Most of our dentures are for children. These are mechanical prostheses of the hand and forearm. The Stradivarius bioelectric prosthesis from summer 2017 is tested by adult users. In the new year, we are starting to develop a children's bionic prosthesis .
A child's prosthesis should be appropriate for the child's age in size and weight. The weight multiplied by the sleeve lever determines the degree of hand fatigue. If the parameters do not match, posture may noticeably change, pain in the spine and joints may appear. The mass of the bioelectric prosthesis is the mass of the battery, motors and the receiving sleeve.
In existing prostheses, the battery is located in a cultured sleeve. In order not to increase it, you need a smaller battery and, accordingly, capacity. You can consider the option of "hot" battery replacement (3-4 times a day), use thin-film batteries or wait for the development of graphene batteries (and in the future, a nuclear battery). With motors it is more difficult: powerful + light = expensive, and power gives speed and force of compression. Suppose we give up the force. A child will be able to perform various manipulations with his hand, even folding gestures. But to lift and hold something heavy (at least 2-3 kg) will no longer be possible. You can sacrifice speed. But reliable and tenacious. Also controversial. Slowly bending and unbending the brush is not very convenient, and not high-tech. The absence of cheap powerful micromotors is a key problem in the development of a child prosthesis. Only a few companies in the world are engaged in the development of such engines, they are used in aviation, rovers, medical robots.
The second problem is the cost and the need to replace as the child grows. Bionic prostheses are rarely included in the program of children's rehabilitation, despite the recommendations of specialists . Replacing the liner will be required in six months or a year. The brush module will become noticeably smaller than the second hand in a year or two. The cost of a bionic prosthesis cannot be lower than 200 thousand rubles (the price of motor-reducers, individual production of a sleeve). And it turns out that such expenses will be needed regularly. How to solve this problem? Gearmotors are either 6 (for each finger, two for the thumb) and you can control the fingers separately; or one - then the hand makes only grasp in the pinch. According to the experience of adult users, the number of gestures does not matter, but the gripper (even one) must be reliable and fast.
Prosthetic liners are traditionally expensive. According to the general rules, they consist of 2 parts - an external rigid carrier sleeve made of laminated plastics or carbon, and an internal soft liner made of silicone or polyurethanes. There are a lot of materials and manufacturing techniques, each has its own advantages and disadvantages. Liners are made strictly on the mold, even if they are intended for use by fast-growing children. In addition, the constant wearing of a device that does not quite fit, can be painful and frustrating, even to the point of abandoning use. The classic liner manufacturing method is gypsum, carcass, resin and lamination:
The task is to come up with a sleeve that will grow with the child and be customized individually. A suitable option would be a skeletal system with an adjustable compression socket with a closing device for lacing. These sockets expand to provide a rapidly growing limb and allow the prosthesis to be used for a longer period of time between fittings. In addition, the skeletal sheath will be significantly easier.
Another way to solve a problem is to divide 2 processes. The sleeve is made individually every six months, in compliance with the new unanimous standard in terms of attaching the brush and placing the sensors. And the brush module is replaced as the child grows every 1.5-2 years and is reused by another child. With regular maintenance, the module will last more than 5 years, while maintaining the internal mechanics of the brush with updating the appearance as desired by the new user. Now, after a year of use, expensive foreign prostheses often lie on the shelf.
The third problem is the fragility of bionic prostheses. Not only do they react to moisture and magnetic fields, children use the prosthesis in different ways.
Max is rollerblading, on hockey skates.Worn, running, jumping.Sometimes it detaches the hand and uses it as a cudgel.And the same is done by his friends.An ordinary kid.Do not keep track .
We need a durable, maintainable prosthesis, preferably waterproof and washable. Otherwise, the prosthesis will be used only in special cases.
2. What is in Russia and the world
Prosthetics are recommended from year to year, sometimes even six months. Children are ready for upper limb prostheses when they begin to sit and use both hands - between the ages of 3 and 7 months. The advantages of early prosthetics are habit formation and symmetrical development of the muscles of the upper shoulder girdle. The child at this time is still difficult to cope with an active prosthesis.
Cosmetic prostheses - this is the likeness of a hand made of solid silicone or PVC. The grip is not done with such a hand, but the weight, though small, puts a strain on the muscles, and the child gets used to the right hand movements. Cosmetic prostheses also include in the IPRA of older children. But such a hand does not have a functional, and the fixed arm of the dummy looks quite suspicious, so children rarely wear a prosthesis.
Such a prosthesis is quite simple to get. In Russia, production is standardized, and regional prosthetic enterprises usually even have a supply of silicone shells in stock. There are no problems with the free issue either. With self-purchasing, the cost of a cosmetic prosthesis will be 20-30 thousand rubles.
In Germany, there are cosmetic prostheses with full details - hairs on the skin, acrylic nails - their cost is from 100,000 rubles.
Let's go back to the traction child prostheses that exist in the world.
In the US, prosthetic hooks are common. Different things can be clamped between two metal parts, the control is carried out according to the traction principle.
In the prosthetic enterprises of Russia, traction prostheses traditionally make five-fingered and use a cosmetic casing, the grip of the brush is carried out by movement in the elbow or shoulder girdle.
We also make prostheses anthropomorphic, but the design is far from imitating an ordinary hand. The prosthesis allows you to perform the gripper in the pinch, hold small objects, there is an adjustment of the force and sequence of compression of the fingers.
Each prosthesis is equipped with additional functional and gaming nozzles - for skipping rope, telephone, cutlery, flashlight - and even allows you to play computer / mobile games.
Traction dentures do on open source sites e-nable, open bionics and robohand.
The model uses a single charity platform for designers, owners of 3D printers and children who need a prosthesis. In open access lined files for printing items on household FDM printers. The advantages of Open source in the ability to make low cost products and bring to the work of new people from other areas from around the world. That robohand inspired us in 2013. Of the minuses - low quality, lack of full technical support, complex individual characteristics of the stump are not taken into account and there is no program for preparing for prosthetics and subsequent rehabilitation.
Separately, it is worth highlighting specialized “working” prostheses. These are prostheses for performing a specific narrow task. For example, riding a bike, archery or gymnastics.
And finally, children's bioelectric prostheses. These have long existed. Electrohand 2000 ad from Ottoboka in 1989 magazine:
The prosthesis has proven itself to be used by children, so for 30 years it has hardly changed:
For about 2 years, there is a female (he childish) prosthesis BeBionic. Its weight is 390 g (30% less than standard adult models), length is 16.5 cm. Such a hand can suit teenagers. The market price of the prosthesis is 1.5-2 million rubles. Last year, the company Steeper (manufacturer BeBionic) acquired Otto Bock, perhaps in a short time through the collaboration a new prosthesis for children will appear.
Touch Bionics and Vincent Systems, which are quite similar to them, also have a children's brush. The cost of the prosthesis is about 2-4 million rubles. Considering the functional limitations of modern prostheses - 2 mia sensor, stepwise selection of gesture, mounting complexity, low reliability and the need for annual replacement - such costs seem unjustified.
And our favorite bioelectric prosthesis Lego. It can not be used in life, but interesting design solutions.
In short, there are 4 classes of products - cosmetic, mechanical, working and myoelectric (bionic) prostheses of the hand.
Cosmetic prostheses perform a decorative function:
Benefits
disadvantages
Well proven in partial amputation of brushes
Lack of active gripper
Low weight
Very limited functionality
Ease of manufacture and use
Expensive customized silicone shells
Low maintenance costs
Low cost (with the exception of individual cosmetic shell)
Mechanical prostheses work on the principle of traction:
Benefits
disadvantages
Stable construction
Limited grip strength
Low weight
Limited degree of movement
Acceptable price
The system may be uncomfortable and limit movement.
Low maintenance costs
Moisture resistant, easy care
Myelectric prostheses have higher functionality and are currently the most modern prostheses:
Benefits
disadvantages
High grip strength
High price
Increased comfort and greater freedom of movement.
Increased weight
Ability to perform multiple gestures depending on the model
Fragile construction
Sometimes attractive futuristic design
The unreliability of the mechanism, frequent repairs
Battery charge requirement
Thanks to a variety of materials in the media about sensation of prostheses and control of the power of thought, it seems that the problem has long been solved, and that using open source, you can even today order yourself a cheap, modern prosthesis with full functionality. In fact, in the USA (Shriners Hospital, Los Angeles) they make such artificial limbs:
And this is today, perhaps, the most functional solution for Vadim: traction shoulder prostheses with two types of grippers - a hook and a crocodile.
3. What could have been (recent developments - implantation, feedback, several degrees of freedom)
Given the technological advances of the last 10-15 years, it is obvious that prosthetic hands are far behind the capabilities of our time. Interesting research is being conducted all over the world, but it is still very early to talk about mass use: - invasive electrodes for control - sensation of the prosthesis - the emergence of new degrees of freedom - neural interfaces.
The most interesting and promising projects:
DARPA MPL - osseointegration, invasive control, full arm prosthesis with the most similar kinematics, virtual learning
The prosthetic arm possesses 26 degrees of freedom, 17 of which are motorized, i.e. must be managed by the user. The control system of such a prosthesis is based on reconstructive surgery and / or sensors implanted into the pectoral muscles.
For the prosthesis of the forearm and shoulder, the developers stopped on the surface EMG electrodes in the prosthesis of the forearm 4 electrodes are used, in the shoulder - 8. The electrodes are made in the form of a bracelet that also contains an assembly of inertial sensors (gyroscopes, accelerometers), which allows you to set the prosthesis modes depending on arm movements in space. Using a larger number of sensors allows you to calculate some patterns of phantom gestures, which significantly increases the number of programmable grip on 1 mode to 5-6 (instead of 1-2 for commercial prostheses). However, a greater number of sensors require more fine-tuning and the probability of failures and false recognitions increases. In addition, there is the problem of rigid fixation of sensors, which makes the use of the bracelet extremely inconvenient (the bracelet squeezes the arm strongly).
OPRA Osseointegration - osseointegration, invasive management A feature of the prosthesis is the absence of a culture-receiving sleeve, instead of which a titanium probe is used, implanted into the bone by the osteointegration method. The difficulties of the existing osseointegration technologies lie in the fact that the average lifetime of titanium implants is 5 years, after which a second operation is needed to replace the implant.
LifeHand 2 - invasive control, sensation of the prosthesis (integration of feedback sensors with the human peripheral nervous system) The main goal of the research is to create a bi-directional biological prosthetic control system. Those. the same electrodes must read the control signals from the peripheral nerves of the stump to which they are connected, and also transmit the reverse effect from the sensors located in the hand.
It should be understood that the prostheses of the three projects presented are not commercialized, are under development and are not available for installation. But a company has already emerged that wants to introduce prostheses LUKE arm (DARPA). In the design of the DARPA prosthesis, the most advanced military and civilian technologies (engines, batteries, materials) are used, because of which, according to the most modest estimates, the cost of the prosthesis exceeds $ 100,000
In our experience, it is not so much the functionality of the prosthesis that is important for children as its appearance (although it is the opposite for parents). A robot hand, a wonderful gadget, a stylish accessory is an opportunity to show that it can be interesting to be special. There are many questions to the anthropomorphic form. Given the nature of control and the presence of only 2 channels of information transfer (traditional 2 myo sensors), the presence of 5 fingers is unnecessary. All we can do now is bend and straighten the brush.
The hand may look like this:
Or so:
Most dentures look like an ordinary hand, or rather, a dummy's hand. The traditional way in the design of the prosthesis is an imitation of the skin. And we find ourselves in the “Ominous Valley”. I do not want to go this way. Children are much more tolerant and, perhaps, more eccentric than adults who mask injury.
Prosthesis as a glove:
Or terminator hand:
For Mercedes-Benz Fashion Week this year we made 2 such prostheses:
There are interesting options when there is a smart filling and a removable frame that can be changed to your taste:
5. Our offer
Child prosthesis should be smaller, lighter, stronger. A traction prosthesis is a convenient, simple solution, but everyone wants a roboruku. The bioelectric prosthesis will allow retaining heavier objects, has greater maneuverability and the possibility of gestures.
The prosthesis should look cool. Iron Man, Terminator and Luke Skywalker showed the children that this is quite possible.
The alternative for today is cosmetic dentures, active traction and bioelectric prosthesis of the forearm from Otto Bock (price from 500,000 rubles).
What we want to do: an affordable (or rather, even a free IPRA ) children's electronic prosthesis. In the first version, the gripper will be one (due to weight, cost, and reliability). It should look interesting, until we decide how to argue; there will be removable, replaceable parts or even the entire case.
Functionality: let's try to highlight what's important and possible today.
- keep items of different shapes (use cutlery, a pen, type on a keyboard, hold a stylus for touch screens or make a conductive tip on the prosthesis itself) - streaming control system: speed and force of compression are controlled in proportion to the strength of the signal received from the muscles - a wrist joint that allows flexion, extension and rotation. Such flexibility when using the prosthesis will allow to get rid of compensatory movements of the hand and body. - prosthesis as a digital device with smartphone functionality.
In addition, we are currently working on a new system for removing the signal from the arm muscles. We plan to apply this in a children's prosthesis, to use immediately 4 EMG sensors of our design, which will allow recognizing up to 10 gestures in real time (for a forearm prosthesis). Such a control system is necessary to create a second, more functional version of the prosthesis. She will have not only sufficient strength characteristics, but also perform a certain set of gestures.
If you want to join the development or have ideas on the mechanism, design, prosthesis design, use experience, we invite you to our working chat: t.me/cyborgsamongus We continue the discussion in the format of a dialogue.
Conclusion
Baby dentures can and should be more convenient, more useful and, probably, more fun than the current ones. Prosthetic gadget, prosthetic toy. And while parents ask themselves: can their child with a prosthesis do what other ordinary children do — their children fantasize about their supernormal abilities and how they can still use the new roboruku.