The Jaipur Foot
This posting contains
-- ONE - Information about the Jaipur Foot
-- TWO - Proposal from Rotary District 7020 and the Jaipur Limb Trustees
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ONE - INFORMATION ABOUT JAIPUR FOOT
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Overview
Jaipur Limb technology developed in Jaipur, INDIA is the most functional limb technology in the world. It has following special features –
1) The limbs made with this technology are closest to a normal human limb.
The Jaipur Foot has virtually got the same range of movements which a normal human foot has. It has dorsi-flexion, inversion, eversion, supination, pronation and axial rotation allowing a amputee not only to walk comfortably, but also squat (sitting on hunches), kneeling, crouching, sitting cross legged, walking also on undulated terrain, running, climbing a tree and driving an automobile.
In other words, the Jaipur foot is an all-functional, all-terrain limb. The other limbs with SACH foot cannot have these flexions and functions. There are some Multi Axial Feet but these allow specific limited flexions and functions.
2) Jaipur Foot is cosmetically also closest to the human foot with toes etc.
Once Jaipur Foot was developed many other companies in the world added these cosmetic feature to their limb products to look like normal Foot or Jaipur Foot.
3) Jaipur Foot is waterproof, as many other artificial limbs in the world are.
4) Jaipur Foot is a dual-purpose foot.
It may be worn with shoes or without shoes depending on the desire and the need of the patients. This feature is crucial for meeting the cultural needs of many regions of the world.
For example, most of the modern limbs can be used only with the shoes on, with the result that such amputees cannot enter the temples, mosques, etc, and cannot pray or perform NAMAZ.
5) The normal life of Jaipur Foot piece is around 3 years.
6) The sockets for Jaipur Limb are made of polymers, as is being done in case of other modern limbs in the world.
While in the West, co-polymer or some other polymers are used for making the sockets, these are used in the sheet form. These are heated and wrapped over the Plaster-of-Paris positive moulds, which are the replicas of the remaining stump.
This process leaves the seams or joints in the socket. This also affects their strength.
In case of Jaipur Foot, the outer socket is made, not by using the heated sheets, but by using the heated HDPE pipes through a special process. The result is that the outer socket is both seamless and strong.
It may also be mentioned here that the HDPE pipe, unlike PVC pipe (not used in Jaipur Foot Technology) is inert and non-toxic and bio-compatible.
It also needs to be mentioned that initially hand-beaten aluminum sheets were being used to make Jaipur Limb sockets. This was an advancement over the wood and araldite laminated sockets which were very heavy and cumbersome.
With the availability of polymers in socket making, BMVSS shifted to the HDPE pipes which made the fitment modern, better and lighter. For almost a decade, aluminum sockets are not at all being used by BMVSS.
7) Except where total contact socket cannot be provided because of the condition of the remaining stump of the amputee, invariably Jaipur Limb has both the total contact socket and an outer socket.
For making the total contact socket, the Plaster-of-Paris is generally used. Lately BMVSS received the Sand casing technique developed by Dr. Wu of Center for International Rehabilitation, Chicago, USA.
BMVSS is among the 2 or 3 limb-making centers in the world using this highly efficient and extremely time-saving technique for making total contact socket. As usual BMVSS is also using the vacuum-forming suction system.
8) The above-knee prosthesis is of highly advanced ischial containment variety.
9) While making these limbs, special efforts are made to ensure correct bio-mechanical alignment.
For example, for the below-knee limb, the combination of the in-process wall-frame system of alignment used by some of the well-known prosthesis making companies of the West, is being used by BMVSS in combination with the laser in-process alignment system (used by another set of well-known prosthetic companies of the west).
This combination ensures even better standardized alignment.
For the above-knee sockets, IPOS brims both of hybrid and ischial containment variety are used.
10) It is really a quick-fit limb.
A below-knee, prosthesis can be made in three hours. An Above-knee prosthesis can be made in one or two days.
This is done while following all the technical requirements including those relating to alignment. The Jaipur Foot technology is such that it enables us to hold on-the-spot-limb/caliper-fitment-camps in remote areas where the limbs / caliper are custom fabricated and delivered mostly on the same day.
This distinguishes Jaipur Limb Technology from other technology which send their teams twice to the camps - once for making assessment and taking measurements and second for fitment and delivery after a few weeks or months. It is a known feature that many of the patient do not come during the second visit meant for fitment.
11) Jaipur Limb is light weight.
For a middle-sized person the socket with belt and Jaipur Foot, the total weight of a below-knee limb varies between 1.3 Kg. to 1.5 Kg.
Similarly, for a similar kind of person, the total weight of the above-knee limb varies between 2.25 Kg. to 2.5 Kg.
The Jaipur Limb as first developed in 1968, and Jaipur Limb now are radically different, For last several years, and particularly presently, in the matter of socket making, in terms of equipments employed, modern tooling introduced, new materials used, application of modern bio-mechanical principles, adoption of alignment systems, induction of modern management and production techniques, selection of more qualified human resource etc., is now much superior and more comfortable to the amputees.
The earlier Jaipur Foot, a purely indigenous invention, has also undergone many substantial structural, material and manufacturing changes making it lighter, durable and efficient foot in energy conservation and performance.
Regarding the foot piece, one more fundamental change is under way. The Indian Space Research Organization (ISRO), one of the leading scientific organizations of the world, making and launching satellites, etc., (and the Indian counterpart of the NASA of the USA), got involved in the designing of a foot piece, perhaps because of its experience with polymer materials and moved by humanitarian consideration.
ISRO, recognizing BMVSS as the largest organization for the handicapped in the world, transferred this design to BMVSS, which with the support of the world-renowned Fortune 500 Company – the DOW Chemicals of USA, and local company Pinnacle Industries, Indore and Liberty Shoes Company; New Delhi has made new Polyurethane (PU) Foot.
This is under field trial, and may provide one more choice of the modern foot to the amputees. The Ministry of Social Justice and Empowerment, Government of India, has sanctioned a project to BMVSS and Dr. Mathur, the chief consultant, BMVSS for the development of this new foot.
One more research project regarding the development of the indigenized energy-storing foot (Synergy foot) is also underway. This is also a project sanctioned by the Ministry of Social Justice and Empowerment, Govt. of India to BMVSS on which Mr. Sanjeev Kumar, Manager, BMVSS, New Delhi and Dr. Dharmendra Kumar, Director IPH, New Delhi, (a National Institute for the handicapped in India) are working.
One of the principal objectives of BMVSS is to remain committed to Research & Development so that the patients get more advanced aids & appliances.
Total Contact Socket
Jaipur below-knee prosthesis is indigenously designed and fabricated from locally available and durable high density polyethylene/ Co-PP sheets and HDPE pipes and fitted with world famous Jaipur foot. It becomes highly functional prosthesis with a total contact socket. It looks like a normal limb, has good range of movement required for normal human locomotion.
Total Contact Socket has many advantages over conventional open ended socket:
a) It provides better sensory feedback to the wearer.
b) It helps in preventing edema at the lower end of the stump and helps in improving venous return, a great advantage in the immediate post surgical fittings.
c) Gives better proprioception to the wearer.
d) Allows scientific weight distribution over large surface area of the stump.
e) Provides facility for easy alignment changes.
f) PTS (PTB-SC) helps in self suspension IPOS Brims for AK Prosthesis provides the most advanced and functional ischial containment sockets.
This socket system is the most bio-mechanically appropriate and user-friendly system, which allows an above-knee amputee to walk with a near normal gait with minimum energy consumption.
Recent Advancements
Lately BMVSS signed a formal agreement with Indian Space Research Organization (ISRO) – premier scientific body of India – to make a foot from Polyurethane’s (PU) – used by them in their rockets and satellites. The research and
development wing of BMVSS, after making necessary modifications in the design, dies and materials, have produced several foot pieces of the new type.
These are undergoing field trials and laboratory tests. DOW Chemicals, one of the
world’s largest chemical and polymer company of the world, is also helping us in selection of proper PU material, supply of such material and manufacturing of foot pieces.
The initial reactions of users to the new feet is quite positive. This has
made the new foot lighter and has improved its cosmoses. Since we are using a computer-controlled injection moulding process for making the new foot, the quality is both better and uniform.
When the field trials are concluded successfully, this new PU Foot is going to be another breakthrough in limb-making technology in the world.
Jaipur Limb, which was earlier made of aluminum with open-ended socket, is now being made of HDPE with the very advanced Total Contact Socket System. For this, BMVSS has purchased the advanced vacuum-forming machines from Germany. Because of total contact sockets, the Jaipur limb has a very comfortable stump socks interface.
To get the best alignment, BMVSS has married two different alignment systems; i.e., wall frame from Endolite Prosthetics, a British Company, and Laser alignment system of Otto Bock Prosthetics, a German Company.
The above-knee prosthesis are made with IPOS brims, providing ischeal containment sockets – the highly advanced socket system in the world. Apart from BMVSS, this system is being used in India only by one more organization.
We also have an understanding with the Center of International Rehabilitation (CIR) Northwestern University, Chicago, USA. They have transferred the technology of making total-contact socket through sand-casting method, which is superior
in terms of quality, and also takes much less time in making the total contact sockets.
Efforts are also underway for improvement in the design of joints, belts, stump socks etc.
For more information and photographs go to www.jaipurfoot.org or www.rotaryjaipurlimb.co.uk
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TWO - PROPOSAL
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PROPOSAL FROM ROTARY DISTRICT 7020
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THE JAIPUR LIMB TRUSTEES
Assumptions
1. We assume there is a need for prostheses to be provided to amputees, both adult and children, who have suffered the loss of a lower limb, either as a result of the earthquake or through other circumstances.
2. We assume there are a number of prosthetic technicians already trained in the process of fitting lower limbs and with the rehabilitation process.
Offer
1. We will finance the cost of providing training in the Jaipur technology to a group of Haitian technicians.
Assuming they already have qualifications, the training will take six to ten weeks. The technicians will travel to the Jaipur Foot headquarters in Jaipur, India. At least one person travelling must be fluent in English.
2. We will provide funding for the establishment of at least one clinic, to be situated close to an existing hospital, with a workshop and all the necessary equipment, materials and supplies to produce an initial 50 lower limbs.
This clinic will be available for the fitting, manufacturing of lower limbs to amputees at no cost to the recipients. The process for providing a limb will take
approximately one week, from arrival at the clinic to departure with the limb.
Concerns
1. We understand that there may be a need for corrective surgery in many cases of those amputees who suffered loss of limbs from the earthquake.
Rotary will not be responsible either financially or professionally for these procedures.
2. The Jaipur prosthesis is suitable for city dwellers as well as agricultural workers, and can be fitted either above or below the knee.
The conditions for fitting (for example after the necessary stump revision or corrective surgery) are the same as for any other prosthetic. The major difference is the cost – which is free to the recipient.
3. Many of the aid agencies currently assisting in the aftermath of the disaster will leave the country in due course.
As long as the technicians remain available, The Jaipur Clinic(s), once set up, will be in a position to provide ongoing maintenance and replacement services at little or no cost.
4. It has been requested that the Jaipur Clinic be a mobile facility.
While this would offer a much-needed service, it is most unlikely that the necessary equipment and supplies could be housed in a suitable vehicle. However, it is recommended that we set up transportation services for amputees from outlying areas to come to the clinic for fitting.
