Fit-for-purpose, affordable body-powered prostheses

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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.