Konstantin Deblikov deftly extends one black, bionic finger to rub the side of his nose as he talks. The casual observer might think that the young journalist from Voronezh has complete mastery of his bionic hands, but his dexterity belies the struggle that prosthesis-wearers can face on a daily basis.
Fyodor Merkulyev, left, poses with a fellow prosthetic leg-wearer at last week's conference in Moscow. Photo: Sk.ru.
“It’s impossible to learn how to do something with a prosthetic hand once and for all. Every object is new, every zipper on clothing is new, you have to get used to every object in order to be able to use it quickly, without thinking about it,” Deblikov told Sk.ru at a conference in Moscow last week devoted to developing the hi-tech prosthesis market in Russia.
For Fyodor Merkulyev, sitting beside Deblikov, the challenges of getting used to walking with a prosthetic leg were quite different.
“I call it a step into emptiness,” he told Sk.ru. “When a person takes a step on a prosthesis, they don’t know what will happen, and that’s scary. And when they make the step, it gets easier,” he said, explaining that it was important to focus on the result.
“There’s no choice. Well, there is a choice: either you walk or you don’t. Either you walk properly, or you don’t. It just depends on what’s in people’s heads. I understood the point of it in three or four days, and within a month, I was already walking,” he said.
Set out on tables in the lobby at the conference – and modelled by people attending the event – were various kinds of prostheses, ranging from cosmetic hands made to look as realistic as possible but with limited functions, to body-powered cable-operated hands, when the fingers are moved by flexing the arm, and myoelectric models powered by electrical signals generated by the wearer’s remaining muscles.
Journalist Konstantin Deblikov pictured at the event. Photo: Sk.ru.
Merkulyev is wearing what he describes as a “basic Austrian prosthesis” while waiting for a Genium X3 bionic leg with a microprocessor-controlled knee from the German company Ottobock. While he says the Russian prostheses he has tested have been absolutely fine from a technical point of view, he doesn’t see the point in Russia trying to invent technology that already exists in other countries.
“If a myoelectric prosthesis would cost less than its foreign counterparts, then [it would be worth it], but if it’s more complex, the Russian ones will be more expensive,” he says.
The question of the need for Russian-made prostheses and their place in the international market was central to the conference. While some argued that most of what Russian companies are working on already exists abroad, others are adamant that it is essential for Russia to develop its own hi-tech prostheses.
Budget considerations
Under the Russian health system, people who need a prosthesis are entitled to receive one free of charge – but not all kinds of prostheses are available to everyone. People who lose a limb as a result of an accident at work – like Merkulyev, who was hit by a train while working on the railway – are entitled to a higher sum of compensation, and accordingly, a more advanced prosthesis, than people injured outside the workplace or who lose a limb through illness.
Deblikov, who lost his hands in a pyrotechnic accident in 2014, was able to get his Bebionic 3 hands made by the British company Steeper after his friends launched a fundraising campaign.
“They are very expensive by any standards, I don’t know if I would have been able to get them if it hadn’t been for the help of a lot of people who helped me to raise the money for them,” Deblikov told Sk.ru, adding that the hands each cost about 1.6 million rubles ($25,000 at current exchange rates).
“There is a [state] budget, and it’s expensive to fit everyone with bionic hands. It’s not that they just want to give everyone cosmetic, non-functional prostheses, but there has to be a happy medium,” says Yulia Gulenkova, head of medical equipment and IT for health in the Skolkovo Foundation’s biomed cluster.
Accordingly, if Russia could make hi-tech prostheses cheaper than their foreign competitors, some Russians would be able to upgrade their prostheses. This has become a more pressing issue since the ruble’s steep devaluation in the last few years, which has made foreign imports twice as expensive. Making cheaper models would also enable Russian hi-tech prosthesis companies to compete on the international market, says Albert Yefimov, head of the Skolkovo Foundation’s Robocentre, one of the conference’s organisers.
Russian manufacturers “should focus on the international market because with prices like those of Bebionic, it will be easy to compete with them,” he told Sk.ru. “It’s probably quite a high level of technology, but nothing that we can’t do.”
Made in Russia
Yefimov believes Russian companies can go above and beyond existing technology, so long as they keep an eye on international trends.
“While we’re making a new kind of body-powered prosthesis, the price of bionics will drop by five times,” he told the conference.
“We have to set ourselves genuinely ambitious goals, taking into account international experience,” he said. And developers aiming for ambitious goals, he added, should not be deterred by current costs.
“Americans never think – and they are absolutely right – about how much it costs now,” Yefimov said, pointing out that GPS was originally developed for strategic missiles and is now found in every smartphone.
Despite the title of the conference, Yefimov said he is “categorically against talking about a ‘Russian market.’ Russia is a tiny part of the market,” he said.
The market, many agree, has potential, though official statistics on the number of prostheses needed in Russia per year are hard to come by.
“It’s hard to find statistics on amputees, on what limbs people are missing,” says Gulenkova of Skolkovo’s biomed cluster. “There are medical statistics for illnesses, but for amputations, to find out who needs which limbs – no one can find complete statistics,” she said.
Ivan Krechetov, CEO of Skolkovo resident Kleiber Bionics. Photo: Sk.ru.
Ivan Krechetov, CEO of Kleiber Bionics, a resident company of the Skolkovo Foundation’s IT cluster that makes bionic prosthetic upper limbs, told the conference that he estimates that 20-22,000 prostheses are needed per year in Russia.
“Professional prosthetists are trained in only two places here: in St. Petersburg and Korolyovo, which produce about 40 specialists a year,” Krechetov said.
Currently, there are waiting lists for people in need of prostheses who want to receive them under the state insurance programme, though those who can afford to do so can buy their own prostheses without waiting and then claim back the money, says Gulenkova.
Kleiber Bionics says the production of its hands could quickly and easily be expanded. In five to 10 years’ time, people will be able to receive a prosthesis within a week or two after losing a limb, Krechetov predicts.
Technological breakthrough
Another development that, according to Yefimov, has “changed everything,” is 3D printing.
Conference organiser Motorica, a resident company of Skolkovo’s biomed cluster that specialises in making enhanced cable-operated hands for children, uses a 3D printer to produce them, a technology that the company’s director Ilya Chekh says has enabled them to make prostheses that are more sturdy and high performance than those made using more traditional methods, not to mention faster to make.
“People said that printed prostheses are fragile and break easily, so we decided to test the smallest [and most fragile] of our hands,” he said, starting a video that showed the Motorica team putting a small child-size prosthesis through its paces with a blowtorch, throwing it off the roof of a seven-storey building, exerting force on the fingers and finally running over the hand in a car. In all the experiments, the fingers remained attached, and only in the final test did the cable need replacing.
Motorica is currently working on a myoelectric hand for adults named the Stradivary.
Albert Yefimov, left, head of Skolkovo's Robocentre, and Ilya Chekh, director of Motorica. Photo: Sk.ru.
“Our task now to make prostheses that will satisfy all the needs of a Russian person and that they can get anywhere in Russia and, most importantly, learn how to use,” says Chekh.
“Just as with our cable-operated prostheses for children, our bionic prosthesis should significantly exceed the abilities of an ordinary arm: it should take on the role of an electronic gadget that connects its wearer to the digital world around us. In five to 10 years, we will all live in smart homes, with smart cars and so on, and the gadget should be compatible with all that,” he said.
Live for today
The Skolkovo Foundation and Russia’s other development institutes are currently working with the ministries of Health, Trade and Industry, Economy, Labour and Education to form a working group dedicated to the reform of Russia’s rehabilitation system through 2030.
In the meantime, neither Deblikov nor Merkulyev has allowed the loss of their limbs to hold them back from living life to the full. Merkulyev, an accomplished high-jumper, has his eye on the 2020 Paralympic Games in Tokyo. He is also the first person in Russia to ice skate following an above-the-knee amputation, and is currently trying to get it registered as a new sport, not just in Russia, but at an international level.
“If we get 10 countries to participate, we could take it to a Paralympic level for the Winter Games,” he says.
Deblikov, meanwhile, is currently training together with Motorica for the world’s first international Cybathlon, due to be held in Zurich in October. Six teams from Russia will attend the event, said Gulenkova, to demonstrate how robotic technology helps them perform everyday tasks.