The $80 prosthetic knee that's changing lives
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0:01 - 0:03Nine years ago, I worked
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0:03 - 0:05for the U.S. government in Iraq,
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0:05 - 0:08helping rebuild the electricity infrastructure.
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0:08 - 0:11And I was there, and I worked in that job
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0:11 - 0:12because I believe that technology
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0:12 - 0:15can improve people's lives.
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0:15 - 0:18One afternoon, I had tea with a storekeeper
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0:18 - 0:21at the Al Rasheed Hotel in Baghdad,
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0:21 - 0:24and he said to me, "You Americans,
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0:24 - 0:25you can put a man on the moon,
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0:25 - 0:26but when I get home tonight,
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0:26 - 0:29I won't be able to turn on my lights."
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0:29 - 0:31At the time, the U.S. government had spent
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0:31 - 0:33more than two billion dollars
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0:33 - 0:36on electricity reconstruction.
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0:36 - 0:39How do you ensure technology reaches users?
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0:39 - 0:41How do you put it in their hands
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0:41 - 0:43so that it is useful?
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0:43 - 0:46So those are the questions that my colleagues and I
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0:46 - 0:48at D-Rev ask ourselves.
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0:48 - 0:51And D-Rev is short for Design Revolution.
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0:51 - 0:54And I took over the organization four years ago
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0:54 - 0:56and really focused it on developing products
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0:56 - 0:58that actually reach users,
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0:58 - 1:00and not just any users,
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1:00 - 1:04but customers who live on
less than four dollars a day. -
1:04 - 1:06One of the key areas we've been working on recently
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1:06 - 1:08is medical devices, and while it may not be obvious
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1:08 - 1:11that medical devices have something in common
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1:11 - 1:13with Iraq's electricity grid then,
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1:13 - 1:15there are some commonalities.
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1:15 - 1:18Despite the advanced technology,
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1:18 - 1:21it's not reaching the people who need it most.
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1:21 - 1:23So I'm going to tell you about one of
the projects we've been working on, -
1:23 - 1:26the ReMotion Knee, and it's a prosthetic knee
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1:26 - 1:28for above-knee amputees.
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1:28 - 1:31And this project started when
the Jaipur Foot Organization, -
1:31 - 1:34the largest fitter of prosthetic limbs in the world,
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1:34 - 1:36came to the Bay Area and they said,
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1:36 - 1:39"We need a better knee."
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1:39 - 1:42Chances are, if you're living on
less than four dollars a day, -
1:42 - 1:44and you're an amputee,
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1:44 - 1:46you've lost your limb in a vehicle accident.
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1:46 - 1:47Most people think it's land mines,
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1:47 - 1:49but it's a vehicle accident.
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1:49 - 1:51You're walking by the side of the road
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1:51 - 1:52and you're hit by a truck,
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1:52 - 1:54or you're trying to to jump on a moving train,
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1:54 - 1:58you're late for work, and your pant leg gets caught.
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1:58 - 2:01And the reality is that if
you don't have much money, -
2:01 - 2:03like this young named Kamal right here,
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2:03 - 2:05the option you really have
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2:05 - 2:08is a bamboo staff to get around.
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2:08 - 2:10And how big a problem is this?
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2:10 - 2:13There's over three million amputees every year
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2:13 - 2:17who need a new or replacement knee.
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2:17 - 2:18And what are their options?
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2:18 - 2:21This is a high-end. This is
what we'd call a "smart knee." -
2:21 - 2:23It's got a microprocessor inside.
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2:23 - 2:25It can pretty much do anything,
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2:25 - 2:27but it's 20,000 dollars,
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2:27 - 2:29and to give you a sense of who wears this,
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2:29 - 2:32veterans, American veterans coming
back from Afghanistan or Iraq -
2:32 - 2:35would be fit with something like this.
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2:35 - 2:37This is a low-end titanium knee.
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2:37 - 2:40It's a polycentric knee, and all that that means
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2:40 - 2:42is the mechanism, is a four-bar mechanism,
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2:42 - 2:44that mimics a natural human knee.
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2:44 - 2:47But at 1,400 dollars, it's still too expensive
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2:47 - 2:49for people like Kamal.
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2:49 - 2:52And lastly, here you see a low-end knee.
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2:52 - 2:54This is a knee that's been designed specifically
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2:54 - 2:55for poor people.
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2:55 - 2:57And while you have affordability,
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2:57 - 2:59you've lost on functionality.
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2:59 - 3:02The mechanism here is a single axis,
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3:02 - 3:04and a single axis is like a door hinge.
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3:04 - 3:06So you can think about how unstable that would be.
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3:06 - 3:08And this is the type of mechanism
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3:08 - 3:12that the Jaipur Foot Organization was using
when they were looking for a better knee, -
3:12 - 3:14and I just wanted to give you a sense
of what a leg system looks like, -
3:14 - 3:16because I'm showing you all these knees
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3:16 - 3:18and I imagine it's hard to think
how it all fits together. -
3:18 - 3:20So at the top you have a socket,
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3:20 - 3:22and this fits over someone's residual limb,
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3:22 - 3:25and everyone's residual limb is a little bit different.
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3:25 - 3:26And then you have the knee,
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3:26 - 3:27and here I've got a single axis on the knee
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3:27 - 3:29so you can see how it rotates,
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3:29 - 3:33and then a pylon, and then a foot.
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3:33 - 3:36And we've been able to develop a knee,
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3:36 - 3:38a polycentric knee, so that type of knee
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3:38 - 3:41that acts like a human knee, mimics human gait,
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3:41 - 3:43for 80 dollars retail.
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3:43 - 3:47(Applause)
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3:47 - 3:49But the key is, you can have this great invention,
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3:49 - 3:51you can have this great design, but how do you get it
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3:51 - 3:53to the people who most need it?
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3:53 - 3:56How do you ensure it gets to them
and it improves their lives? -
3:56 - 3:59So at D-Rev, we've done some other projects,
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3:59 - 4:02and we looked at three things that we really believe
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4:02 - 4:06gets technologies to customers, to users,
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4:06 - 4:07to people who need it.
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4:07 - 4:10And the first thing is that the product
needs to be world class. -
4:10 - 4:12It needs to perform on par
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4:12 - 4:14or better than the best products on the market.
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4:14 - 4:17Regardless of your income level,
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4:17 - 4:18you want the most beautiful,
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4:18 - 4:21the best product that there is.
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4:21 - 4:24I'm going to show you a video now
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4:24 - 4:26of a man named Ash. You can see him walking.
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4:26 - 4:28He's wearing the same knee system here
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4:28 - 4:29with a single axis knee.
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4:29 - 4:31And he's doing a 10-meter walk test.
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4:31 - 4:35And you'll notice that he's struggling
with stability as he's walking. -
4:35 - 4:38And something that's not obvious, that you can't see,
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4:38 - 4:41is that it's psychologically draining
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4:41 - 4:44to walk and to be preventing yourself from falling.
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4:44 - 4:46Now this is a video of Kamal.
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4:46 - 4:49You remember Kamal earlier,
holding the bamboo staff. -
4:49 - 4:51He's wearing one of the earlier versions of our knee,
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4:51 - 4:55and he's doing that same 10-meter walk test.
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4:55 - 4:58And you can see his stability is much better.
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5:00 - 5:03So world class isn't just about
technical performance. -
5:03 - 5:06It's also about human performance.
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5:06 - 5:08And most medical devices, we've learned,
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5:08 - 5:11as we've dug in, are really designed for Westerners,
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5:11 - 5:12for wealthier economies.
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5:12 - 5:16But the reality is our users, our customers,
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5:16 - 5:18they do different things. They sit cross-legged more.
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5:18 - 5:21We see that they squat. They kneel in prayer.
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5:21 - 5:24And we designed our knee to have
the greatest range of motion -
5:24 - 5:28of almost any other knee on the market.
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5:28 - 5:30So the second thing we learned, and this leads
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5:30 - 5:32into my second point, which is that we believe
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5:32 - 5:35that products need to be
designed to be user-centric. -
5:35 - 5:37And at D-Rev, we go one step further and we say
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5:37 - 5:39you need to be user-obsessed.
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5:39 - 5:42So it's not just the end user
that you're thinking about, -
5:42 - 5:44but everyone who interacts with the product,
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5:44 - 5:46so, for example, the prosthetist who fits the knee,
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5:46 - 5:50but also the context in which the knee is being fit.
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5:50 - 5:51What is the local market like?
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5:51 - 5:53How do all these components get to the clinic?
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5:53 - 5:55Do they all get there on time? The supply chain.
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5:55 - 5:58Everything that goes into ensuring
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5:58 - 6:00that this product gets to the end user,
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6:00 - 6:04and it goes in as part of the system, and it's used.
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6:04 - 6:06So I wanted to show you some of the iterations
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6:06 - 6:10we did between the first version, the Jaipur Knee,
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6:10 - 6:12so this is it right here.
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6:12 - 6:14(Clicking)
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6:14 - 6:16Notice anything about it?
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6:16 - 6:19It clicks.
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6:19 - 6:22We'd seen that users had actually modified it.
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6:22 - 6:25So do you see that black strip right there?
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6:25 - 6:28That's a homemade noise dampener.
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6:28 - 6:30We also saw that our users had modified it
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6:30 - 6:32in other ways.
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6:32 - 6:34You can see there that that particular amputee,
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6:34 - 6:36he had wrapped bandages around the knee.
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6:36 - 6:38He'd made a cosmesis.
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6:38 - 6:40And if you look at the knee,
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6:40 - 6:43it's got those pointy edges, right?
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6:43 - 6:45So if you're wearing it under pants or a skirt
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6:45 - 6:48or a sari, it's really obvious
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6:48 - 6:49that you're wearing a prosthetic limb,
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6:49 - 6:53and in societies where there's social
stigma around being disabled, -
6:53 - 6:56people are particularly acute about this.
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6:56 - 6:59So I'm going to show you some
of the modifications we did. -
6:59 - 7:02We did a lot of iterations, not just
around this, but some other things. -
7:02 - 7:04But here we have the version three,
the ReMotion Knee, -
7:04 - 7:06but if you look in here, you can see
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7:06 - 7:11the noise dampener. It's quieter.
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7:11 - 7:14The other thing we did is that
we smoothed the profile. -
7:14 - 7:16We made it thinner.
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7:16 - 7:17And something that's not obvious is that we
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7:17 - 7:21designed it for mass production.
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7:21 - 7:22And this goes into my last point.
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7:22 - 7:24We really, truly believe that if a product
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7:24 - 7:27is going to reach users at the scale that it's needed,
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7:27 - 7:28it needs to be market-driven,
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7:28 - 7:32and market-driven means that products are sold.
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7:32 - 7:35They're not donated. They're not heavily subsidized.
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7:35 - 7:37Our product needs to be designed to offer value
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7:37 - 7:38to the end user.
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7:38 - 7:40It also has to be designed to be very affordable.
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7:40 - 7:43But a product that is valued by a customer
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7:43 - 7:44is used by a customer,
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7:44 - 7:47and use is what creates impact.
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7:47 - 7:48And we believe that as designers,
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7:48 - 7:52it holds us accountable to our customers.
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7:52 - 7:54And with centralized manufacturing,
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7:54 - 7:56you can control the quality control,
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7:56 - 7:58and you can hit that $80 price point
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7:58 - 8:00with profit margins built in.
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8:00 - 8:03And now, those profit margins are critical,
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8:03 - 8:04because if you want to scale, if you want to reach
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8:04 - 8:06all the people in the world who possibly need a knee,
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8:06 - 8:10it needs to be economically sustainable.
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8:10 - 8:12So I want to give you a sense of where we are at.
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8:12 - 8:16We have fit over 5,000 amputees,
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8:16 - 8:18and one of the big indicators
we're looking at, of course, -
8:18 - 8:20is, does it improve lives?
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8:20 - 8:22Well, the standard is, is someone
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8:22 - 8:24still wearing their knee six months later?
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8:24 - 8:27The industry average is about 65 percent.
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8:27 - 8:29Ours is 79 percent,
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8:29 - 8:32and we're hoping to get that higher.
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8:32 - 8:35Right now, our knees are worn in 12 countries.
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8:35 - 8:37This is where we want to get, though,
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8:37 - 8:38in the next three years.
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8:38 - 8:41We'll double the impact in 2015,
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8:41 - 8:44and we'll double it each of
the following years after that. -
8:44 - 8:46But then we hit a new challenge,
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8:46 - 8:48and that's the number of skilled prosthetists
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8:48 - 8:51who are able to fit knees.
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8:51 - 8:54So I want to end with a story of Pournima.
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8:54 - 8:55Pournima was 18 years old
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8:55 - 8:58when she was in a car accident
where she lost her leg, -
8:58 - 9:01and she traveled 12 hours by train
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9:01 - 9:04to come to the clinic to be fit with a knee,
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9:04 - 9:06and while all of the amputees who wear our knees
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9:06 - 9:09affect us as the designers,
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9:09 - 9:13she's particularly meaningful to me
as an engineer and as a woman, -
9:13 - 9:14because she was in school,
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9:14 - 9:17she had just started school to study engineering.
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9:17 - 9:19And she said, "Well, now that I can walk again,
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9:19 - 9:22I can go back and complete my studies."
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9:22 - 9:25And to me she represents the next generation
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9:25 - 9:28of engineers solving problems
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9:28 - 9:30and ensuring meaningful technologies
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9:30 - 9:32reach their users.
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9:32 - 9:34So thank you.
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9:34 - 9:38(Applause)
- Title:
- The $80 prosthetic knee that's changing lives
- Speaker:
- Krista Donaldson
- Description:
-
We've made incredible advances in technology in recent years, but too often it seems only certain fortunate people can benefit. Engineer Krista Donaldson introduces the ReMotion knee, a prosthetic device for above-knee amputees, many of whom earn less than $4 a day. The design contains best-in-class technology and yet is far cheaper than other prosthetics on the market.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 09:55
Morton Bast edited English subtitles for The $80 prosthetic knee that's changing lives | ||
janet dragojevic edited English subtitles for The $80 prosthetic knee that's changing lives | ||
janet dragojevic edited English subtitles for The $80 prosthetic knee that's changing lives | ||
Morton Bast approved English subtitles for The $80 prosthetic knee that's changing lives | ||
Morton Bast edited English subtitles for The $80 prosthetic knee that's changing lives | ||
Morton Bast edited English subtitles for The $80 prosthetic knee that's changing lives | ||
Madeleine Aronson accepted English subtitles for The $80 prosthetic knee that's changing lives | ||
Madeleine Aronson edited English subtitles for The $80 prosthetic knee that's changing lives |