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Innovation & Design

Ossur: Design That Walks the Line

To offer a prosthetic foot with greater stability, Hilmar Janusson and his colleagues used innovative software and artificial intelligence

Several years ago, Hilmar Janusson and his colleagues at Reykjavik (Iceland) prosthesis maker Ossur discovered what he calls "a well-kept secret" among below-the-knee amputees.

Applying a user-centered design approach, the research-and-development team at Ossur—supplier for South African runner Oscar Pistorius, the controversial, first-ever amputee Olympic Games hopeful—regularly collects patient anecdotes relayed by clinicians in various nations, including Germany, Belgium, and the U.S. And Janusson, Ossur's vice-president of R&D, spotted patterns in the feedback. Many amputees, Janusson and his team noticed, reported falling when wearing the very prosthetic feet that are meant to help them walk and move about.

But while other medical-device designers may have known about this problem, none came up with Ossur's sophisticated solution: to create a truly lifelike foot that can react in real time to an amputee's motion, similar to a biological appendage. And Janusson's solution was to involve a technology never before used in the field of consumer prosthetics: artificial intelligence.

"If you've ever walked around wearing ski boots, you'll get a sense of what it is like wearing a typical prosthetic foot every day," Janusson says, referring to the inflexible and uncomfortable footwear that alpine skiers wear to keep their ankles stable on the slopes, but which are notoriously difficult to walk in.

A Foot with a Brain

In the clinical reports that Ossur reviewed, many of the amputees wearing stiff traditional prosthetic feet admitted being frustrated. They reported being afraid to take a simple stroll or exercise, but continued immobility for fear of falling could potentially jeopardize their cardiovascular and muscular health, possibly leading to further medical issues such as heart disease.

Learning about this unfortunate secret helped Janusson and his engineering and design colleagues address the user need for a more comfortable, stable, and natural prosthetic foot—one that moved more like a human foot than a cumbersome peg leg. So Janusson, an Iceland native who holds a PhD in chemical science and engineering from Britain's Leeds University, led a team to design a foot that uses motion sensors and advanced software to provide fluid, natural movement. Made of aluminum, the Proprio features hardware that senses and measures ankle and leg motion more than 1,000 times per second, to gauge how fast and in what direction the user is walking.

Proprietary software analyzes the data and then instructs the foot to adjust to the user's movement, so the amputee can walk with ease. The foot also points downward when an amputee is sitting, a more natural, lifelike position not previously achievable in foot prosthetics.

Filling a Need

The advanced bionic foot was released in the fall of 2006, and this June it won a Medical Design Excellence Award, a top industry honor given by the publisher of trade publication Medical Device & Diagnostic Industry. The U.S. Defense Dept. and the Veteran's Administration are currently using the Proprio foot for wounded soldiers returning from Iraq and Afghanistan, as well as for other veterans with amputated feet.

Janusson sees diabetics as another market. Statistics from the Centers for Disease Control published on the American Diabetes Assn.'s Web site state that more than 60% of nontraumatic lower-limb amputations occur in people with the disease. Together, these markets and the introduction of its state-of-the-art, potentially revolutionary device, helped Ossur's worldwide sales in 2006 grow 57%, to $252 million, the highest growth rate in the company's 36-year history.

Integrating Biology and Mechanics

"What really differentiates Ossur from its other market participants is its innovative bionic product platform," writes Archana Swathy, a medical device research associate at Frost & Sullivan, a consultancy headquartered in San Jose, Calif., via e-mail. "Use of artificial intelligence and the adaptive capabilities of the prosthesis give the user a sense of independence and safety, restoring lost function. The unique integration of biology, mechanics, and electronics has led to the evolution of motorized prostheses that sense, think, and act accordingly."

Other Ossur bionic devices include the Rheo Knee, designed in partnership with Hugh Herr and the Artificial Intelligence Lab at MIT, and overseen by Janusson. This design uses a complex system of hardware and software to monitor and control an amputee's movements, sensing and adjusting its motion in real time, similar to the Proprio Foot.

For the past two years, Frost & Sullivan gave Ossur an annual Medical Devices Technology Innovation Award. In 2005, it was bestowed on the Rheo Knee; in 2006, Ossur's growing platform of bionic prosthetics garnered the top award. And Frost & Sullivan isn't alone in recognizing the company's accomplishments: In 2006, a panel of venture capitalists and technologists at the World Economic Forum named Ossur a "Technology Pioneer," recognizing the company as a game-changing innovator. Ossur's chief executive, Jon Sigurdsson, was then invited to the World Economic Forum's annual meeting in Davos, Switzerland. This year, he participated in a panel with Google (GOOG) co-founder Larry Page.

"Sweeping New Technologies"

Janusson has been at the design helm of Ossur since 1993, and his approach to the industry has been dependably unusual. His philosophy, which permeates Ossur as a company, is to innovate specifically in the realms of materials science and artificial intelligence, rather than merely adapting what was available from other sectors, such as the aerospace or auto industries, where engineers perennially work with high-performance materials and new technologies. That had been the typical trajectory of product development among prosthetics makers.

"More often than not, medical designers borrow from another industry," says Erik Swain, editor-in-chief at Medical Device & Diagnostic Industry. "But Ossur seems to be a company that's very willing to swing for the fences. It's not content with 'me too' products or building on others' ideas. It seems to have a philosophy of introducing sweeping new technology and bold ideas."

As it happens, Janusson was not initially drawn to prosthetics and orthotics (brace) design. He received his bachelor's degree in chemistry and his master's in solid state chemistry from the University of Iceland, before enrolling at the School of Materials at the University of Leeds as a doctoral student. On graduation, he worked as a researcher with the Technological Institute of Iceland, when he was asked by an acquaintance to consult on manufacturing issues for Ossur.

The Cost of Risk

As he learned more about the company, which was founded in 1971 by amputee and prosthetics inventor, Ossur Kristinsson, Janusson grew fascinated by its history of innovation and the attention it paid to user experience. Many of the staff were amputees or had friends or family members who needed prostheses or orthoses, and couldn't find what they were looking for—so they had to invent new ones.

"Usually, PhDs who study materials end up in the military, aerospace, or auto industries," Janusson says. "I stumbled upon Ossur [which] gave me a wonderful opportunity to learn. The company offers the most appreciative crowd for materials. For amputees, what's desperately needed are high-strength, light[weight] devices. That was interesting to me."

Janusson admits, though, that by adhering to his strategy of experimenting with innovative materials and technologies never used before in the prosthetics field, Ossur is taking risks. Certainly, its products come with a hefty price tag: the Proprio foot costs between $25,000 and $30,000, whereas a new plastic prosthetic spring-action foot from Niagara Prosthetics & Orthotics in Ontario, Canada, will cost $35 when it's released in September.

An Open-Innovation Approach

But given the Proprio's integrated high-tech software, the comparison is not strictly fair, and Janusson says that the Proprio's price will eventually be lower. He cites the precedent of quartz watches, astronomically expensive when they first came to market but which then dropped in price when they were manufactured more widely. Currently, Ossur dedicates 8% to 10% of its revenue to R&D, a strategy intended to offset the financial risk of developing high-end devices with the continued creation of simple products with enduring audiences, such as knee braces.

"The idea is to manage our product portfolio correctly, so we can continue to introduce new technologies over the long term," says Janusson.

Taking an open-innovation approach also helps share risk, and the company collaborates with leading research institutions from around the globe, including MIT's Artificial Intelligence Lab, Harvard Medical School, Sweden's Royal Institute of Technology, and Kings College in London. This is in line with the strategies of other major prosthetics makers such as competitor Otto Bock, headquartered in Duderstadt, Germany, which is working with researchers at Chicago's Northwestern University on sophisticated prototypes for realistic prosthetic hands and limbs.

"Yes, there has been a lot done in artificial intelligence at the university level," says Medical Device & Diagnostic Industry's Swain. "But in the [prosthetic foot] segment, Ossur has been first to bring it to market." On top of the recent booming sales and awards, Janusson's vision is bringing real relief for amputees.

For a look at a variety of Ossur prosthetic and orthotic designs overseen by Janusson, click here.

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