PolyProPylene TechnologyPhysical Rehabilitation Programme

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PolyProPylene Technology

MISSION

The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of war and internal violence and to provide them with assistance. It directs and coordinates the international relief activities conducted by the Movement in situations of conflict. It also endeavours to prevent suffering by promoting and strengthening humanitarian law and universal humanitarian principles. Established in 1863, the ICRC is at the origin of the International Red Cross and Red Crescent Movement.

International Committee of the Red Cross19 Avenue de la Paix1202 Geneva, SwitzerlandT + 41 22 734 60 01 F + 41 22 733 20 57E-mail: shop.gva@icrc.orgwww.icrc.org© ICRC, June 2007Cover photograph and inside photographs (unless specified): ICRC/PRP

Introduction 2

TheICRC’spolypropylenetechnology:Abriefhistory 4

TheICRC’spolypropylenesystem 6

Internationalrecognition 8

Trainingresources 9

Aconstantlyevolvingtechnology 10

Aboutpolypropylene 11

introductionAs part of its mandate, theICRCplaysanactiveroleinthephysicalrehabilitationofvictimsof conflict and violence. Since1979,theICRChasdiversifieditsactivitiesthroughouttheworld.Theworkofprovidingphysicalrehabilitation for people withdisabilities, as one aspect ofhumanitarian assistance, wasonce confined to emergencyresponse.The ICRC has gonewell beyond that now, inrecognitionofthefactthattheneedforphysicalrehabilitationwillpersistthroughoutthelivesofthedisabled.

TheICRChascometooccupyaleading position in the field ofphysicalrehabilitation,mainlyonaccountoftheworldwidescopeofitsactivities,thetechnologyithasdeveloped,itsexpertiseandits long-term commitment totheprojectsitsupports.Inmostcountries where the ICRC has

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provided support for physicalrehabilitation, such serviceswere either non-existent orminimal. In most cases, theICRC’s support became thebasisforestablishinganationalreintegrationservice.

The ultimate objective of theICRC’s efforts in this area isto make possible the socio-economic rehabilitation of thephysicallydisabled,duringandafter the period in which theyreceive assistance from theICRC. Providing adequate careandcomfortableprostheticandorthoticfittingforthepatientisanimportantfirststep.ThemainaimsoftheICRC’ssupportare:• tomakerehabilitationservices

accessible;• toimprovethequalityofsuch

services;• toensurethattheseservices

continueinthelongrun.

The role of appropr iatetechnology1 – one that is bothinexpensiveandofhighquality–iscrucial.Suchtechnologymakesrehabilitation services moreaffordableandthusmorewidelyaccessible.Italsomakespossiblethe production of orthopaedicdevicesthataredurableandthatconformtosoundbiomechanicalprinciples.Low-costtechnologyalso minimizes the operatingexpenses of rehabilitationcentresandmakesthelong-termsurvival of such centres morelikely.

TheICRCPhysicalRehabilitationUnitwasestablishedin1979,markingthestartofalong-termcommitment.

1 Appropriate technology: “A system providing proper fit and alignment based on sound biomechanical principles [that] suit the needs of the individual and can be sustained by the country at the most economical and affordable price.” N. Jacobs (ed.) Report of ISPO Consensus Conference on Appropriate Orthopaedic Technology for Developing Countries, ISPO, Phnom Penh, 1995, p.8.

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Inthebeginning,theICRCreliedonimportedmaterialstomanufactureorthopaedicdevicesindevelopingcountries.

It became obvious quickly that while it was possible to produceorthopaedic devices of high quality with such materials, it was alsoprohibitivelyexpensiveandoftenoflimitedusefulness.

Becauseimportingorthopaediccomponentswassimplytooexpensive,the ICRC began to develop and produce them on its own. At first,theICRCusedlocallyavailablematerials;thischangedin1991whenthermoplasticsbecametheICRC’srawmaterialofchoice.Theadvantagesofusingpolypropylenesoonbecameobvious.

WhilethefirstpolypropylenekneejointwasproducedinCambodiain1991,variousalignmentsystemsweredevelopedinColombia inthesameperiodand,gradually,improvementsweremadetothem.In1993,theICRCproduceditsfirstcomponentsmadeofpolypropylene.

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the icrc’s polypropylene technology: A brief history

Atthattime,orthopaediccomponentsweremadebyrecyclingmaterialleftoverfromtheproductionofsockets.

Today,inmostcountrieswheretheICRC’spolypropylenetechnologyisinuse,suchwastematerialisrecycledtomakecomponentsforwalkingaids.

The ICRC’s polypropylene technology has gradually developed sinceits beginnings. Components for all kinds of lower and upper limbprosthesesarenowavailable.

TheICRCchosepolypropyleneforanumberofreasons:• itisrelativelycheap;• ithasalongshelflife(itislong-lastingandcanbestoredeasily);• itrequiresveryfewothermaterialsinthemanufacturingprocess;• itiseasytoprocessandversatile;• itisrecyclable.

TheICRC’spolypropylenetechnologyhasbeendevelopedtomanufactureprostheticdeviceswiththefollowingconsiderationsinmind:• Thedevices/componentshavetobedurable,comfortable,andeasy

forpatientstouseandtomaintain;• Thetechnologyhastobesimpleandeasytoputintopractice;• Thedevices/componentshavetobecompatiblewiththeclimatein

differentregionsoftheworld;• The technology has to be inexpensive and consistent with

internationallyacceptedstandards;• Thetechnologyhastobeflexibleenoughtoaccommodatetheneeds

ofeveryindividual.

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the icrc’s polypropylene technology: A brief history

Connector,

Concave cylinder for

knee-joint small and

feet size between 22

to 28 cm with M10

bolt

Knee-disarticulation setup

Page 24 50

Hip-disarticulation setup

Page 26 50

Trans-Femoral prosthesis setup

Short stump

Very short stump

Connector, Concavecylinder for knee-joint

small and feet sizebetween 22 to 28 cm

with M10 bolt

Page 20 50

the icrc’s polypropylene system

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The design of the componentspermitsprostheticfittingateverylevelofamputationforthelowerandtheupperlimbs.

EVA sheet

soft socket

Trans-Tibial prosthesis setup

cotton

stockinette

long stump

very long stump

Page 22 50

description & setup

Working roundring tool

Rubberwasher

Stainlesssteel spring

(4) Pan headframing screw

Cup elbow,M6 T-nut

Rubber joint

Elbow shell

Washer

Screw M5

Foream

PP wrist unit,M10 T -nut

Hook

Lockinglever

Socket

Page 24 50

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polypropylene provides the core for the prosthetic system developed by the icrc. the injection process is used for making the components.

the other parts of the assistive devices (sockets, cosmetic covers, etc) are made out of polypropylene sheets using thermoforming.

In 2004, the ICRC was awarded the Brian Blatchford Prize by theInternationalSocietyforProstheticsandOrthotics(ISPO).Thiswasinrecognition of the ICRC’s role in making rehabilitation devices morereadily available by developing and propagating low-cost, high-quality polypropylene technology.This technology has become astandardinprostheticsandisbeingusedbyanincreasingnumberoforganizations.

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ThEBRIAnBLATChFORDPRIzE

“...inrecognitionofitsinnovativeachievements,particularlyinthedesignanddevelopmentofthe

polypropyleneprostheticsystem,whichovertheyearshasbecome

astandardforappropriateandlowcostprostheticservicesin

developingcountries.”

internAtionAl recognition

The ICRC has developed short training courses and manuals ofmanufacturingguidelinestointroduceprofessionalstotheuseof itspolypropylenetechnology.

Inaddition,theICRCSpecialFundfortheDisabledhashelpedaccreditedschools – those classified by theISPOas“CategoryII”–toincorporatepolypropylene technology intotheircurricula.

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1. LOWER LIMB PROsthEtIcsPhysical Rehabilitation Programme

PROSTHETICS & ORTHOTICS MANUFACTURING GUIDELINES

Using polypropylene technology

2. UPPER LIMB PROSTHETICSPhysical Rehabilitation Programme

PROSTHETICS & ORTHOTICS MANUFACTURING GUIDELINES

Using polypropylene technology

3. LOWER LIMB ORTHOTICSPhysical Rehabilitation Programme

PROSTHETICS & ORTHOTICS MANUFACTURING GUIDELINES

Using polypropylene technology

trAining resources

Every year, ICRC-supported physical rehabilitation centres use theorganization’spolypropylenetechnologytoproducetensofthousandsof orthopaedic appliances throughout the world. A large number ofnon-governmentalorganizationshavealsoadoptedthistechnology.

Overtheyears,severaltestreportspublishedbytheISPOhaveendorsedtheICRC’spolypropylenetechnologyforuseindevelopingcountries.2

TheICRCconstantlymonitorstheperformanceofitsvariousorthopaedicproductstoensuretheirhighquality.

TheICRC’seffortstowidentherangeofitsproductsthroughresearchconductedtogetherwithitssupplier3andtoimproveitspolypropylenetechnology are unceasing. As a result, these devices have benefitedrecently:kneeandhipdisarticulationprostheticjointsandprostheticfeetforlongtrans-tibialstumps.

2 “The [polypropylene] prosthetic technology [...] is an attractive and durable solution for trans-tibial amputees, which can be recommended, “ISPO report Field test on Trans. tibial prostheses (Heim & Jensen, 2000) page 54. “The ICRC polypropylene system do live to clinical acceptable standards” – ICRC polypropylene technology for Trans-femoral amputees (Raab & Jensen 2004) ISPO 11th world congress report 2004.

3CREquipements SA. Coppet, Switzerland (www.Crequipements.ch).

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A constAntly evolving technology About polypropylene technology

Polypropylenewasdiscoveredintheearly1950sbyanItalianchemist,Giulionatta(1903–1979).hewasawardedthenobelPrizeforChemistryin1963.

In1957,polypropylenewasproducedindustriallybytheItalianchemicalcompany,Montecatini.Itsoverproductionanditslowcostresultedinmanycommercialusesbeingfoundforthenewmaterial. Inmodernscience, inventions often occur in different places simultaneously.Polypropylene is an extreme instance of this phenomenon: it wasindependently invented about nine times. It is a near sibling to oneofitspredecessors,polyethylene.Likepolyethylene,polypropyleneisinexpensive,butitismuchmorerugged.Itisathermoplasticpolymerwith many applications – from plastic bottles to carpets to plasticfurniture–andisveryheavilyusedinautomobiles.

Twotypesofpolypropyleneareusedinprostheticsandorthotics:

Co-polymer(morethan5%polyethyleneisusedinthepolymerizationprocess);Homopolymer(lessthan5%ofpolyethyleneisusedinthepolymerizationprocess).

Polypropylenecan’tbedissolvedandisdifficulttoglue.ItisUV-sensitivebutcertainadditivescanmakeitmoreresistant.Itbecomesmorebrittleatlowtemperatures.

Polypropylenecanbemadelessbrittleandmoreflexiblebymeansofco-polymerizationwithpolyethylene.

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A constAntly evolving technology About polypropylene technology

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public Ations And films

MoreICRCpublications,technicalresourcesandfilmsareavailableon www.icrc.org

Physical Rehabilitation ProgrammeTRANS-FEMORAL PROSTHESIS

MANUFACTURING GUIDELINES

MISSION

The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization whose exclusively humanitarian mission is to protect the lives and dignity of victims of war and internal violence and to provide them with assistance. It directs and coordinates the international relief activities conducted by the Movement in situations of conflict. It also endeavours to prevent suffering by promoting and strengthening humanitarian law and universal humanitarian principles. Established in 1863, the ICRC is at the origin of the International Red Cross and Red Crescent Movement.

International Committee of the Red Cross19 Avenue de la Paix1202 Geneva, SwitzerlandT + 41 22 734 60 01 F + 41 22 733 20 57E-mail: shop.gva@icrc.orgwww.icrc.org© ICRC, June 2007Cover photograph and inside photographs (unless specified): ICRC/PRP

PolyProPylene TechnologyPhysical Rehabilitation Programme

0913

/002

0

6/20

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PolyProPylene Technology