Low cost through knee prostheses. TaKeuP

Cambodia is one of the world's most landmine affected countries with over 64,000 casualties recorded since 1979 and over 25,000 amputees. Added to this there is also a rise in the number of amputations resulting from road traffic accidents. Currently around 10 million people in South East Asia, India and Sri Lanka need but do not have access to prosthetic and orthotic services and there is a deficit of circa 40,000 professionals. This project directly targets end-users (Prosthetists and amputees) in Cambodia with a view to future expansion into the Philippines, Myanmar, Indonesia and Sri Lanka through strategic partnership with Prosthetics and Orthotics NGO Exceed Worldwide and the Exceed Research Network. We have active collaborations with UK (and European) prosthetics manufacturers (Blatchfords, Otto Bock, Össur), NHS prosthetics and rehabilitation services, and the Defence National Rehabilitation Centre Headley Court.

Recent developments in medical care have resulted in a surgical preference for through-knee amputation where previously above knee amputation was considered preferable. Through-knee amputations allow the socket for the prosthesis to fit on the stump so that the load through the artificial foot and knee is transmitted directly to the end of the stump; this maintains healthy, normal load through the thigh bone. An above knee amputation does not permit this normal loading; the socket has to transmit the loads all the way to the pelvic bone, partially bypassing the thigh, causing pressure sores, inhibiting the range of motion of the amputated limb, and producing bone fragility in the thigh. Therefore, through-knee amputations result in a reduction in pain, fewer incidences of bone formation within muscle (a highly debilitating complication), the ability to bear significantly higher loads, and maintain bone health.

The cost (>£50,000 per device) and maintenance required make modern sockets and powered knee mechanisms designed for through-knee amputees inappropriate for use in low and middle income countries. Current low cost solutions for this provided by the adaptation of Red Cross knee joint prostheses suffer from major limitations such as an inability to be locked in extension, severe compromises on cosmetic appearance resulting in social exclusion, and a very low prosthetic knee joint (due to the long thigh component) producing other functional deficits.

In this project we will develop a low-cost through-knee prosthesis the initial concept for which has been developed by the applicants through prior work with partners in Cambodia. This will be developed further to create a pathway to support the translation of future frugal technology projects (projects that are low cost in terms of manufacture and maintenance) and we will populate this frugal technology pathway with a series of follow on prosthetics and orthotics projects for amputees. Finally, we will ensure that there is a route to harness the frugal technology development for low and middle income countries for the benefit of healthcare in the UK. This project will create a community of researchers, engineers and clinicians developing and translating affordable prostheses.

The impact of this research would extend from new devices for amputees in low and middle income countries (LMICs) to economic impact in LMICs and beyond.

Society: TaKeuP will look to develop new applicable frugal devices in the field of prosthetics. It will benefit not only patients and their carers, but also healthcare providers (Prosthetists and Technicians) who currently have limited availability and resources to undertake the necessary adaptations to existing systems. Our innovation pathway will enable new concepts to be developed more quickly, driven by the needs and requirements of the end-user through a meaningful user engagement methodology. The concept for a new through-knee prosthesis, and the proposed pipeline projects of child-sized prosthesis and enriched physiological capacity will not only improve a user's functional ability but also prevent users from feeling conspicuous in social situations, an issue that is of prevalence in a society that can be inconsiderate towards people with disabilities.

Economy: The proposed devices will assist amputee victims of blast injuries and road traffic accidents in the process of returning to a functioning working life. As many of these users come from rural backgrounds this requires a robust prosthesis able to handle the demands of physical labour and prolonged squatting under load. The ability to return to a fully active workload affects not only the user but also those who are assigned as their carer, allowing two people to return to full time labour (or education).

The proposed innovation pathway has the utilisation of local manufacturers and maintenance facilities at its heart. As such, each new concept that passes through the pipeline will go towards increasing the demand for local manufacturing skills, boosting the local economic benefits even further as concepts roll-out to neighbouring countries.

The potential for Reverse Innovation could see the effects of these developments benefit not only the local economy within Cambodia, but also within the UK as the arising intellectual property will seed further investment in related research and the development of products through partners, licensees and spinouts. The creation and growth of companies will boost employment and enhance business revenue, license income and innovation in the UK knowledge economy, leading to wealth creation and economic prosperity. The UK is particularly well placed to exploit commercial opportunities arising from TaKeuP due to its strong research base, unified healthcare system, and world leading rehabilitation expertise as exemplified by Headley Court.

Knowledge: The development of an innovation pathway will help to translate technical knowledge from laboratories into the market place, while the network of collaborators will assist to empower researchers with knowledge from users and Prosthetists in the field as to the areas of primary interest, in order to focus their research. This network is critical to the flow of knowledge not only between the collaborators but also the knowledge which is disseminated to the community at large. The network provides a number of outlets through which knowledge gained within the developments associated with this project may be communicated.

People: The researchers in this project will develop multidisciplinary research skills in frugal healthcare technologies, complemented by professional skills, management and career development training delivered through Imperial's award winning postgraduate development centre, as well as bespoke training through courses within the Department of Bioengineering (e.g. Human Centred Design of Assistive and Rehabilitation Devices; Human Neuromechanical Control and Learning; Robotics). Personal and professional development will be enhanced through their three periods of research in Cambodia. TaKeuP will produce highly-skilled staff ready for careers in industry, healthcare and academia.