60 Minutes features NC State alumnus and his prosthetics research
~posted 04.17.2009

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Jonathan Kuniholm—recipient of a 2009 College of Design DESIGNsmith distinction for visionary alumni—was featured on 60 Minutes’ April 19 broadcast. NC State magazine, a benefit of Alumni Association membership, covered him in this Spring 2008 article.

A Helping Hand: Kuniholm’s mission to build a better prosthetic arm isn’t just business. It’s personal.

Three years ago, Jonathan Kuniholm ‘02, ‘03 MID MS was installing a ceiling fan in his 5-year-old son’s bedroom. It was a project that would have taken about 15 minutes if he had both his arms.

Earlier in 2005, the Marine Reserve captain had returned to the U.S. from Iraq after being injured in an insurgent attack that killed a fellow soldier. Bleeding but still conscious after the attack, he knew that he would lose much of his right forearm, including his dominant hand. But after surgery at Duke University Medical Center, Kuniholm declined the common treatment protocol for a lost arm: up to two years’ stay at Walter Reed Medical Center in Washington, D.C. He opted instead for outpatient visits that wouldn’t take him away from his son, Sam, and his wife, Michele Quinn, an obstetrics-gynecology resident at Duke.

“I was a very bad patient,” he says. ”[Full residential treatment at Walter Reed] would have included daily visits to occupational therapy, tasks like moving little things back with Velcro, sticking pegs in holes. I was reasonably good with that stuff quickly. I didnt have a lot of time to hear somebody with two arms tell me how to tie my shoestrings.”

He had no choice, though, but to take his time when installing the ceiling fan in Sam’s bedroom. He balanced on a ladder, using his left hand to turn screws and his prosthetic, which he had gotten about six weeks earlier, to keep the fan in place. Sam would scramble to pick up the screws Kuniholm dropped. It took hours to finish the job, and he was frustrated. Shouldn’t it be possible to build a more effective prosthetic arm?

Most artificial arms and hands don’t come close to duplicating the motion of human limbs. Kuniholm estimates that many tasks he could do pre-amputation take as much as three times longer. It’s difficult for him to sign receipts because the metallic hook prosthetic he most often uses doesn’t have the “stickiness” of the natural ridges on human fingertips. And he can’t play bass and guitar anymore.

It wasn’t long before Kuniholm channeled his frustration. A doctoral student in biomechanical engineering at Duke University, he switched his research focus from nanotechnology and high-tech atomic microscopes to prosthetics research.

He also enlisted the help of his partners at Tackle Design Inc., the Durham industrial design firm he co-founded in 2003 with Jesse Crossen ‘04, Chuck Messer ‘00 MID, and Jason Stevens ‘01, ‘02 MSE; and engineer Kevin Webb, a UNC-Chapel Hill graduate.

With Kuniholm leading the way, Tackle created the Open Prosthetics Project (OPP), an initiative that encourages engineers, prosthetic users, robotics experts and garage tinkerers to work together to improve prosthetic technologies and make them more available to the people who need them. On some occasions, Tackle’s engineers and volunteers build prototypes that they send to amputees for testing. They disseminate their findings online, at the Web site www.openprosthetics.org, where visitors can ask questions, make suggestions or share their own improvements to prosthetics. Designs are posted online, for anyone to see, and it’s Kuniholm’s hope that, with Tackle’s technical know-how and the OPP’s give-and-take feedback, the project will yield ideas that will soon become products.

Efforts to improve on existing prosthetic technology are long overdue, the partners say. When they learned of Kuniholm’s injury, his colleagues researched the available prosthetics for upper-extremity amputees. “We found the latest stuff was ‘80s technology and the predominant [prosthetics used] were from World War I and World War II,” Messer says. “We were like, ‘What have they been doing?’ ”

Their research also soon revealed barriers to innovation. The challenge of producing prosthetics is making ones that can be customized to fit the amputee’s unique needs, a problem made more difficult by the complex architecture of the hand. “Think of what you can do with your hands as opposed to your leg,” Kuniholm says.

The hand works as a system with the palm and the forearm, whose muscles animate the fingers and thumbs. Using almost 30 joints and another 30 muscles, the hand not only opens and closes, but enables humans to do tasks like grasping a pencil, pointing and threading a needle. By contrast, the legs and feet don’t have the same capacity for the fine motor skills required to bead a necklace or button a shirt.

Those factors have made advances in prosthetic technologies for lower extremities easier to pursue. In January, the track-and-field world governing body determined that the state-of-the-art carbon-fiber prosthetics used by South African runner Oscar Pistorius “should be considered as technical aids which give him an advantage over other athletes not using them,” rendering him ineligible to participate in Olympic qualifying events. Born without fibulas, Pistorius had both legs amputated below the knee when he was 11 months old. A professor affiliated with the Institute for Biomechanics and Orthopaedics at the German Sport University in Cologne determined that using the prosthetics Pistorius was able to run at the same speed as able-bodied sprinters while expending about 25 percent less energy, according to the statement issuing the decision.

That’s a sharp contrast to the type of results upper-extremity amputees can expect using even the most sophisticated technologies. Kuniholm’s first prosthetic was a myoelectric limb, which works by sensing the tiny electric signals sent from the remaining part of the arm or other residual limbs. But though the myoelectric limb is the prosthetic most commonly used for several decades, it has its limits.

“The wrist has a clutch in it,” Kuniholm says, “and mine was too weak to turn a doorknob.” Unable to do such a simple task, he tried a body-powered prosthetic, which typically use rubber bands, cables or harnesses to connect to another body partoften the shoulderthat propels its movement. He finally settled on a body-powered hook to which he can add attachments, such as a stylus to do engineering sketches. Does it work well?

There are other barriers beyond the technical challenges to improving existing prosthetics. Only 50,000 to 100,000 of the 1.8 million amputees living in the U.S. are missing an upper extremity, according to the National Limb Loss Information Center. From the perspective of an industrial manufacturer, Messer says, creating a product for a market that size isn’t worth the effort and investment. And that’s assuming it can be mass-produced, which might not be possible with such an individualized product.

Government funding has helped fill some of the void. Kuniholm also works as a subcontractor for a $65 million Defense Department-funded upper-extremity research and development project, called Revolutionizing Prosthetics, at John Hopkins University in Baltimore, Md. That project might be the largest chunk of money devoted to upper-extremity prosthetic research, with ambitious aims of producing a prosthetic that would take its cues straight from the brain and its associated nerves, as well as simulating a human arms freedom of movement. Kuniholm points out, though, that while the funding is a welcome help, he isn’t optimistic that it will be enough to realize the project goals.

The low-budget OPP is another approach to making useful changes to prosthetics. “The general idea [in business] is that you don’t show anybody anything until you’re done,” he says. “But good ideas are not worth as much as you think they are. There’s a lot more to getting something to the stage of being a viable product. My partners convinced me there was no way we could make money [in prosthetic design].

“My first reaction was ‘I don’t really care, I’m scratching my own itch.’ But Kevin said if there’s no market for it, why not do it as open source. We were trying to satisfy our own desires first, but the hope is … that we create enough buzz that we can get others to help us and achieve more than we could otherwise.

The project is part of the Shared Design Alliance, a nonprofit chaired by Messer that works to promote the concept of open design, the same principles that guided computer programmers working on open- source software such as the Linux operating system. The approach runs contrary to business models in which ideas and products are considered proprietary and belong only to their owners. With Linux, programmers made the source codethe valuable foundation of the programavailable so anyone could modify it without threat of fines or punishment for patent infringement. The theory was that the open exchange of ideas and broad participation would lead to a better product that would benefit more people and be able to adapt more rapidly than those produced with traditional business models.

The OPP operates in much the same way. Kuniholm reads online postings about issues amputees face with their prosthetics, and those tidbits can become the basis for improvements. Some ideas, like an experimental hand and wrist made by Tackle volunteers from Lego pieces, which can mimic the twisting motion of a real wrist, are whimsical; others involve reworking elements of existing technologies with the goal of getting better prosthetics to the users as quickly as possible.

Kuniholm has enlisted the help of engineering students and faculty at NC State and Duke to help realize that goal. An example are improvements two NC State graduate students in biomedical engineering are making to the Trautman hook, a prosthetic with two grasping “fingers” and a post that connects to the arm socket. A cable and rubber band system connects the hook to muscles, which propels its movement. The fingers automatically close when the muscles are at rest. The very simplicity of the hook, designed in the early 1900s, has made it an enduring favorite among upper-extremity prosthetic users. But it’s no longer being produced, which means there’s no ready source of new parts for those who continue to use it. And they do break; Kuniholm talked with one Boeing employee and amputee who had welded his hook back together more than a dozen times.

Kuniholm and the graduate students, Andy Richards and Richard Shoge, asked OPP subscribers to send them their broken Trautman hooks, noticing that they were broken in similar places. The students will redesign the hook this spring during a special seminar taught by Ola Harryson, an assistant professor in the Edward P. Fitts Department of Industrial and Systems Engineering. Options they’re considering include fashioning them from a sturdier metal than stainless steel, such as the more expensive titanium; adding ridges that provide better structural support; or adding curves that change the hook’s look and redistribute impact. They’ll make a prototype of the hook and send it to an amputee for field-testing. The plans for the improved Trautman hook will be published online, along with estimated costs and suggested manufacturers for individuals who want to get one made for themselves. “The day after we get done with it, a person can take it and make their life better,” Richards says.

Three undergraduate students in the Department of Industrial Design are taking on a different OPP project, working with department chair Bryan Laffitte ‘86 ms. They’re designing a plastic version of the split hook, or Dorrance hook, the world’s most popular terminal device (the Trautman hook is a variation on the split hook). The reason? A plastic hook would be less expensive. Many amputees in developing nations currently must make do without prosthetics because they can’t afford them. A prosthetic that could be produced cheaply could radically change their lives for the better.

The number of subscribers to the OPP list is smallfewer than 100 peoplebut highly engaged. Patrick Early of Shreveport, La., follows the Tackle projects with interest, visiting the Web site regularly to check its postings. He lost a hand in a washing-machine accident when he was 12. He’s now 51, and the type of prosthetic he used as a pre-teen then is still used today because the technology hasn’t evolved.

Early has three different prosthetic devices: one for driving; a body-powered one to which he attaches hooks with different grippers; and a top-of-the-line myoelectric limb that he calls a “wall hanging” because he uses it so rarely. It needs structural repairs to make it fit adequately and a new switch. It has an expensive battery he has to constantly recharge. Plus, the electrodes that sense the muscle signals to move can corrode and short because they are exposed to human sweat.

Early has never been able to bounce a tennis ball and catch it on the rebound with his myoelectric hand due to its slow response time. His dream prosthetic would enable him to flex his mechanical wrist at a greater angle, cup his palm and independently control some of his prosthetic fingers. “The core difficulty has long been one of a failure to communicate,” he says. “Failure by amputees to effectively organize and communicate their desires for better tools; failure by prosthetologists to look outside their narrow fields for new technologies, techniques, materials and tools; failure by scientists and engineers to take that small additional step and ask, ‘What else might this be useful for?’ ”

That’s one of the questions that Kuniholm is trying to answer. Under his guidance, engineering students at Duke are testing rubber tubing to develop more durable bands for body-powered prosthetic devices. Such bands get dirty quickly due to their contact with the body, tend to crack and often last only several months. Those bands may be the first commercial product to come out of the project; the OPP is in talks with a possible manufacturer.

Everyone sees ways to make it easier to interact with the world around them, but that’s especially true for engineers, Kuniholm says. “My goal is that no upper-extremity amputee in particularor any amputee in generalwould have to think that there was something that they could imagine that would make their life easier that they could not have.”

For his part, Kuniholm has several things on his wish list. He’d like to work on a prosthetic that would enable someone missing a forearm to pluck the strings of a bass or strum a guitar. He’d like a prosthetic that would make it easier to handle the buckles on skis and snowboards. And, he says, “I’d like to be able to do a Rubik’s Cube. We are nowhere close to that.”

Written by Cynthia Greenlee-Donnell
Photographed by Christopher Sims