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Page 1: Joint Lecture at the Royal Society of Edinburgh...5 The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013 From an engineering point of view, there were some

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Ian StevensCEO

Touch Bionics

Joint Lecture

at The Royal Society of Edinburgh

Monday 4 march 2013

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The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013

The Royal Society of Edinburgh

The Royal Society of Edinburgh (RSE) is Scotland’s National Academy of Science & Letters. It is an independent body with charitable status. The Society organises conferences and lectures for the specialist and for the general public. It provides a forum for informed debate on issues of national and international importance. Its multidisciplinary Fellowship of men and women of international standing provides independent, expert advice to key decision-making bodies, including Government and Parliament.

The Society’s Research Awards programme annually awards over £2 million to exceptionally talented young researchers to advance fundamental knowledge, and to develop potential entrepreneurs to commercialise their researchand boost wealth generation.

Among its many public benefit activities, the RSE is active in classrooms from the Borders to the Northern Isles,with a successful programme of lectures and hands-on workshops for primary and secondary school pupils.

The Royal Society of Edinburgh, working as part of the UK and within a global context, is committed to the future of Scotland’s social, economic and cultural wellbeing.

The Royal Academy of Engineering

"As Britain’s national academy for engineering, we bring together the country’s most eminent engineers from all disciplines to promote excellence in the science, art and practice of engineering. Our strategic priorities are to enhance the UK’s engineering capabilities; to celebrate excellence and inspire the next generation; and to lead debate by guiding informed thinking and influencing public policy."

Strategic PrioritiesThe Academy’s work programmes are driven by three strategic priorities, each of which provides a key contribution to a strong and vibrant engineering sector and to the health and wealth of society.

Enhancing national capabilitiesAs a priority, we encourage, support and facilitate links between academia and industry. Through targeted national and international programmes, we enhance – and reflect abroad – the UK’s performance in the application of science, technology transfer, and the promotion and exploitation of innovation. We support high-quality engineering research, encourage an interdisciplinary ethos, facilitate international exchange and provide means of determining and disseminating best practice. In particular, our activities focus on complex and multidisciplinary areas of rapid development.

Recognising excellence and inspiring the next generationExcellence breeds excellence. We celebrate engineering excellence and use it to inspire, support and challengetomorrow’s engineering leaders. We focus our initiatives to develop excellence and through creative and collaborative activity, we demonstrate to the young, and those who influence them, the relevance of engineering to society.

Leading debateUsing the leadership and expertise of our Fellowship, we guide informed thinking; influence public policy making; provide a forum for the mutual exchange of ideas; and pursue effective engagement with society onmatters within our competence. The Academy advocates progressive, forward-looking solutions based on impartial advice and quality foundations, and works to enhance appreciation of the positive role of engineeringand its contribution to the economic strength of the nation.

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The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013

Ian Stevens was born in 1963 in Belfast and educated at the city’s Royal Academy and then at the University of Edinburgh, gradua2ng in economics in 1985.

A#er University Ian spent six years in The Royal Air Force and then joined KPMG, trained, qualified and worked as a Chartered Accountant in Oxford and Prague ending up back in Edinburgh in 1998

Between 1998 and 2007 Ian was employed by Optos plc, a medicaltechnology company specialising in the imaging of the re2na, firstly in the roles of CFO in Dunfermline, Scotland, and then from 2003 as General Manager, North America in Boston, USA.

From 2007 Ian was CEO of Mpathy Medical, a surgical medical devicecompany and in 2011 he joined prosthe2c hand manufacturer, TouchBionics, as CEO.

Ian counts himself fortunate to have been associated with the development of three disrup2ve and leading healthcare technologiesover the last 14 years. Firstly the Optomap re2nal scan from Optos, thenSmartmesh for pelvic floor restora2on with Mpathy Medical and, mostrecently, the I-limb mul2-ar2cula2ng prosthe2c hand from Touch Bionics.

In the 2013 Annual Joint Lecture, Ian explored how these inven2ons werebrought to market, describing some of the challenges overcome and discussing how the products evolved to meet the needs of their users.

Image on front cover: Touch Bionics were the ‘representa#ve of innova#on’for the UK Government’s Olympic Campaign in 2012.

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The crucial career moment came for Ian in the summer of 1998 whenhe went to work at Optos, with Douglas Anderson in Dunfermline. Hehad met Douglas a few months earlier, who had then shared the Optosfledgling business plan. At that 2me there was one prototype imagingsystem, ten (mainly R&D) staff and absolutely no revenue.

Ian had been working in corporate finance and part of his job wasto assess the business plans of young companies looking for equityfunding. The Optos business plan was the most compelling that he had ever seen: a massive unmet need, combined with clearintellectual property and a technology which was tricky, but possible to manufacture.

Optos was founded because Douglas’s young son, Leif, was unfortunateenough to suffer from re2nal detachments. These le# him blind in oneeye and with reduced vision in the other. Douglas was determined thatother pa2ents and parents would not have to go through what he andLeif had. As Ian said, “it’s so much be3er to invent something whichsolves a known problem, rather than stumbling across an interes2ngtechnological discovery and then thinking, ‘well that’s interes2ng, nowwhat shall I do with it?’”

The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013

Growing Healthcare Technology Businesses –Bringing Engineering Inven2ons to Market with Limited Resources

The main aim of this lecture was to illustrate some of the key decisions surrounding the introduc2on and growth of:

F the Optomap re2nal exam from Optos;

F Smartmesh for pelvic floor restora2on from Mpathy Medical; and

F the i-limb bionic hand from Touch Bionics.

Ian discussed the impact of these decisions on the engineering development of the products, especially in rela2on to their physical appearance, range of func2onality and, where appropriate, in the so#ware and mechanical interfaces used to control them.

He showed how the technologies were adapted to meet their users’ needs, to survive and then flourish as businesses.

OPTOSIt took the third team hired byDouglas to solve his problem. To get an image of the re2na, you have to shine light on it andthen get that light back, in andout of an opening, the pupil, whichfundamentally does not like toomuch light interfering with it, andconstricts in those circumstances.

Douglas’s team reminded himthat an ellipsoidal mirror has twofocal points. The solu2on to theproblem was therefore to placethe eye at one focal point, fire alow energy laser beam into it andthen place the collec2on device atthe other focal point to collect thereflected energy. This gave no 2mefor the pupil to constrict, meaningthere was no need for uncomfortablecontact with the cornea. Ian observed that the thing aboutclever inven2ons like this one isthat they always seem obvious,just a#er they have been invented!

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From an engineering point of view, there were some significant issues to be solved, such as scanningthat laser light around the en2re surface of the re2na.That challenge required the use of a spinning polygonrota2ng at exactly 27,356 revolu2ons per minute.

Then there was an ergonomic requirement to posi2onthe eye of the pa2ent in precisely the right place toget the laser beam through the pupil in the first place.

In addi2on, there were extremely demanding manufacturing tolerances rela2ng to the performanceand posi2oning of 15 or so mirrors and lenses to direct and collect that returning informa2on.

The bigger ques2on was as yet unanswered. Oncethe technical problem was solved, “well then, sowhat really – how does it all get paid for – how doyou make it a business?”

The highly skilled ophthalmologist had not, via hismanual examina2on, obtained enough informa2onto sa2sfactorily diagnose Leif’s condi2on. He had admi3ed that he was only ‘ge4ng a glimpse’.

By inven2ng the Optomap technology, Douglassolved those two problems – they could get lotsmore informa2on and could record it digitally so it was there for review, rather than accessible only via the prac22oner’s memory. But the technologyneeded to do this was very expensive – tens of thousands of pounds for each device, even a#ermanufacturing volume reduc2ons. So how could a viable business be created?

The answer relates to our desire to be reassured about our health. Condi2ons of, or evident in, there2na, such as diabe2c bleeding, macular degenera2on,re2nal detatchment, glaucoma and high blood pressure are o#en a-symptoma2c and can be detected at an early stage via regular and comprehensive examina2on of the re2na.

Essen2ally, when we have our eyes checked – andthis should be annually – we want to be told onlyone thing – that we are fine. But we also want tohave confidence that if we are not fine then our doctor will iden2fy and recognise the visual signspromp2ng an adverse diagnosis.

So Optos made several decisions very early on, before it ever earned a single dollar in revenue.

Optos determined:

• that it would sell the Optomap image, rather thanthe device itself, giving the prac22oner the means tocarry out the screening exam and building the confidence of the pa2ent;

• that the Optomap would be easily reviewable,saveable and available for comparison with subsequent images each year;

• that huge resources would go into the so#ware to deliver that educa2onal experience to the pa2entand the performance;

• that usage levels of the prac2ce would all berecorded and transmi3ed daily to Optos, so thatthey could proac2vely help those prac22oners whowere not being successful in ge4ng all or most oftheir pa2ents to have an annual Optomap exam; and

• that it would do all this mainly in the USA, wherethe medical side of optometry was already a servicethat pa2ents were prepared to pay for, rather thanin this country, for example, where we generally donot expect to pay an extra fee.

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Subsequent engineering was focused on the business objec2ves of high usage levels, precise and easy image-taking by the pa2ent themselves,and modular equipment design, for example:

• the pa2ent so#ware was designed with minimumdata input 2me and maximum educa2onal opportunity, u2lising libraries of disease imagesfor comparison, allowing zoom and pan features to review areas of interest in greater detail;

• the alignment system was consistently refined sothat the pa2ent would know when they were exactlyin the right posi2on to get that 2ny laser beamthrough the 2ny pupil, first 2me, saving 2me;

• the original whole system unit was modularised inorder to extend the life2me of the equipment indefinitely. Rental contracts could be extended a#erthe ini2al three-year term expired, without the needfor expensive equipment replacement – both theequipment and the so#ware were ‘evergreen’.

And all of this went alongside the necessary con2nuousimprovements to the repeatability, shortening andcost-effec2veness of the manufacturing process.

These engineering policies allowed the stakeholdersand financial backers to feel confident in the futureof the company. The shareholders could see thenumber of Optomaps and placements rising, thusjus2fying their investment, the bank providing leasingfinance could see that each system was financiallyself-sufficient, i.e., the prac22oner was sellingenough Optomaps to his pa2ents to cover the leasepayments, and the investment bank handling Optos’seventual IPO could see that this revenue could con2nue well into the future without the need forexpensive equipment replacement.

To summarise, Optos raised its first invoice for $94.50,that’s six Optomaps at $15.75 each, on 31 August 1999,and floated on the London Stock Exchange 6½ yearslater in February 2006 at a market capitalisa2on ofc$250m, by which 2me revenue was up to $65m annually, with over 3,000 loca2ons selling Optomaps.

Renewal percentage rates were in the high 90s, remainhigh today, and the company con2nues to grow, withrevenue now heading towards $200m annually.

Dave Nelson, President of the American OptometricAssocia2on, who in 2006 was leading America’s35,000 Optometrists, recognised how cri2cal theearly detec2on capability was to his pa2ents and heremains a customer today. Optos tended to find thatonce a customer had this sort of experience, andthey did o#en, that they would never give the equipment back – they were with Optos for the long run. And of course they were making significant revenue for their prac2ce through the sale of the Optomap exam – which helped!

The finalcommentrela2ng toOptos wasthat it wasthe proximityand regularcontact ofstaff withcustomersand pa2entsthatpromptedhugeamounts offeedback,driving thedirec2on of further

hardware and so#ware development. Optos built a direct sales force and as many clinical consultants, constantly visi2ng and training in the loca2ons inAmerica. Since daily usage and performance datacame from every single system, the company couldact quickly to rec2fy any customer issues. Ian saidthat these were big lessons for him.

Ian had moved to the USA in 2003 as General Manager and stayed for a year a#er the float to help keep the growth going. But his wife and children headed back to Scotland in 2006 for schooling reasons, so in April 2007 he le# Optos and a couple of months later was luckyenough to meet another brave and visionary inventor.

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MPATHY MEDICALJames Browning is a consultant gynaecological surgeon who le# his hospital post and joinedEthicon, a division of Johnson & Johnson in the mid 1990s. At the 2me, Ethicon were introducing anew surgical product for women’s health and Jameswas recruited to lead the product development.

Ethicon had adapted the polypropolene mesh used for male hernia repair, which by then was becoming the norm rather than repairing herniasusing sutures. It was planning to use the same mesh for pelvic floor prolapse in women, a condi2on o#en caused due to old age, obesity or following child birth.

James was concerned that the hernia mesh was tooheavy for the more delicate area it was now beingasked to be effec2ve in, and that problems wouldensue were the body to reject this implanta2on.

So in 2001 he quit his job and a secure future, raised some money from Archangel and Sco4sh Enterprise, and set about inven2ng a lighter stronger mesh.

James did invent his lighter mesh. He invented a way to promote much higher new 2ssue growtha#er implanta2on.

Below is an image of the material. Compared toEthicon’s mesh there was much more space andthe mesh consisted of carefully woven fibres with2ny distances separa2ng them.

James knew the size of the 2ny par2cles, calledmacrophages and neutrophyls, which are togetherresponsible for new 2ssue growth. He believed that if the spaces between individual fibres making up thestrands of the mesh could be restricted to approximately100 microns, then this would be an ideal loca2on fornew 2ssue growth to commence.

Since the spaces between the strands could now be bigger, there could be more air and less mesh per square metre. Mpathy’s mesh was therefore able to be patented at less than 19 grammes persquare metre – less than half the weight of that of the leading compe2tors, but in clinical trials approximately 60% stronger.

Having come up with the idea and prototype, Jamesand a couple of colleagues spent six years inven2ng,literally weaving, mesh, protec2ng his inven2on byregistering his intellectual property, conduc2ng clinical trials and obtaining the necessary CE marks,and FDA approvals.

But by 2007, he was out of money, and the big compe2tors in the market place, billion-dollar companies such as Ethicon, Tyco Covidien, Bard,Coloplast, Boston Scien2fic and American MedicalSystems, were happy with their less effec2ve products and didn’t want to buy James’s technology.

So the first phase of the engineering was complete.The next phase involved se4ng up a US corpora2on,branding the new company and products as ‘advanced’and ‘market leading’, and going head-to-head in avery focused way with these huge corpora2ons.

Mpathy Medical had a limited range of products, and chose to sell only in the US, to carefully targetedleading urologists and urogynaecologists, with again a direct sales force.

Just as with Optos, Archangel agreed and funded thisfurther business development, and in early 2008Mpathy Medical launched a range of pelvic floor prolapse and stress urinary con2nence implantablemedical devices, all manufactured in Prestwick, Scotland from this new, lightweight, physiologically-compa2ble material called, Smartmesh.

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Unusually for a new product in this area of medicine,at the 2me of final FDA approval and product launch,Mpathy had substan2al and very posi2ve clinical evidence on Smartmesh’s results. There was otherwise a general absence of favourable outcomedata for polypropolene mesh used for this type ofsurgery. It appeared that James had been correct in his reason for leaving Ethicon. The other mesheswere not performing very well.

But Smartmesh had achieved outstanding results in over 200 fully documented cases performed by respected surgeons before a single piece was sold.Mpathy had learned that in addi2on to Smartmesh’slow density per square metre, there were other important success factors for this type of surgery;such as the surface area of mesh le# in the body, the means of securing the mesh within the body, and the actual shape of the mesh in rela2on to theactual loca2on of the prolapse.

Historically, this type of surgery had typicallyinvolved the surgeon popping down to the back of the opera2ng theatre with a pair of scissors,

needle and thread and fashioning a bespoke device for that par2cular opera2on, with the pa2ent already in the theatre under a general anaesthe2c. Women were being cured of prolapse, but o#en suffering complica2ons and rejec2on because of the intrusiveness of the heavy mesh.

In bringing Smartmesh to US hospitals, Mpathy focused on a prac2cal and 2mesaving approach for the surgeon – customised mesh. Different shapes of mesh, and different means of fixa2on.

Over the next two years, Mpathy annoyed their huge compe2tors so much that one of them eventually sued for alleged patent infringement.This was code for ‘we would like to buy you so thatwe can use your technology to advance our business’.

As a result Mpathy was sold to the Danish wound management and male urology company Coloplast.With access to their wider distribu2on capability,product sales were able to grow faster and thusoutsourced manufacturing stayed in Scotland. So InMarch 2011, Ian was out of work again. Where next?

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TOUCH BIONICSNext for Ian came the chance to work with the amazing inven2on that is the i-limb hand, with the aim of bringing its benefits to as many suitable recipients as possible. Ian again was lucky enough to be associated with the best product in the worldin its field – and again the challenge was, and is, to develop that product and its suppor2ng organisa2on so as to encourate wide adop2on.

Ian stated that our hands are truly amazing things.He invited the audience to consider the range ofmovement possible, the precision with which objectscan be grasped, the sensory feedback from touchingsomething, the assistance to balance and posi2onalawareness. And humans take them for granted.

Ian encouraged the audience to try pu4ng theirhands in their pockets and keeping them there foreven a few minutes. He suggested that this demonstrates how the en2re means of dealing with the world immediately changes. He then asked the audience to imagine that to be permanent,and reminded them that “everyone you meet willno2ce this and form a view of you based on how you are different, not necessarily in a malevolentway, but just because we no2ce these things.

So how can an advanced electronic hand provide a conforming grip and dexterity? Inven2on, shrewdobserva2on skills and innova2ve engineering wererequired…”

Ian had known about Touch Bionics before 2011. It would have been hard not to have been aware of David Gow’s inven2on when the first i-limbscame to market in 2008. At that stage however, he didn’t know anything about the history.

The roots of the Touch Bionics project went back to the early 1960s and to the tragedy that was Thalidomide. The project was evolved over manyproject teams, twists and turns, to eventually bring to pa2ents who had suffered upper limb loss, a mul2-ar2cula2ng, variably-gripping, self-esteem-eleva2ng, prosthe2c hand.

Electric hands have been around for decades, but they have been clawlike in appearance. They were very strong in their grip, but their digits lacked the ability to conform around an object, to grip with sufficient force or toindependently ar2culate. Those features are necessary to truly confer to the user a significant restora2on of their ability to perform a wide range of the ac2vi2es of daily living.

One day in the late 1980s, David, an engineer working for the Sco4sh NHS, was working out on his wife’s exercise bicycle. He no2ced that thespeedometer on the bicycle was loose, that themechanism that transmi3ed the speed reading was going round and round instead of being fixed,and that it had a par2cular combina2on of gearing called a worm wheel inside it, and he spo3ed a solu2on to the manufacture of prosthe2c digitswhich he had been trying to perfect for ten years.

It was that problem-resolving discovery that allowed David to con2nue his research work, inser2ng a small motor into each digit, thus achieving sufficient grip strength combined withminiaturisa2on. That advance, along with gainingfunds from Archangel & Sco4sh Enterprise, eventually allowed him to found Touch Bionics in 2002.

The Royal Society of Edinburgh had last heard about the i-limb four years previously, at theRAE/RSE Joint Lecture in March 2009. At that2me, Touch Bionics had introduced its prosthe2c digits in the form of a full hand, called the i-limbhand, and also for pa2ents with par2al hand loss. At that 2me around 500 pa2ents had been fi3ed.

By the 2me of this lecture over 4,000 pa2ents hadbeen fi3ed with i-limbs and this was now the thirdgenera2on of i-limb called the i-limb ultra.

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The main aim of Touch Bionics is the provision of a hand of which the pa2ent can be proud, thus encouraging that person to use it for a wider range of ac2vi2es.

Ian said it was constantly evident that if pa2ents feelless self conscious, more empowered and confident,and if they have been properly trained, then theywear and use their replacement limb more o#en, especially when comple2ng normal everyday livingtasks such as holding a cup, using a camera, playingwith a ball or picking up small objects. It had beenfocus on everyday tasks which was the defining features of the development of the i-limb over theprevious four years.

Some of the tools for produc2vity are obvious which,he said, is the whole point. Touch Bionics seeks tosimplify the use of the i-limb, believing that thewearers already have enough challenging situa2onswith which to deal. And that simplifica2on and learning starts before the device is fi3ed.

It has been found that prac2sing how to use themuscles which control the hand and ge4ng used to the Biosim so#ware before actually being fi3ed,improves familiarity and encourages faster and more permanent adop2on. Pa2ents simply connect up to their computers – the virtulimbis another blue tooth device.

And all of the control so#ware available on the computer can also be provided on an ipod touch.

Tapping favourite grips and features in a coupleof seconds allows i-limb wearer more flexibility inwhat they can do – so they can easily pick up aplate in a restaurant or type on a key board usingan extended index finger or 2e their shoelace.

In fact the limita2on of the usefulness of an i-limb hand is not in the range of movement possible, but in the wearers physical ability to control those movements.

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There are 14 commonly availablepopular grips, although in prac2cethe hand can move to any combina2on of digit posi2ons.The ipod, and lots of training help, but the new fron2er is tocome up with ways to provide the brain and the body more ways actually to access and control these features quickly.

Ian then described two recentimprovements that came about inresponses to the wishes of the pa2ents just to be ‘more normal’.

The first is called Autograsp.Because the hand does not confera sense of touch to the user, someassistance is required to stop objectswhich have been grasped beingdropped accidentally. This canhappen if the user sends anaccidental ‘open’ command to the hand. If this happens then the motors will instantly operate, reclosing the fingers around theobject.

The second feature is the Varigrip.This was introduced to increasethe strength with which the fingerscan grip, essen2ally by providingan extra por2on of grip forcethrough each finger, one at a 2me,much as we would when we graspan object, our fingers conformingaround it, 2ghtening just enoughto hold it securely. By applying theforce sequen2ally to the fingers,the hand can be controlled muchmore sensi2vely, more power canbe available to each finger, andba3ery life can be conserved. Sothere is less anxiety about runningout of ba3ery, plenty of power available, but controlled and applied one digit at a 2me.

A lot of 2me is also spent coming up with simple li3le things to‘humanise’ the hand. For instance,allowing the hand to return to itsnatural posi2on, “as you and Iwould do involuntarily, a#er it has been used, without having to command it to do so”. All that’sneeded is to set the 2me delay,and this will happen every 2meautoma2cally.

The wrist is a very useful addendumto our hands, providing us withenormous posi2onal flexibility forour hands and digits to grasp,press, point etc. But most wholehand amputa2ons mean the lossof the wrist. To try to bring backsome of that func2onality a flexible powered mechanical wristis supplied and also one which cancon2nuously rotate.

These wrists can flex in all direc2ons, and their introduc2on

reduces thetypes of repe22ve stressinjuries whichotherwise occurwhen the shoulders for example areforced into awkward movementsjust to get thehands in theright posi2on.

Ian went on totalk about i-limbdigits. Wholehand amputa2onor deficiency isless commonthan par2al hand

loss. Thus, Touch Bionics has introduced a ‘1 to 5’ digit solu2onfor those pa2ents with par2alhand loss. It’s a very demandingprosthe2c challenge, with aunique solu2on for each pa2ent,because every injury is poten2allyvery different from the next.

But an incredible degree of func2onality can be restored,from workplace or DIY ac2vi2es to the ubiquitous playsta2on and the independence of opera2ng a mouse. And using the ipod, together with good rehabilita2on therapy, can make all these daily ac2vi2es a reality again.

During and a#er the fi4ng of the first 200 or so pa2ents withi-limb digits, Touch Bionics

received significant feedback,which led to a set of criteria forthe next itera2on of i-limb digits.

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The most visible improvement needed, related tothe size of the digits themselves, or more accurately,the distance from their base to the point of rota2onof the digit. That needed to be reduced and, oncethat was done, because the digits rotate around apoint much closer to the base of the amputa2on,they look much more natural and its much easier toget the fingers and thumb to oppose easily. That is,for example, how we pick up objects.

And they learned other things about par2al hand pa2ents. For example, that they wish to have fullwrist movement, that they want their par2al hand to be lighter, and therefore less sweaty – we perspirea lot through our hands – and that they want the so#ware to be increasingly easy to use and for theba3eries to be easily swappable so that there is noanxiety about running out of power.

Thus i-limb digits were developed which are lighter,smaller, stronger and with all the so#ware featuresand manufacturing robustness improvements builtin. In addi2on they are controllable with an ipod and have removeable and replaceable ba3eries.

Ian reiterated that self confidence and reduced selfconsciousness are the keys to usage, and that this is an important feature of the cosme2c appearanceof i-limb.

Whilst Touch Bionics is happy to provide the terminator look-alike, ta3oos, bright red, etc, most pa2ents are sa2sfied with access to over 400 skin colour tones, matched freckles and hairs, and nails that can be painted.

In 2008, Touch Bionics actually purchased a companywhich makes these cosme2c coverings and has spent a lot of 2me and money in developing newcovering methods, an2-slip coa2ng to allow the covering to be put on and off easily, as well as more robust and consistent formulae for the consistency of the silicon gloves. The i-limb usercan therefore be unno2ced in public, just as we all are normally.

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In earlier men2ons of Optos and Mpathy, Ian referred to the need to ensure that, as well as being focused on the needs of the pa2ent, product development must also take into account the needsof the stakeholders, whether investors, bankers orcorporate financiers.

This is all also true at Touch, and a further dimension is added by the requirement for outcomes evidence by the funders of these devices,who are most o#en likely to be an insuranceprovider or public health authority.

How are the pa2ents actually doing; are they using the hands regularly; are they able to performan increased number of everyday func2onal acitvi2es of daily living?

So having manufactured the hands, another crucial ac2vity is to ensure that their use is recorded and measured, in order to jus2fy the expense to the payer.

High levels of usage can be monitored by a combina2on of methods – including seeking regular and comprehensively documented pa2entfeedback on how they are achieving their goals, onhow many of the features of the hand are in use, onhow soon and easily they have got back to work andon how well the hands are maintained by enablingthem always to be available for use and not in needof repair or service. The development of the repor2ng capability so#ware and databases to hold this data has and will con2nue to be a focus.

This is done by ge4ng ilimb wearers to connect over the internet, so that they can report in a consistent documented manner on how they areprogressing. When they do that, the hand sends alog of every movement of the hand during that 2me,enabling a rich bank of data to be built up of whatfeatures they have been using most o#en, and alsohow well the hand is working.

All of this informa2on is key to jus2fying the expenseand providing input for future product development.

And so to the future ....

The i-limb is capable of doing more than the humanbody can command it to do. No ma3er what TV orthe newspapers might say or hope, we will never,well not in our life2mes, make something as wonderful as a human hand. But we can do lotsmore to redress that balance.

Ian described three contras2ng examples of developments, each of which has their importance,in controlling the hand, in improving dexterity and in making it easy to switch between the different features, so that the dexterity can be accessedquickly and effortlessly.

ControlIt has been discovered that gold pla2ng the electrodeswhich carry those 2ny electrical signals from the armmuscles to the hand’s microprocessor, telling it whatto do, improves the reliability and clarity of those signals enormously. And it was also recognised thatlower profile electrodes allow the manufacture of aless obtrusive prosthe2c socket – wearers just wantnot to be no2ced. So these very low profile electrodes are very useful in both func2on and inimproving appearance.

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The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013

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DexterityIan had talked about how incredible our hands are,but he went on to point out that 40% of our manualdexterity is es2mated to come from our thumb. Un2lthen it had been very difficult to make thumbs thatare electronically rotatable as well as open and close.

But now the solu2on had been found. This meansthat the wearer can now autom2cally and preciselyuse powered rota2on of the thumb for those finemotor ac2vi2es. So, for example, just ge4ng thethumb out of the way to put on and take off clothes,or to carefully pick up small objects between thumband index finger, can now happen with one i-limbhand movement followed by use of the other handto get the thumb posi2on just right.

It seems unimportant but, Ian explained, “if you hadone hand, were carrying a briefcase in it, and thenwanted to use your i-limb to pick up a set of keys,well you wouldn’t want to have to put down yourbriefcase in order to posi2on your thumb to do that would you?”

Ease of useAnd finally, thanks to the brilliance of the Apple corpora2on it is now possible to pull all the elementstogether, the responsiveness of electrodes, thechoice of grips for different ac2vi2es, all in a simpleapp available in the app store. The objec2ve is tomake prothe2c devices a ‘normal’ feature of oureveryday lives – so amputees are comfortable with-their adop2on – not inhibited or under-confident inusing them.

Ian stated that this was what was coming out at that2me or imminently from the Touch engineeringgroup led by Hugh Gill. They were building on thekey inven2on – prosthe2c digits which areindependently ar2cula2ng, robust and strong, andtrying to get them used as easily and unobtrusivelyas possible, because the users demand it!

Before closing, Ian men2oned some key development areas that are the next fron2er for upper limb prosthe2cs.

What if surgeons could reposi2on nerves in ac2vemuscle. Then the body could think it was moving a

real hand and that informa2on could be relayed tothe i-limb. This work is underway in various researchloca2ons around the world by external organisa2onsand Touch Bionics were hopeful that the results willeventually be accessible by pa2ents using i-limb.

Touch Bionics itself was working and collabora2ngwith leading universi2es in the areas of pa3ern recogni2on and gyroscopic control.

To explain – If microprocessors and so#ware could together interpret certain signals from the electrodes, and/or related physical movementsand gestures, as unique to certain, grips or features,then the hand could be commanded to respond accordingly – “think of an advanced Wii and you have the general idea”.

And of course we would like to get closer to the original intent of this whole project, to make a smallerhand, perhaps not suitable for very young children,but certainly aimed at smaller humans, whether theyare of school age or from for example Asian countries.With the smaller digits, neater electrodes andsmaller electronics this is perfectly possible.

Ian Stevens could not be more enthusias2c aboutthe future course of these developments. The company is mo2vated not only by its founder’s vision,but also by witnessing the hardships overcome bythe amazing pa2ents who restore their func2ons, not fully, because the human hand is a truly wondroustool, but by very significant amounts.

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The image below shows a young man, Patrick Kane who was severely disabled by meningi2s when he was just a few years old.

Yet he ran on his prosthe2c legs, carried the Olympic torch and proudlyheld his arms alo# in Trafalgar Square on the day before the openingceremony of the Olympic Games.

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The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture

Ian concluded by thanking the Royal Society of Edinburgh and the RoyalAcademy of Engineering for invi2ng him to present this Lecture and repeated how privileged he feltto have had the opportunity to work with these great inven2ons. “I know that for all of these inven2ons there is much more to be done”.

Sigmund Freud said, in his book Civilisa#on and its Discontents, published in 1929:

Man has, as it were, become akind of prosthe#c God. When heputs on all his auxiliary organs heis truly magnificent. But those organs have not grown on to himand they s#ll give him much trouble at #mes.

“I am not sure about the prosthe2c God statement, butthose last two sentences couldvery neatly sum up our ambi2onat Touch Bionics. Raise the self esteem of the wearer – makethem feel magnificent, we all deserve the chance to feel goodabout ourselves don’t we? But atthe same 2me my colleaguesrecognise the limita2ons of aprosthesis, and we seek to minimise those limita2ons bywringing every bit of u2lity fromthe ilimb by training, by making iteasy to use, by making its movements mechanically be3er”.

Ian stated that Society must not deny Patrick, or others like him, the opportunity fully to par2cipate in this world. Patrick is empowered by his own resolve and also by the devices that assist him, and this is the big mo2va2on to try to bring forward engineering advances more quickly so that his life can be improved further.

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Contact:The Royal Society of Edinburgh – www.royalsoced.org.uk – 0131 240 5000The Royal Academy of Engineering – www.raeng.org.uk – 020 7766 0600

The Royal Academy of Engineering/The Royal Society of Edinburgh

Joint Lecture 2013ISBN No 978 0 902198 71 5

© The Royal Society of EdinburghMarch 2013

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