"Simplicity is the ultimate sophistication."
—Leonardo da Vinci
Six men on a mission are showing what is possible when imaginative out-of-the-box ideas team up with practical, analytical thinking.
Six engineering students at the University of Illinois Urbana-Champaign (UIUC) compose the team at Illini Prosthetic Technologies (IPT), Champaign, whose mission is to create practical, affordable, comfortable, and durable prostheses for transradial amputees in the developing world.
Jonathan "Jon" Naber, president, started the not-for-profit company in 2008 and assembled a team of five other dedicated engineers: Adam Booher, vice president and director of engineering; Ehsan Noursalehi, director of product development; Hari Vigneswaran, director of patient relations; Luke Jungles, mechanical design; and Richard Kesler, biomechanics.
What is unique about IPT's approach is that the organization brings prosthetists and end-users into the research-and-development process, thus bridging the all-too-common disconnect between ivory-tower engineering projects and the "real world."
How It All Began
Before starting IPT, Naber had been a research intern in a field he really did not want to pursue. He explains, "So I asked myself, ‘What could I do that would really create some value in the world today and put my skills to better use?' I've always been passionate about helping people with disabilities and people in need. We're so comfortable here in the United States that I felt I should give back." Creating technology that would help people in developing nations was the answer, Naber decided, especially after learning that 80 percent of persons with amputations live in the developing world and only about 2 percent have access to prosthetic care.
Since about 90 percent of amputations are lower-limb, humanitarian efforts to develop appropriate prosthetic technologies have largely concentrated on this aspect, leaving a gap in the technologies upper-limb amputees often need in order to work and to take care of themselves and their families. Naber thus decided to focus on upper-limb prosthetics.
IPT's website (www.supportIPT.com) includes an interactive map of developing-world amputation "hot spots," with additional details about each area. Common causes of upper-limb loss include land mines, war, civil violence, farming and machine accidents, disease, electrical shock, and birth defects, the website notes, adding, "Developing nations have historically experienced a higher number of such incidences."
In 2010, Naber and the IPT team won the $30,000 Lemelson MIT-Illinois Student Prize for their development of a socketless, breathable, wearer-adjustable prosthetic arm for use in the developing world. (Editor's note: For more information, visit www.oandp.com/articles/news_2010-03-11_01.asp) Other financial sources include a prize from the 2008 Idea Bounce Competition; support from Illinois Launch, a venture pipeline program to encourage entrepreneurship and innovation in Urbana-Champaign; and a Clinton Global Initiative Grant to fund IPT's work in Guatemala.
Fresh Approach to Prosthetic Design
At first, IPT focused on high-tech development. "Engineers tend to engineer to the max," Noursalehi explains, "but we found that for our prosthetic arm to be useful in developing countries, we had to go in the opposite direction—simple, practical, and low-tech."
Serendipitously, an opportunity opened up for Noursalehi to participate in a unique pilot course—User Oriented Collaborative Design (UOCD)—offered at UIUC in partnership with the Franklin W. Olin College of Engineering, Needham, Massachusetts.
The course focuses on collaborative, holistic solutions that integrate user and functional perspectives and emphasize gaining an understanding of users' or customers' values and lifestyles. "The premise of the course is to teach engineers how to understand users and to develop valuable products for the identified user group," according to the online IPT Journal. "UOCD showed us that it is possible to structure our creativity and has effectively fueled our progress," the journal article states.
"That's what is unique about our organization," Naber adds. "We're the interface between engineers and prosthetists and their patients. We can put these two worlds together and truly benefit each one."
Although "structured brainstorming" may sound like an oxymoron, the UOCD technique worked remarkably well for the team: "We would have very exciting brainstorming sessions, yet the outcome would be difficult to turn into action," according to the journal. Team members changed their strategy and began to structure their thoughts from each brainstorming session into a meaningful framework. They thought of all the challenges they would face in creating a mass-producible transradial prosthetic arm and created a structured framework to address the identified challenges. Then they brainstormed solutions based on that framework. "Several concepts…eventually crystallized from this process and led to the prototypes we tested in Guatemala," Naber says.
Guatemala, Here We Come
To make full use of the UOCD user-oriented approach, the engineers wanted to have hands-on involvement with the prosthetists and patients who would be testing their designs. In September 2009, IPT contacted Range of Motion Project (ROMP) CEO David Krupa, CP, who was interested in collaborating with the engineering team. The collaboration unfolded from July 9–18 last year as Naber, Noursalehi, Booher, and Vigneswaran journeyed to Zacapa, Guatemala, to field-test three IPT prototypes with seven ROMP patients.
All three prototypes incorporated IPT's design approach:
- Socketless, thus not requiring casting and custom fabrication and fitting.
- Breathable, with an open design to avoid heat buildup within the prosthesis, thus making the device more comfortable and less likely to cause skin issues.
- Easily adjustable for the user as well as the prosthetist.
- Affordable. Naber was inspired by the well-known, low-cost India Jaipur foot (also known as the Jaipur leg) to develop upper-limb technology that, when production-ready, would likewise use inexpensive materials and fabrication methods to keep costs low for developing-nation organizations and amputees.
Each prototype also had distinctive features. Prototype 1 was designed to be adjustable and rugged; prototype 2 was created to be rapidly and intimately fitted; and prototype 3 was designed to be modular and lightweight. The three prototypes were made mainly of metal—steel for prototypes 1 and 3 and aluminum for prototype 2. A powder coating protected the metal from weather damage, and foam linings protected residual limbs from direct metal contact, providing increased comfort and a decreased chance of skin problems. However, production devices will likely use more plastic, Noursalehi says. Naber adds that inexpensive materials like metal and plastic sheeting work surprisingly well for the designs.
At the ROMP clinic, the IPT team was impressed with the amputees' patience and willingness to help. Some traveled long distances and waited patiently for hours to be fit. "They knew they wouldn't be going home with a new prosthesis," Naber says, "yet they wanted to help us in developing designs that might give themselves and others in the same boat a better prosthetic future."
One patient who especially impressed Noursalehi had traveled a long distance and arrived just as the clinic was closing for the day. ROMP gave the patient some money to spend a night in a hotel and return the next day. However, he didn't like the cosmetic prosthesis he received, so he returned it—along with the money he had spent on the hotel. "Seeing the clinic and what was being done for patients really opened his eyes," Noursalehi says. "He didn't want to take anything away from the clinic's resources."
Another patient, Heberto Alvaro Garcia Lopez, mentioned in the first issue of the IPT Journal that chronicled the Guatemala trip, missed three days of morning work to come into the clinic "at no obvious benefit to himself," but simply because of his desire and commitment to help in the product development. The team notes, "The amputees we worked with were by far some of the most patient and accommodating people we have worked with in our lives." (Author's note: To learn more about the IPT team's work in Guatemala, see the mini-film, 10 Days in July, on the IPT website.)
While in Guatemala, the team conducted in-depth interviews with the patients and received extensive feedback on the prostheses and on the patients' daily activities and needs. They were surprised and delighted to find out how functional the initial three prototypes were. For instance, Santos Estanisiao Morales Choc was able to write his name using one of the prototypes, and Heberto Garcia Lopez was able to tie his shoelace using another. Through these real-world user tests, the IPT engineers found both strengths and aspects needing improvement among the three prototypes. When they returned home, the IPT engineers analyzed voluminous notes, hours of video footage, and thousands of photos—data they would use to draw conclusions, generate ideas, and develop the second iteration of the prosthesis.
This past February, IPT traveled to Scheck & Siress, Chicago, Illinois, to meet with an amputee patient who also is a prosthetic technician. Based on the results of last summer's Guatemala trip, the team had developed five second-generation designs, which were test-fitted to the patient. The process provided deep insight into the key features of each design, Naber explains. After returning to Urbana-Champaign, IPT reworked the design for another user test, which took place in April. Naber says that the team hopes to emerge from this test with enough data to develop a third iteration of the prosthesis, which they plan to deploy for user testing in Guatemala in July.
IPT has also been busy developing the business component of the organization, including completing paperwork for 501(c)(3) nonprofit status and writing a number of grants. Naber adds, "In recognition of our progress, IPT was named as the 2011 Social Venture of the Year by the Champaign County Chamber of Commerce and as the recipient of a 2011 Office of the Vice-Chancellor for Public Engagement Grant to fund this summer's work in Guatemala."
Although the entire IPT team graduates from the University of Illinois this month, the organization is looking toward an exciting future. They hope to emerge from the iteration 3 tests at the ROMP clinic in Guatemala this summer with a final design that they will subject to long-term usability tests over the coming year. The long-range hope is that the design will then be production-ready for widespread use.
Naber describes his biggest take-away from the work in ROMP's Guatemala clinic: "There is so much more needed to really help amputees in their jobs, with their self-esteem, and in their daily activities and caring for their families than just prosthetic arms. We need to not only provide the technology, which is what IPT does, but we also need to bring this all together and tackle the problem on many fronts."
Author's Note: IPT is independent from the University of Illinois Urbana-Champaign and is supported by grants and donations. Donations, whether monetary or in-kind donations of supplies and materials, are welcome. Besides transradial prostheses, IPT also is developing low-cost prosthetic fingers and invites inquiries from prosthetists or organizations interested in providing low-cost upper-limb solutions for patients. For more information, visit www.SupportIPT.com
Miki Fairley is a freelance writer based in southwest Colorado. She can be reached at
Meet IPT's Seven ROMP Patients
Santos Estanisiao Morales Choc: An electrical accident resulted in the amputation of both arms below the elbow for this 20-year-old law student, although emergency physicians and surgeons attempted for a week to restore function after the accident. Without his prostheses, Morales Choc is unable to perform activities of daily living.
Luisa Ortiz Cortez: The mother of three and grandmother of one, Cortez, 37, has had a difficult life. At age 15, she was injured by a pickup truck, and at age 25 she suffered a stroke, which caused minor paralysis on the right side of her face and right arm. Last year her (now) ex-husband and his mistress attacked her and her eldest daughter Corina with a machete. This attack left her with deep cuts across her nose and mouth, and she lost her left eye and left arm. Her daughter survived, sustaining only minor cuts and bruises. Her poor self-image makes it difficult for her to be in public, spend time with friends, and rely on outside help, plus she is struggling to care for her family with only one arm.
Jorge Medez Garcia: Married with three children, Garcia, 34, hitchhiked a ride 12 years ago on a truck that also was carrying metal construction rods. The driver lost control, and Garcia was thrown from the cargo area along with the rods. The accident cost him his left arm just above the wrist.
Heberto Alvaro Garcia Lopez: Born with a genetic disorder that left him missing part of his left arm, Garcia Lopez, 19, also has suffered significant muscle atrophy in his deltoids, biceps, triceps, brachialis, and other left arm muscles over the years. He studies at a university in Zacapa during the afternoons and works on a farm in the mornings to make money to pay for his education. Although he has a donated Otto Bock (Duderstadt, Germany) prosthesis, he is unable to make full use of the potential range of motion due to the lack of early prosthetic intervention and the atrophied muscles.
Jorge Audelvo Perez: After a severe electrical accident, Audelvo Perez spent 17 days in intensive care as doctors attempted to salvage his left arm and repair his damaged body. Unable to continue his work in construction, Perez supports himself with about four welding jobs per month and needs help to hold tools and lift objects. When he tried on a prosthetic device at the Range of Motion Project (ROMP) clinic for the first time, he learned about the functional advantages a prosthetic hook can provide.
Erick Madriz Caballeros: A relative of Madriz Caballeros enlisted the help of a friend to attack him with a gun and machetes. Caballeros, 43, and the father of two teenagers, fled to the nearest hospital, one kilometer away. His left arm was amputated due to injuries, and he received a prosthesis last year at the ROMP clinic.
Eidy Jasmin Lopez: The driver lost control of a truck in which Jasmin Lopez, seven, and her family were traveling. All 24 passengers were ejected. The accident cost Lopez her left arm below the elbow. She has not returned to school and continually worries about falling. She has not been able to continue some favorite activities as well.
Note: Ages are as of July 2010; more about these patients' stories can be read in the IPT Journal at www.supportIPT.com