Innovating to Make Prosthetics More Accessible and Affordable People in India are not aware of how many organisations are providing open source hardware and the benefits that an open source approach can bring to both hardware developers and hardware users

India has an ancient affinity with prosthetics. The earliest known historical document to describe a prosthesis is the Rigveda, an ancient Indian collection of Vedic Sanskrit hymns, whereby the lost foot of the warrior Vispala is replaced with a "metallic leg" by her husband, Khela, enabling her to walk again.

Unfortunately, today, according to research by Dinesh Mohan from the Centre for Biomedical Engineering at IIT, India has over half a million upper limb amputees and more than 23,000 people are added to the Indian upper limb amputee population every year. Research by Lahiri Sangeeta and Ghosh D Pooja from the National Institute for the Orthopaedically Handicapped, Kolkata, suggest that the number of people with disabilities has increased over the last 10 years, in part, due to medical advances that preserve and prolong life, which has created an insatiable demand for health and rehabilitation services. India already has 100 million people over the age of 65, a number second only to China. Since body-powered prosthetic devices are unsuitable for older patients who often lack the physical strength required to actuate them, the market for low-cost, limited function battery-powered prosthetic devices will continue to grow; one of the biggest changes to the Indian prosthetic industry has been this clear demographic shift in need.

Additionally, the highest rate of amputation occurs in rural areas, typically as a result of road, rail, and agricultural injuries. Additionally, as the proliferation of motor vehicles and modern agricultural machinery continues throughout rural areas, these figures are set to steadily increase.

Addressing the prosthetics sector through innovation

For communities living in low-income and rural areas, there are still great concerns regarding accessibility to prosthetic devices. In fact, many of parts used to produce hand prostheses in India are still imported from overseas countries in Europe and North America. This results in devices that are unsuitable for day-to-day rural life and cost over six times the monthly income of the average rural family, despite studies suggesting that almost 70% of India's population lives in rural areas.

India's reliance on international imports has largely been due to a lagging manufacturing sector and a reluctance to invest in R&D and innovation. However, these attitudes are changing as government initiatives, including the Make In India campaign, aim to step up the pace of manufacturing and expand it to 25% GDP from the current 16%. Alongside this, the emergence of digital manufacturing and design has enabled those with a taste for disruption to breach the walls of manufacturing and even mass customisation by leveraging new technologies such as advanced additive manufacturing and cloud-based computer-aided design.

By leveraging these technologies and opening up India's manufacturing sector to disrupt the economic barriers that prevent innovators from bringing products to market in the first place, digital fabrication and cloud-based computer-aided design has the potential to create locally manufactured prosthetic devices that are more lightweight, durable, comfortable, and affordable than their mass-produced overseas counterparts.

Additionally, 3D scanning technology has drastically reduced the time required to produce bespoke sockets for prosthetic limbs. The traditional method of socket fabrication requires a plaster bandage to be wetted and rolled around the residual limb of the patient. Once hardened, this cast is then removed from the limb and filled with a liquid moulding plaster that forms a positive model of the limb. This model is then modified using surform rasps until the technician arrives at the desired shape. This entire process can take more than two weeks. However, by using a handheld 3D scanner rather than traditional plaster cast, a full 360-degree scan of a residual limb can be created in around 30 seconds and then used to generate a 3D printable socket using 3D CAD software in a matter of hours.

The impact of time-saving innovations in the prosthetics industry cannot be overstated; research by World Health Organization (WHO) suggests that the supply of prosthetic technicians falls short by around 40,000, and WHO estimate it will take around 50 years to train just 18,000 more. By reducing the time required to fabricate a prosthetic limb, the burden on healthcare providers with fewer staff can be reduced and significantly more patients successfully rehabilitated each year.

Challenges while innovating

The availability of materials, resources and skilled personnel, together with a variety of cultural considerations makes developing prosthetics for low-income and rural communities a subject in itself.

A research paper by Erin Strait concluded that for long-term benefit to poorer amputee communities, culture-specific designs and materials are more appropriate. Furthermore, in his paper, Strait explains that the problem with importing components from industrialised countries to build prosthetic limbs is not only increased costs but also the fact that these parts are designed for very different lifestyles and usually do not hold up to the challenges which nature presents in rural environments.

For entrepreneurs looking to innovate within the Indian prosthetics industry, a clear understanding of the local manufacturing ecosystem is just as important as a clear understanding of the needs of the end users.

Innovation opportunities that entrepreneurs can learn from other countries

For the last few years, Open Bionics, based in Bristol, UK has been leading the way in regards to culture-specific designs and materials for children with limb differences as young as nine, who typically require a new prosthesis every 6-12 months. The company has been working with Disney to design a range of prosthesis covers from the massively popular Star Wars, Marvel and Frozen universes with the goal of making children feel proud of their prosthesis. Open Bionics' Hero Arm is also the world's first medically certified, 3D printed bionic hand, and by leveraging the capacity for hyper-personalisation that 3D printing provides, even custom-made parts can be quickly and affordably replaced. This is especially important in the context of providing for growing children.

Open Bionics also release all of their designs under an open source license, meaning that the technology is available to anyone who wants to take their work and develop it further. Open source hardware maximises the ability of third-party developers to work with a given device, by providing detailed schematics, design files, bill of materials, and assembly instructions to the end-user. This information makes it easier to modify existing technologies to meet the needs of underserved communities without having to design a new product or solution from scratch.

In fact, hardware development is beginning to take a similar path to open source software, which has enabled rapid innovation and progress over the last 30 years—the combination of Linux and other open source tools such as Apache and GNU made developing websites and servers significantly more accessible, which gave rise to the highly transformational Internet era.

A similar paradigm shift could happen if hardware engineers and designers collaborated on a global scale to improve and create technology together rather than develop in isolation. However, very few people in India are aware of just how many organisations are providing open source hardware and the benefits that an open source approach can bring to both hardware developers and hardware users.