The field of prosthetics is rapidly advancing with life-altering technology. Devices that were once relegated to the annals of science fiction are being developed and tested, potentially usable in the not-too-distant future. As we advance the design, material, and functionality of these prostheses, it is essential to know that people remain the irreplaceable core of prosthetics.
In conjunction with Bespoke Bodies, we hosted UNITE: Human Tech Connect – a panel discussion that strove to bring the people behind the prostheses together to share their experiences and insights. Our panel consisted of moderator Shashi Jain, Innovation Manager at Intel as well as 3D printing professional and enthusiast; Erin O’Brien, an ABC certified Prosthetist and Orthotist at Hanger Clinic; Erica Bruns, prosthesis user and client of Erin; and Dr. Albert Chi, trauma surgeon with a background in biomedical engineering, and Medical Director of the Targeted Muscle Reinnervation Program at OHSU.
Building Trust and Confidence
The heart of the field of prosthetics is the relationship built between the user and clinician . A prosthetist is responsible for customizing and fitting a limb that might have been lost in a traumatic incident, ultimately providing an opportunity for the patient to assume the activities, however mundane, they once enjoyed.
Erin’s role as a prosthetist has led to some incredible experiences: “I think one of the coolest moments in my job is when I get to see someone walk again for the very first time, and we’re lucky that it is part of our job. It can be everything, you get a lot of emotions, I get emotional sometimes. You get to experience a lot of that with the patient, certainly nervousness, anxiety, excitement, happiness that they’re walking… I think there’s a lot of doubt that you’re not going to get back to that same life that you had before. I think a sense of hope is restored.”
Erin’s patient, Erica Bruns, shared her experience of learning to walk again: “I started walking full time 9 months after my accident. It took that long for my limb to heal up enough to be able to wear a prosthetic full time. It feels a lot like you’re wearing a high-heel, you can only kind of feel the ground. You’re not really sure if that next step you take your foot’s going to be there or not.” Erica began running again about a month after she felt comfortable walking, which presented another set of challenges. Describing the feeling of running on the blade: “It’s like a spring, there’s so much energy in it and harnessing it takes a lot of force not only in your residual limb but the other to keep up with it.”
Breaking the Taboo
Prosthetic limbs have been misunderstood or misrepresented for a long while. Many prosthesis-wearing people have shied away from drawing attention to themselves, which in turn leaves many people without exposure and understanding of what living with limb loss is like. Each panelist was passionate about reversing this taboo and sharing their stories so that they might inspire more people to do the same.
Erica’s occupation at a childcare center has allowed her to show off her prosthetic leg to her kids. “One specifically comes up to me on his way home to make sure that my robot foot is still there… He and his sister go home and cut barbie legs off.. and they cut teddy bear legs off… and they try to rebuild them. Just to have that impact on that side of the community and me personally feeling empowered to show my prosthetic means that I get to share that with the future, and know one day that those kids could be designing prosthetic limbs.”
Erin follows, “I think it’s really amazing that it’s becoming much more of an awareness publicly, a disability doesn’t have to mean something bad. Something that’s really important to me is that the person that I’m providing a prosthesis to feels that it is a part of them, and that they’ve designed it and is something that’s beautiful to them. I think it’s great that people have the power to choose, because the more that they can take ownership of that limb the more that it does become part of their everyday life. There’s a healing process that comes with having an amputation, and I think a part of that is sort of getting to design and accept your own limb as part of their body.”
The Role of Technology
3D-printing technology is shaping the future of prosthetics in numerous ways, from more efficient socket fitting to more affordable devices. “We’ve started to capture shapes instead of with plaster with the 3D scanner,” says Erin, “which allows us to possibly 3D-print as some point, we can modify things on the computer. Upper extremity prosthetics is in a place that’s really amazing in terms of advanced technology.” Dr. Chi follows, “It’s all about the math… with pattern recognition and how we interpret all of the muscle activity and things. It’s gotten to a point where we actually can have things down to individual finger control with people missing their limbs above the elbow. Which seems crazy, but I’ve seen it.”
Shashi recounted the first time he gave a 3D-printed hand to a child. “We put together a hand that just worked for him and it was amazing to see that moment when he put it on and was flexing it and you could see that the hand was functional, and then there was that moment where it became part of his body. The mother pulled me aside after this and she said, ‘my body did this to my child, I did this to my child and until now I’ve had no way to do anything about it.’ You can’t imagine what it’s like to hear that from a mother. From my perspective, the technology that we put into this is going to empower us as people.”
The Future of Prosthetics
As technology progresses, prosthetics will likely become less expensive and, hopefully, more understood by insurance companies. Erin shared how frustrating it can be when she isn’t able to provide a patient with a prosthesis because either their insurance won’t pay for it or they can’t afford to buy it. “Almost no insurance companies pay for a running leg. I would love to provide all kids with a running leg – kids run, right? To be able to provide what someone needs and not worry about the financial aspect of it would be so freeing, you would have such amazing outcomes and the technology would just marry into that beautifully.”
Dr. Chi shares his experience as a Navy Reserve Commander and Director of Surgical Services during Operation Enduring Freedom in 2013: “Of all our wounded warriors coming back, 80% of them have some type of limb loss. When you look at the distribution of pattern of injury, most of those that are able to return to active duty had injuries involve lower extremity loss and a lot of that is because of the technology that is available. If you have upper extremity loss that’s a life-altering and almost career ending injury for you. What I’m most excited about is the upper extremity technology and the goal of many of the advanced research projects is to enable our wounded warriors to be active duty again.”
In closing, Shashi asks: What do you want to leave the public with? What do you want the public to know about prosthetics?
Erica: “I want the community to know that I’m just a normal person, first and foremost. But it’s okay to ask me questions, and that just because I have a limb difference that I’m approachable and I think that I can say for a lot of people in our community that just because I look different doesn’t mean that you can’t ask me why I look different. I also want to leave the audience and everyone knowing that prosthetics are the future – the design future, but also the technological future.”
Erin: “I think I just want to reiterate the human connection to this. We talk about prosthesis as if it is a thing, right, as if it is a device. But there’s a whole team of people. First is the patient, there’s a prosthetist that works with them, there’s a physical therapist, there’s an occupational therapist, there’s a surgeon, there’s a physical medicine and rehabilitation doctor, so don’t think of prosthesis as a thing, think of it as a part of the way for that person to heal. A way for that person to be functional… it’s all about the person that comes from.”
Dr. Chi: “That we live in an incredible time right now and I think I mentioned this before but there’s just incredible breakthrough surgeries, and incredible breakthrough technologies and to the audience anything you dream of, we can make it happen… Really anyone, even in this audience right now anyone that wants to get involved, you can get involved. I know it seems like I’m involved in a lot of advanced crazy technology too but I’m an eNabling the Future volunteer as well. It just really takes the right mindset and source to get involved.”
Shashi: “If you feel inspired, if you want to get involved, the thing I want to leave you with is something I just actually already said and that is “Say yes a bit more than you say no.” Be up, be there, be present, help out. There’s a lot of work to be done on the design side and on the technology side, and there’s a community out there that’s wanting to help push the boundaries of prosthetics and you can get involved today.”
Bespoke Bodies: The Design & Craft of Prosthetics is a major exhibition and education program by Design Museum Foundation, on view at the Pacific Northwest College of Art from February 15 – May 9, 2018. From sculpting ocular prosthetics to crowdsourcing affordable 3D printed hands, this exhibition surveys past, present, and future of prosthetic design on a global scale. Visitors will explore evolution and design process behind a range of prostheses through visual stories, historical surveys, videos, and interactive models. Over 35+ case studies — spanning DIY-inventions from kids to mind-controlled bionic limbs — tell the stories behind the patients, clinicians, designers, and artists changing how we think about the impact of design, and ultimately, the future of our mobility.