabil. Assist. Technol. Eng., vol. 4,
p. 205566831771297, 2017.
[25] H. Y. Thong, S. H. Jee, C. C. Sun, and R. E. Boissy, “The
patterns of melanosome distribution in keratinocytes of human
skin as one determining factor of skin colour,” Br. J. Dermatol.,
vol. 149, no. 3, pp. 498–505, 2003.