-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
1/16
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
-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
2/16
2
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.
-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
3/16
3
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 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.
-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
4/16
4
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?
The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013
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!
-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
5/16
5
The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013
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.
-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
6/16
6
The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013
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.
-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
7/16
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.
The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013
7
-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
8/16
The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013
8
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?
-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
9/16
The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013
9
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.
-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
10/16
The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013
10
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.
-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
11/16
The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013
11
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.
-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
12/16
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.
The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013
12
-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
13/16
The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013
13
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.
-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
14/16
The Royal Academy of Engineering and The Royal Society of Edinburgh Lecture 2013
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.
-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
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.
-
7/29/2019 Growing Healthcare Technology Businesses Bringing Engineering Inventions to Market with Limited Resources
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