Some friends and I started OpenProsthetics.org in 2006, after a year in which I became disappointed in the true state of the art of prosthetic arms, even for a very well-insured customer. I've written the article "Open Arms" about what I believe are the reasons for the lack of progress and suggested some solutions (http://spectrum.ieee.org/biomedical/bionics/open-arms). At the heart of the problem is the sheer lack of customers: there just aren't enough of us to get shareholders and investors excited about developing solutions. Indeed, we're lucky to have had the investment we have-a very large investor in solutions over the years has been the U.S. government. A challenge that I believe remains is ensuring that government efforts are effective, well-coordinated, and transparent. It's a daunting task, considering that prosthetic research in the United States is funded by the Department of Veterans Affairs (VA), Department of Defense (DoD), Defense Advanced Research Projects Agency (DARPA), Department of Education, Department of Commerce, National Institutes of Health (NIH), National Science Foundation (NSF), and likely others we haven't even heard of. Portfolio managers within these agencies, through no fault of their own, can be ignorant of efforts funded through their own agency. Worse, there is a perverse incentive to claim outright success for these projects-which the media is all too happy to oblige-and a lack of focus on getting products to market. This is unsustainable for all of us. How can we ask for more money to do something we said we did last year? And where can I order one of those? Will my insurance pay for it? It's worth acknowledging that although we've been amazingly successful for a bootstrap project with less than $3,000 worth of funding, Open Prosthetics has still not been successful in getting anyone to bring a new design to market. Our website is actually a collection of several free hosting services. We've been threatened regarding intellectual property rights for the Trautman hook, and yet no one has done anything with the designs we published. We've had small successes in encouraging companies to make improvements to existing products that hadn't been updated in years. Despite our advocacy for open systems, however, major companies are bringing next-generation products to market that will be incompatible with those from any other company, limiting your choice in creating solutions for patients and changing the "mix and match" status quo for upper limb. While we don't have specific solutions for all of these challenges, I still believe that the key is more and better communication among the stakeholder groups: amputees, prosthetists, academic researchers, industry professionals, and volunteers. Open Prosthetics has made headway with the first and last groups, but we could use your help figuring out how we can better serve you-the clinical professional. We believe that innovation in prosthetics will most consistently come from users, and that prosthetists and technicians are the most likely of these "lead users" of the technology to recognize needs and create innovative solutions. In partnership with United Cerebral Palsy-which now has a broad focus on many disabilities and a $100 million annual research budget-we've made a proposal to rethink the way we connect all of these groups. We're trying to build on the success of our websites and involve the rest of you by making it easier to do what you're already doing. We'd like to create ways for you to efficiently access and add "Web 2.0" content on Open Prosthetics that will help you better serve your patients and stay profitable. For an explanation of Web 2.0-essentially the possibility that the web can allow each of us to add value to and organize information through comments, ratings, references, and the like-visit www.youtube.com/watch?v=6gmP4nk0EOE Our plan is to better connect those who fund and conduct research with the folks who are the intended targets-prosthetists and their customers. As we develop our plan for the improved web tools, we'd very much like your input. What information can we provide you that you can't get anywhere else? What information would you like to share with others? What information do you need every day in your practice that either you do not have access to or you spend too long looking for? Help us generate a wish list and discuss what you would like at http://openprosthetics.ning.com/group/clinical Jonathan Kuniholm is founder and director of the Open Prosthetics Project and is a PhD candidate in biomedical engineering at Duke University, Durham, North Carolina, working on a Defense Advanced Research Projects Agency (DARPA) Revolutionizing Prosthetics project. He is also a former Marine Reservist who sustained a transradial amputation due to injuries sustained in Iraq on New Year's Day, 2005.
