Growing Healthcare Technology Businesses – Bringing Engineering Inventions to Market with Limited...

7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources

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Growing Healthcare Technology Businesses

Bringing Engineering Inventions to Market

with Limited Resources

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 Scotlands National Academy ofScience & Letters. It is an independent body with charitable status. TheSociety organises conferences and lectures for the specialist and for thegeneral public. It provides a forum for informed debate on issues ofnational and international importance. Its multidisciplinary Fellowship ofmen and women of international standing provides independent, expertadvice to key decision-making bodies, including Government andParliament.

The Societys Research Awards programme annually awards over 2 million to exceptionally talented youngresearchers 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 thefuture of Scotlands social, economic and cultural wellbeing.

The Royal Academy of Engineering

"As Britains national academy for engineering, we bringtogether the countrys most eminent engineers from alldisciplines to promote excellence in the science, art and

practice of engineering. Our strategic priorities are to enhancethe UKs engineering capabilities; to celebrate excellence andinspire the next generation; and to lead debate by guidinginformed thinking and influencing public policy."

Strategic PrioritiesThe Academys work programmes are driven by three strategic priorities, each of which provides a keycontribution 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 targetednational and international programmes, we enhance and reflect abroad the UKs performance in theapplication 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 providemeans of determining and disseminating best practice. In particular, our activities focus on complex andmultidisciplinary areas of rapid development.

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

Leading debateUsing the leadership and expertise of our Fellowship, we guide informed thinking; influence public policymaking; provide a forum for the mutual exchange of ideas; and pursue effective engagement with society on

matters within our competence. The Academy advocates progressive, forward-looking solutions based onimpartial 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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Ian Stevens was born in 1963 in Belfast and educated at the citys

Royal Academy and then at the University of Edinburgh, graduang

in economics in 1985.

Aer University Ian spent six years in The Royal Air Force and

then joined KPMG, trained, qualified and worked as a CharteredAccountant in Oxford and Prague ending up back in Edinburgh

in 1998

Between 1998 and 2007 Ian was employed by Optos plc, a medical

technology company specialising in the imaging of the rena, 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 device

company and in 2011 he joined prosthec hand manufacturer, Touch

Bionics, as CEO.

Ian counts himself fortunate to have been associated with thedevelopment of three disrupve and leading healthcare technologies

over the last 14 years. Firstly the Optomap renal scan from Optos, then

Smartmesh for pelvic floor restoraon with Mpathy Medical and, most

recently, the I-limb mul-arculang prosthec hand from Touch Bionics.

In the 2013 Annual Joint Lecture, Ian explored how these invenons were

brought 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 representave of innovaon

for the UK Governments Olympic Campaign in 2012.


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The crucial career moment came for Ian in the summer of 1998 when

he went to work at Optos, with Douglas Anderson in Dunfermline. He

had met Douglas a few months earlier, who had then shared the Optos

fledgling business plan. At that me there was one prototype imaging

system, ten (mainly R&D) staff and absolutely no revenue.

Ian had been working in corporate finance and part of his job was

to assess the business plans of young companies looking for equity

funding. The Optos business plan was the most compelling that he

had ever seen: a massive unmet need, combined with clear

intellectual property and a technology which was tricky, but possible

to manufacture.

Optos was founded because Douglass young son, Leif, was unfortunateenough to suffer from renal detachments. These le him blind in one

eye and with reduced vision in the other. Douglas was determined that

other paents and parents would not have to go through what he and

Leif had. As Ian said, its so much beer to invent something which

solves a known problem, rather than stumbling across an interesng

technological discovery and then thinking, well thats interesng, now

what shall I do with it?


Growing Healthcare Technology Businesses

Bringing Engineering Invenons to Market with Limited Resources

The main aim of this lecture was to illustrate some of the key decisions surrounding

the introducon and growth of:

the Optomap renal exam from Optos;

Smartmesh for pelvic floor restoraon from Mpathy Medical; and

the i-limb bionic hand from Touch Bionics.

Ian discussed the impact of these decisions on the engineering development of theproducts, especially in relaon to their physical appearance, range of funconality

and, where appropriate, in the soware 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 by

Douglas to solve his problem.

To get an image of the rena,

you have to shine light on it and

then get that light back, in and

out of an opening, the pupil, which

fundamentally does not like too

much light interfering with it, and

constricts in those circumstances.

Douglass team reminded him

that an ellipsoidal mirror has two

focal points. The soluon to the

problem was therefore to place

the eye at one focal point, fire alow energy laser beam into it and

then place the collecon device at

the other focal point to collect the

reflected energy. This gave no me

for the pupil to constrict, meaning

there was no need for uncomfortable

contact with the cornea. Ian

observed that the thing about

clever invenons like this one is

that they always seem obvious,

just aer 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 enre surface of the rena.

That challenge required the use of a spinning polygon

rotang at exactly 27,356 revoluons per minute.

Then there was an ergonomic requirement to posion

the eye of the paent in precisely the right place to

get the laser beam through the pupil in the first place.

In addion, there were extremely demanding

manufacturing tolerances relang to the performance

and posioning of 15 or so mirrors and lenses to

direct and collect that returning informaon.

The bigger queson was as yet unanswered. Once

the technical problem was solved, well then, so

what really how does it all get paid for how do

you make it a business?

The highly skilled ophthalmologist had not, via his

manual examinaon, obtained enough informaon

to sasfactorily diagnose Leif s condion. He had

admied that he was only geng a glimpse.

By invenng the Optomap technology, Douglassolved those two problems they could get lots

more informaon and could record it digitally so

it was there for review, rather than accessible only

via the praconers memory. But the technology

needed to do this was very expensive tens of

thousands of pounds for each device, even aer

manufacturing volume reducons. So how could

a viable business be created?

The answer relates to our desire to be reassured

about our health. Condions of, or evident in, therena, such as diabec bleeding, macular degeneraon,

renal detatchment, glaucoma and high blood

pressure are oen a-symptomac and can be

detected at an early stage via regular and

comprehensive examinaon of the rena.

Essenally, when we have our eyes checked and

this should be annually we want to be told only

one thing that we are fine. But we also want to

have confidence that if we are not fine then our

doctor will idenfy and recognise the visual signs

prompng 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 than

the device itself, giving the praconer the means to

carry out the screening exam and building the

confidence of the paent;

that the Optomap would be easily reviewable,

saveable and available for comparison with

subsequent images each year;

that huge resources would go into the soware

to deliver that educaonal experience to the paent

and the performance;

that usage levels of the pracce would all be

recorded and transmied daily to Optos, so that

they could proacvely help those praconers who

were not being successful in geng all or most of

their paents to have an annual Optomap exam; and

that it would do all this mainly in the USA, where

the medical side of optometry was already a service

that paents were prepared to pay for, rather than

in this country, for example, where we generally do

not expect to pay an extra fee.


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Subsequent engineering was focused on the

business objecves of high usage levels, preciseand easy image-taking by the paent themselves,

and modular equipment design, for example:

the paent soware was designed with minimum

data input me and maximum educaonal

opportunity, ulising libraries of disease images

for comparison, allowing zoom and pan features

to review areas of interest in greater detail;

the alignment system was consistently refined so

that the paent would know when they were exactly

in the right posion to get that ny laser beam

through the ny pupil, first me, saving me;

the original whole system unit was modularised in

order to extend the lifeme of the equipment

indefinitely. Rental contracts could be extended aer

the inial three-year term expired, without the need

for expensive equipment replacement both the

equipment and the soware were evergreen.

And all of this went alongside the necessary connuous

improvements to the repeatability, shortening and

cost-effecveness of the manufacturing process.

These engineering policies allowed the stakeholders

and financial backers to feel confident in the future

of the company. The shareholders could see the

number ofOptomaps and placements rising, thus

jusfying their investment, the bank providing leasing

finance could see that each system was financially

self-sufficient, i.e., the praconer was selling

enough Optomaps to his paents to cover the lease

payments, and the investment bank handling Optoss

eventual IPO could see that this revenue couldconnue well into the future without the need for

expensive equipment replacement.

To summarise, Optos raised its first invoice for $94.50,

thats six Optomaps at $15.75 each, on 31 August 1999,

and floated on the London Stock Exchange 6 years

later in February 2006 at a market capitalisaon of

c$250m, by which me revenue was up to $65m

annually, with over 3,000 locaons selling Optomaps.

Renewal percentage rates were in the high 90s, remain

high today, and the company connues to grow, with

revenue now heading towards $200m annually.

Dave Nelson, President of the American Optometric

Associaon, who in 2006 was leading Americas35,000 Optometrists, recognised how crical the

early detecon capability was to his paents and he

remains a customer today. Optos tended to find that

once a customer had this sort of experience, and

they did oen, 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 pracce through the sale of the

Optomap exam which helped!

The finalcomment

relang to

Optos was

that it was

the proximity

and regular

contact of

staff with

customers

and paents

that

prompted

huge

amounts of

feedback,

driving the

direcon

of further

hardware and soware development. Optos built a

direct sales force and as many clinical consultants,

constantly vising and training in the locaons inAmerica. Since daily usage and performance data

came from every single system, the company could

act quickly to recfy any customer issues. Ian said

that these were big lessons for him.

Ian had moved to the USA in 2003 as General

Manager and stayed for a year aer 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 lucky

enough 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 joined

Ethicon, a division of Johnson & Johnson in the

mid 1990s. At the me, Ethicon were introducing a

new surgical product for womens health and James

was 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 hernias

using sutures. It was planning to use the samemesh for pelvic floor prolapse in women, a

condion oen caused due to old age, obesity

or following child birth.

James was concerned that the hernia mesh was too

heavy for the more delicate area it was now being

asked to be effecve in, and that problems would

ensue were the body to reject this implantaon.

So in 2001 he quit his job and a secure future,

raised some money from Archangel and Scosh

Enterprise, and set about invenng a lighterstronger mesh.

James did invent his lighter mesh. He invented a

way to promote much higher new ssue growth

aer implantaon.

Below is an image of the material. Compared to

Ethicons mesh there was much more space and

the mesh consisted of carefully woven fibres with

ny distances separang them.

James knew the size of the ny parcles, called

macrophages and neutrophyls, which are togetherresponsible for new ssue growth. He believed that

if the spaces between individual fibres making up the

strands of the mesh could be restricted to approximately

100 microns, then this would be an ideal locaon for

new ssue growth to commence.

Since the spaces between the strands could now

be bigger, there could be more air and less mesh

per square metre. Mpathys mesh was therefore

able to be patented at less than 19 grammes per

square metre less than half the weight of that ofthe leading competors, but in clinical trials

approximately 60% stronger.

Having come up with the idea and prototype, James

and a couple of colleagues spent six years invenng,

literally weaving, mesh, protecng his invenon by

registering his intellectual property, conducng

clinical trials and obtaining the necessary CE marks,

and FDA approvals.

But by 2007, he was out of money, and the big

competors in the market place, billion-dollarcompanies such as Ethicon, Tyco Covidien, Bard,

Coloplast, Boston Scienfic and American Medical

Systems, were happy with their less effecve

products and didnt want to buy Jamess technology.

So the first phase of the engineering was complete.

The next phase involved seng up a US corporaon,

branding the new company and products as advanced

and market leading, and going head-to-head in a

very focused way with these huge corporaons.

Mpathy Medical had a limited range of products,

and chose to sell only in the US, to carefully targeted

leading urologists and urogynaecologists, with again

a direct sales force.

Just as with Optos, Archangel agreed and funded this

further business development, and in early 2008

Mpathy Medical launched a range of pelvic floor

prolapse and stress urinary connence implantable

medical devices, all manufactured in Prestwick,

Scotland from this new, lightweight, physiologically-

compable material called, Smartmesh.


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Unusually for a new product in this area of medicine,

at the me of final FDA approval and product launch,

Mpathy had substanal and very posive clinical

evidence on Smartmeshs results. There was

otherwise a general absence of favourable outcome

data for polypropolene mesh used for this type of

surgery. It appeared that James had been correct

in his reason for leaving Ethicon. The other meshes

were 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 addion to Smartmeshs

low 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 relaon to the

actual locaon of the prolapse.

Historically, this type of surgery had typically

involved the surgeon popping down to the back

of the operang theatre with a pair of scissors,

needle and thread and fashioning a bespoke

device for that parcular operaon, with the

paent already in the theatre under a general

anaesthec. Women were being cured of

prolapse, but oen suffering complicaons

and rejecon because of the intrusiveness

of the heavy mesh.

In bringing Smartmesh to US hospitals, Mpathy

focused on a praccal and mesaving approach

for the surgeon customised mesh. Different

shapes of mesh, and different means of fixaon.

Over the next two years, Mpathy annoyed their

huge competors so much that one of them

eventually sued for alleged patent infringement.

This was code for we would like to buy you so that

we 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 distribuon capability,

product sales were able to grow faster and thus

outsourced manufacturing stayed in Scotland. So In

March 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 invenon 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 world

in its field and again the challenge was, and is,

to develop that product and its supporng

organisaon so as to encourate wide adopon.

Ian stated that our hands are truly amazing things.

He invited the audience to consider the range ofmovement possible, the precision with which objects

can be grasped, the sensory feedback from touching

something, the assistance to balance and posional

awareness. And humans take them for granted.

Ian encouraged the audience to try pung their

hands in their pockets and keeping them there for

even a few minutes. He suggested that this

demonstrates how the enre 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 will

noce this and form a view of you based on how

you are different, not necessarily in a malevolent

way, but just because we noce these things.

So how can an advanced electronic hand provide

a conforming grip and dexterity? Invenon, shrewd

observaon skills and innovave engineering were

required

Ian had known about Touch Bionics before 2011.

It would have been hard not to have been aware

of David Gows invenon when the first i-limbs

came to market in 2008. At that stage however,

he didnt know anything about the history.

The roots of the Touch Bionics project went backto the early 1960s and to the tragedy that was

Thalidomide. The project was evolved over many

project teams, twists and turns, to eventually

bring to paents who had suffered upper limb

loss, a mul-arculang, variably-gripping,

self-esteem-elevang, prosthec 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 to

independently arculate. Those features are

necessary to truly confer to the user a

significant restoraon of their ability to perform

a wide range of the acvies of daily living.

One day in the late 1980s, David, an engineer

working for the Scosh NHS, was working out

on his wifes exercise bicycle. He noced that the

speedometer on the bicycle was loose, that the

mechanism that transmied the speed reading

was going round and round instead of being fixed,

and that it had a parcular combinaon of gearing

called a worm wheel inside it, and he spoed a

soluon to the manufacture of prosthec digits

which he had been trying to perfect for ten years.

It was that problem-resolving discovery that

allowed David to connue his research work,

inserng a small motor into each digit, thus

achieving sufficient grip strength combined with

miniaturisaon. That advance, along with gaining

funds from Archangel & Scosh 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 the

RAE/RSE Joint Lecture in March 2009. At that

me, Touch Bionics had introduced its prosthec

digits in the form of a full hand, called the i-limb

hand, and also for paents with paral hand loss.

At that me around 500 paents had been fied.

By the me of this lecture over 4,000 paents hadbeen fied with i-limbs and this was now the third

generaon ofi-limb called the i-limb ultra.


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The main aim of Touch Bionics is the provision ofa hand of which the paent can be proud, thus

encouraging that person to use it for a wider range

of acvies.

Ian said it was constantly evident that if paents feel

less self conscious, more empowered and confident,

and if they have been properly trained, then they

wear and use their replacement limb more oen,

especially when compleng normal everyday living

tasks such as holding a cup, using a camera, playing

with a ball or picking up small objects. It had been

focus on everyday tasks which was the defining

features of the development of the i-limb over the

previous four years.

Some of the tools for producvity are obvious which,

he said, is the whole point. Touch Bionics seeks to

simplify the use of the i-limb, believing that the

wearers already have enough challenging situaonswith which to deal. And that simplificaon and

learning starts before the device is fied.

It has been found that pracsing how to use the

muscles which control the hand and geng used

to the Biosim soware before actually being fied,

improves familiarity and encourages faster and

more permanent adopon. Paents simply

connect up to their computers the virtulimb

is another blue tooth device.

And all of the control soware available on thecomputer can also be provided on an ipod touch.

Tapping favourite grips and features in a couple

of seconds allows i-limb wearer more flexibility in

what they can do so they can easily pick up a

plate in a restaurant or type on a key board using

an extended index finger or e their shoelace.

In fact the limitaon 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 pracce

the hand can move to any

combinaon of digit posions.

The ipod, and lots of training

help, but the new froner is to

come up with ways to provide

the brain and the body more

ways actually to access and

control these features quickly.

Ian then described two recent

improvements that came about in

responses to the wishes of the

paents just to be more normal.

The first is calledAutograsp.

Because the hand does not confer

a sense of touch to the user, some

assistance is required to stop objects

which have been grasped being

dropped accidentally. This can

happen if the user sends an

accidental open command to

the hand. If this happens then

the motors will instantly operate,

reclosing the fingers around the

object.

The second feature is the Varigrip.

This was introduced to increase

the strength with which the fingers

can grip, essenally by providing

an extra poron of grip force

through each finger, one at a me,much as we would when we grasp

an object, our fingers conforming

around it, ghtening just enough

to hold it securely. By applying the

force sequenally to the fingers,

the hand can be controlled much

more sensively, more power can

be available to each finger, and

baery life can be conserved. So

there is less anxiety about running

out of baery, plenty of power

available, but controlled and

applied one digit at a me.

A lot of me is also spent comingup with simple lile things to

humanise the hand. For instance,

allowing the hand to return to its

natural posion, as you and I

would do involuntarily, aer it

has been used, without having

to command it to do so. All thats

needed is to set the me delay,

and this will happen every me

automacally.

The wrist is a very useful addendum

to our hands, providing us with

enormous posional flexibility for

our hands and digits to grasp,

press, point etc. But most whole

hand amputaons mean the loss

of the wrist. To try to bring back

some of that funconality a

flexible powered mechanical wrist

is supplied and also one which can

connuously rotate.

These wrists can flex in all

direcons, and their introducon

reduces thetypes of

repeve stress

injuries which

otherwise occur

when the

shoulders for

example are

forced into

awkward

movements

just to get thehands in the

right posion.

Ian went on to

talk about i-limb

digits. Whole

hand amputaon

or deficiency is

less common

than paral hand

loss. Thus, Touch Bionics hasintroduced a 1 to 5 digit soluon

for those paents with paral

hand loss. Its a very demanding

prosthec challenge, with a

unique soluon for each paent,

because every injury is potenally

very different from the next.

But an incredible degree of

funconality can be restored,

from workplace or DIY acviesto the ubiquitous playstaon

and the independence of

operang a mouse. And using

the ipod, together with good

rehabilitaon therapy, can

make all these daily acvies

a reality again.

During and aer the fing of

the first 200 or so paents with

i-limb digits, Touch Bionics

received significant feedback,

which led to a set of criteria for

the next iteraon ofi-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 rotaon

of the digit. That needed to be reduced and, once

that was done, because the digits rotate around a

point much closer to the base of the amputaon,

they look much more natural and its much easier to

get the fingers and thumb to oppose easily. That is,

for example, how we pick up objects.

And they learned other things about paral hand

paents. For example, that they wish to have full

wrist movement, that they want their paral hand

to be lighter, and therefore less sweaty we perspire

a lot through our hands and that they want the

soware to be increasingly easy to use and for the

baeries to be easily swappable so that there is no

anxiety about running out of power.

Thus i-limb digits were developed which are lighter,

smaller, stronger and with all the soware features

and manufacturing robustness improvements built

in. In addion they are controllable with an ipod

and have removeable and replaceable baeries.

Ian reiterated that self confidence and reduced self

consciousness are the keys to usage, and that this

is an important feature of the cosmec appearance

ofi-limb.

Whilst Touch Bionics is happy to provide the

terminator look-alike, taoos, bright red, etc,

most paents are sasfied 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 company

which makes these cosmec coverings and has

spent a lot of me and money in developing new

covering methods, an-slip coang 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 user

can therefore be unnoced in public, just as

we all are normally.


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In earlier menons of Optos and Mpathy, Ianreferred to the need to ensure that, as well as

being focused on the needs of the paent, product

development must also take into account the needs

of the stakeholders, whether investors, bankers or

corporate 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 oen likely to be an insurance

provider or public health authority.

How are the paents actually doing; are they

using the hands regularly; are they able to perform

an increased number of everyday funconal

acitvies of daily living?

So having manufactured the hands, another

crucial acvity is to ensure that their use is

recorded and measured, in order to jusfy the

expense to the payer.

High levels of usage can be monitored by a

combinaon of methods including seekingregular and comprehensively documented paent

feedback on how they are achieving their goals, on

how many of the features of the hand are in use, on

how soon and easily they have got back to work and

on how well the hands are maintained by enabling

them always to be available for use and not in need

of repair or service. The development of the

reporng capability soware and databases to

hold this data has and will connue to be a focus.

This is done by geng ilimb wearers to connect

over the internet, so that they can report in a

consistent documented manner on how they are

progressing. When they do that, the hand sends a

log of every movement of the hand during that me,

enabling a rich bank of data to be built up of what

features they have been using most oen, and also

how well the hand is working.

All of this informaon is key to jusfying the expense

and providing input for future product development.

And so to the future ....

The i-limb is capable of doing more than the human

body can command it to do. No maer what TV or

the newspapers might say or hope, we will never,

well not in our lifemes, make something as

wonderful as a human hand. But we can do lotsmore to redress that balance.

Ian described three contrasng 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 accessed

quickly and effortlessly.

Control

It has been discovered that gold plang the electrodes

which carry those ny electrical signals from the arm

muscles to the hands microprocessor, telling it what

to do, improves the reliability and clarity of those

signals enormously. And it was also recognised that

lower profile electrodes allow the manufacture of a

less obtrusive prosthec socket wearers just want

not to be noced. So these very low profile

electrodes are very useful in both funcon and in

improving appearance.


14/16


14

DexterityIan had talked about how incredible our hands are,

but he went on to point out that 40% of our manual

dexterity is esmated to come from our thumb. Unl

then it had been very difficult to make thumbs that

are electronically rotatable as well as open and close.

But now the soluon had been found. This means

that the wearer can now automcally and precisely

use powered rotaon of the thumb for those fine

motor acvies. So, for example, just geng the

thumb out of the way to put on and take off clothes,

or to carefully pick up small objects between thumb

and index finger, can now happen with one i-limb

hand movement followed by use of the other hand

to get the thumb posion just right.

It seems unimportant but, Ian explained, if you had

one hand, were carrying a briefcase in it, and then

wanted to use your i-limb to pick up a set of keys,

well you wouldnt want to have to put down your

briefcase in order to posion your thumb to do

that would you?

Ease of use

And finally, thanks to the brilliance of the Apple

corporaon it is now possible to pull all the elements

together, the responsiveness of electrodes, the

choice of grips for different acvies, all in a simple

app available in the app store. The objecve is to

make prothec devices a normal feature of our

everyday lives so amputees are comfortable with-

their adopon not inhibited or under-confident in

using them.

Ian stated that this was what was coming out at that

me or imminently from the Touch engineering

group led by Hugh Gill. They were building on the

key invenon prosthec digits which are

independently arculang, robust and strong, and

trying to get them used as easily and unobtrusively

as possible, because the users demand it!

Before closing, Ian menoned some key

development areas that are the next froner

for upper limb prosthecs.

What if surgeons could reposion nerves in acve

muscle. Then the body could think it was moving a

real hand and that informaon could be relayed to

the i-limb. This work is underway in various research

locaons around the world by external organisaons

and Touch Bionics were hopeful that the results will

eventually be accessible by paents using i-limb.

Touch Bionics itself was working and collaborang

with leading universies in the areas of paernrecognion and gyroscopic control.

To explain If microprocessors and soware

could together interpret certain signals from

the electrodes, and/or related physical movements

and 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 they

are of school age or from for example Asian countries.

With the smaller digits, neater electrodes and

smaller electronics this is perfectly possible.

Ian Stevens could not be more enthusiasc about

the future course of these developments. The

company is movated not only by its founders vision,

but also by witnessing the hardships overcome by

the amazing paents who restore their funcons,not fully, because the human hand is a truly wondrous

tool, but by very significant amounts.


15/16

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

Yet he ran on his prosthec legs, carried the Olympic torch and proudly

held his arms alo in Trafalgar Square on the day before the opening

ceremony of the Olympic Games.

15

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

Ian concluded by thanking the Royal

Society of Edinburgh and the Royal

Academy of Engineering for inving

him to present this Lecture and

repeated how privileged he felt

to have had the opportunity to work

with these great invenons. I know

that for all of these invenons there

is much more to be done.

Sigmund Freud said, in his bookCivilisaon and its Discontents,

published in 1929:

Man has, as it were, become a

kind of prosthec God. When he

puts on all his auxiliary organs he

is truly magnificent. But those

organs have not grown on to him

and they sll give him much

trouble at mes.

I am not sure about theprosthec God statement, but

those last two sentences could

very neatly sum up our ambion

at Touch Bionics. Raise the self

esteem of the wearer make

them feel magnificent, we all

deserve the chance to feel good

about ourselves dont we? But at

the same me my colleagues

recognise the limitaons of a

prosthesis, and we seek to

minimise those limitaons by

wringing every bit of ulity from

the ilimb by training, by making it

easy to use, by making its

movements mechanically beer.

Ian stated that Society must not deny Patrick, or others like him, the

opportunity fully to parcipate in this world. Patrick is empowered

by his own resolve and also by the devices that assist him, and this

is the big movaon to try to bring forward engineering advances

more quickly so that his life can be improved further.


16/16

Contact:

The Royal Society of Edinburgh www.royalsoced.org.uk 0131 240 5000

The Royal Academy of Engineering www.raeng.org.uk 020 7766 0600

The Royal Academy of Engineering/

The Royal Society of EdinburghJoint Lecture 2013

ISBN No 978 0 902198 71 5

The Royal Society of Edinburgh

March 2013

The Royal Society of Edinburgh, Scotlands National Academy, is Scottish Charity No SC000470

The Royal Academy of Engineering is Registered Charity No 293074

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