A $426,000 federal grant awarded to the University of North Texas Health Science Center at Fort Worth (UNTHSC) will fund a groundbreaking study on the bioethical challenges surrounding bionic and robotic prostheses.
The grant from the National Institutes of Health (NIH) will allow Graci Finco, PhD, CPO, an assistant professor at the university who holds joints appointments in the Department of Physical Therapy and the Center for Anatomical Sciences, to conduct the study to capture the perspectives of people with limb loss, clinicians, and policymakers.
While technological advancements have propelled the field forward, bioethical concerns—such as equitable access, insurance reimbursements, and user involvement in development—remain largely unaddressed, Finco said.
“Prosthetic technology is often developed without meaningful input from the people who actually use it,” she said. “We want to ensure that future advancements are not only innovative but also practical, accessible, and aligned with the users’ needs.”
Finco coauthored an article on bioethical issues in prosthetic development, which served as a foundational step to strengthen the R21 grant application. Building on this work, her research will involve interviews with individuals across the United States, particularly from underserved and underrepresented communities, to develop a decisional support document to guide researchers, manufacturers, and funding agencies.
An R21 grant is a type of NIH research funding that supports early-stage, high-impact projects. The awards are designed for exploratory studies, pilot projects, or new research ideas that may not yet have extensive preliminary data but show strong potential. Only about 14 percent of applications receive funding.
“This work is crucial for shaping policies that will determine who gets access to cutting-edge prosthetic technology and how it’s integrated into clinical practice,” said Cody McDonald, PhD, MPH, CPO/L, a collaborator from the University of Washington. “Bioethical considerations should not be an afterthought. They need to be part of the conversation from the start.” McDonald was a coauthor on the initial study.
Finco and McDonald are among the few individuals in the country who hold a doctorate in their respective fields while also being certified clinicians. This dual expertise allows them to offer unique insights from both patient care and research perspectives.
Despite growing investment in bionic prostheses, the adoption rate has remained stagnant. Research on upper-limb prosthetic users from two decades ago identified key user needs, yet a recent update found those needs unchanged, which underscores a persistent disconnect between technological innovation and real-world usability.
“A lot of engineering goes into prosthetics, and that’s what gets attention in the media,” Finco said. “But from a clinical perspective, these are often not devices that insurance covers, and many don’t even make it to market in a way that serves the population that needs them most.”
The study will employ qualitative research methods, including structured interviews, to uncover widespread concerns among key stakeholders. The insights gathered will inform the creation of a decisional support document designed to guide ethical research and policy development in the field.
The project includes collaborations with experts from Baylor College of Medicine, Northwestern University, and the Amputee Coalition, among others.
“The goal is to create a tool that ensures people with limb loss are part of the conversation from the outset,” Finco said. “Nothing about us without us—that’s the guiding principle.”
“This research has the potential to influence how prosthetic technology is designed and implemented for decades to come,” McDonald said. “By prioritizing ethical considerations now, we can help ensure that future advancements serve those who need them most.”
Editor’s note: This story was adapted from materials provided by UNTHSC.
The open-access study that led to the grant, “Advances in prosthetic technology: a perspective on ethical considerations for development and clinical translation,” was published in Frontiers in Rehabilitation Sciences.
