In­dia sup­port­ing de­vel­op­ment of myo– pros­thet­ics

BioSpectrum (India) - - BIO CONTENT - Su­jatha Ra­masamy, Sci­en­tist-B; Pu­lak Ran­jan Basak, Sci­en­tist-F; Srikanta Priyadar­shan Pa­tra, Project As­so­ciate (Tech­nol­ogy In­for­ma­tion, Fore­cast­ing and As­sess­ment Coun­cil (TIFAC) - Depart­ment of Sci­ence & Tech­nol­ogy, Gov­ern­ment of In­dia, New Delhi).

With an in­crease in the trend of am­pu­ta­tions in In­dia where about 2.68 crore per­sons are ‘dis­abled’ (vis­ual, hear­ing, speech, lo­co­mo­tor, and men­tal dis­abil­i­ties), the gov­ern­ment of In­dia launched. Ac­ces­si­ble In­dia Cam­paign (AIC), a na­tion­wide flag­ship cam­paign, with an aim to make a bar­rier free and con­ducive en­vi­ron­ment for the dif­fer­ently-able com­mu­nity. There are sev­eral star­tups com­ing up with su­pe­rior and ad­vanced tech­nolo­gies, which would serve and de­liver an Af­ford­able, Sen­si­tive, Spe­cific, User-friendly, Rapid and ro­bust, bio­med­i­cal de­vices which are af­ford­able to Low and Mid­dle-In­come Coun­tries (LMIC).

In­dia is a vast coun­try with a large num­ber of in­di­vid­u­als in the com­mu­nity of var­i­ous dis­abil­i­ties. It is roughly 0.62 am­putees per thou­sand pop­u­la­tions which are close to one mil­lion in­di­vid­u­als with am­pu­ta­tions in the coun­try. The two main causes of am­pu­ta­tions are trauma (road traf­fic ac­ci­dents, rail­way ac­ci­dents, and burns due to fire, elec­tro­cu­tion, and chem­i­cal in­juries), vas­cu­lar disease and car­ci­noma. In the group aged over 60 years, pe­riph­eral vas­cu­lar disease was a more com­mon cause of am­pu­ta­tion than trauma. Mo­tor ve­hi­cle col­li­sions, gun­shot wounds, and an­i­mal at­tacks also con­trib­ute to trau­matic limb am­pu­ta­tions. There is in­creas­ing trend of am­pu­ta­tions in In­dia where about 2.68 crore per­sons are ‘dis­abled’ (vis­ual, hear­ing, speech, lo­co­mo­tor, and men­tal dis­abil­i­ties) which is 2.21 per cent of the to­tal pop­u­la­tion. How­ever preva­lence rates are de­clin­ing for all dis­abil­ity types ex­cept lo­co­mo­tors dis­abil­ity.

So the way out for am­pu­ta­tions should be pros­the­sis: an artificial (limb) ex­ten­sion that re­places a miss­ing body part such as an up­per (arms) or lower (legs) body ex­trem­ity. The type of artificial limb used is de­ter­mined largely by the ex­tent of an am­pu­ta­tion or loss and lo­ca­tion of the miss­ing ex­trem­ity.

There are four main types of

artificial limbs which are the transtib­ial, trans­femoral, tran­sra­dial, and tran­shumeral pros­the­ses.

Cur­rent sce­nario and mar­ket de­vel­op­ment

The us­age of Cos­metic Arm and Me­chan­i­cal Arm for up­per limb is more preva­lent in In­dia. Some of the play­ers in man­u­fac­tur­ing and sup­ply­ing these pros­thet­ics which may be worth men­tion­ing are

1. Artificial Limbs Man­u­fac­tur­ing Cor­po­ra­tion of In­dia (ALIMCO), Kan­pur which pro­duces 355 types of aids and ap­pli­ances with a prod­uct range in­cludes or­thotic and pros­thetic ap­pli­ances for up­per and lower ex­trem­i­ties, spinal braces, cer­vi­cal col­lars, trac­tion kits, re­ha­bil­i­ta­tion aids like wheel chairs, crutches and tri-wheel­ers. The cor­po­ra­tion pro­vides tools and equip­ment re­quired for fit­ment of or­thotic and pros­thetic as­sem­blies by the Limb Fit­ting Cen­tre.

2. The Jaipur Foot brand of Bhag­wan Ma­haveer Vik­lang Sa­hay­ata Samiti (BMVSS) is the world’s largest or­ga­ni­za­tion re­ha­bil­i­tat­ing over 1.55 mil­lion dis­abled gives as­sis­tance in­clud­ing artificial limbs, calipers and other aids and ap­pli­ances to­tally free of charge.

3. Tata group have opened 15 au­tho­rized cen­ters across In­dia to fa­cil­i­tate the pa­tients. They run them in col­lab­o­ra­tion with pri­vate prac­ti­tion­ers and non­govern­men­tal or­ga­ni­za­tions. They have long-term pro­grams for man­u­fac­tur­ing pros­thetic prod­ucts and to re­main in com­pe­ti­tion in field of bio­med­i­cal aids and ap­pli­ance busi­ness.

4. Saket Ortho Ap­pli­ances Cen­tre is in­volved in man­u­fac­tur­ing and sup­ply­ing artificial lower limbs, cos­metic restora­tion (sil­i­cone base artificial fin­gers, ears, nose, eyes, par­ial hand/foot, etc.), trac­tion kit, walker-crutches, la­tex free grip band and weight lose belt. Some more prod­ucts are up­per limb, di­a­beti­cortho foot wear, di­a­betic-ortho sil­i­con foot care, pres­sure gar­ment, con­toured back sup­port etc.

5. Nevedac Pros­thetic Cen­tre rec­og­nized by cen­tral gov­ern­ment a pioneer in the field of artificial limbs in Asia. It pro­vides low cost artificial limbs and or­thotic ap­pli­ances and has re­ha­bil­i­tated over 65,000 dis­abled per­sons.

6. In­ter­na­tional Pros­thetic Eye Cen­tre in Hy­der­abad, known to pro­vide the best cus­tom­ized oc­u­lar (artificial eye) and max­illo­fa­cial (or­bit, ear, nose, fa­cial) pros­thetic ser­vices.

7. En­do­lite In­dia is a re­ha­bil­i­ta­tion ser­vice com­pany in Delhi hav­ing a network of 250 fran­chises. Com­pany aims at pro­vid­ing re­li­able, cost ef­fec­tive, tech­no­log­i­cally su­pe­rior pros­thetic & or­thotic prod­ucts with tech­ni­cal and clin­i­cal sup­port pro­vid­ing range if pros­thetic sys­tem to max­i­mize ben­e­fits to the clients.

8. Ot­to­bock In­dia be­ing one of the re­puted artificial limb (pros­thetic arms and legs) fit­ting cen­ters in In­dia, of­fer­ing pros­thetic legs and pros­thetic arms to as­sist peo­ple to re­gain their free­dom. 9. Os­sur In­dia pro­vides Non-in­va­sive ortho­pe­dics to de­liver ad­vanced and in­no­va­tive tech­nolo­gies within the fields of pros­thet­ics, braces, sup­ports and com­pres­sion ther­apy etc.

Cost of per­form­ing Pros­thet­ics

With high end in­fra­struc­ture and ex­per­tise in the health­care sec­tor there is al­ways grow­ing im­prove­ment in the field of Artificial Limb Pros­the­sis Surgery. Global pa­tients have made this coun­try the first pre­ferred place due to the low cost and high qual­ity Artificial Limb Pros­the­sis Surgery. The most ad­vanced med­i­cal treat­ment and the med­i­cal ex­perts help pa­tients with post-treat­ment re­cov­ery and phys­i­cal ther­a­pies to help them get friendly with new limbs. Fa­cil­i­ties are avail­able at rea­son­able cost.

Re­cent Tech­nol­ogy De­vel­op­ment

The choice of pros­thet­ics is based on the re­quire­ment of the user. Most of the works are in nascent stages and lacks in­te­gra­tion with the tech­nol­ogy due to its mul­ti­dis­ci­plinary na­ture and the non­avail­abil­ity of funds. How­ever sev­eral break­through tech­nolo­gies

like Brain-ma­chine in­ter­face, My­o­elec­tric pros­the­sis, Bion­ics, Biomecha­tron­ics etc. have evolved with in­te­gra­tive ap­proach eg. De­sign of pros­thetic hand needs a com­pelling knowl­edge of phys­i­ol­ogy, anatomy, elec­tri­cal and elec­tron­ics, me­chan­i­cal de­sign, soft­ware, and so on, de­pend­ing on the na­ture of con­trol etc. Dif­fer­ent types of pros­thetic hands rang­ing from body-pow­ered pros­thetic hand to neu­ral in­ter­face-based pros­thetic hand, which are be­ing man­u­fac­tured and at­tempted in the mar­ket and for the pur­pose of re­search.

Star­tups in mak­ing of Myo-Elec­tric pros­thet­ics

Un­der the flag­ship pro­gram of Make in In­dia, star­tups are com­ing for­ward to make the my­o­elec­tric pros­thet­ics a re­al­ity in In­dia. DeeDee labs is de­vel­op­ing a non-in­va­sive bionic pros­thetic so­lu­tions with Multi­grasp Hand Pat­tern Recog­ni­tion Soft­ware, it re­places the cur­rent surg­er­i­cal mode with more non­in­va­sive way. More like thought con­trolled pros­the­sis ex­pe­ri­ence. It com­pletely fo­cuses on light­weight de­sign, less learn­ing time for am­putees, longer bat­tery life and the most im­por­tant af­ford­abil­ity. The cur­rent myo elec­tric pros­thet­ics are in­va­sive and are costly. Their idea is to make use of the body’s nat­u­rally gen­er­ated elec­tric sig­nals of the mus­cles and process it in or­der to per­form the de­sired action by the hand. While the prod­uct is mainly be­ing de­vel­oped to per­form hand ac­tions, namely con­trac­tion and re­lax­ation, pinch­ing and point­ing at ob­jects, en­gi­neers are also work­ing on adding more ges­tures.

Lim­bot Tech­nolo­gies which fo­cuses on af­ford­able and ad­vance myo elec­tric pros­thet­ics to per­form daily task with com­fort and ease. Lim­Bot deals with in­te­gra­tion of pros­thetic or artificial limbs, or­thotic de­vices, mo­bil­ity aids, and re­ha­bil­i­ta­tive care. Their mis­sion is to reach out to peo­ple with ex­pe­ri­enced limb loss, who lacks fi­nan­cial re­sources, and do not qual­ify for any other fund­ing as­sis­tance, and to pro­vide those in­di­vid­u­als with as­sis­tance in ob­tain­ing ap­pro­pri­ate and qual­i­fied pros­thetic and or­thotic fit­ting and re­ha­bil­i­ta­tion to live pro­duc­tive and ac­tive lives with dig­nity.

An­other startup based in R.V. Col­lege of En­gi­neer­ing com­pris­ing of a young team work­ing on in­no­va­tion bionic arm. It was found that re­ha­bil­i­ta­tion for the hand­i­capped is a big is­sue in the world. They went through many stud­ies about as­sis­tive de­vices for the hand­i­capped and found that pros­thetic hands for the up­per limb are ei­ther hook or hand-shaped and are ac­tu­ated by ei­ther body or ex­ter­nal power. Body-pow­ered pros­thetic limbs are con­trolled by ca­bles con­nect­ing them to else­where on the body. Ex­ter­nally pow­ered pros­thetic limbs are pow­ered with mo­tors which can be con­trolled by the pa­tient in sev­eral ways through switches or but­tons. While these are func­tional, they wanted to de­velop pros­thetic limbs that are more has­sle free and more in­tu­itive to con­trol. They found that a more ad­vanced way to con­trol a pros­thetic limb was by ‘lis­ten­ing’ to the mus­cles re­main­ing in the resid­ual limb that the pa­tient could still con­tract. Be­cause mus­cles gen­er­ate small elec­tri­cal sig­nals when they con­tract, elec­trodes placed on the sur­face of the skin can mea­sure mus­cle move­ments. Although no but­tons are phys­i­cally pressed by the mus­cles in this case, their con­trac­tions are de­tected by the elec­trodes and then used to con­trol the pros­thetic limb- in a way sim­i­lar to the switch con­trol method.

Way for­ward

With the ad­vent of Ac­ces­si­ble In­dia Cam­paign (Sugamya Bharat Ab­hiyan) to serve the dif­fer­entlyable com­mu­nity of the coun­try, there are sev­eral star­tups com­ing up with su­pe­rior and ad­vanced tech­nolo­gies. The tech­nolo­gies would serve and de­liver an Af­ford­able, Sen­si­tive, Spe­cific, User­friendly, Rapid and ro­bust, bio­med­i­cal de­vices which are af­ford­able to Low and Mid­dle-In­come Coun­tries (LMIC).

Cranes Me­chan­i­cal pros­thetic arm (Source-open­pros­thet­ics)

Test­ing trial of Myo pros­thet­ics on Pa­tient Source@Deedee­labs (twit­ter)

Test­ing trial of Myo pros­thet­ics on Pa­tients (Source at LimBots lab)

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