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imagine you are walking to school going
about your daily routine you've done it
a hundred times before except today
today you stand on a bomb
the blast throws you into the air and
you land several meters away at least
part of you does your legs are no longer
attached to your body and in that moment
your life changes the prospect of going
shopping with friends driving a car and
even going to the toilets have changed
forever but what happens next this is
where prosthetic limbs come in a
prosthesis is a device that replaces any
bodily function in this case a limb you
might start thinking about the different
things that you've seen in the movies or
perhaps you're a fan of Strictly Come
Dancing and you remember Johnny peacock
with his running blades they were all
pretty different some are arms
some are legs some are made from wood
metal and other materials but they've
all got one thing in common they need a
way to attach to the body and usually
this is done using a prosthetic socket a
socket is basically a bucket that you
attach one end of the prosthesis to and
stick what's left of the limb into the
other end and this is the part that
interests me most I am a biomedical
engineer which means I look for
solutions to medical problems and I'm
currently doing my PhD at Imperial
College London with the center for blast
injury studies I want to use my
interests and skills to help people
which is why I've chosen to research a
way to improve the quality of life of
amputees specifically those who have
lost one or both legs by improving the
design of prosthetic sockets
let's go back to the beginning of the
day we stand on a bomb this might sound
like a pretty unrealistic story to you
but this is something that happens
everyday to multiple people around the
world children going to school or
soldiers on patrol for now let's follow
the journey of an average British
soldier let's call him John on the day
he loses his legs
John is 19 and serving in the British
Army and one day his Patrol is cut short
because he steps on a bomb what happens
for John next John is airlifted out to
the field within 10 minutes and taken to
a nearby airfield for emergency surgery
the surgeons are ready and waiting to
perform this incredible life-saving
surgery and many hours later John comes
out of surgery he's alive and his wounds
have been cleaned and tidied but there's
still a long way until John is fully
recovered later that day John is
transferred back to the United Kingdom
where he is staying in the wing
specifically for injured military
personnel to recover unfortunately John
has to have another surgery on his legs
to clean out an infection that has
developed and then he continues with his
recovery but this isn't the end of
John's treatment his wounds are healing
he's alive and he's on the mend
physically but this is just the start of
John's rehabilitation journey John then
moves to the residential rehabilitation
centre so he can continue his
physiotherapy with the hopes of being
fitted with prosthetic limbs so that he
is able to walk again rather than having
to rely on a wheelchair for the rest of
his life the prosthetic fitting process
for a prosthetic socket has been nearly
the same for over a hundred years now to
put that into perspective that's before
the invention of the ballpoint pen ready
sliced bread post-it notes and
sunglasses
a prosthetist takes a plaster cast of
the residual limb and uses it to create
a negative which is the same shape as
the limb that is left the processes in
shape this model to make it smooth
before using a technique called vacuum
forming to pull plastic over it and
create the socket this socket probably
needs a bit of changing though because
when the process takes it to John to try
on it's not very comfortable it's
pinching in places and is hurting a bit
the process is pretty similar to when
you buy a pair of shoes you slip them on
and see if they're comfortable they seem
it but then you walk up and down the
shop to see if they rub a big difference
though is that because of the damage to
John's legs he's had a lot of
reconstructive surgery which means that
his skin is delicate and his nerves have
been damaged when he thinks that the
socket is comfortable he tells the
prosthetist and the rest of the limb is
fitted out with the latest computerized
joints John starts to use his prosthetic
limbs to learn to walk again but a few
days later he has to take his legs off
and stop wearing them he has pressure
sores they're blistered and bleeding
John's legs aren't used to the pressure
that's on them so the limbs have started
to break down the rest of the limb is in
perfect condition but the socket just
isn't right and there's nothing John can
do except wait for his wounds to heal
this is the experience of many amputees
it doesn't matter how great the rest of
the prostheses is if the socket is
causing problems the prosthesis can't be
worn this person is a Paralympic
medalist and he experiences these
problems too he's got really advanced
prosthetic running blades yet when his
socket isn't fitting properly he gets
the same issues and can't wear them
imagine you buy the shoes in the shop
they're made by your favorite designer
they look really cool and they go with
all your outfits
but they give you blisters would you
wear them I mean probably he spent money
on them and they look good besides you
can wear them for a short while and then
take them off or perhaps you decide
actually the more hassle than they're
worth and you pick another pair to wear
while these live on the shoe rack but
what if these were your only pair of
shoes and without them you couldn't walk
what would you do then this is the
choice that amputees have to wear legs
which will cause them pain and
potentially more damage or be
wheelchair-bound
my research is to address this to
provide a solution to sockets the cause
damage to the residual limb but without
relying on the feedback from amputees
due to the damage to the residual limb
many amputees can't feel the way you or
I can which means that pressure sores
can develop without them knowing
sometimes in just a few hours and when
they take off their processors there's
blood in the socket I'm also trying to
do this as low-cost as possible
personally I believe that's one of the
most important things about what I'm
doing solutions need to be affordable
not only so our National Health Service
can provide it but also thinking about
the wider world so many of worlds
amputees are in low and middle income
countries where people just can't afford
to spend on their own health care I'm
using pressure sensors inside the socket
to enable processes to see what's
happening inside there are a hundred and
forty four of them arranged in 12 strips
of twelve senses as you can see in the
image it doesn't rely on what the
amputees can feel but as objective
information the sensors transfer the
information to a computer where a 3d
model is shown with a color map to show
where areas of high and low pressure are
it's being designed to work in
time so that as the prosthetists sorry
as the amputees walk around the
prosthetists can see the changes in
pressure the processes can then use this
information to design individual
prosthetic sockets prosthetic socket
design is a really difficult thing not
only does the socket have to function as
the connection between the body and the
prostheses but it has to be lightweight
tight enough to stay on but not too
tight so that it causes more injury and
the socket can't be the same for
everyone because everyone's injuries are
different but and that's because of the
cause of injury the amount of damage to
the limb and every surgery is different
surgeons use different techniques
depending on the circumstances of injury
the resources available and the training
that they have undertaken in a different
combination of all these things for each
amputee means that processes have to be
really skilled to give amputees the
opportunity to learn to walk again
having people involved in the making of
technology is so important because the
different perspectives need to be heard
what the amputees want compared to the
surgeons compared to the prosthetists
might all be slightly different there's
no point making something the I as an
engineer think is great but no one knows
how to use or it doesn't do what's
required I work together with the
surgeons who perform the amputation
surgery the prosthetists who design and
fit the prostheses the amputees who wear
them and the physiotherapists who he
helped rehabilitate them to find the
best possible solution for all working
with different people allows me to
create something that works for as many
people as possible by understanding the
whole journey from amputation through
rehabilitation and on into the amputees
lives one person's best is not always
the same as someone else's
going forward I want to use the
information that we get from the census
not only to help clinicians with their
treatment but also to inform the design
of prosthetic sockets as a whole I can
use programming and data analysis to
find patterns in the data perhaps I can
find out which surgical techniques lead
to the most well fitting sockets or
maybe I can see what type of sockets
lead to the most pressure sores this
information will allow us to inform
policy and best practice to minimize the
development of pressure sores and skin
breakdown to improve the lives of
amputees around the world I am NOT a
medical doctor and I don't treat
patients I am an engineer using my
skills to help people I'm not using the
newest most exciting technology that you
might hear about on the news but nor am
i creating something that is so
expensive that only a few people will
benefit from it the technology that I am
creating is low cost and easy to use and
is designed to improve the quality of
life of the increasing number of
amputees around the world by working
with those who know most about the
issues faced
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you