Spotlight on O&P

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By Miki Fairley

How O&P is igniting creativity and capturing the public's attention around the world and closer to home, and what it means for the profession.

The Possible's slow fuse is lit by the Imagination.

-Emily Dickinson

Introduction

Photograph courtesy of
Scott Suchman
www.suchmanphoto.com

Prosthetic design and the many unique applications of prosthetic technology are inspiring the imaginations of artists, writers, filmmakers, industrial designers, students, educators, and the general public. The intricately carved wooden legs (pictured on left) that the late British fashion designer Alexander McQueen commissioned for Aimee Mullins-an athlete, model, motivational speaker, and bilateral transtibial amputee whom McQueen selected for a runway show in 1999-were recently on display at The John F. Kennedy Center for the Performing Arts, Washington DC, as part of a special event, "Redefining Disability: Body as Art," held in October. Warner Bros.-based Alcon Entertainment is currently filming A Dolphin Tale-a major motion picture inspired by the story of Winter, an Atlantic bottlenose dolphin who gained a prosthetic tail fluke after her tail fluke was entangled in a crab trap and subsequently fell off. And these are just two recent examples.

What implications does this kind of exposure have for prosthetic clinicians, researchers, manufacturers, and the amputee community?

"Any time the profession is highlighted in these ways, it helps to educate people about who we are and what we do," says Kevin Carroll, MS, CP, FAAOP, who was part of the team that developed the many iterations of Winter's prosthetic tail fluke.

Indeed, this creative ferment is raising awareness of the needs of persons with limb loss and limb difference and the role that the prosthetics community plays in helping them achieve professional and lifestyle goals. A greater awareness of the amputee community and the professionals who serve them may help to bring about favorable legislation, increased funding for research, and highlight prosthetics and orthotics as an attractive career choice for bright, creative minds.

But it may also lead to continued innovations that will improve function and quality of life in practical ways. Perhaps a university industrial design student's creative but impractical concept could find an answering spark in the mind of a biomechanical engineer who knows how to make it work.

This two-part article explores a potpourri of ways prosthetics have impacted the world outside the O&P community. While space does not permit us to provide a comprehensive list, this article instead will provide a taste of what's happening around the world today, as well as some of the projects and initiatives happening closer to home to bring O&P awareness to communities and legislators alike.

Attendees of the China World Expo stop to look at part of the
Otto Bock HealthCare exhibit. Photograph courtesy of Otto Bock HealthCare.

Part I: Industrial Design

Industrial design and prosthetics tend to be a complementary fit, according to Scott Summit, founder of industrial design firm Summit ID, San Francisco, California, and chief technology officer of Bespoke Innovations, San Francisco. Summit has created a suite of lower-limb prostheses that are not yet available commercially although amputees have successfully used them on a trial basis.

"Industrial design is about using the arts in design to improve the quality of life," Summit says. "Over the years, it's been co-opted into more of a vehicle to sell products, but I think that there are many designers who really do wish to return to the original intent of our profession. This is an ideal place to combine the arts, technology, fresh perspectives, and innovation in order to address quality-of-living issues for many people. Fortunately, recent advances in technology have allowed us to extend design into prosthetics-an area that has long been ignored from the industrial design standpoint, and one where its impact stands to make a large change in someone's life."

Design Students Tackle Prosthetics

An industrial design class at the University of Washington, Seattle, tackled a real-life design challenge during the fall 2009 quarter by creating a simple, inexpensive, and effective prosthetic arm. Seattle-area artist Joanne Tilley proposed the project to Magnus Feil, MFA, assistant professor of industrial design, according to an article by Nancy Wick in the February 11, 2010, edition of the university's newsletter, University Week.

Tilley has a transradial amputation and uses a prosthesis with a hook, but she says she believes that better designs are possible [for body-powered prostheses]. "It should be a marriage of function and design, like in architecture or even fashion," she is quoted as saying in the article. "What if Apple designed a prosthesis? What if I.M. Pei designed one? What would those look like?"

A University of Washington student demostrates a function of the prosthetic arm she designed.

Dana Badeen's prosthetic arm design. Both photographs above are courtesy of the University of Washington and Ellen Garvens

Tilley showed the class the devices she owns and explained how they work. The students were also shown videos of how the devices are made and heard presentations by local experts. "Seeing Joanne and knowing that someone was going to be wearing this device, it made me want to give it a cool factor-something people would want to look at instead of wanting to look away," commented design student Stephen Stum.

The models that the 21 students created varied in form and function, as well as materials used to fabricate the devices. According to the University Week article, one student used "three flexible prongs that look a bit like flower petals and can be operated individually, so the person can hold a spherical object with all three prongs and a drinking glass with just two."

Another student, Dana Badeen, focused on the low-cost aspect of the assignment. She started by molding a flat piece of plastic around a plaster cast of a person's arm. She then folded the plastic over on one end, "forming a softer looking hook" that can pick up various items. The folded-over area also has a slot in the middle for picking up a smaller item, such as a pencil. According to Badeen, the arm costs $25 to produce.

"I learned in this project that you can't do everything with one design solution," Badeen is quoted as saying. "I decided to push myself to prioritize and make something that would do the things most important to the user."

The student models were displayed in an exhibit February 19-20, 2010, at the university's Lawrence Gallery. (Author's note: For more information and to see more photos of the students and projects, visit uwnews.org) Although the students could not produce totally functional prototypes within the short time frame allotted for the class, Feil noted that since some special guests with interests in prosthetic devices were invited, a dialogue could begin.

Ellen Garvens, MFA, professor of art, who photographed some of the students' projects, also had some of her art included in the gallery exhibit. Garvens is noted for her interest in prosthetics and has taken a series of photographs of prosthetics facilities in the United States and Southeast Asia, including the Prosthesis Foundation in Chang Mai, Thailand; the Cooperative Orthotic and Prosthetic Enterprise (COPE) National Rehabilitation Centre, Vientiane, Laos; and the Cambodian School of Prosthetics and Orthotics (CSPO), Phnom Penh. Her work can be viewed on her website, www.ellengarvens.com/ambivalence.html

The 2010 Paralympic Games in Vancouver, British Columbia, Canada, sparked a five-week industrial design class competition at Purdue University, West Lafayette, Indiana. The competition, sponsored by DePuy Orthopaedics, headquartered in Warsaw, Indiana, and Leeds, United Kingdom, challenged students to create a product that would assist Paralympic athletes in a sport that is not yet offered in the Paralympics. Winning designs included a snowboard with remote-controlled boot bindings, a transfemoral prosthesis for rock climbers, and a device to help bilateral upper-limb amputees don and doff their prostheses. (Editor's note: For more information, visit Student Designers Inspired by Paralympics.)

During the fall 2009 semester, 21 students at the School for Visual Arts, New York, New York, took on a ten-week project for a 3D design class, which focused on upper-limb prosthetics. Professor Allan Chochinov, who is also editor-in-chief of Core77 online design magazine and resource , taught the class. Also involved were Mullins; Jonathan Kuniholm, engineer and founder of the Open Prosthetics Project and transradial amputee; Frank Wilson, MD, neuroscientist and author of The Hand; Elliot Washor, co-founder of Big Picture Learning, an initiative to develop innovative, personalized schools ; and photographer Diana Lui. The results, grouped in the categories of "Decorative," "Playful," "Utilitarian," and "Awareness," can be viewed here.

Practical, Affordable Prosthetics: A Reality Check

Kuniholm, however, says he would rather see less of a "head in the clouds" approach to prosthetic design and more "feet on the ground" solutions. Although he mentions two Open Prosthetics pages on "fantasy" prostheses (openprosthetics.wikispot.org/fantasy_arms and openprosthetics.wikispot.org/fantasy_legs), he points out, "Most of these fail to contain the first notion of any legitimate concept of how such arms and legs might be actuated, mechanisms that might sustain real loads and wear, etc."

Left: Ben Rogers designed this device which could help people with bilateral arm amputations don and doff their prostheses. Right: The Markhor, developed by Purdue student Sydney Minnis, is a prosthetic leg and foot for rock climbers.
Photographs courtesy of Purdue University.

Kuniholm continues, "I suppose that in some way the real problem here is that amputees and prosthetics are seen as a kind of lens through which the able[-bodied] like to examine issues like the convergence of man and machine, what makes us human, and the like. Amputees, for the most part, simply want to regain function."

The goal of the Open Prosthetics Project is to produce useful innovations in the prosthetics arena and to freely share the designs. "This project is an open source collaboration between users, designers, and funders with the goal of making our creations available for anyone to use and build upon," the project's website explains.

Part II: Raising O&P Awareness

National and World Exhibitions

Real Life Wall at the China World Expo.

While the mainstream media and artistic communities have certainly helped to spark an interest in O&P and its many applications, much of that interest is being fueled by the real-world solutions currently in development and on the market today-solutions which are being highlighted in increasingly creative ways. The China World Expo (officially titled Expo 2010 Shanghai China) provided a showcase for the needs of people with disabilities and the technologies that can help them. For the first time in the 159-year history of the Expo, a separate exhibit, the Life and Sunshine Pavilion, was dedicated to the interest of people with disabilities. The World Expo attracted 72 million visitors-approximately 370,000 people per day-during its six-month run from May 1 through October 31.

Expo organizers selected Otto Bock HealthCare, Duderstadt, Germany, to design the pavilion's physical mobility exhibit. Welcoming visitors at the entrance was a stunning kinetic sculpture comprising 100 computer-controlled Otto Bock prosthetic hands with small mirrors reflecting points of light that form the Chinese character for "mobility," the symbol of the pavilion exhibition. At the Real Life Wall, visitors could see how diversified and individual the lives of persons with disabilities can be. An "intelligent living" area showcased such advances as an automatic kitchen, an automatic bathroom, and a stair-climbing wheelchair. Various interactive installations and displays of high-tech devices manufactured by Otto Bock and other companies enlivened the pavilion, educating as well as entertaining visitors.

Interactive Otto Bock exhibit at the China World Expo.

Some of the technological advances by Össur, headquartered in Reykjavik, Iceland, were showcased in the Expo's Nordic Lighthouse Lifestyle Exhibition.

Closer to home, Otto Bock is creating an exhibit to be featured at the April 2011 grand opening of the renovated Leonardo, a science, technology, and art center in Salt Lake City, Utah. The center is partnering with Otto Bock to develop an Innovation Gallery, which will showcase technology for people with disabilities.

Sarah McCarville, development engineering manager at Otto Bock's research, development, and manufacturing plant in Salt Lake City, is working closely with personnel at the art center to design the exhibit. McCarville says that the exhibit will have three main goals: (1) to help people reflect on the amazing complexity of the coordinated interaction of muscles, nerves, joints, and ligaments involved in human locomotion; (2) to provide information on disability and the challenges the human body can face; and (3) to display the technology and innovation involved in Otto Bock's solutions to those challenges.

"The museum...wants to connect innovation, creativity, science, stories, and art," McCarville says. "That's exciting for us; we will have a chance to work with local amputees and tell the story of prosthetics through the story of the user and the device."

However, she continues, "This is not about the devices so much as it's about the people. It will be very hands-on and interactive and will include videos and static displays as well." Medical doctors and engineers should find the exhibit as informative and enjoyable as other visitors, she adds.

Other notable museums with prosthetics-related exhibits and events include the Smithsonian Institution's Cooper-Hewitt National Design Museum and the Smithsonian's National Museum of American History Lemelson Center, both in Washington DC; the International Museum of Surgical Science, Chicago, Illinois; the Chicago Museum of Science and Industry; and the Art Institute of Chicago.

Local Awareness: O&P Companies Reach Out

Össur displays its bionic leg technology and prosthetic feet at the China World Expo. Photograph courtesy of Össur Americas.

While national and world exhibitions are integral to raising awareness about O&P at the national and world levels, a number of O&P companies are also involved in community events and charitable activities. Such involvement not only helps communities and people in need, it also helps to raise awareness about what prostheses and orthoses can do to improve quality of life for people with disabilities and, not incidentally, provides positive publicity for the facility itself-definitely a win-win situation.

For example, the Fillauer Companies, based in Chattanooga, Tennessee, encourage its employees to take the prosthetics message beyond the O&P community. Fillauer engineers work with their alma maters to develop senior student design projects, according to Gerald "Gerry" Stark, MSEM, CPO/L, FAAOP, vice president of development and education. These projects help to build awareness of prosthetics and orthotics, formulate applicable research, and create interest in O&P careers, he explains.

Fillauer also participates with area museums on demonstrations and displays, along with classroom "show and tell" presentations at area elementary schools. "The kids really enjoy the myoelectric arms," Stark says. "Some kids that are now teenagers still remember when they lined up for an opportunity to make the hand move. Using our prosthetic CAD system, we made a model of a seahorse exoskeleton and a helmet shaped like a seahorse."

Stark says that experts at Fillauer are also frequently called upon to provide their knowledge about orthotics and prosthetics to writers and filmmakers. "A mystery writer asked me if the fingerprints on a prosthetic hand skin could still be seen, and could the fingerprints be linked to a hand model," he says. "Some prostheses are made for theatrical and movie sets. We also receive many requests for devices for animals. I didn't make this, but I saw a small cart for a paralyzed hamster that was injured by a cat. The cart looked like parts from a toy car."

Kinetic sculpture made up of 100 Otto Bock prosthetic hands.

Ron Pawlowski, CPO, and his wife Micki, owners of Calumet Orthopedic & Prosthetics, Hobart, Indiana, educate their community about orthotics and prosthetics through events such as fairs, exhibitions, and mall events. They have been raising awareness and knowledge about O&P by hosting student groups, Scouts, and others for many years. For instance, students from Kouts High School, Indiana, along with nursing school and physical therapy students, go on an annual field trip to the facility.

Micki Pawlowski, founder of A Fitting Image post-mastectomy boutique, located inside Calumet Orthopedic and Prosthetics, is active in breast cancer awareness activities, such as the annual Breast Cancer Awareness Tea sponsored by The Pink Ribbon Society, and Spa Day sponsored by an area Methodist hospital. She also is active in legislative advocacy for people with disabilities and coordinates with medical assistance groups to bring children from developing countries to the United States for prosthetic and orthotic care.

O&P Associations Help to Spread the Word

Gerry Stark gives a prosthetic arm demonstration to an elementary school class. Photograph courtesy of Fillauer.

The national O&P trade associations provide a number of tools and resources to make it easier for individuals and groups to raise awareness about O&P in their communities and elsewhere. The American Academy of Orthotists and Prosthetists (the Academy) provides help to O&P professionals and facilities who want to promote O&P as a promising career as well as to educate the public about what O&P does. Available for download on the Academy's website are a ten-minute video, A Future with Meaning: Making a Career of Making a Difference, a PowerPoint presentation, and a brochure. Career kits also can be ordered by sending an e-mail to

The Academy's website also includes helpful tips about working with local print and broadcast media and partnering with high schools, two- and four-year colleges, universities, and local hospitals.

The national O&P associations as well as the Amputee Coalition of America (ACA) also reach out to the wider world by seeking to obtain federal and state legislation and regulations favorable to O&P professionals, companies, and individuals with limb loss and limb difference. For the last several years, many members of the American Orthotic & Prosthetic Association (AOPA) gather with other interested parties in Washington DC to learn how to be effective volunteer lobbyists for their profession during AOPA's Policy Forum. They then have meetings with senators and representatives to educate and present their case for the needs and value of prosthetics and orthotics to those who shape the nation's healthcare laws and policy.

This year has been especially important because of healthcare reform as well as the 2010 mid-term elections.

AOPA also encourages its members to become congressional liaisons and to build relationships with their congressional legislators to help communicate O&P's message to Congress. AOPA notes on its website that "members of Congress want to hear from their constituents and the messages from 'back home'-whether delivered in person, by letter, or phone. Congressional liaisons help to achieve legislative and regulatory objectives and better position the O&P field for the present and future challenges." AOPA provides resources in such areas as inviting and conducting a visit by your congressperson to your facility, conducting a political fundraiser for your legislator, and scheduling a meeting with your congressperson.

No Barriers: Creating a Bridge from the Present to the Future

Seahorse exoskeleton and helmet made by Fillauer. Photograph courtesy of Fillauer.

Bringing together researchers, inventors, healthcare professionals, and end-users to impart, share, and discuss ideas and information can ignite a creative synergy, and No Barriers USA is just one example of an organization that accomplishes this goal. The No Barriers signature program is a biannual international summit that brings together persons with physical challenges, scientists, innovators, adventurers, and outdoor enthusiasts. The program includes product demonstrations, nature excursions, keynote addresses, leadership exercises, and a scientific symposium with film, art, and music. "Attendees leave empowered, not only with knowledge about particular equipment or techniques which will work for them, but in realizing that they need to be active participants in developing the solutions which will help them realize their potential," according to the organization's website, which adds, "In addition, developers and end-users learn from each other, and this interaction shapes the next wave of innovation." Some of the cutting-edge technology presented at various No Barriers summits have later been highlighted in national magazines including National Geographic ("Bionics," by Josh Fischman, January 2010) and Forbes ("A Step Beyond Human," by Andy Greenberg, December 14, 2009). The Forbes article features cutting-edge technology developed by No Barriers board member Hugh Herr, PhD, assistant professor of the MIT Media Laboratory and the MIT-Harvard Division of Health Sciences and Technology). The next No Barriers summit is scheduled to take place in Winter Park, Colorado, from June 30-July 3, 2011.

The No Barriers University complements the summit by providing online education on techniques, technologies, and ideas to assist people with challenges, as well as offering sessions throughout the country for rehabilitation hospitals, nonprofit organizations, professional conferences, and community events.

Creative Imagination-Real Results?

The impact of prosthetics on thought and creativity in such diverse areas as art, industrial design, open source projects, expositions, and education may indeed coalesce into future real-world benefits for amputees. As Napoleon Hill, author of the best-selling book, Think and Grow Rich, said, "First comes thought; then organization of that thought into ideas and plans; then transformation of those plans into reality. The beginning, as you will observe, is in your imagination."

Miki Fairley is a freelance writer based in southwest Colorado. She can be reached at