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Last Updated: Wednesday, 13 August, 2003, 10:07 GMT 11:07 UK
Could Ali type with his new hands?

The world has been gripped by the plight of 13-year-old Ali Abbas since he lost both arms in the Iraq war. Now he is in London to be fitted with artificial limbs. How do they work and what sort of life might they help him lead in the future?

After four months in a Kuwait hospital, where he was treated for severe burns, the Iraqi teenager Ali Abbas is in the UK for the next stage of his treatment.

The 13-year-old is set to receive artificial arms, to replace those which he lost in a missile attack during the Iraq war.

It's not an overnight process. Like any prostheses patient, Ali, who also lost his parents in the attack, will be fitted with custom-made limbs. Once in place, he will have to embark on a lengthy course of instruction to help him get the most from his new arms.

But the future for Ali is starting to become clear, says Robin Cooper, a prosthetics specialist working with the boy.

Myoelectric prostheses are the most advanced type
Others will be cosmetic prostheses, which have little function but look natural...
...and "working" prostheses, which use a harness of basic electric function
"Myoelectric" pertains to the electric properties of muscle
Doctors plan to fit the teenager with two artificial arms, which will be strapped together and worn somewhat like a rucksack.

In the world of prostheses, gone are the days of wooden legs and hooks for hands.

On his right-hand side, Ali will be fitted with a "myoelectric" control system, a state-of-the-art technology which uses electrodes to pick up nerve signals from existing muscles in the stump.

Because Ali's left arm was amputated higher up - at the shoulder - its replacement may not offer the same functionality since there is less muscle to work with.

With the myoelectric system, small electrodes sit on the skin and receive tiny "microvolt" electrical charges produced when a muscle is tensed.

Everyone produces these electrical impulses, for even the slightest movement, such as waggling a finger.

Pincer movement

The signals are sent down special stretch-proof wires to a microprocessor which interprets them and sets the motor going.

Ali Abbas in hospital in Baghdad
Ali Abbas was air-lifted to Kuwait City from Baghdad
So, a tensing of the upper arm muscle would cause a motorised hand to grip, while relaxing it would release the pincer movement.

The greater the tension, the quicker the motor works.

In Ali's case, says Mr Cooper, his right hand could be wired to his bicep and his motorised wrist to his tricep. For the elbow, a better option might be to use a simple pulley system which Ali would operate simply by shrugging.

The electrics depend on a lithium ion battery, which would be worn in a pouch on the upper body and replaced daily.

Just as great strides have been made in the functionality of prosthetic limbs in recent years, so too has their appearance improved. It's uncertain whether specialists will opt for a hard-wearing PVC "glove" for Ali's new limbs, or a more convincing cover made from high-definition silicone.

Realistic imperfections

The latter is built up using layers of material, designed to match the natural skin colour of the patient. Hairs, spots and blemishes can all be added for the sake of reality.

Once the limbs are in place, Ali will need to learn how to use them. For this, he will have the help of a senior occupational therapist at Queen Mary's Hospital in Roehampton, London, where he is being treated.

Zeinab Hazed, 9, and grandmother, in Basra General Hospital
Many others still suffer in Iraqi hospitals
The whole process could take up to six months. But once complete, what difference will it make to Ali's daily life?

He has already learned to type with his feet and has a simple sling for his stump, which can hold a fork or a toothbrush.

"In the future, he'll be able to dress himself with the new limbs and do the bodily functions" says Mr Cooper, who works for the prosthetics makers RSL Steeper.

"Cutting with a knife will be difficult but he'll be able to use a fork or spoon almost naturally, comb his hair, type with two fingers.

"Eventually he could drive. I have one patient who lost both arms and now flies light aircraft."

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