Fit-for-purpose, affordable body-powered prostheses

Lead Research Organisation: University of Salford
Department Name: Sch of Health Sciences


Upper limb loss can have devastating effects on an individual, particularly if that person is already surviving at a subsistence level. Prostheses can be used to replace the missing limb, offering both cosmetic and functional benefits. In lower and middle income countries (LMICs), conflict and road traffic accidents mean that demand for upper limb prostheses is high, however provision is sparse, and maintenance is a major challenge.

Body-powered (BP) prostheses have seen little development since the early 20th century, despite high self-reported rates of rejection. Nevertheless, BP prostheses are well suited for use in LMICs, being potentially simple to manufacture and maintain. If the reasons for rejection (e.g. limited functionality, cost and heat-related discomfort) can be addressed, BP prostheses offer a potentially viable solution. Therefore, this project will bring together an experienced team from across the UK, Uganda and Jordan to create a new BP prosthesis that is optimised for adoption by LMIC prosthetic services and acceptable to LMIC users. This will include establishing methods of fabrication, fitting and evaluation of the prosthesis which are appropriate to LMICs.

Our two LMIC partners (Uganda and Jordon) have been selected because of the unique challenges of prosthetic provision in these countries. Uganda is one of the least developed countries in the world, with poorly resourced and fragmented rehabilitation services. Jordan is an upper middle income country, with well-developed clinical training, but facing immense pressures on prosthetic services due, in part, to regional conflicts.

To achieve our goals, the following work packages (WPs) are planned:

WP1: The requirements of amputees in both Jordan and Uganda will be investigated using focus groups and questionnaires.
WP2: We will develop an engineering/human factors specification for a BP prosthesis optimised for LMICs by identifying the key features of the conventional BP prosthesis that determine its functionality and usability.
WP3: Informed by WP1 & 2 we will develop a new design, optimised for LMICs. We aim to restore a high level of functionality, in a culturally acceptable manner, and in a way that is well suited to local prescription, manufacture and fitting. To ensure local relevance, we will work closely with our partners in Jordan and Uganda.
WP4: In parallel to the work in WP3, we will address more ambitious design challenges, creating and testing a highly novel prototype in the laboratory. This division of the work will allow us to move quickly towards a practical solution for LMICs and to also include more novel but higher risk research.
WP5: There is currently no objective data on the extent to which prostheses are worn, how they are used, or the impact on daily life. We will develop a digital tool kit that includes a sensor system to capture both motion of the prosthetic arm and complementary data (for example, prosthetic hand opening/closing and location), and an Android app to provide feedback to designers, clinicians, and users.
WP6: To support the long term impact of this project, we will work with our LMIC partners to support improved provision (including local manufacture and better clinical support) and hence enable uptake of the new BP prosthesis.

Planned Impact

The work will impact on a number of communities, in several countries.

Uganda. In common with many other African countries not directly involved in conflict, the Ugandan economy, is accelerating, with annual growth forecast to be 5.6% in 2019 ( The World Bank notes the Public Financial Management Act (2015) as a significant step towards improved financial management. Both the growing economy and improved regulations will encourage investment in the country. Through our collaboration with the Uganda Industrial Research Institute (UIRI), a government agency for industrialisation, we expect our project to take advantage of these economic opportunities, primarily through the establishment of a prosthetics manufacturing facility in Uganda. Such a facility would reduce the need for costly imports, provide opportunities for lower cost prosthesis production, and potentially export to relevant markets.
Through our knowledge exchange work in Uganda, we see a new cadre of allied health professionals emerging. These are 'tech-savy' individuals, looking to technological solutions to both guide their work and measure the impact of their work on patients. Through our web-based support and the new digital tool kit (sensors and associated app), we will demonstrate the value and impact of rich data on their work.

Jordan. Jordan's economy is under great pressure, due to the neighbouring conflicts in Syria and Iraq and the consequent impact on trade, tourism and public services. However, there is a centre of excellence in prosthetics based in the University of Jordan, with the capacity to expand its services and (through the University) nurture spin-outs. Brain/skills drain remains a major challenge. We focus our work in two areas, prosthetics services in Amman and in refugee camps. Neither of these provide good upper limb prosthetics provision and all rely on costly imports. We also recognise the need to move towards a multidisciplinary team approach to clinical support for upper limb amputees and our planned work with other Universities in Jordan will support this. Our partners, International Committee of the Red Cross (ICRC) and Médecins Sans Frontières (MSF)are both aware of the challenges involved in upper limb prosthetics delivery to refugee populations and we will be advised by them (through our Advisory Board) on how best to impact on this service.
In a similar way to Uganda, we would envisage a new cadre of 'tech-savy' allied health professionals emerging and the links with Uganda will strengthen the feeling of community amongst these individuals.

Other LMICs. We would see the project as an exemplar for other countries, inspiring changes to training and moving the focus for purchasing decisions away from the high cost manufacturers based in the UK, EU and North America.

UK. Prosthetics services in the UK are coming under immense pressure due to the steep rise in demand (primarily lifestyle-driven) coupled with a rapid increase in the cost of top end componentry. The NHS needs to move towards a more evidence-based approach to practice and find a way of managing both demand and costs. Some of the lessons learnt from this project, including the use of digital evaluation tools and low cost designs, will be introduced into Salford University's prosthetics and orthotics curriculum at the end of the study, thereby having direct impact on the NHS.

Longer term impact. Towards the end of the project, we will evaluate the design advances coming from WP4, demonstrated through a highly novel prototype. We believe these will revolutionise body-powered prostheses and we will form a consortium to bid for near-market funding to produce a pre-commercial prototype. This has the potential to impact on the UK economy and amputees globally.
Description As part of the agreed pathways to impact work, Bernadette Deere and Steven McCormack, trainee NHS clinical scientists from North Bristol NHS Trust (Deere) and Royal Liverpool and Broadgreen University Hospitals NHS Trust (McCormack) carried out an elective placement aligned with the project. They visited Uganda in December 2018 and produced a report on how people in Uganda get their prostheses repaired. This was investigated from both a technical perspective, by interviewing orthopaedic technologists and observing prosthetic workshops, and from a client perspective, by interviewing prosthetic users. The findings are informing the development of a PhD project, for a biomedical engineering student in Uganda
First Year Of Impact 2019
Sector Healthcare
Impact Types Societal

Description Royal Society Human Transformation 'moving and sensing' workshop
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Description Interview with Research Professional 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact I was interviewed about the award by a journalist working for the Research Professional website
Year(s) Of Engagement Activity 2018