Innovations in soft prosthetics are revolutionizing patient care by improving accessibility and outcomes for individuals with limb differences. This article explores the key factors driving these advancements and their impact on rehabilitation and accessibility.
Improving patient outcomes
One of the most important factors in patient outcomes is how closely different medical disciplines can work together in multi-disciplinary teams. The effectiveness of such multi-disciplinary teams is greatly improved if they can be co-located. A second factor is how quickly rehabilitation can occur. Dr. Geoff Watson highlighted this factor in his blog: https://www.lsngroup.org/post/bridging-healthcare-gaps-through-mobile-clinics-stepin-s-journey-from-iraq-to-ukraine
Geoff wrote of the importance of recognising that recovery should start from the moment a person is injured with rehabilitation pathways in place prior to injury
“Getting it Right First Time means resuscitation, life-saving interventions and early surgery have to be coordinated and planned before the trauma occurs; from the frontline to distant rehabilitation centres. That physical distance is also illustrative of the difference in the mindset of those fighting to save a life, to those seeking to help a survivor return with dignity and purpose to their families and communities”.
Building independence early
As Geoff wrote: “Building independence early is crucial in the rehabilitation journey of an amputee; leading to enhanced quality of life, increased self-esteem, smoother reintegration into society and a reduced burden on caregivers.”
“The impact of an integrated recovery and rehabilitation programme is optimal only if it involves a multidisciplinary team including doctors, nurses, prosthetists, physical therapists, occupational therapists, and psychologists. Engaging friends and family early and integration of the pathway with joined-up thinking is key.”
What difference does the speed of fitting and adaptability of the prosthetic socket mean for amputee support services?
The simpler and more repeatable the process for fitting a new amputee with their first prosthesis, the greater the opportunities to start the rehabilitation process in settings other than traditional prosthetic clinics. We are therefore likely to see a trend towards a more distributed approach to amputee services, a model captured in this blog:
Crucially, these newly enabled processes will also tend to increase standardisation in patient experience and reduce variation in clinical practice. As Deming noted “variation is the enemy of quality”, so we should expect new pathways to be associated with an improvement in quality of care and therefore outcome.
In a humanitarian setting, we may see such services integrated with mobile models of healthcare in this blog:
Case studies and global insights
Crucially, prosthetics which are simpler and faster to fit, can transform the accessibility of prosthetic services. Traditional designs often require multiple visits to a clinic as well as access to specialist workshop facilities. New designs using soft prosthetics such as those of Koalaa can transform access.
This has been illustrated by ground-breaking programmes around the world. Project Limitless was launched in December 2020 in a private public partnership including a consortium of UK charities.
Project Limitless initially provided children aged 3-9 with a revolutionary new prosthetic technology; one that is easy to put on and take off, is light and soft to the touch and grows with the child adapting to their changing needs such as eating, riding a bike, playing an instrument and even surfing!
The approach avoided the need for hospital visits as the children received their new prosthetics through the post with online support for their parents, thereby taking pressure off the NHS at a time when access to clinics was severely restricted. Each child has also been provided with peer-to-peer support, with limb buddies guiding them through their journey every step of the way.
Project Limitless was hugely successful in its aims, rapidly getting prosthetic arms to over half the 3-9 year olds with an upper limb difference across the UK without any of them needing to visit a clinic. Wearer acceptance has been very high at over 90% and the ‘abandonment rate’ has been less than one-tenth of the 70% rate reported as normal by the NHS.
In 2021, it became apparent from requests received from parents, that Project Limitless needs to expand its remit – to increase our beneficiaries’ age range from age 3 – 9 to 3 – 18 in the UK enabling Project Limitless to help adolescents. The adolescent years are where new sporting activities, music and self-image all become crucial to development and mental wellbeing. The provision of a soft-shell prosthetic arm to young people in this category can enable them to take part in these and other activities, giving them more social contact and enhancing their self-confidence. Later in 2021 the scope was expanded again to also infants under the age of three.
The potential to fit high volumes of people effectively and efficiently was demonstrated in August 2021 at a LimbBo Foundation adventure day for children at Cawthorne Cricket Club in Yorkshire, England. A small Koalaa team successfully fitted prosthetic arms to over 30 new wearers in a morning, enabling all of them to have a go at playing cricket. This was all done in a temporary gazebo in the middle of the cricket field and without any access to power or water.
These pioneering approaches have been built on around the world:
Syria – The first mobile fitting was delivered from a car which then led to larger scale a programme for Syrian refugees.
To date close to 100 Syrian refugees have been fitted with Koalaa upper limb prostheses through Physicians Across Continents (PAC) clinics. One of the insights from this programme was that hands-on training delivered face-to-face was even more effective than online training. There was a noticeable step-up in wearer satisfaction scores after Koalaa visited Turkey to provide PAC teams with in-person training.
The next stage is to develop outreach programmes so that people who are not near a clinic and are in different regions can have access to prostheses.
Ukraine– in Ukraine, a scoping visit by a multi-disciplinary team established proof of concept through a successful fitting of Dima, an Ukrainian soldier, swiftly followed up with a much larger programme through local partners. To date over 100 veterans have been fitted with Koalaa prostheses including several who have been able to start wearing a Day One sleeve immediately after amputation.
These ultra-soft sleeves go over dressings and cope with volume changes in the post-amputation period. Using these speeds up the time when the recovering veteran can move on to a heavier duty prosthesis, such as Koalaa’s ALX, and move on to full physical rehabilitation including upper body gym work.
Trial with H&I in Thailand/Cambodia – H&I are currently evaluating the clinical and cost-effectiveness of Koalaa prostheses after collaborative in person training in refugee camps in both Thailand and Cambodia. H&I staff were able to fit new wearers in less than 20 minutes each after the training session, including in non-clinical settings.
A Trial with ICRC in Lebanon – a face-to-face training session of ICRC clinicians in Beirut in September 2022 enabled ICRC to evaluate Koalaa prostheses in both Lebanon and Syria. As a consequencely, Koalaa soft prosthetics have now been added to the ICRC catalogue and supply chain and are available for use by all ICRC clinicians operating in 45 countries.
Sierra Leone – the majority of upper limb amputees in Sierra are unable to visit one of the four prosthetic clinics in the country due to cost or time constraints and, for those who do get to a clinic, there is frequently no prosthetic solution available. Koalaa has been working with the national health programme and has proven an innovative model that allows trained staff to visit amputee camps and fit prostheses from Koalaa kit bags, which about the size of a shoulder bag.
In conclusion, making prosthetic services more accessible is essential for improving the lives of individuals with limb differences, fostering a more inclusive society, reducing healthcare costs. Koalaa innovative soft-shell prosthetics illustrate how this can be done.
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