The Alternative Prosthesis

Final report internship Sri Lanka 2002

September 2002 – Colombo - Sri Lanka,

February 2003 Delft – the Netherlands

Authors: Boudewijn Wisse - IO9964426

Wouter van Dorsser - IO9195386

Mentors: Johan Molenbroek

Henk Kooijstra
Jan Witte

Counterpart: Consortium of Humanitarian Agencies,

Malathi Thalgodapitiya
 The Alternative Prosthesis TU-Delft 2002-2003 Wisse & v Dorsser

1. Preface Support in Sri Lanka

In the fist place we have to thank the Colombo
Amputees, prostheses, Sri Lanka, the great
Friends in Need Society, especially the Colombo
experiences and people we met. For already a
headquarters. Within the CFINS-C we have to
full year they are daily on our (Wouter and
thank Ms. Kalyani Ranasigne (president), Ms.
Boudewijn) minds. It’s not finished. It never will
Rupa Jayasekera (administrative secretary), Mr.
be, I guess, not as long there’s war and poverty.
Francis (chief foot and polypropylene department)
But this project feels unfinished in particular,
Mr. Nepala (chief aluminium department), the
because it’s potency. The problem is defined, a
employees (the "boys" at the workshop, who were
solution at hand, but implementation is still
extremely friendly to us) and of course we also like
difficult.
to thank all the amputees who were willing to help
With this report we hope to encourage and to us and gave us feedback on our ideas. Besides
inspire the reader to find ways to improve. To these people we like to thank Ron McGaw, a
improve prostheses, to improve the world, to prosthetist from the United Kingdom, who was
improve your and our experiences and to inspire always willing to assist us with his knowledge and
all the fantastic people we met. People who evaluate our ideas.
inspired us in the first place.
Outside the FINS we like to thank our neighbours
Support in the Netherlands who cared for us like parents. Also we like to thank
Prof. Dr. Anton Jayasuriya, who offered us the
First of all we have to thank Dr. Henk Kooistra great opportunity to speak on the world congress
who initiated the project and later supported us of "Medicina Alternativa".
in Sri Lanka. Johan Molenbroek, teacher of the
subject "Design for All", and Inne ten Have who For our support in Sri Lanka we like to thank
inspired us during the analysis, just as Jan van Malathi Thalgodapitiya, our counterpart working at
den Berg from the Dijkzigt Hospital who helped the Consortium of Humanitarian Agencies.
us understanding the medical aspects of
designing a prosthesis. Last but not least we have to thank our parents for
their never failing support in every situation.
Financial support
The Fleur Groenendijk foundation made
everything possible financially. We also like to
thank Karin Paasen and the “Fonds
Internationale Stages” (TU Delft).
Team
Happily, Farshad Soleymani and Michelle
Kriesels (designers as well) teamed up with us
in Sri Lanka. Together we were able to produce
these results. Barbara de Nooijer, who lived with
us in Sri Lanka, supported us with ideas as well
in other ways.

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2. Contents
Appendix
1. Preface........................................................1 A. Problem definitions ...................................... 1
1. Preface........................................................1 A.1. Summary start ................................ 1
2. Contents .....................................................2 A.2. Analysis (NL) .................................. 2
3. Summary ....................................................3 A.3. Research and Development (SL) ... 2
4. Introduction................................................4 B. Figures ........................................................... 3
5. Project history............................................5 B.1. Sri Lanka: ....................................... 3
5.1. Start & Initiation 5 B.2. Properties of Amputees .................. 5
5.2. Analysis (NL) 6 B.3. Worldwide....................................... 8
5.3. Research and Development (SL) 8 C. List of references.......................................... 9
5.4. Finalization (NL) 9 C.1. UN................................................... 9
6. Developing alternatives for developing C.2. Consortium of Humanitarian
countries...................................................10 Agencies......................................... 9
6.1. Process 10 C.3. CFINS - Colombo ........................... 9
6.2. Collecting Information 11 C.4. CFINS - Kandy Branch ................. 10
6.3. Sharing information 12 C.5. Army ............................................. 10
7. Developing Prostheses in Sri Lanka .....13 C.6. CT, the Cambodia Trust ............... 10
7.1. Current designs 13 C.7. ICRC ............................................. 11
7.2. Current production situation 13 C.8. WHO ............................................. 11
8. Recommendations ..................................14 C.9. Medics .......................................... 11
8.1. Final product proposal 14 C.10. Team Design for All ...................... 11
8.2. Optimisation 15 C.11. Experts in NL ................................ 11
8.3. Project continuation 15 D. Current designs .......................................... 12
8.4. New projects 15 E. The Friends in Need Society...................... 13
9. Conclusion ...............................................16 E.1. Departments ................................. 13
10. Evaluation.................................................16 E.2. Internal research........................... 15
F. Contacts and Residences .......................... 16
G. Price estimation .......................................... 17
H. Flowchart – socket designs....................... 17
I. Flowchart – foot design ............................. 17

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3. Summary
These are the results of a project in which a new
concept for prostheses for the trans-tibial
(below-knee) amputees of Sri Lanka was
developed.
Although civilian landmine victims are a minor
cause, Sri Lanka copes with a shortage of care
for amputees. The lack of prosthetists is the
bottleneck, resulting in a low production capacity
of prostheses and little aftercare.
Other problems include: Price, locating
amputees, difficulties distributing prostheses and
the long time needed to fit, produce and adjust
prostheses.
Research trails and prototypes strongly suggest
that the situation could be improved with an
alternative for trans-tibial prostheses, in this
report presented as the “DFU” (Designed For
You)..
Though the design philosophy is very strong, the
actual design is not optimised and could still be
altered. Therefore this project needs to be
continued, so the design will be implemented
and much more trans-tibial amputees can be
helped.
Not only trans-tibial amputees will benefit fin
such a way. The freed production capacity can
then be used to produce above knee prostheses
or otheses.

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 The Alternative Prosthesis
4. Introduction
This report contains the results of the “The
Alternative Prosthesis” project done from March
2002 till March 2003. Although this is the “final”
report, continuation of the project is still sought.
The project focused on the design of a new
concept for below-knee prostheses. The project
team consists of students of the Delft University
of Technology (the Netherlands. Doctor Henk
Kooistra initiated the project in the context of the
subject “Design for All”. He assisted us in Sri-
Lanka as well, where the main part of the project
took place.
TU-Delft 2002-2003 Wisse & v Dorsser
How to read this report
The purpose of this report is to inform everybody
who is interested in designing (below-knee)
prostheses, which can be produced and used in
developing countries, especially in Sri Lanka.
In chapter 5 the history of this project can be
found. A summary of the results of the first part of
the project, the analysis done and concepts
created in the Netherlands, can be found in the
chapter 5.1. The second part of the project (see
chapter 5.2) was the research and development
done in Sri-Lanka (August 2002-December 2002).
The end result of this part was a totally new design
concept for a below-knee prosthesis and a
presentation held in the world 40th congress of
Medicina Alternativa, Colombo, November 2002.
The last part of the project is the finalization in the
Netherlands and can be found in chapter 5.3.
Chapter 6 consists of several recommendations
on the development of alternatives (in developing
countries).
Chapter 7 consists of recommendations for the
development of prostheses in Sri Lanka
specifically.
Chapter 8 contains the final product proposal and
project recommendations.
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 The Alternative Prosthesis
5. Project history
A quick history will explain the choices made. It
will also give you an idea about the subject and
the process followed.
Ever description of a phase of the project will be
split in two main parts: first the “problem
definition and design philosophy” and secondly
the “designs and results.”).
Problem definition and design
philosophy
To create a good design, you need to know the
problem well. Therefore designers often start
with a description of the problem, the problem
definition. The design philosophy contains the
most basic requirements and values needed to
tackle the problem (according to the designers).
The problem definition and design philosophy
are directly related to each other. At the moment
the problem definition changes, the design
philosophy changes as well. It is important to do
the right thing before doing things right. Here the
right thing is to make sure what the real and
main problem is and redefine the design
philosophy before developing a good prosthesis
for the wrong situation.
Designs and Results
In this section the design concepts will be shortly
discussed, As well as “side products” such as
presentations and reports. An overview of all the
design concepts can be found in Appendixes H:
“Flowchart – socket designs” & I “Flowchart –
foot design”.
5.1. Start & Initiation
In March 2002 this project was started as part of
the subject “Design for All” at the Delft University
of Technology. Dr. Henk Kooistra spotted the
problem that in Sri Lanka amputees are still not
treated well enough. Understanding that
Industrial Design Engineers could address this
problem, he discussed this problem with dr. ir.
Johan Molenbroek. Johan in his turn introduced
the project to the students.
Problem definition and design
philosophy
Henk Kooistra made a project description1 using
the information from the landmine report Malathi
1 2
See appendix A.1 for a summary
TU-Delft 2002-2003 Wisse & v Dorsser
Thalgodapitiya gave him in Sri Lanka and his
contact with other experts. The focus was on
children and a different approach to the production
and design of prostheses. Prostheses are being
designed for over 150 years, but mainly by
medical professionals. Instead of a medical basis
for the design, Industrial Design Engineers base
their designs on user interaction and production
possibilities. Different projects were started
addressing the landmine awareness problem as
well.
Designs and Results
Maybe it is appropriate to introduce Inne ten
Have’s design here, because it was a major
source of inspiration (just as Inne himself). Inne, a
designer from Eindhoven, designed a prosthesis
for Cambodia as final subject ten years ago. At
that time, the amount of limbless in Cambodia was
enormous. Very little prosthetists and resources
were available. Inne designed a prosthesis, which
could easily be adjusted and produced by the
amputee himself. Unfortunately, he had no
opportunity to test the design and could not find a
party interested enough to get his design
produced or otherwise implemented. More about
his project can be found on his website2.
Figure “Inne”: Here the design of Inne is shown. It is
easy to see the low-cost material usage and ease of
production.
http://www.xs4all.nl/~inne/ ; See Appendix H.2
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Designs and Results

5.2. Analysis (NL)
The first part of the project started with Dr. Henk
Kooistra’s problem definition. Loads of questions
needed to be answered and our knowledge
about prosthetics needed to be increased. After
the analysis we made a new problem definition3
together with some design and implementation
concepts.
The results of the first part of the project can be
found in the first report4 written in the
Netherlands. It mainly consists of an analysis
and some concepts for a solution.
Problem definition and design
philosophy
Instead of focussing on children, It’s only fair to
first reduce the amount of victims on the waiting
list. Therefore a proper design for adults is first
priority.
At this moment most designs are custom-made.
The socket fits only one amputee. Other parts
are modular. But some research shows that a
highly adjustable design could also provide
enough comfort for the amputee. All parts of the
prosthesis are then standardized, so one design
fits all (full standardization of the design of shank
and feet and a modular system for the socket).
Local (see textbox) carpenters, or other small
village workshops, should be able to produce,
repair or replace the prosthesis.
The prosthesis must have a ‘Western look’ and
the owner of the prosthesis learns to reproduce
all the parts, so he can use this design principle
for the rest of his life.
Basic prostheses are provided the first time, but
the amputee can improve the aesthetics himself.
Eventually we came up with our first concepts:
1. Inne+
The design as made by Inne ten Have is
theoretically right, but was never taken into
production. Therefore we decided to modify the
design, mainly by adding some parts.
When an extra rubber piece is added on the
metal sheet that loads the patellar tendon, the
pressure can be divided better when under
load.
With some padding at the sides (vertical
sheets) the pressure can be divided further.
A broad strip on the backside can be used,
instead of using a thin thread, also increases
comfortable use.
A western look can be obtained by adding a
nice aesthetic cover from foam or
polypropylene. The appearance is lifelike, but
a local carpenter can still make the underlying
skeleton.
By having different sized inserts ("klickable"
solutions) customized prostheses can be
presented. The measuring time can be
reduced to minutes instead of days.

Local: Many use the term “local” to describe

different situations. In this report we use the
following definition hierarchy:
• International
• National
• Regional
• Local

3
Appendix A.2 Figure “Inne+”: The total Inne+ can be seen on the left.
4
“Prostheses for Tibial Amputees focused on the 3rd The arrows indicate the places where the forces
World; Introduction Report “Design for All” “ – April (pressure) will be high. Therefore at those places extra
2002 – Dorsser, Wisse and Soleymani. A Summary padding is added. On the right is an impression of the
can be found at www.kladder.nl socket.

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The Alternative Prosthesis
2. The textile & Leather Socket
The leather design is on the outside made
from the materials leather and denim. On
the inside special padding can be found at
the places on the limb where two wooden
sticks will suspend the limb. The padding is
meant to give the prosthesis more comfort
and also to create a larger contact surface.
The great advantage of the leather socket is
that it can be adjusted easily to a persons
stump.
Figure “Leather socket” The inside and the
application of the leather prosthesis are shown here.
The leather socket is easy to produce and adjusts
itself to the form of the stump.
TU-Delft 2002-2003 Wisse & v Dorsser
3. Implementation plan
Implementation could be as follows:
Start the (development and) production of a
mechanically and medical correct, but very
basic design, which is focussed on productivity
and comfort.
Later implement an aesthetic design: The
ideas can be found in the report5; the final
design should be made in Sri-Lanka.
Eventually produce luxurious versions: In the
future, if the trials are successful, a new and
improved, more expensive design could be
made. This design could be sold to third
parties, such as the army or the world market,
thus making the whole project self-sufficient.
5
Prostheses for Tibial Amputees focused on the 3rd
World; Introduction Report “Design for All” “ – April 2002
– Dorsser, Wisse and Soleymani
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Designs and Results

5.3. Research and Development (SL)
Convincing the project initiators with our ideas Sockets
and the underlying research, and winning their As might be noticed, the design philosophy has its
harts with our enthusiasm, we were selected to emphasis on the socket. This is because the
travel to Sri Lanka to continue our project. socket is very crucial and the major innovation is
this part.
Problem definition and design The Inne+ and the Jaipur+ were redesigned many
philosophy times during the process. In the flowchart the most
During the stay in Sri Lanka the problem important innovations can be found. More details
definition and therefore also the design about the development of these designs can be
philosophy needed to be adjusted several times. obtained by contacting the writers or Michelle
While optimising the concepts created in the Kriesels7.
Netherlands (we wanted to implement them)
new information was collected all the time. Feet
Eventually we understood that the focus of the Some development was also conducted on the
project was completely wrong. Instead of feet of the prosthesis. Current “Western” designs
focussing on price or production capacity, the cannot be used globally. Other materials are
real problem was the total amount of prosthetists required, the foot should be lifelike and usable
(experts) available. At the end we came up with without shoes, on unpaved roads, etc.
our final problem definition6 and design Eventually we settled for a design based on a
philosophy. This design philosophy helped us to design made 150 years ago. This design was
design a totally new concept for below-knee replaced for a simple reason: price. We believe
prostheses: nowadays a simple, cost-efficient variation is
“There is a market-niche for a new type of possible.
prosthesis. This prosthesis can be produced in
developing countries, but has market potential
all over the world. Mass production is necessary Eventually we came up with our (total) final design
and should ideally be sponsored by local (read: proposal, which is described in the chapter 8.
Sri Lankan) chemical industries.
To enable mass-production, while reducing the
price, the prosthesis needs an adjustable socket
principle. The amputee must be able to adjust
the prosthesis himself through time. This way
the design is suitable for children as well. The
prostheses can be fitted everywhere, thus
reducing the need for amputee to travel. The
current workshops are still needed to produce
unconventional lower limbs, upper-limbs and
ortheses.
The design should require less attention from
prosthetists. This can be achieved by the use of
use-cues (clues integrated with the product how
to use it).
And last but not least, the design needs to be
highly comfortable.
Only if these requirements combine into one
product the market-niche is reached and the
amount of limbless can be decreased. “

6 7
Appendix A.3 See Appendix C.10

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The Alternative Prosthesis
Presentation
At the 40th World Congress of Medicina
Alternativa, this project was presented. The
emphasis was on the development of
alternatives. Therefore the “Beat Tradition”
presentation8 was divided in two parts:
“Alternatives: “Can we beat tradition?” (How to
develop alternatives) and “The Alternative
Prosthesis” (case description).
Figure “The flyer”: This flyer was distributed at the
world congress. It promoted our lecture about the
development of alternatives. We wanted to improve
our network of acquaintances.
8
See Chapter 6.1 & 8.1 for a summary and
www.kladder.nl for the complete download.
TU-Delft 2002-2003 Wisse & v Dorsser
5.4. Finalization (NL)
In the Netherlands the project was finalized. Well,
finalized, continuation would still be preferred9. For
continuation by others new students or a company
interested in the results need to be found and
informed. Therefore this report is written in a way
that most vital information is present.
Problem definition and design philosophy
The final problem definition should be broader
than for Sri Lanka only. No solution is anticipated
to encourage different project groups to think
about the same problem:
“Worldwide there are about 15 million
amputees. With 39 percent of them living in
the Asia’s, this area deserves special
attention. In some countries landmines are a
problem, though most common causes are
accidents, diabetics, cancer, infections and
congenital deformities.
Heath care for the amputees is in many cases
insufficient. The production capacity is low and
there is a lack of experts (prosthetist) to fit the
prostheses. Current designs are expensive,
outdated or unsuitable for different
environments (social and geographical)
worldwide. Aftercare is often forgotten.
Although different groups are thinking about
(and working on) this problem and developing
alternatives, no alternatives are implemented
yet.
The design philosophy is concentrating around the
development of a new concept for prostheses:
“A new (design) concept for prostheses could
improve the situation of amputees.
Evidence shows possibilities for an adjustable
but comfortable socket. This enables mass
production. Distribution will speed up, among
others because the need to travel to
distribution points is cancelled. Costs will
reduce. Children amputees can use the
prostheses longer.
The prostheses should be easy to fit and
adjust, thus reducing the lack of prosthetists.
Ideally, the end users are capable of adjusting
the prostheses themselves.
9
In the first place we can think of continuation by
ourselves. Probably one of us will graduate on this
project.
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The Alternative Prosthesis
The new design adds to the produced
amount of prostheses. Current production
should not be replaced, because it is
needed for extraordinary prostheses and
ortheses.
The design should be accepted worldwide,
though the function and price may be a little
different“
Apart from this the speed up the development of
prostheses could be improved. Research groups
should team up, while leaving room for different
viewpoints, thus improving the service for the
amputees.”
Designs and Results
After November 2002 (end stay in Sri Lanka) no
improvements were made to the final design
proposal, although many improvements are
possible (see chapter; “recommendations”).
New contacts were acquired. While giving a
lecture (“Ergonomics 2: Designing for specific
target groups”) we met Bram Joosen10. Bram
has designed a artificial knee joint in Tanzania,
while doing his internship for the Haagse
Hogeschool. Because his project came to a
dead end (as well), we discussed the
possibilities for a platform, which will aid in the
passing on of (development) projects11.
Our final result is this report itself.
10
Bram Joosen, alumni Technology of Human
Kinetics, Haagse Hogeschool. His report: “Plastic
Atrificial Leg”, Tanzania, Dar es Salaam, November -
March 2002.
11
More details can be found on the website
www.kladder.nl at “Platform Zinvolle Stage”,
TU-Delft 2002-2003 Wisse & v Dorsser
6. Developing alternatives for
developing countries
Developing alternatives is not easy. Some of our
findings on how to do it the best way can be found
in the following paragraphs.
6.1. Process
Most of this text was published on a flyer12 we
spread at the World Congress and after:
Analysis
Start with a good analysis. Just doing something
seldom leads to a satisfactory result. Get
acquainted with the subject: What is opinion and
what is inherently true?
Making a list with the primary functions or the
basic requirements helps you to look further than
the current solutions.
Think different
Dare to think different. Dare to imagine and
dream. Great inventions were dreamed about and
many now conventional thoughts were
condemned in the time of their conception. Think
of “unconventional” ideas such as the sun as the
centre of the solar system. Generate many ideas
(quantity = quality). Eventually you’ll be able to find
great possibilities.
Find the range of possibilities of the
alternative
Now you’ve come up with an alternative, make a
list of all the strengths and weaknesses you can
image around your innovation. What are the
possible applications of the alternative? And which
applications have a “conventional” solution? It is
also important not to forget yourself. What are
your possibilities? Do you have spare time or
financial assets? Maybe you’ll have a vast network
of acquaintances that might be willing to help you.
In brief, find the “strengths” and “weaknesses” of
yourself.
Find a non-invasive niche
With all the information found in step three, you’ll
be able to find an evasive market niche. Beginning
the development of the alternative is easier when
others don’t think of you as a threat. Often found
niches consist of small or specific groups, which
are often neglected by big companies. It’s also
12
This flyer/folder can be downloaded at www.kladder.nl
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 The Alternative Prosthesis
rewarding to think about groups without access
to money or other requirements (like time or
transport). If you find an application where there
are none yet, than that’s your way to realize you
ideas, because you’ll be the alternative to
nothing!
Produce enough confidence
How will you convince your surrounding to
accept your idea and to help you? Most
important is to start with yourself. If you think of
(easy) ways to validate some advantages of
your idea, validate them! Don’t try to convince
every sceptic, especially when (they think)
money or jobs are on stake. Better find a few,
reliable contacts. Also, don’t get lost in
searching for or producing statistical data and
figures. These are always difficult, because
there is always room for objections. Instead, rely
on the smile of the customer.
Act different
While fine-tuning your alternative, it’s time to
start thinking about the implementation. Be
generous with your knowledge (were possible),
you’ll earn trust. When the situation allows it,
grow gradually. This enables development while
deploying your alternative and is less risky.
Speaking of risk, expect to rise and fall. Few
developments where a first time success! You
will encounter new problems and will have to
adjust. Last of all, don’t focus on money. Where
the focus is on money, little room is left for
innovation or development.
6.2. Collecting Information
Information is of fundamental importance when
you are doing a research and development
project. In developing countries specific
difficulties while collecting information can be
anticipated.
The need for information
Every decision is based on information. The
more recent and accurate the information is, the
better the decision will be. Without (the right)
information you will spend lots of energy (time
and money) without any results.
Information types
During the project different information will be
needed at different moments. The first
information you need is the information related
to the problem definition. In this project the
TU-Delft 2002-2003 Wisse & v Dorsser
problem definition changed several time because
new (other) information was collected. Secondly in
the conceptualisation specific information needs to
be collected. Another type of information needed,
especially in developing countries, is daily
information,
Problem definition. The first information needed
is related to the problem definition. Important
questions to be answered are:
What are the (main) problems? For who do we
need a solution? Do we really need a product to
solve the problem? Why is the problem not solved
yet? What will happen if the problem will not be
solved or what will happen if the problem will be
solved, does this imply new problems?
The subject. Before starting drawing and
systematically thinking about solutions a proper
knowledge of the subject is required. The main
part of this type of information related to this
project can be found in the first report13. In
developing countries it’s important to collect
information about social aspects specifically. While
developing alternatives information on new
developments and existing products is very
important as well.
Specific Information. This information is needed
in a later stage of the project. In this case we can
think of information about stump measurements,
specific material data or specific production
methods.
Daily information. Another type of information is
daily information. While doing a project abroad
daily information can be very important for the
progress of the project. For example, what is the
political situation? Are there any health care
issues, disturbance, roadblocks or strikes which
disable you to travel? What is the weather forecast
(think about the rain seasons)? When are the
holidays (shop close)? The knowledge of all kinds
of these information will be very helpful for the
progress and planning of the project. Buy a travel
guide.
13
“Prostheses for Tibial Amputees focused on the 3rd
World; Introduction Report “Design for All” “ – April 2002
– Dorsser, Wisse and Soleymani. A Summary can be
found at www.kladder.nl
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Information sources example, if the ergonometrics of a group is known

When a project is done abroad conventional
sources, like books, companies and other
connections can be unavailable. Nowadays the
internet closes this gap. In our project a lot of
crucial information was collected by internet.
While doing a project in another country a
backup team in your home country can be very
helpful. Search people who know about the
subject and are willing to spend some time.
Especially when you operate in developing
countries networking is very important. Often
you will start without any connections in the
foreign country. But be aware of the reliability of
the information you get. What is your source’s
second agenda?
Reliability
Three important issues determine how reliable
your information is.
Match your specific target group. Not all the
information you can find on your topic is
applicable on your target group. For example,
ergonomic measurements (ergonometrics) differ
from country to country.
Information ages. A lot of information is out of
date. Of course, some information can be used
for a longer period but be sure the information
still applies.
Sources. Governments, companies, NGO’s,
army’s or newspapers, they will often offer you
false information. Sometimes because they do
not know better, but as often in purpose.
Everybody has second agenda’s (which is not
always negative). Try to make a list of all
sources and their second agenda. Combine their
information and draw your own conclusions.
(for example DINES) and we know our population
(target group) is 20% less tall we could use that
factor on all properties. Increasing the error margin
will increase the reliability of the estimations.
6.3. Sharing information
It’s possible that you want to spread your collected
information and other findings to help others or
just to tell your opinion (the truth?) about
something.
Be careful
It is important to be careful with your knowledge.
Especially when you are developing alternatives
people are not always happy with your
information. They can be afraid of you(r ideas),
although you think they are helpful.
On the other hand, some will try to get all your
information, just to copy and make money out of it.
Your ideas will loose market value and the
following production and distribution will be
uncontrollable. In this case it can be good ideas to
think about patents before sharing your
knowledge.
Be generous
If your are sure you want to share your knowledge
you can think about media like the Internet,
television, newspapers, forums, reports and
congresses. Especially the last one can be very
helpful when you have developed something
totally new because on congresses you can find a
lot of people especially interested in your topic.

Adapt information
It will often happen that the information you seek
is not available. The most difficult information to
collect is statistical data. First of all ask around if
someone can help you. If not, you can conduct
your own research. But be aware, this will take a
lot of energy. Make sure you really need the
(specific) information.
Don’t focus too much on the data. Use available
data, adjust it and apply a safety margin. For

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 The Alternative Prosthesis TU-Delft 2002-2003 Wisse & v Dorsser

7. Developing Prostheses in production (1984) a total of at most 20.000

prostheses were distributed.
Sri Lanka
Amount of limbless
We believe there are at least 23.000 civilian, trans-
7.1. Current designs tibial (below knee) amputees in Sri Lanka of which
At the moment there are several designs at least 13.000 are still limbless (without any
available in Sri-Lanka. (Here follows a summary. prosthesis) (2002). But it is probable this number
For a complete overview, see appendix D: “ is much higher, up to 44.000 civilian, trans-tibial
Current designs”). amputees of which 35.000 are still limbless. (For
The main technology used is the Jaipur limb, more figures see appendix B: “Figures”).
which is easy to produce and low cost. It is
produced by local production methods. Recently
there is also an adjusted version using Poly
Propylene sockets. The foot is extremely
suitable for tropical climates and uses an
esthetical design.
The similar Mukti system uses a biocompatible
material (High Density Poly Ethylene) for the
socket.
Also the ICRC is comparable. It was designed to
be made of recycled Polypropylene by local
mass production. But unfortunately recycled
Poly Propylene does not have the
recommended stiffness and strength. So now
non-recycled Poly Propylene is used. This is
why some believe the ICRC failed.
Western prostheses simple are the state of the
art. But the best in Europe or America is not
always the best in the Asia’s.
A recently new technology introduced in Sri
Lanka by the Kandy branch of the FINS is the
Mobility Kit from India. Important to notice is
that the all use a non-adjustable, custom-made
principle for the socket.

7.2. Current production situation

Providers of prosthetic services
The main provider of prosthetic services in Sri
Lanka is the Colombo Friends in Need Society
(CFINS), a non-governmental organization,
based in Colombo (headquarters), Kandy, Jaffna
and Galle. Others providers of prosthetic
services are the Army Rehabilitation Centre of
the Sri Lanka Army in Ragama and White
Pigeon which operates in the Vanni. (See
appendix E: “The Friends in Need Society” and
appendix C: “List of references” for more
information).
Together they produce around 230 prostheses a
month (= 2700 a year). From the start of

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 The Alternative Prosthesis
8. Recommendations
In this chapter the final product proposal (design
concept) and project recommendations can be
found.
8.1. Final product proposal
After a year of development we came to belief it
is possible to design prostheses according to an
unconventional philosophy, which consists of the
thoughts found in Chapter 5. This philosophy
combined with a lot of research let to a new
trans-tibial design, the “DFU” (Design(ed) For
You). Some of the advantages follow.
Figure “Total Kit”: The total DFU could be
distributed as a kit. Also see Appendix I
One design fits all
One of the advantages of an adjustable socket
is that there are fewer prostheses needed
through time. Normally a patient needs at least a
new socket every two years due to the
deformation of the stump. Another advantage is
the possibility to use it direct (within the first
month) after the amputation. Especially for the
West this advantage is very interesting. But the
main advantage is that a one-design-fits-all
principle enables mass production, which in turn
has a positive effect on the costs and the
production capacity.
Alignment
If we combine these advantages with the
advantages of a prosthesis alignable by the end
user instead of the prosthetist, prosthetists can
focus on extraordinary cases, thus improving
overall care. We implemented use-cues to make
this possible. Use-cues are indications how to
handle (in this case how to align) a product.
Specifications
TU-Delft 2002-2003 Wisse & v Dorsser
The DFU has an adjustable socket, suitable for
trans-tibial amputees with stump lengths between
10 to 23 cm long, measured from the patellar
tendon (p.t.).
The prosthesis fits stumps with a circumference
(at the p.t.) of 25 to 35 cm. Knee extension of 5
degrees and flexion up to 15° can be
compensated, abduction and adduction both up to
10°.
The price is estimated at € 6614 apiece based on
20.000 pieces in 2 years.
The total prosthesis (including foot and cosmetic
cover) will be available as a kit.
Market possibilities
In figure “Niche”, the market possibilities are
shown of popular prostheses in respect to the
DFU.
Though the DFU is less comfortable as the
Western designs and approximately as
comfortable as the Mukti limb, the adjustability
makes the DFU a winner. The DFU is suitable for
the use in the Asia’s as well as in the West.
Most adjustable DFU The West
Jaipur
Mukti
ICRC Western
The Asia's
Alignment in time possible Most comfortable
No alignment through time
Figure “Niche”: in this figure on the Y-axis the most
adjustable sockets can be found. On the X-axis the
most comfortable sockets can be found. The
combination of the two shows the strength of de DFU.
14
Details can be found in Appendix G: “prices”
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 The Alternative Prosthesis TU-Delft 2002-2003 Wisse & v Dorsser

8.2. Optimisation 8.4. New projects

At the moment the design is ready to be
optimised and implemented. Strength and strain
analyses and long-term / cyclic tests have to be
performed. We are working on improving the
aesthetics of the design.
8.3. Project continuation
This project is worthless if it is not continued.
Too often this type of projects end up where
they started because no implementation was
done. With difficulties collected information and
knowledge will get lost. New projects will be
started by other people while other projects are
still unfinished. The cause of this is often the
lack of persistence of the initiators. It would be
better (more efficient) if already existing projects
would be finished firstly before new, similar,
projects would be started.
We think, to continue this and other projects,
there is a need for a platform, an organisation
where people doing development projects all
around the world can share their knowledge (and
projects) and are able to meet and help each
other. The Internet is perfect for this.15
An internship-system for prosthetists in education
could increase the amount of working prosthetists
in Sri Lanka. Also the knowledge about the need
and possibilities for prostheses in developing
countries will improve. This could result in more
appropriate solutions.

For this project in particular we can find different

ways of continuation. As mentioned before the
final product proposal is not finished yet. It is
possible that one (or both) of us will continue
this project and graduate on it. Otherwise we will
inform and motivate a group of new students
who can finish this project.
Another solution is to involve a company
interested in the results. The choice for this
commercial solution is defendable if the situation
of the amputees increases significantly. If the
project has commercial value, patents on the
design(s) must be bought.
Also, an independent company could sponsor
the project (e.g. a plastic manufacturer). This
way, a third party would still control the project
while funds would be available.

But which way eventually will be chosen: The

project must go on.

15
More about this on the website www.kladder.nl at
“zinvolle stage”.

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 The Alternative Prosthesis
9. Conclusion
After a full year of research and development we
came up with a good design philosophy. As
mentioned before in the preface, the amputee
problem is not solved and it never will be, we
guess, not as long there’s war and poverty. But
this project feels unfinished in particular,
because it’s potency. The problem is defined, a
solution at hand, but implementation is still
difficult.
Especially we are confident about our final
design philosophy. It offers a total new approach
opening new possibilities. The DFU is just one
possible solution. Using the design philosophy,
other good solutions could be found.
In this report a lot of figures can be found. It was
very hard and it took us a long time to collect
and rightly interpret all these figures. The figures
about the amount and properties of amputees
are extremely useful to understand the scale of
the problem and not to be misled by people or
(non governmental) organisations with second
agenda’s. Besides these figures, the figures
about stump measurements can be very useful
to design (adjustable) prostheses.
In this report also an idea how to develop
alternatives (in developing countries) is given.
Thinking about the process can be very helpful
to develop and implement alternatives. Also the
words said about collecting and sharing
information can be helpful while designing
alternatives, especially in foreign counties.
As said before, with this report we hope to
encourage the reader to find ways to improve.
To improve prostheses, to improve the world, to
improve your and our experiences. Most of all
we want to inspire all the fantastic people we
met. People who inspired us in the first place.
TU-Delft 2002-2003 Wisse & v Dorsser
10. Evaluation
At the Friends in Need Society we have seen that
the production of a prosthesis is a difficult process.
Different aspects have to be taken in account. One
of the most important issues is that the prosthesis
has to be comfortable and well aligned. People
have to walk on it, every day! You can’t put
pressure on every part of the stump. Besides this
it has to be light, but also stiff and strong enough.
Not to forget the social aspects.
Nowadays most of the prostheses in developing
countries like Sri Lanka are custom made. If we
want to produce them in mass production, it will be
even more difficult; besides a comfortable
prosthesis we now also need an adjustable and
re-alignable one. If you know there is a great
difference in stump measurements and
contractures you can imagine it’s a difficult job to
design a prosthesis suitable for mass production.
It took us a long time to understand all the
problems and to come up with a good design
philosophy. We also made a product proposal but
unfortunately we did not have time enough to
implement our ideas.
There is need for people who can combine
medical knowledge with technical (especially
industrial designing and developing) knowledge.
With this combination good solutions can be found
to help al lot of different patients (not only
amputees). We think the technical university of
Delft has to take a leading role in this.
Sri Lanka inspired us to look to the medical world
at a different approach. We met people who made
us think in a different way, who inspired us. You
can’t, and do not have to, think in high-tech
materials only to help people. Not only patients
who can effort this need to be helped. There is a
need to think in global solutions.
Page 16 version date: 18-10-2004
Appendix

Appendix ..............................................................0
A. Problem definitions ......................................1
A.1. Summary start ................................1
A.2. Analysis (NL) ..................................2
A.3. Research and Development (SL) ...2
B. Figures ...........................................................3
B.1. Sri Lanka:........................................3
B.2. Properties of Amputees ..................5
B.3. Worldwide .......................................8
C. List of references ..........................................9
C.1. UN...................................................9
C.2. Consortium of Humanitarian
Agencies .........................................9
C.3. CFINS - Colombo ...........................9
C.4. CFINS - Kandy Branch .................10
C.5. Army .............................................10
C.6. CT, the Cambodia Trust ...............10
C.7. ICRC .............................................11
C.8. WHO .............................................11
C.9. Medics ..........................................11
C.10. Team Design for All ......................11
C.11. Experts in NL ................................11
D. Current designs ..........................................12
E. The Friends in Need Society......................13
E.1. Departments .................................13
E.2. Internal research...........................15
F. Contacts and Residences ..........................16
G. Price estimation ..........................................17
H. Flowchart – socket designs.......................17
I. Flowchart – foot design..............................17
 The Alternative Prosthesis
Problem definitions
Different problem definitions were used during
the project. Here they are presented:
A.1. Summary start
This is a summary of the short report of Dr.
Kooistra’s visits to Sri Lanka16.
Dr. Kooistra had conversations with many
experts, organisations and victims.
Prospectus POF
The prospectus from the Pakistan Ordnance
Factories: “The mine has been designed with a
view to disable personnel. Operating research
has shown that it is better to disable man than to
kill him. A wounded man requires attention,
conveyance and evacuation to the rear, thus
causing disturbances in the traffic lines of the
combat area. Also a wounded person has a
detrimental psychological effect on his fellow
soldiers.”
In Sri Lanka there rages (raged) a war for over
18 years. Landmines are used, the Mine Ban
Treaty is not signed.
Amount of Amputees:
Reliable figures are difficult to get, but the
amount lies between ten and twenty thousand
amputees. 80% is male, 60 percent is between
11 and 13 years old. 78% is below-knee
amputee.17.
Facilities (services)
There are three main services producing
prostheses. The Army rehab centre, the
Colombo Friend in need Society and White
Pigeon.
These are all dependent on external funds
(redaction: US-Aid is most important). Only army
receives governmental funds (for two prostheses
per amputee), but their production capacity is
lacking.
Total maximum amount of prostheses produced
per year is 2500 pieces. Average is about 1800.
But 5000 pieces per year are needed for
replacement only18. This results in waiting times
16
Redaction: In 2001/2002
17
Redaction: read the figures section in the appendix
about the reliability of these figures
18
Redaction: Excluding reparation
TU-Delft 2002-2003 Wisse & v Dorsser
of up to 15 years. Even without increasing the
amount of amputees helped, an enormous
increase in production is needed. Because of the
return of refugees to their home-area and the
spread of landmines in these area’s, the amount of
amputees is expected to rise drastically.
US-Aid puts around 75 USD19 at disposal for every
produced prosthesis. This does not meet the
expenses.
Children are being neglected, resulting in
contractures in their knees.
At this moment the Jaipur limb is used. Now, to
increase the imago, the polypropylene technique
is used as well. This technique is high-tech but
expense and it takes years to learn.
Conclusion
Possibilities for cheaply produced prostheses have
to be researched. Wear-resistant materials need
to be used. Ergonomic research could lead to a
good gait without the use of an ankle joint.
The local (in Sri Lanka) production needs to be
analysed, so training time can be reduced. A
bicycle repairer should be able to produce the
prosthesis.
A socket should be developed specially for
growing children, reducing the replacement rate.
The prosthesis needs to be basic, but if possible
have a Western High-tech atmosphere as well.
Mine Awareness should be increased. Maybe by
creating a game.
The following parties are interested in the results
and will provide (some) support:
o Army rehab
o CFINS
o Anti Landmine Advocacy
o Presidential Secretary Human Intervention
Unit
The consortium of Humanitarian Agencies will act
as counterpart.
19
Redaction: Actually 100 USD
Page 1 version date: 18-10-2004
 The Alternative Prosthesis
A.2. Analysis (NL)
Many third world countries are or were a
“playground” for civil wars. Millions of mines, left-
over weapons of these wars, but still potentially
lethal, are scattered over 70 countries in Africa,
Asia, Europe, the Middle East and the Americas.
Landmines strike thousands of innocent victims
every year, shattering lives and destroying
futures.
Sri Lanka is one of the countries where
landmines are still used resulting in many
landmine victims, which usually loose a lower
limb (78%). At this moment the production
capacity in Sri-Lanka is too small to provide
everyone with prostheses. To increase the
production capacity in the currently available
workshops the technicians needs a training of at
least two years. Although there are some
workplaces in Sri-Lanka that provide prostheses
for free most people can’t afford one. Even if
they have enough money they can’t leave their
family for a long time to fit a prosthesis and
rehabilitate (learn to use it).
For children the situation is even worse.
Because they are growing they will need
replacements (too) often. At this moment most
children have to wait until they are full-grown.
But if they do not use their muscles several
years heavy contractures in their knees will
appear and they will never be able to walk on a
prosthesis. The waiting lists need to be reduced,
so the children can be helped at last.
Some of the current prostheses provided in Sri-
Lanka are recycled prostheses from Europe and
America. Apart from the price, the problem with
these prostheses is that the materials used are
not suitable for the (sub)tropical climates.
Besides, they are difficult to repair and not
suitable for typical local work. Especially working
in the paddy fields and fishing are major sources
of income in developing countries.
It is necessarily to come up with a new, simple
solution to provide all limbless with a suitable
prosthesis.
TU-Delft 2002-2003 Wisse & v Dorsser
A.3. Research and Development (SL)
As described in our previous problem definition
landmines indeed strike thousands of innocent
victims every year, shattering lives and destroying
futures. Sri-Lanka is one of the countries where
landmines are used, but the amount of landmine
victims is only a few percentage (The data shows
6%, we believe a maximum of 8%, because the
services in the North (where the most landmines
can be found) are very minimal.) of which about
75% end up with a trans-tibial amputation.) of the
total amount of civilian amputees. Most civilian
amputees are traffic victims (29%), diabetic
patients (21%) or had an amputation after an
infection (15%). This does not take away that it is
indeed true that at this moment the production
capacity in Sri-Lanka is too low to provide
everyone with a prosthesis. About 2800
prostheses are made every year (2002), but the
amount of prostheses still functioning (still being
used) is insufficient for the current amount of
(civilian) amputees.
To increase the production capacity in the
workshops the technicians need a training of at
least two years. With the current designs,
increasing the production takes time, but it is
possible.
But technicians are not prosthetists. All the current
prostheses (using an unadjustable socket
principle) are made by the technicians. Every
patient gets his own custom-made prosthesis.
After that an available and well-educated
prosthetist has to align it for a decent gait. We
believe there are about a maximum of 10
prosthetists in Sri Lanka at this moment (2002). In
three years (2005) there will be probably about 15-
20 prosthetists in Sri Lanka. In the current
situation Sri Lanka needs at least about 12520
prosthetists for proper healthcare. Education of a
prosthetist will take about 4 to 5 years and is
expensive. Education usually takes place in India
or Cambodia. After they finished their studies,
many prosthetists start their practice in Europe or
America, thus decreasing the amount of
prosthetists further.
Apart from the amount of prosthetists, the costs of
prostheses are still high. Limbless can’t leave their
family for a long time to measure a prosthesis and
rehabilitate.
20
See appendix “figures”
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The Alternative Prosthesis
For children the situation is even worse. They
grow and need replacements often, because
current prostheses are difficult to adjust. At this
moment most children have to wait until they are
full-grown, resulting in contractures.
There is need for a design, which is easily
adjusted, thus reducing the time needed by the
prosthetists to improve the gait. The (sub)tropic
climate and society should be taken in account;
the prostheses need to be produced and used in
developing countries. The production should
require fewer technicians and be low-cost. The
goal is a system, which will provide everybody
with a suitable prosthesis.
Still difficult is the aftercare for amputees. Now,
amputees are barely checked, prostheses are
barely adjusted. “If you provide one prosthesis,
you’ll have to be able to provide the amputee
their entire live”.
TU-Delft 2002-2003 Wisse & v Dorsser
B. Figures
B.1. Sri Lanka:
Amount of limbless
We believe there are at least 23.000 civilian, trans-
tibial (below knee) amputees in Sri Lanka of which
at least 13.000 are still limbless (without any
prosthesis) (2002). 21
It is probable there are 44.000 civilian, trans-tibial
amputees in Sri Lanka of which 35.000 are still
limbless.22
From the figures of the WHO we can estimate that
Sri Lanka has proximally 70.000 civilian foot or leg
amputees. (also see appendix B.3: “Figures –
Worldwide”)
• The population of Sri Lanka is about
20.000.000 (2002). If we multiply this amount
with its area factor (0,370 %) we find 74.000
foot or leg amputees.
[If we multiply this amount with the European
factor (0,162) for an estimation of the
minimum of foot or leg amputees we find
32.000 amputees.]
• According to the Sri Lanka Army (see
appendix C.5: “List of references – Army”) the
Army has about 4.000 (5%) foot and leg
amputees. So we believe there are a
proximally (74.000 - 4000 =) 70.000 (95%)
civilian foot and leg amputees in Sri Lanka.
[The total (civilian and military) amount of foot
and leg amputees is 32.000 (89%) + 4000
(11%) = 36.000 amputees].
From the data collected from the CFINS we can
estimate that about 44.000 (63% of 70000)
civilians are below knee (trans-tibial) amputees.
(see appendix B.2. Figures – Properties of
amputees)
• From the data we can expect that about
23.000 (33% of 70000) of these civilian
amputees are above knee amputees (trans-
femoral).
[Trans femoral civilian = 33% of 36.000 ≈
12000]
21
In blue this minimal calculation is given.
22
This estimation is given in a normal font colour.
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The Alternative Prosthesis TU-Delft 2002-2003 Wisse & v Dorsser

• About 44.000 (63% of 70.000) are below Estimated production

knee (trans-tibial) amputees.
[Trans tibial civilian = 63% of 36.000 ≈ Current
23000] The current production rate of ortheses and
• From the data collected from the CFINS we prostheses (trans tibial, trans femoral and arm
can also see that almost all the Army victims prostheses) is about 2.800 a year (2002)
are below knee amputees (92%). The cause • In the table “services” we find 230 prostheses
of this is the high amount of landmine and ortheses a month are produced. 230*12 =
victims in the Army. So we can estimate that 2.760 ≈ 2.800.
the total amount of below knee amputees in
Sri Lanka will be proximally 48.000 (44.000 Service Amount Source Reliability
+ 4.000) [23000 + 4000 = 27000].
Army: 50-80 C.5 Reliable
FINS-C: 80 C.3 Reliable
There are still 57.000 [21.000] limbless (without
any prosthesis) in Sri Lanka of which 35.000 FINS-J: 20 C.3,7 Probably
[13.000] are below knee amputees. FINS-K: 90 C.4 Too high, not true
• The CFINS has about 13.000 patients in its 30 C.7 Probably
archives (18.000 prostheses and ortheses 10 C.3 At least true.
produced). Together with the other providers Although some
of prosthetic services we believe there are at suspect even less
most 20.000 patients already once helped in FINS-G 5-10 C.7 Reliable
Sri Lanka. This includes arm prostheses and
ortheses. White P 15 C.7 Varies strongly. It
dependents on the
• The amount of arm amputees is 22.000 amount of materials
(0,11% of the population) received. Capacity
[14000 if we take the European factor of with enough
0,07%] (see appendix B.3: “Figures – materials
Worldwide”) max: 40-50 (10)
• The total amount of amputees (foot, leg and Totaal: 180-280 230 a month is a
arm amputees) in Sri Lanka will be good estimation
proximally 96.000 of which about 74.000
Table “Services”: The amount of prostheses produced
(77%) foot and leg amputees and about
per month and as well the total production capacity. In
22.000 (23%) arm amputees.
the first column the service-centre. The Source-column
[Total = 36.000 (72%) + 14.000 (28%) = refers to Appendix C. The reliability is about our
50.000]. impression of the trustworthiness of the figures.
• So if we presuppose that the CFINS and the
other providers of prosthetic services have
the same type of amputees helped in the
same percentages there will be a proximally
15000 (77% of 20.000) foot and leg
amputees already helped once.
• This means there are still 59.000 (74.000 –
15.000) foot and leg limbless (without any
prosthesis) in Sri Lanka of which 37.000
(63% of 59.000) are below knee amputees
and 20.000 (33%) are above knee
amputees.
[foot and leg limbless: 36.000 – 15.000 =
21.000 of which 63% trans tibial ≈ 13.000
and 33% trans femoral ≈ 7.000].

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The Alternative Prosthesis TU-Delft 2002-2003 Wisse & v Dorsser

Needed
With a replacement rate of three years B.2. Properties of Amputees
(according to Dr. Gratzl (C.7) a prosthesis has
an average life expectancy of 3 years or less
depending on the income generation of the Measurements of below knee amputees
amputee) at least 7000 a year need to be
produced for the currently registered amputees Important data, derived from 139 patient cards:
• 20.000 patients known get 1 prosthesis (*1) Column1 stump lengths
per 3 years (/ 3) ≈ 7000 a year.
For all the estimated amputees a production of Mean 166 mm
at least 17.000 prostheses a year is needed. It is
Standard Error 4,4 mm
probable 32.000 prostheses are needed.
Median 160 mm
• 96.000 patients estimated get 1 prosthesis
(*1) per 3 years (/ 3) ≈ 32.000 a year. Mode 140 mm
[At least 50.000/3 ≈ 17.000 a year are Standard Deviation 52 mm
needed] Minimum 0 mm
• Of which trans tibial civilian amputees are: Maximum 381 mm
48.000/3 ≈ 16.000 Sum 2312,145
[At least 23.000/3 ≈ 8.000] Population (n) 139
• And trans femoral civilian amputees are:
23.000/3≈ 8.000
[At least 12.000/3 ≈ 4.000] 1
Amount of prosthetists (needed) 0,9
We believe there are about 10 prosthetists in Sri 0,8
Lanka (2002). In three years (2005) there will be 40
about 15-20 prosthetists in Sri Lanka. For a 0,7
proper care Sri Lanka needs at least 125 0,6 actual
prosthetists. counts
0,5
• For proper care one prosthetist is needed for expected
400 patients. 0,4 spread
20
• 20.000 / 400 = 50 prosthetist needed for the 0,3
current situation.
0,2
• For the minimal estimated amputees a total
of 50.000 / 400 = 125 prosthetists. 0,1
• For the estimated amount of amputees a 0 0
total of 96.000 / 400 = 240 prosthetists. 0 20 40
• Prosthetists needed for patients with
ortheses are not even taken in account in
this figures.
Graph “stump lengths”: In this figure the spread of the
stump lengths is found to be nearly a standard
deviation.

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The Alternative Prosthesis TU-Delft 2002-2003 Wisse & v Dorsser

Below knee and Above Knee Cause of amputation

This data is from the FINS’s databases January This data is from the FINS’s databases 1993 to
1993 to December 1997 (total of samples (n) = 1997:
2214): Category Amount %
23
Total civilians (n) 1105 100
Civilian Army
Amount % Amount %
Subtotal diseases 449 41
Above knee 391 33,3 78 7,5
Cancer 101 9
Below knee 744 63,4 955 91,7
Diabetic 233 21
Both legs 30 2,6 8 0,8 24
Congenital 27 2
On knee 8 0,7 0 0 25
Other Diseases 88 8
Total 1173 100 1041 100

Subtotal trauma 506 46

26
Accidents 320 29
27
Infection 163 15
Trapguns 23 2

Subtotal max-war 150 14

28
Blasts 89 8
29
Landmines 61 6

Total military30 1020 100

Subtotal diseases 1 0
Subtotal trauma 29 3
Subtotal max-war 990 97
Landmines 916 90

23
From the 2228 (including the second prosthesis of
bilaterals 2246) entries only 1105 civilians and 1020
military are taken into account.
24
Also wounds
25
Diseases of the blood or of the bone.
26
These Accidents are mainly traffic, train and
accidents which occurred during work
27
Gangrenous but also snakebites, etc. Also
"wounds", which could belong to another section
as well.
28
Bomb blasts, shell blast, but also gun shots (of
which the minimal of 23 trap guns are excluded
and transferred to subtotal trauma)
29
Pressure mines or landmines and UXO’s.
30
Military= Army + Air force + Navy + Police

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 The Alternative Prosthesis TU-Delft 2002-2003 Wisse & v Dorsser

Age spread
On this page the amount of amputees (helped at
the FINS Headquarters 1993-1997) per age can
be found. Red is military (subtotal = 1029), blue
is civilian (subtotal = 1172) adding up to 2200
patients of which the age was recorded.

Age-group Civilian Military

0-15 56 3
16-30 256 961
31-45 302 62
46-60 372 2
61-75 168 0
76+ 18 1
Totals (n=): 1172 1029

180

160

140

120

100
Military
Civilian
80

60

40

20

0
10

13

16

19

22

25

28

31

34

37

40

43

46

49

52

55

58

61

64

67

70

73

76

79

82

85
1

Graph “Age Spread”: This graph stacks the amount

of the Military and Civilians by age. For example 20
civilians were helped at the age of 22 and about 150
military adding up to 170 twenty-two-year-old
amputees (given a prosthesis by the FINS between
1993 and 1997).

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B.3. Worldwide
The following data is collected from the World Total Amputated % of % of
Health Organisation (WHO)31 Population Arm pop. all
Columns:
Africa 655.477.000 1.041.000 0,1588 19
1. Area or criterion
America’s 837.966.000 662.000 0,0790 12
2. Total amount of persons in that area
Europe 874.178.000 614.000 0,0702 11
3. Total amount of amputees in that area
SE Asia’s 1.559.810.000 1.692.000 0,1085 30
4. Total amount of amputees divided by the
total amount of persons = the percentage of Western 1.701.689.000 899 0,0001 16
that area which has an amputation Pacific

5. Total amount of amputees of the area Eastern 493.091.000 644 0,0001 12

divided by the total amount of amputees of Mediterranean
the world = percentage of world figure of Males 3.083.884.000 3.623.000 0,1175 65
amputees living in that area. Females 3.038.327.000 1.930.000 0,0635 35
TOTAL 6.122.211.000 5.552.000 0,0907
Total Amputated % of % of
Table “WHO arm”: Figures about the estimated
Population Foot/leg pop. all
amount of arm amputees by point prevalence according
Africa 655.477.000 3.235.000 0,4935 22 to the World Health Organisation.
America’s 837.966.000 1.115.000 0,1331 7
Europe 874.178.000 1.416.000 0,1620 9
SE Asia’s 1.559.810.000 5.769.000 0,3699 39
Western 1.701.689.000 1.591.000 0,0935 11
Pacific
Eastern 493.091.000 1.833.000 0,3717 12
Mediterranean
Males 3.083.884.000 8.025.000 0,2602 54
Females 3.038.327.000 6.934.000 0,2282 46
TOTAL 6.122.211.000 14.959.000 0,2443 100
Table “WHO leg”: Figures about the estimated
amount of foot or leg amputees by point prevalence
according to the World Health Organisation.

31
See Appendix C: “References”

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 The Alternative Prosthesis
C. List of references
C.1. UN
Who: Mr. Matthew Todd:
Matthew Todd is a professional, sited in the
building of the UN in Sri Lanka. He loves figures
and statistics and does his utmost to collect
reliable figures. The big question: “Does his
focus on figures blind him for the real situation?”
Matthew researches the effects of the use of
pressure mines and UXO’s (unexploded objects)
in Sri Lanka. He is the man with the most
accurate statistical data in Sri Lanka. He collects
among others data from the Army, White
Pigeon, the ICRC and UN’s own research.
What: Most accurate statistical data on
(civilian) landmine victims. His information is
(partly) independent of the FINS information.
Contact: United Nations Resident Coordination
Office, Colombo, Sri Lanka.
Website:
http://www.icbl.org/lm/2002/sri_lanka.html
(Landmine report Sri Lanka),
http://www.peaceinsrilanka.org/insidepages/RR
R/UNHCR/UNHCR5.asp (internally displaced
persons / refugees),
http://www.undp.org/erd/mineaction/countries/sri
_lanka.htm
C.2. Consortium of Humanitarian
Agencies
The Consortium of Humanitarian Agencies is an
association of agencies working in, and
supporting work in, areas affected by conflict.
The Consortium aims to enhance the quality,
effectiveness, professionalism and transparency
of its members so that they may better realise
their objectives.
Who: Mrs. Malathi Thalgodapitiya,
Programme Officer
While Malathi is connected with Matthew Todd
(see 1), she has a totally different view on the
subject and totally other figures as well. Its
possible she has but a wild estimation of the
total amount of amputees in Sri Lanka. As well
she knows that pressure mine victims is a “sexy
subject” in the NGO-business. People are more
willing to donate money for war victims than for
amputees due to diabetics.
TU-Delft 2002-2003 Wisse & v Dorsser
What: Most helpfully, she gave us the report
"Impact of Landmines in Sri Lanka", Report of
Symposium Colombo, Sri Lanka, March 2001,
Contact: Consortium of Humanitarian Agencies,
10 Kynsey Terrace, Colombo 8, SL.
E-mail: cha_prog@sri.lanka.net
Website: http://www.humanitarian-srilanka.org
C.3. CFINS - Colombo
Headquarters of the Colombo Friends in Need
Society. The Colombo Friend-in-Need Society
(CFINS) started in 1831 is the oldest Charitable
Organisation in Sri Lanka. At present CFINS is the
largest provider of prosthetic and orthetic services
in Sri Lanka.
Who: Mr. Ron McGaw,
Volunteer prosthetic
consultant
Ron McGaw, nicknamed
Ronnie, is a prothetist from the
UK. He has a good technical knowledge. Except
producing (better: supervising the production of)
the more difficult limbs, he is busy developing a
new design for developing countries (see
appendix “Current Research”) and plans a new
centre in the north of Sri Lanka. He also works
Pakistan and Italy.
Ron, in our opinion, sometimes exaggerates. Does
he do that in the figures he uses as well?
Who: Mr. Francis, Workshop manager, closely
affiliated to FINS-J
Mister Francis was one of the major forces in the
creation of the Jaffna branch of the Friends in
Need Society. Therefore information about (the
history of) the Jaffna branch can be found here as
well.
Who: Rupa Jayasekera, Administrative
Secretary
Rupa has (controls) all the access to the
(statistical) data of the FINS. She will obey in and
check everything with Kalyani. Computer database
is available, though it will take some trouble to
obtain access.
Who: Kalyani Ranasigne,
Chairperson & President
Kalyani has access to all the
information of the FINS, and
thus the best view of the
amputee problem in Sri Lanka.
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 The Alternative Prosthesis
But, it seems not all the information is presented
fairly. Look at the website and search for the
amount of army victims helped… yes, these are
the “civil commotion victims”.
What:
Statistical data (though very difficult to obtain
some details, see website for common),
technical knowledge & Jaipur system
improvements (Ron) and loads of amputees!
Contact: 171, Sir James Peiris Mawatha,
Colombo 2, Sri Lanka
Email: fins@dpmce.com
Web: www.cfins.org
C.4. CFINS - Kandy Branch
the Kandy branch tries to become independent
from the CFINS.
Who: Vinod (Singanayanam?)
Vinod is a prosthetist from India, hired by the
president of the Kandy branch (T.R.R. Rajan) of
the FINS to improve the production of the
prosthesis. First, the Kandy branch used the
Jaipur design as well, soon they changed to the
Mukti-limb. Now they are started to buy and
produce the Mobility system from India. Vinod is
a reseller of this company. Therefore, the target
of Vinod is not so clear and the figures he uses
are very positive about the Mobility design.
Anyways, Vinod is intelligent and has a very
good knowledge about prostheses.
Who: Mr T.R.R. Rajan
Mr. Rajan is the president of the local (but well
known) match factory Soorya. He believes in the
power of his own people and resources.
What: Information about the activities of the
Kandy branch. Information about the Mukti- and
the Mobility-system.
Email: Mr. Rajan: Soorya@slt.lk
Website: www.cfins.org
TU-Delft 2002-2003 Wisse & v Dorsser
C.5. Army
Who: Lt. Colonel S.W. Sunil Somaweera
The Colonel is discrete and reliable. If he doesn’t
want to give specific information he will elaborate
“around” it. Matthew Todd says that it is possible
that the army under-reports, but expects that this
will change the information only by a few percent.
The colonel is very helpful and gave us the feeling
he really cares about the landmine victims.
Who: General Perera
Although we had little contact with the general he
could be willing to assist.
What:
Global statistical data on military landmine
victims and the way landmines are used by the
Army and The LTTE.
Contact: Office: Commanding Officer,“Ranaviru
Sevana”, Army Rehabilitation Centre, Ragama, Sri
Lanka
Email: lt.col Sunil: rvs@eureka.lk
General Perera:: Dudley@panlanka.net
Website: http://www.army.lk/
C.6. CT, the Cambodia Trust
Who: These experts have done research about
the necessity and ask for an Prosthetists and
Orthetists school in Sri Lanka. Therefore they
made an estimation of the amount of amputees as
well.
What: Estimation of amount of amputees and
amount of prosthetists.
Website: www.cambodiatrust.org.uk
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 The Alternative Prosthesis
C.7. ICRC
Who: Dr Pierre Gratzl:
Although the contact with the ICRC while this
project was done in Sri Lanka was worthless, it
seems that Dr Gratzl should know more about
the subject. The information used is from the
"Impact of Landmines in Sri Lanka" report (see
2) in which he wrote an article. Another author in
this paper is Joe Williams of the Canadanian
Int. Development Agency.
Contact: Seemed to be difficult in Sri Lanka.
Though we’ve been to the Kandy office as to the
Trincomalee office, both new no figures or
whatever about amputees.
Website: www.icrc.org
C.8. WHO
Who: World Health Organisation
What: Worldwide figures.
Website: http://www.who.int/en/
Report Point Prevalence (see table 1,3,4 of
"Discussion Paper 50"):
http://www3.who.int/whosis/burden/estimates/20
01/….
C.9. Medics
Who: Dr. Wickremasinghe:
Email: ranaviru@sltnet.org
C.10. Team Design for All
Who: Boudewijn Wisse
Boudewijn is one of the authors of this report.
He participated from March 2002 till April 2003
in this project
Who: Wouter van Dorsser
Wouter is one of the authors of this report. He
participated from March 2002 till April 2003 in
this project.
Who: Michelle Kriesels
Michelle teamed up with us in August 2002,
joining us in Sri Lanka. She was the main drive
after the Jaipur+. It was initially her design.
TU-Delft 2002-2003 Wisse & v Dorsser
Who: Farshad Soleymani
Farshad participated from March 2002 till
September 2003.
What: All you like!
Contact: B.M.Wisse: 0031152190549,
Buitenwatersloot 177, 2613 TE Delft, NL
Email: B.M.Wisse@student.tudelft.nl,
Michellekriesels@yahoo.com,
Farshad.soleymani@planet.nl,
W.D.vanDorsser@student.tudelft.nl
Website: www.kladder.nl
C.11. Experts in NL
Who: Inne ten Have
Inne ten Have is the intellectual father of the
design we for convenience called the Inne. Right
now he is a software engineer, but always
interested in developments in prosthetics.
Who: Johan Molenbroek
Dr. ir. Johan Molenbroek is, among other things,
the chairman of the Dutch society for Ergonomics
(“Nederlandse Vereniging voor Ergonomie”). He is
an important researcher at the Faculty of Industrial
Design engineering of the Technical University
Delft.
Who: Henk Kooistra
Dr. Henk Kooistra is the person who innitiated this
project. He is a medical doctor and an
acupuncturist. Henk’s network in Sri Lanka is very
good, because his frequent visits to this country
for the past five years.
What: Project information and research
possibilities.
Email: j.f.m.molenbroek@io.tudelft.nl,
inne@xs4all.nl, henk.kooistra@worldonline.nl
Website: www.tudelft.nl, www.xs4all.nl/~inne/
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 The Alternative Prosthesis TU-Delft 2002-2003
D. Current designs
At this moment there are several designs
available in Sri-Lanka. We will describe their
properties here briefly:
Jaipur Limb:
The Jaipur limb is the main
technology, which has been
used in Sri Lanka from 1984
till now (2002). It’s easy to
produce and low cost. The
amputee who has been
rehabilitated doesn’t have the
best prosthesis in the world,
but he has the means to walk
and work again, to retain his
dignity and get back to a “normal” life. The limb
is traditionally made of local materials (wood,
rubber, aluminium) and is produced by local
production methods. The FINS-technicians also
make an adjusted version with Poly Propylene
(PP). The foot is extremely suitable for tropical
climates and can be used without shoes
because of its lifelike appearance.
Mukti limb:
The Mukti system is based on
the same design philosophy
as the Jaipur Foot (Easy to
produce, low cost, not the
best there is but suitable) This
design is made of a
biocompatible material (High Density Poly
Ethylene [HDPE]) simply bought as drainpipes.
The foot is (almost) similar to the Jaipur -foot
ICRC limb:
Also the ICRC (International Committee of the
Red Cross) has the same principle. (Easy to
produce, low cost, not the best there is but
suitable) The ICRC is made in local mass
production. Unfortunately there are only two
(mass-producing) factories at the moment (in
Geneva and Ethiopia). It was designed to be
made of recycled Poly Propylene. But
unfortunately recycled Poly Propylene does not
have the recommended stiffness and strength.
So now non-recycled Poly Propylene (much
more expensive, no environmental gain) is used.
This is why some believe the ICRC failed.
Page 12
Wisse & v Dorsser
Western:
“Western” prostheses (Otto Bock,
Blatchford, etc) simple are the state
of the art. But the best in Europe or
America is not always the best in
the Asia’s. The ‘problem’ with these
prostheses is that the materials
used are not always suitable for the
climate in the Asia’s. Besides, they
often need to be repaired because
they are not made for the work people do in the
Asia’s. (Heavy work in rice field, bare feet walking,
etc). And don’t forget the prices.
Mobility Kit:
A recently new technology
introduced in Sri Lanka by
the Kandy branch of the
FINS is the so-called
Mobility Kit from India.
More information can be
obtained by Vinod (C.4).
The Mobility kit is produced
in Bangalore (as far as the
authors know: Mobility
India, 515 Base Workshop,
Bangalore)
It uses a modular system with a custom made
socket (above and below knee prostheses are
both possible). The kit is delivered with sheets for
the socket, the shaft (piston), sheets for the
fixating exoskeleton, foot and slippers (to reduce
wear). The foot is of lower quality than the Jaipur
foot.
The use of a piston makes fitting easy for a
prosthetist, but the need of a exo-skeleton to
support the weight makes later adjustments
difficult.
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 The Alternative Prosthesis TU-Delft 2002-2003 Wisse & v Dorsser

E. The Friends in Need Society
The Colombo Friends in Need
Society is a non-governmental
organization (NGO) in Sri-
Lanka. The CFINS provides
prosthetic services in Sri
Lanka and is based in
Colombo (headquarters),
Kandy, Jaffna and Galle. The main part of this
project in Sri Lanka was done at the Colombo
Headquarters. The Kandy branch has been
visited. The FINS-Colombo produces about 100
prostheses and ortheses a month. They provide
below knee, above knee and arm prostheses.
Besides prostheses they provide ortheses. All
prostheses and ortheses are custom-made. The
FINS-C uses the famous Jaipur Foot
Technology. The FINS-K produces the Mukti
limb and the Mobility kit. The Jaipur Foot
prostheses provided by the FINS-C are funded
by US-AID and if needed the civilian survivors
receive them free-of-charge.
E.1.
Departments
Apart from the administrative and financial
department, the production floor is divided in
several departments.
The Foot department
The Jaipur Foot has wooden and rubber parts
inside covered by a several rubber layers. It is
extremely resistant and has a lot of flexibility,
which is very useful for the unpaved areas in Sri
Lanka. It has an aesthetic design, which is
preferable for walking bare-feet. It lasts a long time
but the problem is that there is no adjustment and
alignment possible. It is completely fixed. It has a
steel bolt which allows the foot to be connected to
the Aluminium shank.
The production capacity of the FINS-C is eight feet
a day. The chief of the feet department is Mr.
Francis. He has been the director of the Jaffna
branch for many years. There are five employees.
One is making the wooden parts and the others
are producing the actual feet. “over”-production is
“sold” to the other branches.
There is a belt saw, a sander, a drill, a bench-vice
and a wood file to shape the wood pieces for the
feet. Furthermore there is an oven and there are
aluminium moulds to produce the feet. The rubber-
glue is made of recycled rubber parts and
petroleum.

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The Alternative Prosthesis
The aluminium department
Most of the prostheses produced at the FINS-C
still have a aluminium shank and socket
combination. They are all custom-made and
their shape depends on the measurements of
the stump. The circumferences of the stump are
taken every two inch downward started from the
patella tendon. These measurements are filled
in on a form. After this the measurements are
drawn on a heat treated sheet of aluminium, the
sheet will be cut, bended, welded together and
beaten up until the shape is good enough. At the
end a round wood piece (Ø = 7 inch) is put in the
lower part of the shank. This allows the shank to
be connected to the foot.
Picture “Cutting the sheets”: Here one of the
authors can be seen cutting the sheets, which will
become sockets.
The total production time of the shank is about
two hours, which is extremely quick. The chief of
the aluminium department is Mr. Nepala. He is a
well-educated man and has given prosthetic
education in Iraq and Sudan. There are five
employees. Three of them are producing the
shanks and two are painting the prosthesis and
producing the leather belts.
TU-Delft 2002-2003 Wisse & v Dorsser
Picture “Painting the Prostheses”: The prostheses
are given a life-like colour.
There is a belt saw (same as the foot department),
a sander, a drill and a wood file to shape the wood
pieces for the aluminium shank. Furthermore there
is a gas burner, to heat the sheets, a welding
apparatus, a bench-vice and there are three work
areas with a toolbox (hammer, aluminium file,
metal scissors, nippers, etc). To produce the
leather belts there is a sewing machine.
In the aluminium department is also a storage
room. All the parts used to produce prostheses
have to be taken out of this store. In this way it’s
possible to check the rate of production and the
amount of material used.
The polypropylene department
As described recently polypropylene is being
used. Polypropylene is lighter, more convenient
and more comfortable for the stump.
The disadvantage of polypropylene is that there
are few adjustments possible. Besides
polypropylene sockets this department also
produce ortheses and scoliosis-corsets.
The first part of making a polypropylene socket is
taking a cast of the stump with bandage and
plaster of Paris. After removing the negative-cast it
will be filled with plaster of Paris. When the plaster
is hard the mould (negative-cast) will be removed.
The positive form is no ready for adjustments
(Hollow the weight bearing areas and build up the
pressure sensitive areas). After the positive form is
adjusted a polypropylene sheet will be heated and
vacuum formed (pulled) over the positive form.
The negative-polypropylene form will be removed
from the positive-plaster form and finished.
The produced polypropylene socket will be used in
combination with an aluminium shank or in
combination with a recycled western prosthesis.
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The Alternative Prosthesis
The total production time of a polypropylene
socket is about one day. The chief of the
polypropylene department is also Mr. Francis.
There are five employees. One produces arm
prostheses and the others produce the sockets.
TU-Delft 2002-2003 Wisse & v Dorsser
E.2. Internal research
The FINS-C does not have a research
department. Research done at the FINS-C is done
by individuals. The main technology, which has
been used for more than 15 years, is the Jaipur
limb technology. (see appendix D: “Current
designs)”. According to de FINS-C this technology
suffices, so why look for something new?
State of technology
The most recent technology that has been
introduced is the use of a polypropylene socket
instead of an aluminium socket. Now both
technologies are used. The shank is still made of
aluminium. During our visit at the FINS-Kandy
branch we have seen trials with a new design from
India (the "mobility kit", see appendix D: “Current
Designs”).
Current developments
People at the FINS-C who develop improvements
are Mr. Francis and Mr. Ron McGaw.
Mr Francis, chief of the foot and polypropylene
department is developing a plastic (recycled
polyproplene) cast piece to replace the wood-
piece inside the rubber foot.
But Mr. Ron McGaw does the most research at
the FINS. Except producing (better: supervising
the production of) the more difficult limbs, he is
busy developing a new design for developing
countries. It must be said: His design is very
useful. Of course, he uses the traditional principles
(PP-socket + piston + adapted Jaipur foot), but the
improvements are promising. Unfortunately, the
presentation of his new product (drawings, etc) is
not very high standard.
Anyways, we hope his design will be implemented
soon, because it will improve the production rate
and make adjustments (gait) easier, thus reducing
the time the prosthetists need to spend. Ron plans
to start up a new centre in the north of Sri-Lanka
(near Killinochchi).
Integration
It was the first time a group of foreign students did
a (research) project at the FINS. At first it was
difficult getting used to each other. They didn't
know what they could aspect from us and we
didn't know what we could aspect from them. The
employees all have their own tasks. They all had
an education of at least two years and know their
trade well. Everything done in another way than
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The Alternative Prosthesis TU-Delft 2002-2003
common was strange, so we first had to inspire
confidence. F.
In the end, contact with the technicians was very
good. Contact with the management seemed to
be well at first, but later we learned our
impression was wrong. Even after three month
we had difficulties obtaining data (see appendix
B: “Figures”).
Page 16
Wisse & v Dorsser
Contacts and Residences
Before we went to Sri-Lanka we arranged a back-
up team in the Netherlands. Two students were
able and prepared to help us if we needed some
(research) work done in the Netherlands. Beside
this team we had the support of Johan
Molenbroek.
Our counterpart in Sri-Lanka was Malathi
Thalagodapitiya. She works at the humanitarian
agencies and arranged transport from the airport
to a hotel very close to the FINS during our first
day in Sri-Lanka. Unfortunately this hotel was too
expensive for us. So we had to look for a cheaper
hotel during the first week. Eventually we found a
location (guest house) which was much better.
When Henk Kooistra came (about two weeks
later) he helped us to find a spacey apartment in
Mt. Lavinia. Our neighbours helped us very much
during our visit in Sri-Lanka. They often invited us
for dinner, had a computer and were always
prepared to talk to us. A few times we left this
home and went out for some days.
The first day Malathi introduced us to the director
of the FINS-C, Ms. Kalayani Ranasinghe and the
chief of the administration department Ms. Rupa.
Ms. Kalayani who only works on wednesdays
introduces us to Mr.Ron McGaw. He is an English
prosthetist who was very helpful to us. We
discussed our ideas and concepts with him.
Besides Mr.Ron, Mr. Francis (chief of the foot and
polypropylene department) and Mr. Nepala (chief
of the aluminium department) were very helpful
during our daily activities. And last but not least
the employees ("boys") of the workshop, they
were great! They always took care of us and in
some way the always knew what we needed
before we even knew it ourselves. Some of the
boys are deaf and can't speak. This resulted in a
very primitive, but also easy and friendly way of
communication.
Thanks to Henk Kooistra we were also able to see
other workshops like the workshop in Kandy
(FINS-K) and the military workshop. He also
introduced us to Prof. Dr. Anton Jayasuriya, an
acupuncturist. He was the chief of the 40th
congress of Medicina Alternativa. When he heard
about our project he invited us to speak. Later he
also offered us an acupuncture course.
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 The Alternative Prosthesis TU-Delft 2002-2003 Wisse & v Dorsser

G. Price estimation
Material costs
Material
Part(sub-) Quantity Material Purchase Productiontech. Price (E)
SOCKET 1
Front p.t.piece 1 pp inject.m. /v.f. 1
klitterband 2 stof purchase - 0,25
padding 2 stof purchase - 0,75
backside 1 cfibre inject.m. /v.f. 4
inferface 2 pp/metaal? inject.molding 4
belts 2 stof purchase - 0,25
tentioner 2 pp purchase - 1
length adjust 2 metaal purchase - 0,25
stumpend cup 1 pp vacuum forming 0,5
padding 1 foam purchase - 0,25
suspention 1 metaal? bending/cold-forming 0,25
bolt and nut 1 metaal purchase - 0,05

LINER 1
liner 1 foam purchase - 0,75

FOOT 1
basis 1 pp inject.m. 1
lid 1 pp inject.m. 0,5
anklerubber 1 rubber casting/inject.m. 1
toes 2 pp inject.nm. 1
interface 1 pp? inject.m. 1
sealing (surface) 1 textiel heat&glue 1
bolt and nut 1 metaal purchase - 0,05
rubbers 3 rubber cut 0,25

Finishing
Tube (shank) 1 metaal purchase - 2
Cosmetic cover 1 foam purchase - 1,5
Box 1 papier purchase - 1
Measurement card 1 papier purchase - 0,05
Manual 1 papier purchase - 0,5
upperlegbelt 1 leather purchase - 2

material costs (p.p.) 26,15

Page 17 version date: 18-10-2004

The Alternative Prosthesis TU-Delft 2002-2003 Wisse & v Dorsser

Investment & Price p.p.

stand. 1 year 2 years 5 years avr.wages
total limbs: 0 5000 20000 50000

building (/year) 1 100000 100000 200000 500000

Machines
Vacuum former 10000 10000 10000 10000
Bender(stance) 10000 10000 10000 10000
Casts 100000 100000 100000 100000
Inject. molder (2) 50000 50000 50000 50000
Personnel
Doctors 0 0 0 0 0
Technician 15 10800 10800 21600 54000 60
Admin/year 10 6000 6000 12000 30000 50
Maintenance/clean 10 4800 4800 9600 24000 40
Gas,light,water 1 3600 3600 7200 18000
Quantity*Material cost. 0 130750 523000 1307500

Totals 295200 425950 943400 2103500

Per piece 85,19 47,17 42,07

Rounded: 300.000 85 47 42

** All prices in Euros

Page 18 version date: 18-10-2004

 The Alternative Prosthesis
H. Flowchart - Socket designs

The flowchart shows the most D, E, F

important intermediary results of two
design lines of the socket (and
shank). Some other design lines are
not presented.
A, B, C
Although many prototypes were
manufactured, in figures A, B and C
the design steps of the Inne+” can be
found.
[A] Features: Triangle shank; glued
patella tendon knob and glued
padding.
Description: The patellar tendon
knob is glued on as in the original
concept. To keep the amount of
material used low, while keeping a
stiff shank, three strips are welded
together making an triangle.
Unfortunately the welding process
reduces the material strength so it
tears apart on strain.
[B] Features: A beaten patella
tendon knob; thicker material; an
extra bar and no padding anymore.
Description: The padding seemed
to enhance the comfort
insignificantly. To stop the separation
of the lower strips of the socket and
the slipping of the stump an extra
strip is added. It helps, but still not
enough.
[C] Features: adjustable round
shank (bicycle mechanism)
Description: To be able to adjust
the length of the prosthesis and to be
able to fit her new socket/shank to
the classic Jaipur foot, the end of the
socket had to be round. Therefore
the “bicycle steer mechanism” was
copied, enabling easy adjustment in
height of the prosthesis and angle of
the foot.
A
D
On the right the design steps of the
Jaipur+ can be found.
[D] Features: A fixed back part; an
adjustable front (patella tendon) and
adjustable round shank.
Desciption: The socket/shank
combination fits in the same piece as
used in design [C]. Increasing the
amount of material used (should)
increase the contact surface,
improving comfort. The front piece is
difficult to produce out of aluminium.
[E] Features: A calf muscle flap (at
the distal backside); An L-profile for
more strength and stiffness
Desciption: To improve the
B pressure distribution for patients with
different stump sizes and forms, the E
backside is cut loose. This
“improvement” is good in mind, but
didn’t work at all in practise.
Attaching the belts on the inside
does not make the prosthesis
uncomfortable, but improves the
force distribution to the patellar
tendon.
[F] Features: Folded out of one strip;
no calf flap
Desciption: To keep the same
principle, while reducing material
usage and to ease the manufacturing
the design was adapted so it’s made
from one strip (and a front piece).
C
F

Aluminum prostheses
G Plastic prostheses H
G, H, K
The decision to leave the hand-made
principle and to design for mass-
production enables the use of synthetic
materials. “Plastics” are highly
formable.
[G] Features: A patellar tendon flap at
the front; ski shoe bindings; calf muscle
holes at the back; adjustable shank
system.
Description: Holes in the product are
small (else skin gets trapped), but large
enough to adjust the socket for
different stump sizes. The holes at the
side make height adjusting possible,
but stepwise.
[H] Features: A flexible socket; a
(flexible) patellar tendon flap; ski shoe
bindings (not in picture); an above
knee belt.
Description: Difficulties with this design
are adjusting the height, contracture
compensation and pressure
distribution. K
[K] Features: Bearing area on stump
end. Adjustable in height and size. DFU - socket
Description: see the chapter 8 version date: 18-10-2004 Page 19
 The Alternative Prosthesis

I. Flowchart – Foot design

The flowchart shows the most important

L M
intermediary results of the design of the foot.
L, M
Designs L and M were developed in the
Netherlands.
[L] Features: Low tech, bicycle parts reusing
foot.
Description: This design although not very
lifelike, is used in some commercial
prostheses. The difference is the use of
(cheap) bicycle parts and the ease of
manufacture. Further development could be
promising
[M] Features: wood based, lifelike, using
slippers, rocker foot shaped. N
Description: The rocker foot is a design, which
uses the shape of the bottom for a good gait.
A. The bottom has a straight part for stability
while standing. The top is purely aesthetic. A
metal sheet and a slipper protect the foot from
wear. No moving part increase the lifetime of
the foot.
N, O
[N] Features: rubber based, linear alignment)
Description: The foot takes the advantages of
the Jaipur and increases lateral flexibility with a
different wood piece. The design of the wood
piece enables linear alignment.
[O] Features: plastic based, linear and angular
alignment, mass production, different stiffness) K O
Description: The foot used in the DFU is
mass-produced. The toes are produced
separately (left and right), thus using the same
part for all prostheses. The stiffness in the heel
and between the toes and the middle can DFU - socket
easily be increased or decreased (for
amputees with different weight and strength).
Making the connection of the toes to the middle
waterproof is still a weak point of this design.
P
The final DFU kit: All parts are shown,
including an easthetic cover, the two main
parts of the socket, L&R toes, a manual and
interfaces. Caution: The drawing contains
parts, which do not resemble the actual
solution.

version date: 18-10-2004 Page 20