Better Together: Pooling Global Knowledge

The benefits of sharing individual experiences, insights, and learning to advance universal change and progress are widely acknowledged. International O&P conferences and device competitions bring together people from diverse backgrounds and perspectives to foster collaboration and the exchange of ideas on a global scale. We asked organizers, attendees, presenters, and competitors to explain the value of what transpires when dedicated minds meet. Science or Magic? The science of chemistry teaches us that when we combine disparate elements new solutions emerge—a result often observed when professionals from different cultures compare and discuss ideologies and methods as a result of international meetings or competitions. The impact, longevity, and far-reaching ripples of the connections achieved at such events also seem consistent with Scottish anthropologist James G. Frazer’s definition of the second principle of magic: “Things which have once been in contact with each other continue to act on each other at a distance after the physical contact has been severed.” 1 “The magic happens when you see professionals getting connected at these conferences and then continuing to collaborate—or starting to do work together,” says Ashley Mullen, PhD, MSAT, CPO, program director, Baylor College of Medicine. “To me that’s a huge measure of success at the outcome of the meeting. Because we put these thinkers in the same room, and they walked away and said, ‘Let’s do a project together!’” Mullen is an example of the power of such gatherings. Her attendance at the International Society for Prosthetics and Orthotics (ISPO) Global Educators Meeting in Germany in 2018 filled her with enthusiasm. “It was a multiday meeting focused on O&P education, which is what I do every day. People from all over the world were offering very different perspectives, working in different situations, within different contexts, but with the same goals. It offered the opportunity to consider a different pathway or a different approach simply because other people in the room were trying to achieve your same objective, but they were doing it with different constraints. I was just blown away by the experience.” Her positive experience inspired her to offer to host the next ISPO Global Educators Meeting at Baylor College of Medicine in October 2024 to facilitate the conversation. “I was able to get involved in the planning committee, which identified objectives such as facilitating ongoing O&P education scholarship and work during the interval between these meetings, which were happening at a cadence—at the time it was every four years; it’s now every two.” Through that effort, she recalls, doors opened to connect her with other like-minded people across the world. “We’ve been working together now since 2020 to continue that work. Some folks come and go from the group, working on different pieces of it, but the thread was that it was an international community, we all happened to align on a focus area, and once we identified that common goal it made it much easier to collaborate and push through the work.” Transcending Cultural Barriers Helen Cochrane, MSc, CPO(c), assistant professor and program director, Department of Rehabilitation Sciences and Technology, University of Pittsburgh, agrees that the person-to-person connection is an invaluable aid to collaboration. “It can be very challenging, and certainly much harder communicating when languages and cultures differ, in order to do things collaboratively rather than independently. Nobody can know everything, and I genuinely think that working with people who come from many different perspectives not only enriches the experience, but it’s essential. “It doesn’t really work to just be in your office having a Zoom meeting; the most successful connections are formed when you’ve gone to dinner informally after the meeting. Sitting beside someone, chatting and exchanging ideas—that’s often where some of the most robust collaborations germinate. Because you find somebody you like and respect enough that you can communicate with them, and work with that person on shared ideas, and recognize that it’s okay to debate and have different opinions. It’s really difficult to find good collaboration through something as structured as a Zoom meeting. “I find that in my role as chair of the ISPO Education Core Committee, I’m always trying to make connections, and I spend a lot of my time making individual connections.” Now in her sixth year as chair, Cochrane works with a team of 47 volunteers on the committee and its subcommittees. “Our primary role is to do accreditations of O&P schools, evaluating them as a voluntary measure of quality assurance. Our volunteers are all from different parts of the world, all committed to sharing their experience, taking or giving advice. In my experience, these things drive change in resources; having that kind of network to draw from has allowed us to do things like write education standards that have become the standard of reference for the World Health Organization and represent more than 50 programs in 26 countries.” Now people all over the world are starting to be able to benchmark from a common standard for all settings as they move forward, she notes. “People who can work well together in a group that is different from themselves, that can be respectful and come to agreement, consensus, or compromise—that is a really important domain of learning, which changes behavior by working in collaboration internationally.” Conversely, people who learn from the same resource are limited by their assumption that “this is the way everybody does it,” Cochrane says. She points to studies that confirm that teams that have a range of perspectives represented from people who come from different backgrounds are measurably more successful in problem-solving and achieving their goals. “If everyone comes from the same perspective and experience and tries to solve the same problem, their solutions are likely to be the same or similar. New perspectives bring new ideas and a greater range of possibilities.” Frazer’s first principle of magic agrees “that like produces like, or that an effect resembles its cause.” 1 “I think the cultural differences are part of those different contexts that help me, at least, to think outside the box,” Mullen acknowledges, “because I’m only used to the environment in which I live and work every day. So, when talking to someone who has a very different context, it can result in a number of things, but usually we can find a solution and at least acknowledge the different considerations. At the same time, it also offers a generally positive reflection on how many things I have in my environment that I overlook, but which are actually things that others may not have.” This leads to observation that the manner in which the healthcare system in this country operates also impacts our approach to O&P care, she adds. Measuring Value How does one assess the effectiveness of an international conference session in bringing about collaborative effects—during, immediately following, and months afterward? Mullen observes that the source of many collaborations goes unacknowledged, since the fact that they initially met at a conference is not something people spontaneously share or consider significant. Antje Feldmann, project director, Confairmed GmbH, organizers of OTWorld Congress, says that visitor surveys are helpful, especially those from practical demonstrations in which specialists can learn and try out techniques on patients. “Many of our specialists and participants report that they integrate the knowledge acquired at OTWorld directly into their daily work, whether it’s through new treatment methods, optimized production processes, or innovative treatment concepts.” The response to the practical workshops introduced at OTWorld 2024, both on-site and afterward, also reflects that participants not only absorb new knowledge, but also actively apply it, she says. “In addition, many topics of the congress and expert discussions in previous years have led to new research initiatives and cooperative ventures. The intensive cooperation between specialists and manufacturers has, for example, let to innovative treatment concepts being transferred into practice more quickly. This makes OTWorld not only a forum for knowledge transfer, but also a catalyst for real progress in patient treatment.” Competition for the Greater Good...for Whom? ETH Zurich, a public university in Switzerland that focuses primarily on science, technology, engineering, and mathematics, conceived Cybathlon in 2013 as a nonprofit project. Since its inaugural competition in 2016, Cybathlon has acted as a platform that challenges teams worldwide to develop assistive technologies suitable for everyday use with and for people with disabilities. Teams consisting of technology developers and a person with disabilities acting as a pilot were challenged to compete using their newest assistive technology advances to perform assigned everyday tasks. Are Cybathlon competitors or developers able and willing to freely share technological details—so that others may duplicate the device(s) in part, or in their entirety, while designing their own prosthetic solutions? Or are these details guarded as secrets (or protected by patents)? Roland Sigrist, cohead, Cybathlon, explains that “teams act very differently. Some are part of a university laboratory, others are student groups, again others represent smaller or bigger startups, companies, or [nongovernmental organizations]. Thus, sharing detailed insights is part of their own policies. However, to compete in Cybathlon Races, teams need to hand in a detailed safety concept, and these documents are kept confidential. Of course, Cybathlon asks the teams to share insights, photos, videos, stories, etc. that can be presented to the audience to enhance the experience. The team decides what it wants to uncover and highlight.” Even though its presentation is rooted in competition, “Cybathlon is an extremely positive project,” he emphasizes. “Teams from all over the world are competitors but share the same vision. Whoever wins, the teams celebrate together. Cybathlon presents what research and development can do for humans around the globe—an aspect that becomes more and more important in these challenging times.” At the original 2016 Cybathlon event, Bob Radocy, TRS/Fillauer consultant, won the first place gold medal using a body-powered Grip Five prehensor hand prosthesis assisted by a mechanical engineering team from the Netherlands’ Delft University; since then, however, the competition has added increasingly complex challenges that showcase the latest in electronic hand technology and seem designed to discourage participants using body-powered prostheses, Radocy believes. His chief competitor in the 2016 race was a pilot using a “supercharged” electric Michelangelo hand, Radocy recalls. “For me, the pleasure was proving to the world not only that body-powered had a place but was equally if not more competitive—and still is today—as the most advanced electric hands in the world. I believe that even now, at age 76, I could probably still outcompete 99 percent of the electric hands in the world at most fair activities. “In the large upper-extremity market,” he says, “most of the money is invested into electronic technology research because there’s a lot more profit to be made than is possible with body-powered. Although I don’t use electronic technology, I think it’s always a good idea to pursue it, because you never know where it’s going to lead. And for certain people it is the right choice.” Cybathlon’s colorful history is traced on its website, including such creative technological marvels as a wheelchair-mounted robotic arm, a robotic seeing-eye dog, and an “intelligent” cane for the visually impaired—entered in categories or disciplines that included a virtual race with thought control, a bicycle race with electrical muscle stimulation, and obstacle courses with prosthetic arms, prosthetic legs, and robotic exoskeletons. Following its most recent competition in October 2024, which included 67 teams from 24 nations competing in eight disciplines, in March 2025 Cybathlon posted an end to its ETH Zurich-based project and noted that it is discussing a hand-off to other organizations interested in continuing its mission of driving innovation and empowering people with disabilities through technology. Radocy observes that the problem of fairly weighting global competitions of body-powered versus high-tech electronic upper-limb devices seems clear: While a myoelectric hand with a 360-degree rotator can perform astonishing tasks single-handedly, such as screwing a lightbulb into a wall sideways, a biologically equipped person normally uses two hands for such a job—and a body-powered hand device would be used similarly, with natural support from the intact hand, he points out. “We always felt that if a competition was going to be structured, it should emphasize more two-handed cooperative activities where you’re using two hands in cooperation with each other as we do in most day-to-day things in life. Certainly, we write with one hand, but we do two-handed transfer all the time in manipulation, and Cybathlon didn’t really test those aspects of practical need and application.” Radocy is presenting at ISPO this year, focusing on the suspension and socket design of upper-body prostheses and, with Debra Latour, OTD, MEd, OTR/L, Single Hand Solutions, discussing the value of activity-specific prostheses from both the psychosocial perspective and the historical-evolutionary aspects. He will also present a new body-powered device that enables people who have bilateral upper-limb absence to play golf. “We’re in our fourth year of testing the device and will be showing videos of the field evaluations. The portion of the population that is missing both their hands is incredibly small. There’s no market for this device, but people have asked for it. One of the reasons I’ve designed prosthetics was initially for myself, then ultimately, I’ve shared those product designs by making them available to other people.” His presentation at ISPO demonstrates the value of a global forum in reaching more of a small population of people who might otherwise never learn what’s available to them. “It may also inspire other people to look at the kinds of effective and affordable body-powered and activity-specific device technologies that we’ve developed and maybe utilize the materials that we’ve employed successfully over the last 30 years.” Assessing the value of both competitive events and conferences in advancing international collaborative opportunities, Feldmann observes that “whether it is congresses, trade shows, or competitions, they all pursue a common goal: to improve the best possible treatment and participation of people worldwide who require orthopedic treatment and care. The OTWorld World Congress focuses on product-neutral innovations and promotes interdisciplinary exchange. As an international organization, ISPO also offers an important platform for knowledge transfer and networking between specialists. “Competition formats such as the Cybathlon or the Paralympics, on the other hand, show impressive technological progress under real-life conditions. They create incentives to develop innovative solutions and overcome technical limitations. At the workshop for the 2024 Summer Paralympics in Paris, 130 prosthetists and orthotists from 42 countries worked around the clock to repair medical aids, including numerous prostheses. Ultimately, all formats contribute in their own way to the transfer of knowledge, the advancement of technology, and the sustainable improvement of patient treatment—whether through collaboration or the incentive of competition.” Reference Frazer, J. G. 1890. The Golden Bough .

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