Fit-for-purpose, affordable body-powered prostheses

失去上肢会对一个人产生毁灭性的影响，特别是如果这个人已经在维持生计的水平上生存。假体可用于替换缺失的肢体，提供美容和功能方面的好处。在低收入和中等收入国家（LMIC），冲突和道路交通事故意味着上肢假肢的需求很高，但供应稀少，维护是一个重大挑战。自世纪初以来，尽管自我报告的排斥率很高，但身体动力（BP）假肢几乎没有发展。然而，BP假体非常适合用于LMIC，可能易于制造和维护。如果可以解决拒绝的原因（例如功能有限，成本和与热相关的不适），BP假体提供了一个潜在的可行的解决方案。因此，该项目将汇集来自英国，乌干达和约旦的经验丰富的团队，以创建一个新的BP假体，该假体经过优化，可供LMIC假体服务采用，并为LMIC用户所接受。这将包括建立适合中低收入国家的假肢制造、安装和评估方法。我们的两个中低收入国家合作伙伴（乌干达和约旦）之所以被选中，是因为这些国家在提供假肢方面面临着独特的挑战。乌干达是世界上最不发达国家之一，康复服务资源匮乏且支离破碎。约旦是一个中上收入国家，拥有发达的临床培训，但面临着巨大的压力，假肢服务，部分原因是地区冲突。为了实现我们的目标，以下工作包（WP）计划：WP 1：在约旦和乌干达截肢者的需求将进行调查，使用焦点小组和问卷。WP 2：我们将通过识别决定其功能和可用性的传统BP假体的关键特征，为针对LMIC优化的BP假体制定工程/人为因素规范。WP 3：根据WP 1和WP 2的通知，我们将开发一种新的设计，针对LMIC进行优化。我们的目标是以文化上可接受的方式，并以非常适合当地处方，制造和装配的方式恢复高水平的功能。为了确保当地的相关性，我们将与约旦和乌干达的合作伙伴密切合作。WP 4：在WP 3工作的同时，我们将应对更雄心勃勃的设计挑战，在实验室中创建和测试一个非常新颖的原型。这种工作分工将使我们能够迅速为中低收入国家找到切实可行的解决方案，并包括更多新颖但风险更高的研究。WP 5：目前没有关于假体磨损程度、使用方式或对日常生活影响的客观数据。我们将开发一个数字工具包，其中包括一个传感器系统，以捕捉假肢的运动和补充数据（例如，假肢手的打开/闭合和位置），以及一个Android应用程序，用于向设计师、临床医生和用户提供反馈。WP 6：为了支持这个项目的长期影响，我们将与我们的LMIC合作伙伴合作，以支持改善供应（包括本地制造和更好的临床支持），从而使新的BP假体的吸收。

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.