Stanford scientists have developed a more stable prosthetic foot which they say could make challenging terrain more manageable for people who have lost a lower leg.
The new design has a kind of tripod foot that responds to rough terrain by actively shifting pressure between three different contact points.
“Prosthetic emulators allow us to try lots of different designs without the overhead of new hardware,” said Steven Collins, an associate professor at Stanford University in the US.
“Basically, we can try any kind of crazy design ideas we might have and see how people respond to them,” he said, without having to build each idea separately, an effort that can take months or years for each different design.
People with a leg amputation are five times more likely to fall in the course of a year, which may contribute to why they are also less socially engaged.
A better prosthetic limb could improve not just mobility but overall quality of life as well, according to the study published in the journal IEEE Transactions on Biomedical Engineering.
One area of particular interest is making prosthetic limbs that can better handle rough ground.
The solution, researchers thought, might be a tripod with a rear-facing heel and two forward-facing toes.
Outfitted with position sensors and motors, the foot could adjust its orientation to respond to varying terrain, much as someone with an intact foot could move their toes and flex their ankles to compensate while walking over rough ground.
Rather than building a prosthetic limb someone could test in the real world, the team, including graduate student Vincent Chiu and postdoctoral researcher Alexandra Voloshina, instead built a basic tripod foot.
They then hooked it up to powerful off-board motors and computer systems that control how the foot responds as a user moves over all kinds of terrain.
The team can put their design focus on how the prosthesis should function without having to worry about how to make the device lightweight and inexpensive at the same time.
The team reported results from work with a 60-year-old man who lost his leg below the knee due to diabetes.
The early results are promising — making the team hopeful they can take those results and turn them into more capable prosthetics.
“One of the things we are excited to do is translate what we find in the lab into lightweight and low power and therefore inexpensive devices that can be tested outside the lab,” Collins said.
“And if that goes well, we’d like to help make this a product that people can use in everyday life,” he said.
ANDREW RUBIN SITS with a Surface tablet, watching a white skeletal hand open and close on its screen. Rubin’s right hand was amputated a year ago, but he follows these motions with a special device fitted to his upper arm.
Electrodes on his arm connect to a box that records the patterns of nerve signals firing, allowing Rubin to train a prosthetic limb to act like a real hand. “When I think of closing a hand, it’s going to contract certain muscles in my forearm,” he says. “The software recognizes the patterns created when I flex or extend a hand that I do not have.”
The 49-year-old college professor from Washington, DC, drives several times a month to Infinite Biomedical Technologies, a Baltimore startup company that is using deep learning algorithms to recognize the signals in his upper arm that correspond with various hand movements.
Each year, more than 150,000 people have a limb amputated after an accident or for various medical reasons. Most people are then fitted with a prosthetic device that can recognize a limited number of signals to control a hand or foot, for example.
But Infinite and another firm are taking advantage of better signal processing, pattern recognition software and other engineering advances to build new prosthetic controllers that might give Rubin and others an easier life. The key is boosting the amount of data the prosthetic arm can receive, and helping it interpret that information. “The goal for most patients is to get more than two functions, say open or close, or a wrist turn. Pattern recognition allows us to do that,” says Rahul Kaliki, CEO of Infinite. “We are now capturing more activity across the limb.”
Kaliki’s team of 14 employees are building the electronics that go inside other companies’ prosthetic arms. Infinite’s electronic control system, called Sense, records data from up to eight electrodes on his upper arm. Through many hours of training on the company’s tablet app, the device can detect the intent encoded in Rubin’s nerve signals when he moves his upper arm in a certain way. Sense then instructs his prosthetic hand to assume the appropriate grip.
Last Friday, Infinite’s Kaliki received notice from FDA officials that Sense had been approved for sale in the United States. Kaliki says he expects to begin installing them in prosthetic limbs by the end of November. In 2017, FDA officials approved a similar system by Chicago-based Coapt. Today more than 400 people are using the system at home, according to CEO Blair Lock.
Lock started as an engineer 13 years ago at the Rehabilitation Institute of Chicago, an affiliate of Northwestern University. He worked with surgeons who were repairing nerve damage in amputee patients. Over time, he realized that building better prosthetics would be easier if he could figure out a way to pick up better signals from the body, he says. “What’s new is providing a much more natural, more intuitive method of control using [bio-electronic] signals,” Lock says.
In earlier versions of prosthetic devices, electrodes recorded signal strengths “but it was like listening to an orchestra and only knowing how loud the instruments are playing,” Lock says. “It was a significant effort to learn the content and fidelity of the signals.” The Coapt system works inside an amputee’s prosthetic hand and costs about $10,000 to $15,000, depending on the amount of customization needed. Artificial limbs can costs anywhere from $10,000 to $150,000, according to Lock.
Nicole Kelly got a new prosthetic device with the Coapt control system about a year ago. Now the 28-year-old Chicagoan can grind fresh pepper into her food and hold playing cards with friends. She can also open a beer.
“For many things, it wasn’t that I couldn’t do them before, but suddenly I can do them much easier,” says Kelly, who was born without her lower left arm.nHer prosthetic “is not my body, and it’s not 100 percent natural,” she said. “There’s a learning curve of my body communicating with this technology. Even the process of the best way to hold the salt and pepper shakers, I am essentially doing it for the first time.”
Source of the Article: https://www.wired.com/story/bionic-limbs-learn-to-open-a-beer/
Evie Lambert, 11, will be able to open Christmas gifts for the first time thanks to ‘a real-life Santa’
A girl has been given the perfect early Christmas gift of a bionic arm and will be able to open her presents unaided for the first time.
Evie Lambert, 11, was born with no left hand and was delighted when a kind-hearted anonymous donor paid for her £10,000 3D-printed arm.
Now Evie is looking forward to opening her presents on Christmas morning with her “Frozen” themed arm.
She said: “I want to say a big thank you to the donor. It is the best Christmas present ever.
“It will really help me to do things that I struggled to do before. It feels really comfortable wearing it and the hand opens and closes like a real hand. I’d love to get make-up for Christmas and now I’ll be able to put mascara on.”
Her mum Sally, 47, of Huddersfield, West Yorks said: “She couldn’t have wished for a better Christmas present.
“If she could have put anything on her wish list it would have been this. The donor is like a real-life Santa.
“It gives her functionality. It’s the simple things that she’s enjoying doing now – like being able to hold and open a can of pop, brushing her hair, opening a lip balm or putting clothes on a hanger, things that we take for granted.
“When she does it her face just lights up.
“The most amazing thing will be seeing her open her presents on Christmas day. I’m also going to have her help me wrap Christmas gifts.”
Sally and her husband Duncan, 49, found out at the 20-week scan that Evie had no left hand.
Sally, who also has an eight-year-old son Henry, said: “We have had incidents where people have called her names and there have been stares, but I think she’s built up a resilience to it.”
The family heard about Bristol-based Open Bionics at a conference in September.
Soon after they got a call to say a donor had paid for a prosthetic for Evie, whose arm was fitted in November.
Sally said: “It’s the kind of thing you think happens to other people. It’s amazing.
“It’s such an act of kindness – you don’t think these people exist.”
Source of the article: https://www.mirror.co.uk/news/uk-news/school-girl-no-hand-gets-13755653
The science-fiction vision of robotic prosthetic limbs that can be controlled by the brain and provide sensory feedback is coming closer. Stuart Nathan looks at progress in the UK.
There is a recurring theme in engineering of trying to match or copy nature. It’s hardly surprising. The world and its biological systems have had millions of years to evolve solutions to the various problems posed by the environment; civilisation, by contrast, has had mere centuries. It’s always a challenge, and humanity’s successes in matching nature are relatively rare.
One of the biggest challenges comes in healthcare, where engineers literally have to match nature. Engineering some device that will have to fulfil the same function as a natural part of the body or coordinate with natural processes is about as difficult as it gets. And replacing missing or lost limbs provides some of the most striking examples of the progress we have made.
Archaeologists have found examples of replacement body parts from ancient Egypt, Greece and Rome. These range from the crude — wooden peg legs and strap-on toes — to primitive, but still impressive attempts at limbs with hinged joints. Fast forward to the 19th century, and we find fully articulated prosthetic hands, which might not have been particularly effective but certainly look impressive.
An iron artificial arm, 1560-1600, once thought to have belonged to a German knight Credit: Science Museum; Wellcome Images; Creative Commons
Today, our expectations have been raised – unfairly – by science fiction. The 1970s television series The Six Million Dollar Man introduced us to a triple amputee whose legs and arm were replaced with robotic limbs that gave him superhuman abilities (running at 60mph, lifting impossibly heavy weights, and seeing acutely with an implanted electronic eye); the series’ enduring legacy is in popularising the term “bionic” for a motorised prosthetic. A decade later, and we saw the right hand of Star Wars hero Luke Skywalker lopped off and replaced with a cybernetic hand that was visually and functionally indistinguishable from his natural extremity, even down to reflexes and sensation.
Luke Skywalker’s hand remains the model for a prosthetic Lucasfilm; Disney Studios
But neither the Bionic Man nor Luke are realistic reflections of what is possible with prosthetics. We still talk of “a hand like Luke Skywalker’s” when we want to evoke an advanced prosthetic, and under examination they still fall well short in functionality, no matter how impressive they look. So, 40 years after we learned to talk about bionics, what is the shape of prosthetics to come?
There are two main challenges involved in developing prosthetics. The first is in designing the mechanical limb itself. With increasing miniaturisation of electric motors and advances in computing power, this is becoming less of a challenge than the second, still-towering difficulty; finding ways to interface the machine with the amputee’s body. How can somebody who has lost a limb control a prosthetic? Is it possible to think about moving a prosthetic arm and move it with brain power alone; or to get even closer to the natural condition, and move it without barely any conscious thought? Can the sense of touch be replicated by a machine, even with today’s advanced sensors? And how about the sense which we rely on but is so fundamental that we are barely aware of it: proprioception — knowing exactly where our limbs and extremities are without having to look? How close can an amputee be returned to natural function with technology? And how is that technology likely to develop in the coming decades?
State of the art
It’s useful here to look at the present state-of-the-art. Current prosthetics have sockets that are made to fit precisely onto the amputee’s stump by a specialist prosthetician. It is absolutely vital that the fit is precise, and most prosthetics have to be adjusted regularly, which is, like all custom-making processes, expensive, time-consuming, and often inconvenient. There aren’t that many prostheticists, and travel to clinics in a problem (this is, of course, even more acute in the developing world and conflict zones, where amputation is disproportionately common and debilitating). Even the best-adjusted sockets are not ideal; the stump can slip against the surface, become sweaty and uncomfortable, and prolonged wear can be painful. This is particularly a problem for lower limb prostheses. As the body’s weight bears down onto the socket sores and resulting infections are a constant danger.
The most advanced prostheses available today do have some degree of mental control, but no sensory feedback. Control is achieved thanks to a phenomenon called myoelectricity. The remaining muscles of the stump still respond when the user “moves” the missing limb, resulting in electrical signals on the skin that can be detected by sensors installed into the socket. Although these signals may not correspond exactly to the movements the missing limb would have made, the user can learn how to make the prosthetic move in the desired fashion.
Myoelectric sensors are quite inexpensive, and the signals can be processed by off-the-shelf chips and sent to motors in the prosthetic. Companies such as Open Bionics, which The Engineer has covered, use such technology in their prosthetic arms and hands, which are designed to be open source and can be built from parts made on commercial 3D printers.
Myoelectric control depends very strongly on the fit between stump and prosthetic, because the sensors that detect the muscle signal have to be precisely placed on the correct area of the skin.
Moreover, this technology is best suited to arms and hands. Legs present a different set of problems, as the movement of knees, feet and ankles in normal walking are more autonomous and less conscious than those of hands, arms and fingers; they also have to deal with different types of stress and perform a more mechanical and supportive function. Because of this, in general the prosthetics field is sharply divided between upper and lower limb specialisms.
Advanced lower limb prosthetics tend to contain more passive systems, based around mechanical joints whose stiffness, in the most advanced cases, can be adjusted automatically during walking. Known as active joints, these often use pneumatics to help create realistic movements of knees and ankles, controlled by electronic actuators.
The most advanced lower limb available is generally accepted to be the Linx system, produced by UK company Blatchford, whose joints adjust automatically to changes in posture and which can be used even on soft and uneven surfaces.
Costing around £20,000 per unit, the Linx is, ironically, not currently available on the National Health Service in England because the equipment purchasing policy only takes into account the initial cost. In Scotland, where through-life costs are considered, the system has recently become available.
This reflects an unfortunate fact faced by lower limb amputees: because of the unbalanced gait resulting from using a prosthetic leg and the stresses this imposes on the skeleton, many amputees eventually have to undergo a replacement of the hip on the opposite side to the missing limb. The cost of this operation, post-surgical care and monitoring, will in most cases outweigh the extra cost of purchasing an expensive prosthetic leg (even though even the Linx needs regular attention from a prostheticist).
New ground or improvement?
Development of prosthetics largely divides into two camps; those working to refine current socket-based technology and those working on new systems more directly integrated into the body. The most basic requirement of the latter is some system that is grafted onto the skeleton using a process known as osseointegration. This requires developing metal systems that can be inserted into or attached to the shaft of a bone, whereupon the body’s innate healing processes grow living bone directly onto and into the metal. 3D printing and advanced coating techniques have helped develop the technology considerably in recent years, as they allow the custom manufacture of textures and shapes suited for bone tissue to grow through.
Indeed, prostheses using such technology have become relatively common, such as hip and knee implants. The important thing about these is that they remain entirely inside the body. For a replacement body part, a section of the implant would have to protrude through the skin. Breaking the skin permanently is potentially dangerous, because it could create a pathway for infection. Until relatively recently, the accepted wisdom was that very few amputees would even consider the risk of a protruding implant.
This perception may now be beginning to change, and the difference has come from a surprising source: veterinary science. Readers in the UK may be familiar with Prof Noel Fitzpatrick, an Irish vet whose clinic in Surrey has been featured in a number of TV programmes which show off his specialism in replacing lost paws of small animals with protruding prostheses. Socketed prostheses are not practical for animals, but regular viewers will be familiar with Fitzpatrick’s frequent struggles to encourage the skin of amputated limbs to adhere to his custom-made implants and the fight against resulting infections. Fitzpatrick is, however, an advocate of these “amputation prostheses” for humans, and works with surgeons on advancing the technology into human clinical practice.
The power of the brain
Kianoush Nazarpour, a bioengineer from Newcastle University, is one of those researching ways of improving existing technology. It is understandable that amputees wouldn’t want to risk implantation, especially when this technology is not fully developed, he told The Engineer. “By definition, if you need an amputation, you’ve already had a very traumatic experience, and the surgery to remove a damaged limb is even more trauma and risk. You can see why people wouldn’t want to expose themselves to another extreme procedure when they might end up with something no better — or even not as good— as something they can already have, and that’s before you consider the risk of infection.”
Nazarpour is an upper limb specialist, and all his work follows one philosophy. “We try not to overcomplicate the prosthetic itself, especially with on-board computing,” he explained. The thinking behind this is that the human brain can already outperform any kind of synthetic processor, and its potential has not been fully explored. “Think of a blind man with a walking stick,” he said. “Does that stick restore his sight? No. But the simple sensory feedback he obtains by tapping it in learned ways allows his brain to reach a relatively sophisticated impression of his surroundings; or at least the small part of his surroundings that he needs to understand to take a next step safely.”
Nazarpour’s research, in which he is working in collaboration with Imperial College London and the universities of Leeds, Keele, Essex and Southampton, is focused on giving prosthesis users sensory feedback. For this, he uses relatively simple sensors in the fingers of the prosthetic to detect temperature, pressure and shear (the last of these is detected by a sensor that responds to force lateral to the surface rather than perpendicular). Their output is translated into small electrical currents that are applied to the stump’s skin. “Everybody might feel the sensations differently,” he said. “For some people, it might feel like tickling, to others scratching. The sensor density cannot possibly be as great as that on a real hand, and the feedback isn’t as rich. But the brain can learn to interpret the sensation on the remaining flesh as though it were on the hand.”
Similar research in the blind has had some success in devices that stimulate the skin of the back in response to the output of a forward-facing camera, he added. “In these people, the sensations on the back are translated into an impression of what is in front of them through the brain’s learning process.”
Part of this, he added, results from neuroplasticity: the brain’s ability to develop new connections between neurons, effectively “rewiring” itself to develop new functions. “It’s not fast or easy,” he admitted. “People who get myoelectric limbs can typically start to learn to control them in about five minutes, because the visual impact of being able to see what your hand is reaching for, for example, is very powerful. Learning to interpret sensory input is an order of magnitude more difficult, and takes correspondingly longer.”
One intriguing direction the research has taken is in integrating machine vision into prosthetic hands. An off-the-shelf camera is attached near the wrist facing the fingers, and when the user moves the hand towards an object a processing algorithm assesses how best to position the fingers to grip the object. “It’s not a difficult algorithm to decide whether a tripod grip or forefinger and thumb would be best, so as the hand approaches the object the fingers move into the best position. All the user has to do is close the hand when it reaches the object.”
This is a transition technology, Nazarpour added, but is achievable with current equipment. “The point is that we shouldn’t be afraid to use different sorts of inputs if that will help us,” he said.
A similar system could conceivably be used on a prosthetic leg, he added; a camera monitoring ahead of the foot could manoeuvre the prosthetic foot into the best position to help the user climb steps, for example.
A USB for the body
Cambridge Bio-Augmentation Systems (CBAS) is one of the most ambitious of the new technology school of prosthetic development. CBAS is developing a standardised interface that could be surgically implanted into the stump of an arm or a leg, where it would integrate with bone and also connect directly to nerves. A robotic limb would then plug in to the interface, and also clamp securely onto the section protruding from the body to fix it into position. “Think of it as a USB port for the body,” explained co-founder Oliver Armitage.
Oliver Armitage with a mannequin sporting a prototype prosthetic interface device. Below, a schematic of CBAS’s prosthetic interface device with a robot hand
CBAS is focusing on developing the interface rather than the limb, Armitage said. The system would be open source to allow robotics specialists to develop the prostheses themselves. “It gives us the best chance of developing technology, reducing the cost and letting other experts play their role,” Armitage said.
Armitage is a bioengineer specialising in the junctions between dissimilar tissue such as bone and tendon, which has led him to work on how synthetic materials can be integrated into the body. One innovation he has been working on is a method to avoid the risk of infection. As well as the bone implant encouraging growth of natural material into metal, he is developing a blend of elastomers and other soft materials into which skin can grow, to help create a waterproof, airtight seal between skin and the protruding part of the implant. His fellow co-founder, Emil Hewage, is a specialist in neuroscience and machine learning.
While Armitage is looking at methods and materials that can connect nerves to the section of the interface inside the body, Hewage is looking at methods of interpreting the spiking electrical signals produced by nerves into forms that motor controllers can understand. This would work in two directions: signals from the motor nerves would be sent to the motors controlling the joints and fingers of the prosthetic, while the output of electronic sensors in the device would be fed into the sensory nerves.
Attaching directly to the skeleton has a variety of advantages, Armitage and Hewage said. “You have a fixed connection, so there’s no slippage and no risk of sores developing on the skin of the stump,” Armitage said. “The stresses of movement are passed directly into the skeleton, which has evolved to cope with them. Neural connection is already being done, and the technology we would use it is similar to that used for cochlear implants or deep brain stimulation in treatment of Parkinson’s disease, but connecting to the peripheral nervous system rather than in the brain.”
Another advantage, Hewage explained, is that direct attachment exploits the existing proprioception sense. “If the prosthetic moves precisely with the skeleton then it’s fulfilling what the brain naturally expects be there, and we just tap into that”
Hewage agrees that the sensory input from a synthetic system can’t match the richness of a natural extremity. “But we can send and receive information at the same speed the nervous system works in a non-amputee,” he said. “And the brain is very good at filling in gaps. We don’t perceive the world in anything like the detail that we think we do, either from our eyes or from our sense of touch. Our brains essentially use sophisticated processing tricks to fill in what our senses are not perceiving from moment to moment.”
CBAS is not a large company, having about a dozen permanent research staff and around 30 regular collaborators in clinical and academic institutions in the UK and around the world. However, the company has been undertaking preclinical trials, and Armitage says that it hopes to proceed to early clinical trials in humans in 2018. The ambition is to develop a standardised interface that would cost around £10,000 per unit, and could be incorporated into upper or lower limb implants.
The Six Million Dollar Man is still a science fiction pipe-dream. But Luke Skywalker’s hand, or at least a close approximation, might be closer than we think.
(CNN) In what’s being hailed as a breakthrough in spinal cord injury research, four men paralyzed from the chest down have risen from their wheelchairs on their own volition and effort.
“I can stand up for more than half an hour,” said Dustin Shillcox, who was paralyzed in a car accident five years ago. “It’s awesome. It’s amazing. It’s a hopeful feeling.”
Shillcox and the other three men had electrical stimulators surgically implanted in their spines, and are working toward walking again someday. Their standing achievements were published Friday in the online journal PLOS ONE by Dr. Susan Harkema and her colleagues at the Kentucky Spinal Cord Injury Research Center at the University of Louisville.
The Christopher and Dana Reeve Foundation, which helped fund the study, has named the Kentucky research as its “Big Idea” and is raising $15 million to do the procedure in dozens more patients.
Already, more than 4,000 people have signed up to become research subjects.
“We’re really excited. We think the future looks very bright for those with spinal cord injuries,” said Peter Wilderotter, the president of the foundation.
While the patients work toward walking — and no one knows if they’ll succeed — they have already experienced other benefits of the stimulator. Their increased mobility (they can lift and swing their legs and two can even do sit-ups) has already improved their health. One patient, for example, has seen his wildly fluctuating blood pressure come under control.
“Sure, I’d like to walk someday,” said Kent Stephenson, one of the study subjects. “But just give me sexual function and bowel and bladder control — I’m a happy camper.”
Dustin Shillcox stands again.
This isn’t the first time people with paralysis have risen from their wheelchairs. Since the mid-’90s, Dr. Ronald Triolo’s team at Case Western Reserve University in Cleveland has implanted stimulators in the legs and hips of more than 30 people, allowing them to stand up. Some have even taken steps.
But according to Triolo, there’s one major difference: The stimulators he uses “hijack” the muscles and tell them what to do. The Kentucky researchers put their stimulators right at the spine, so they affect the central nervous system. The patients themselves then have direct control over their muscles, and make them move on their own.
“The cachet, the unique thing Susie Harkema is doing, is she’s letting the muscles act naturally rather than forcing them to act,” said Triolo, a professor of orthopedics and biomedical engineering at Case Western. “It’s one step closer to more natural function.”
Shillcox, who’s started a foundation to help others affected by paralysis, said he could stand within a month after receiving his stimulator, but he needed people to support his hips, which weren’t steady, and his knees, which sometimes buckled.
Now, after more than two years of practice, he doesn’t need help from anyone getting up or staying up. He does, however, have to put his hand on something for balance.
“I’m working on that so I don’t have to hang on to anything,” he said. “The progress might be coming slowly, but we keep making gains.”
Prosthetics have made amazing advances in recent years – and are slowly changing people’s attitudes to disability. By Patrick Kane
I was born with the usual set of limbs. When I was nine months old, I contracted meningococcal septicaemia, a dangerous infection of the blood, which very nearly killed me. I survived, but because I had sustained major tissue damage, it became necessary to amputate my right leg below the knee, all of the fingers on my left hand and the second and third digits on my right hand. I learned to walk on a prosthetic leg at the age of 14 months, and have gone through my life wearing a succession of artificial limbs.
As time has passed and technology has advanced, so too have my limbs. Like our mobile phones, prostheses have become lighter, faster and more efficient. When I was nine, I was fitted with a lifeless silicone hand, a useless thing that was purely cosmetic, and so clumsy that I refused to wear it after the first day. Now, at 21, and a student in my third year at Edinburgh University, I wear a bionic arm with nimble fingers that move independently, which I operate using controlled muscle movements in my forearm, as well as an app on my phone. As a child I wore a stiff artificial leg attached with straps that frequently fell off; earlier this summer, I took delivery of a new dynamic right leg with shock absorption and carbon fibre blades.
Prosthetics have been around for more than 3,000 years: wooden toes, which strapped on and were specifically designed to work with sandals, were found on the feet of Ancient Egyptian mummies. For most of history, prosthetics have been designed to make life more comfortable for adults, to afford the wearer some limited movement, and to avoid drawing attention to their disability (by filling an empty jacket sleeve, or concealing a stump). It is only recently, as advances in robotics and computing power have been incorporated into artificial limbs, that function has become paramount, and the needs of active disabled people, especially children, have begun to influence design.
Until May this year, the leg I wore was fairly simple: a carbon fibre socket fastened with a pin, and a titanium pole attached to a waterproof foot. It certainly got me around, but it had its limitations, especially on uneven surfaces such as cobbled streets, pebbled beaches and any significant slopes – which, incidentally, describes most of Edinburgh.
In April 2016, I started working with Össur, a prosthetics developer that makes hi-tech joints and limbs for amputees, and has pioneered a new kind of attachment that helps balance and weight-bearing. Two years later, on a bright and chilly May morning, I drove to the Pace Rehabilitation centre in Stockport, where a physiotherapist would fit me with a new leg. I was a little nervous, since I had been going to the same prosthetics centre in Hampshire since I was two, but now that I spend a lot of my time in Scotland, the drive had become too long. Paul, my new prosthetist, met me at the door. I had spoken to him at an Össur training day some months before, and there was no danger of forgetting him. He has tattooed sleeves down both arms, long hair tied back in a ponytail and a strong Geordie accent, but what I remembered most was how many questions he asked.
Paul and a physiotherapist asked a ton of questions and filmed me walking the length of the room several times. They noticed that my old right leg was about an inch too short, a fact that had never occurred to me. When they were satisfied that they had all the information they needed, they made a full plaster cast of my leg. Just three hours later, a simple test socket had been mounted on to the new technology. As Paul described each component and how it is designed to help me move, it was hard to not start planning a marathon in my head.
The top of the new leg has a carbon fibre socket and is attached by vacuum. This evenly distributes the pressure, and won’t tug on any part of my stump, meaning I will no longer have the permanent, painful love-bite where the pin used to pull too hard on my skin. Below a titanium connecting component, there is a large hollow rubber sphere, which provides torsion – the ability to rotate. Dual carbon fibre blades curl into the hollow plastic foot. The blade in the foot is split in half, along where your big toe is. This is so the foot can deal with uneven ground (it also means I can wear flip flops). A small carbon fibre lever rests on top of the blade within the foot. Each time I take a step, my body weight bends the foot slightly, pushing the lever and drawing air out of the socket. It is designed to mimic a human foot as closely as possible, and it all looks very cool.
My first steps in the new leg were unsteady. As I put my weight through the prosthesis, I felt the heel compress and naturally rolled my weight on to the front of my foot, which then pushed me off with the toes. It turned out that I had been putting a lot of effort into walking on my right leg. All of a sudden, my new leg was putting effort back into me. It was extremely comfortable, and I left the clinic after five hours with a spring in my step. I even fancied going for a stroll. Previously, walking was a considerable effort and I wouldn’t do it unless it was necessary, but that evening, I found myself walking around my friend’s garden for the sheer pleasure of it, for the first time I can remember.
I had been a healthy baby, and the first sign that anything was wrong with me came after an unsettled night’s sleep. This was nothing too alarming for a baby of nine months, and my parents went to work that morning as normal, leaving me with my nanny, Sandra. By the afternoon, I was vomiting, floppy and drowsy. Within a few hours I would be fighting for my life.
My mother was at work, and booked a taxi to take Sandra and me to the GP, which was near our house in west London. The GP did not think it was anything too serious, and recommended Calpol: the liquid paracetamol that is a staple in every family’s medicine cabinet. Not quite content with this, my mother, still on the end of the phone, got the taxi to take me to the clinic at St Mary’s hospital in Paddington, less than a mile away. This geographical accident, and my mother’s persistence, saved my life.
At the hospital, I was received by Dr Parviz Habibi, one of the founders of the paediatric intensive care unit at St Mary’s. I spoke with Habibi recently, and he talked me through my arrival with such clarity that you would have thought it happened a couple of weeks ago. Within an hour, I had developed a meningococcal rash, which spread over my entire body. Habibi and his team recognised the signs and hooked me up to a catheter inserted in a large vein in my chest, to give my body the fluids it needed. But the intesive care unit’s medical devices were just not designed for a child that young, and my skin began to stretch and split as fluid leaked from my capillaries. I ballooned to four times my weight in a matter of hours.
Six hours after my arrival, multi-organ failure set in, affecting my kidneys first, then my blood, heart and lungs. Habibi recalled that it was in these first hours that most of the damage was done to my body, and the rest of my nine-week stay in hospital was spent solving the problems caused on the first day. My baptism was originally set for St Patrick’s Day, but because my parents were afraid I would die, it was dragged forwards to the evening of my second day in hospital, with close family and friends awkwardly huddled between the tubes and blinking machinery keeping me alive.
It was among these beeping boxes and flashing lights that my mother slept, vowing not to leave hospital until I did. People handle these traumatic situations differently, and my mother’s way of coping with it was to master the machinery of my care. She made it her mission to understand every tube’s purpose, know which light meant what, and alert a nurse as soon as there was a change on the monitors. I have no recollection of ever being ill, and had no sense of “fighting” the disease; however, I do often think of the strength shown by my mother in those months as an inspiration. When my five-year-old sister, Rosie, decided this had all gone on long enough, she stormed into my room and shouted, “Wakey wakey, Patrick!” For the first time in almost a month, my eyes flickered open.
Over the following days and weeks, different problems arose. I had become addicted to morphine, which I had been given for pain relief. My father vividly remembers seeing my body going into spasms of withdrawal. Once I was weaned off the drug, which took a few days, I was stable enough to be transferred from intensive care to a high-dependency ward. This, strangely, was the most testing time for my family. My mother had taken comfort in understanding the medical machinery and on the new unit, there was none. Without the monitors for reassurance, she felt lost and helpless.
Moving out of intensive care also meant I was well enough to undergo surgery again. Over the weeks, a few of my fingertips had become blackened and gangrenous, because not enough oxygenated blood was getting to them, and my family had expected me to lose some of them. But the blackening spread, including to both of my legs. Somehow, my left leg returned to normal after a few hours, but the right leg stayed black. When this happened, it meant the tissue was dead, so there was no choice but amputation. Each time I went into theatre, my parents would see me return with yet another bandaged stump hanging from me.
My entire life, people have been asking what happened to me, and when I tell them the story they always respond “poor you, how awful”. I have never seen it this way. The fact that I had come so close to death at such a young age had a profound effect on my parents’ attitude to my disability: because they were aware that things could have gone much worse, they did not have, and did not pass on, a “poor me” attitude. I have no memory of those months: I was not the one experiencing the stress and trauma of my illness. It was not until I was much older that I realised what the impact must have been on my family.
Prosthetic legs don’t have barcodes. My mother and I discovered this on a trip to the supermarket when I was about two years old. I used to sit in the child seat of the trolley, with my cumbersome prosthetic leg held on with several straps. Between the frozen produce and the fresh fish my mother heard a clunk, following by loud gasps from everyone else in the aisle who had just witnessed my leg falling off. This was common enough; my mother picked it up and put it in the trolley with the groceries. It would be too much hassle to put it back on there and then, so it could wait until we were in the car. At the till, one item after another went through the scanner, until the cashier’s hand reached for the leg, its little shoe still on. The poor woman was stunned.
I had a normal childhood. It was only in moments like this that we realised it was not quite so normal for everybody else. Three months after I left hospital, when I was 15 months old, we all went on a family holiday to Marbella. My arms and legs were healed up by then, and I was getting the hang of using my stumps to crawl around and hoist myself up on to tables and chairs. One day my sister came running to my mother, crying. One of the other children had told her that her little brother was “disgusting”.
It was not long after that holiday that I was fitted with my first prosthetic leg, and by the time I was 18 months old, I could walk. But it’s hard to design legs for babies. The first ones I used were awkward, and often fell off. My parents found Dorset Orthopaedic, a private clinic near Salisbury that was able to tinker with the standard procedure, initially adapting an arm socket for my leg, to get a better fit. These new prosthetics were up to the task of keeping up with my daily habits, and were designed to look as much like my leg as possible. The flesh-coloured “skin” had the consistency and texture of a fabric bandage, which punctured or tore easily with a fall. I would grow out of one every six months between the ages of three and 18. They weren’t waterproof, but I would always use my most recently discarded leg to go in the water to swim. By the time I was done with a leg, it often looked like I had been attacked.
The legs allowed me to play however I chose. But the prosthetics, and the private clinic, were very expensive. They were only available to me due to another incredible stroke of good fortune. At the time, my father was working for Sunday Business, a weekly financial newspaper, which was owned by the Barclay brothers – the British billionaire twins who also own the Daily Telegraph. Sir David Barclay read about my illness and wanted to help, so he set up a fund to pay for my prosthetics. I am acutely aware that most amputees do not have this possibility. The NHS simply can’t afford to support the cost of this technology.
My parents’ attitude was that I should do everything my siblings did, and when I went to pre-school, I was expected to do everything the other kids could. This meant that I could discover my own limits, rather than have them defined for me by others. It turns out, apart from wearing only shoes with Velcro straps and being slightly less gifted on the recorder, I didn’t have too many issues.
In my first “show and tell” at school, I brought in a sack of prosthetic legs, and it was received as a cool, exciting thing, rather than something to hide. I was fearless, and my choice of legs soon began to reflect this – going from fleshy imposters to bright blue and covered in postage stamps, and even a waterproof leg decorated in leopard print.
I discovered early on that I didn’t want to fit in, if it was at the cost of my own ability to function. While I used a series of prosthetic legs, I carried on using the stump of my left hand effectively, learning to touch type and single-handedly beating my friends at Fifa. When I was about nine, I tried a false arm. My left arm is short, due to damaged growth plates, and all of the fingers are amputated at the knuckle. It looks like half an arm, but it has always been useful, allowing me to hold objects against my body, or to push with. The false arm had a silicone cosmetic glove that fitted over my stump, complete with wrinkles and realistic nails. It was a beautiful looking thing, but I hated it. It was entirely passive, and just sat there. I found that it removed the function I had with my stump, such as typing or catching a ball, and was only there to appease other people’s idea of “wholeness”. I wore it for one day and then never again. I think it was some time before my family understood my decision.
This all changed in 2010, when I was 13, and my stepfather saw an advert in the newspaper for the i-limb pulse, which claimed to be the most advanced prosthetic hand in the world. He phoned the Scottish company that made it, Touch Bionics, and we arranged to meet them. I was doubtful about the benefits of a fake arm: I was functioning very well with Velcro shoe straps, and I could always get family members to cut up my food.
The team from Touch Bionics demonstrated how the hand worked, and checked the muscles in my forearm that control the hand.
They showed me the different looks the hand could have, including skin-toned silicone. I wasn’t interested in imitation flesh, and asked if they had anything that showed off the technology better. They pulled out a semi-transparent thin glove with pointed fingers, through which the robotic components can be seen. It looked perfect.
The hand has slender, elegant black fingers powered by individual motors, which allows each finger to move separately from its neighbours, and to wrap around unusually shaped objects, just as a real hand does. The hand attaches to the socket with a twist motion, and can be removed by rotating it a full 360 degrees. The socket, containing the batteries, wires and electrodes, extends just past my elbow.
The whirring noise of the motors was pure science-fiction. The team from Touch kept telling me I shouldn’t get my hopes up, as there was a chance I wouldn’t be able to use the technology, but it was proving impossible not to get excited about becoming the Terminator. I was fitted with the arm a few months later, and aged 13, became the youngest person in the world with a bionic arm.
My life was transformed by my new arm. Everything got easier. I used to open bottles of water by clamping them between my thighs and twisting with both hands, but now I simply hold the bottle in my firm bionic grip and twist with the other. I noticed that it also changed how others perceive me. No longer did I get looks of pity when walking in public. Instead, the looks I got changed to genuine curiosity at this robotic device. People would approach me to say, “I just have to know what this is and how it works.” I have discovered that people would much rather talk about these things – they just don’t know if it’s allowed. The non-realistic look of the hand is a message to others that I am happy to talk about it.
The hand operates very simply. There are two electrodes that touch my skin when I place my arm into the socket. One of them is responsible for opening the hand, the other for closing it. All I have to do is send a muscle signal. I had a week’s training when I was first fitted with the hand, to teach me how to separate the signals, by twisting and bending my wrist, so I could send each one separately and clearly.
I would upgrade to newer generations of the hand as they emerged, every few years, each better than the last. But I would also need to get a new socket every year or so, as the shape of my arm changed as I grew. My current hand, the i-limb quantum, has titanium digits for increased weight bearing. An app on my iPhone sets the fingers into one of 36 different grip patterns, allowing me to get the right configuration for a specific task, from using a spray cleaner to operating a computer mouse. After more than eight years of practice, I can control the arm to the extent that I can hold a grape between my thumb and forefinger, and squish it on command.
By the time I was 13, my stepfather took over paying for my prosthetics. These devices cost around £20,000 and I was extremely fortunate that my family could afford it. The biggest cause of amputation in the UK is vascular disease, although in younger people, trauma is more often caused by accidents, especially in cars. Sophisticated knee joints have recently become available through the NHS, and the hope is that, in the future, multi-articulating prosthetic hands could become routinely available. But for the moment, they remain out of reach for most people.
I’m acutely aware that my position is extremely privileged, so I see it as an obligation to speak about what happened to me. In 2013 I became an ambassador for the UK Sepsis Trust, and help them to raise awareness by giving talks and doing interviews. In 2015, I became an ambassador for Touch Bionics. I receive free upgrades to the hand in return for helping with research and development of the device. I give them feedback about specific things – such as which grip patterns I use, or how long the charge lasts (two days). I have told them I won’t be fully happy until I can juggle – and I’m only half joking. The hand currently goes from fully open to fully closed in 0.8s, so we still have a way to go.
As an ambassador, I regularly meet other amputees, usually at conferences, where they are looking at the different products. In 2016, Touch Bionics was bought by the Icelandic prosthetics company Össur, founded in 1971 by Össur Kristinsson, the inventor of a revolutionary silicone interface for prosthetic sockets. When I was working with Össur representatives in China, one of them said something I had never considered before: “We have a duty to our customers that other businesses do not, because nobody chooses to need our products.”
The vast majority of amputees do not have access to either the technology or the expertise needed to fit these sophisticated devices. In China, on a visit representing Össur, I spoke to many people who couldn’t afford the latest technology, and had ill-fitting sockets, or limbs they had grown out of, sometimes causing discomfort and injury. “Recycling” old limbs is always difficult, because every person’s residual limb is unique. With more than 1 million new amputees each year globally, the need to make these resources more widely available is increasing. Fortunately, the continued advance of technology such as 3D printing has the potential to bring prostheses to parts of the world where there are no specialist prosthetic teams.
Although I lost part of my right leg and left arm as a baby, it’s only recently that I’ve learned that I am disabled. For most of my childhood, I avoided the word, scared of having it pinned on me. Disabled things are broken and they don’t work. When you enter the password incorrectly too many times on your iPhone, it becomes disabled. I always preferred to be called an amputee, as this says what happened to me without making assumptions about my ability.
The greatest ambition of amputees used to be to fit in, and be normal. I have noticed that it’s partly a generational thing: older people generally aim to make their prostheses as lifelike as possible, and there can be an amazing level of detail involved in making them look lifelike, complete with hairs, moles and tattoos. But for a lot of young people, the priority is function. The new generation of prostheses don’t look like human limbs, and they’re not supposed to blend in. Some of the legs I have seen over the years have had flames, football logos and even speakers. The running blades developed for use in sport are made of woven carbon fibre in a large C-shape, which looks nothing like a leg, but functions very well indeed.
Technology is key to changing perceptions, and does far more than previous generations of well-meaning awareness-raising campaigns have done. The portrayal of bionic characters as superhuman and powerful is helping to shape society’s attitudes towards disability. The change may be slow, but as technology continues to improve, perceptions are evolving. I am sure there will come a time when there won’t have to be a trade-off between function and looks, but even then, will we want these devices to look normal? The more closely something imitates real life, the more jarring it looks. I still enjoy standing out from the crowd.
Although I have made a great effort not to let myself be sidelined by disability, I have also learned that it’s important not to distance myself from a marginalised group just because privilege has taken me somewhat out of it. The sobering truth is that I am – as many disabled people are – just one incident away from seriously struggling. In January I dislocated my knee, and since I can’t use crutches, I couldn’t leave my flat for three days. I had flatmates to bring me food from the shops, but I could not help but think about how helpless I would have been if I was living alone.
While doing research for this piece, I came across one written by my father in 1999. “This time last year my nine-month-old son, Patrick, was as close to death as it is possible to be,” it began. Reading that piece today, it’s hard not to be struck by how far we have come in the 19 years since it was written. The overriding tone was one of worry about what the future might hold for me, and how my life would be difficult. One line in particular stood out: “Barring major advances in medicine, he will never be able to use his left as a normal hand.” When I asked my father about that article recently, he said: “I was wrong, on two counts. Prosthetic technology has been more innovative than I could have imagined. And you have been far more resilient and determined then even I could have known back then.”
Technology is playing an important role in redefining disability, but attitudes are going to have to adapt, too. There are more than 13 million disabled people in the UK, yet a recent survey by Scope reports that 67% of the British public feel uncomfortable talking to disabled people: 21% of 18- to 34-year-olds admit they have avoided talking to disabled people because they were unsure how to communicate with them.
Occasionally I am reminded of the gap between the way I see my disability, and how the rest of the world sees me. When I was 18, I was contacted by an assistant TV producer who had seen my TEDxTeen talk about disability and wanted to know if I would appear on the dating show she was working on. She sent over an email promising it would be shot tastefully and “sensitively portray my search for love”. Wary of the voyeurism of this kind of show, I declined. I later learned that I had been invited to appear on the astoundingly named Too Ugly for Love? The show ran for three seasons, which says a lot about how much work is still needed to change attitudes towards disability.
Advanced prosthetic technology will force a change in public attitudes, as they blur the gap between disability and ability. We have Olympians arguing that legless amputees should not be allowed to compete against them, in case they have an unfair advantage, which would have been tough to imagine at the time of the first Paralympic Games in 1960. Blind people are having their vision restored by cameras, paraplegic people are learning to walk again with powered exoskeletons and I can control my bionic hand with an app on my phone. But sometimes really significant change is more straightforward. It can be as simple as me being able to tie my own shoelaces, and walk away.