1
00:00:00,656 --> 00:00:03,873
Living with a physical
disability isn't easy

2
00:00:03,897 --> 00:00:06,096
anywhere in the world,

3
00:00:06,120 --> 00:00:08,925
but if you live in a country
like the United States,

4
00:00:08,949 --> 00:00:12,018
there's certain appurtenances available
to you that do make life easier.

5
00:00:12,042 --> 00:00:14,691
So if you're in a building,
you can take an elevator.

6
00:00:14,715 --> 00:00:16,971
If you're crossing the street,
you have sidewalk cutouts.

7
00:00:16,995 --> 00:00:19,234
And if you have to travel
some distance farther

8
00:00:19,258 --> 00:00:22,401
than you can do under your own power,
there's accessible vehicles,

9
00:00:22,425 --> 00:00:24,262
and if you can't afford one of those,

10
00:00:24,286 --> 00:00:26,635
there's accessible public transportation.

11
00:00:26,659 --> 00:00:29,326
But in the developing world,
things are quite different.

12
00:00:29,350 --> 00:00:32,545
There's 40 million people who need
a wheelchair but don't have one,

13
00:00:32,569 --> 00:00:35,900
and the majority of these
people live in rural areas,

14
00:00:35,924 --> 00:00:39,785
where the only connections to community,
to employment, to education,

15
00:00:39,809 --> 00:00:42,268
are by traveling long
distances on rough terrain

16
00:00:42,292 --> 00:00:45,005
often under their own power.

17
00:00:45,029 --> 00:00:47,363
And the devices usually
available to these people

18
00:00:47,387 --> 00:00:49,821
are not made for that context,
break down quickly,

19
00:00:49,845 --> 00:00:52,131
and are hard to repair.

20
00:00:52,155 --> 00:00:56,851
I started looking at wheelchairs
in developing countries in 2005,

21
00:00:56,875 --> 00:01:00,667
when I spent the summer assessing
the state of technology in Tanzania,

22
00:01:00,691 --> 00:01:04,480
and I talked to wheelchair users, wheelchair
manufacturers, disability groups,

23
00:01:04,504 --> 00:01:06,337
and what stood out to me

24
00:01:06,361 --> 00:01:08,789
is that there wasn't a device available

25
00:01:08,813 --> 00:01:11,337
that was designed for rural
areas, that could go fast

26
00:01:11,361 --> 00:01:13,953
and efficiently on many types of terrain.

27
00:01:13,977 --> 00:01:15,736
So being a mechanical engineer,

28
00:01:15,760 --> 00:01:18,522
being at MIT and having lots
of resources available to me,

29
00:01:18,546 --> 00:01:20,836
I thought I'd try to do
something about it.

30
00:01:20,860 --> 00:01:23,789
Now when you're talking
about trying to travel

31
00:01:23,813 --> 00:01:25,995
long distances on rough terrain,

32
00:01:26,019 --> 00:01:27,728
I immediately thought of a mountain bike,

33
00:01:27,752 --> 00:01:29,141
and a mountain bike's good at doing this

34
00:01:29,165 --> 00:01:30,980
because it has a gear train,

35
00:01:31,004 --> 00:01:33,814
and you can shift to a low gear
if you have to climb a hill

36
00:01:33,838 --> 00:01:35,440
or go through mud or sand

37
00:01:35,464 --> 00:01:37,554
and you get a lot of torque
but a low speed.

38
00:01:37,578 --> 00:01:39,669
And if you want to go
faster, say on pavement,

39
00:01:39,693 --> 00:01:41,074
you can shift to a high gear,

40
00:01:41,098 --> 00:01:43,146
and you get less torque,
but higher speeds.

41
00:01:43,170 --> 00:01:44,727
So the logical evolution here

42
00:01:44,751 --> 00:01:47,561
is to just make a wheelchair
with mountain bike components,

43
00:01:47,585 --> 00:01:48,919
which many people have done.

44
00:01:48,943 --> 00:01:52,101
But these are two products
available in the U.S. that

45
00:01:52,125 --> 00:01:54,792
would be difficult to transfer
into developing countries

46
00:01:54,816 --> 00:01:57,342
because they're much, much too expensive.

47
00:01:57,366 --> 00:01:59,618
And the context I'm talking about is where

48
00:01:59,642 --> 00:02:03,614
you need to have a product
that is less than 200 dollars.

49
00:02:03,638 --> 00:02:06,045
And this ideal product
would also be able to go

50
00:02:06,069 --> 00:02:10,049
about five kilometers a day so you
could get to your job, get to school,

51
00:02:10,073 --> 00:02:11,901
and do it on many,
many different types of terrain.

52
00:02:11,925 --> 00:02:14,793
But when you get home or want
to go indoors at your work,

53
00:02:14,817 --> 00:02:19,214
it's got to be small enough and maneuverable
enough to use inside.

54
00:02:19,238 --> 00:02:22,619
And furthermore, if you want it to last
a long time out in rural areas,

55
00:02:22,643 --> 00:02:26,681
it has to be repairable using the local
tools, materials and knowledge

56
00:02:26,705 --> 00:02:29,497
in those contexts.

57
00:02:29,521 --> 00:02:32,437
So the real crux of the problem here is,

58
00:02:32,461 --> 00:02:35,585
how do you make a system
that's a simple device

59
00:02:35,609 --> 00:02:37,716
but gives you a large
mechanical advantage?

60
00:02:37,740 --> 00:02:39,903
How do you make a mountain
bike for your arms

61
00:02:39,927 --> 00:02:42,594
that doesn't have the mountain
bike cost and complexity?

62
00:02:42,618 --> 00:02:44,995
So as is the case with simple solutions,

63
00:02:45,019 --> 00:02:48,781
oftentimes the answer is right in front
of your face, and for us it was levers.

64
00:02:48,805 --> 00:02:53,415
We use levers all the time,
in tools, doorknobs, bicycle parts.

65
00:02:53,439 --> 00:02:56,201
And that moment of inspiration,
that key invention moment,

66
00:02:56,225 --> 00:02:58,749
was when I was sitting
in front of my design notebook

67
00:02:58,773 --> 00:03:01,521
and I started thinking
about somebody grabbing a lever,

68
00:03:01,545 --> 00:03:03,634
and if they grab
near the end of the lever,

69
00:03:03,658 --> 00:03:05,468
they can get an effectively long lever

70
00:03:05,492 --> 00:03:08,293
and produce a lot of torque
as they push back and forth,

71
00:03:08,317 --> 00:03:10,513
and effectively get a low gear.

72
00:03:10,537 --> 00:03:12,920
And as they slide
their hand down the lever,

73
00:03:12,944 --> 00:03:15,756
they can push with a smaller
effective lever length,

74
00:03:15,780 --> 00:03:17,876
but push through a bigger
angle every stroke,

75
00:03:17,900 --> 00:03:21,535
which makes a faster rotational speed,
and gives you an effective high gear.

76
00:03:21,559 --> 00:03:23,287
So what's exciting about this system

77
00:03:23,311 --> 00:03:25,890
is that it's really, really
mechanically simple,

78
00:03:25,914 --> 00:03:27,724
and you could make it using technology

79
00:03:27,748 --> 00:03:29,706
that's been around for hundreds of years.

80
00:03:29,730 --> 00:03:31,891
So seeing this in practice,

81
00:03:31,915 --> 00:03:33,868
this is the Leveraged Freedom Chair that,

82
00:03:33,892 --> 00:03:35,608
after a few years of development,

83
00:03:35,632 --> 00:03:37,545
we're now going into production with,

84
00:03:37,569 --> 00:03:39,569
and this is a full-time wheelchair user --

85
00:03:39,593 --> 00:03:41,110
he's paralyzed -- in Guatemala,

86
00:03:41,134 --> 00:03:45,109
and you see he's able to traverse
pretty rough terrain.

87
00:03:45,133 --> 00:03:49,640
Again, the key innovation of this technology
is that when he wants to go fast,

88
00:03:49,664 --> 00:03:53,695
he just grabs the levers near the pivots
and goes through a big angle every stroke,

89
00:03:53,719 --> 00:03:56,620
and as the going gets tougher, he just
slides his hands up the levers,

90
00:03:56,644 --> 00:03:59,216
creates more torque, and kind
of bench-presses his way

91
00:03:59,240 --> 00:04:01,402
out of trouble through the rough terrain.

92
00:04:01,426 --> 00:04:04,414
Now the big, important point here is that

93
00:04:04,438 --> 00:04:07,127
the person is the complex
machine in this system.

94
00:04:07,151 --> 00:04:10,473
It's the person that's sliding
his hands up and down the levers,

95
00:04:10,497 --> 00:04:13,195
so the mechanism itself can be very simple

96
00:04:13,219 --> 00:04:16,267
and composed of bicycle parts you
can get anywhere in the world.

97
00:04:16,291 --> 00:04:17,858
Because those bicycle parts

98
00:04:17,882 --> 00:04:20,363
are so ubiquitously available,
they're super-cheap.

99
00:04:20,387 --> 00:04:22,543
They're made by the gazillions
in China and India,

100
00:04:22,567 --> 00:04:24,399
and we can source them
anywhere in the world,

101
00:04:24,423 --> 00:04:27,138
build the chair anywhere,
and most importantly repair it,

102
00:04:27,162 --> 00:04:29,591
even out in a village
with a local bicycle mechanic

103
00:04:29,615 --> 00:04:33,946
who has local tools, knowledge
and parts available.

104
00:04:33,970 --> 00:04:36,623
Now, when you want to use the LFC indoors,

105
00:04:36,647 --> 00:04:40,143
all you have to do is pull
the levers out of the drivetrain,

106
00:04:40,167 --> 00:04:43,420
stow them in the frame, and it
converts into a normal wheelchair

107
00:04:43,444 --> 00:04:46,064
that you can use just
like any other normal wheelchair,

108
00:04:46,088 --> 00:04:48,081
and we sized it like a normal wheelchair,

109
00:04:48,105 --> 00:04:52,216
so it's narrow enough to fit
through a standard doorway,

110
00:04:52,240 --> 00:04:55,735
it's low enough to fit under a table,

111
00:04:55,759 --> 00:04:59,728
and it's small and maneuverable
enough to fit in a bathroom

112
00:04:59,752 --> 00:05:02,752
and this is important so the user
can get up close to a toilet,

113
00:05:02,776 --> 00:05:04,456
and be able to transfer off

114
00:05:04,480 --> 00:05:10,047
just like he could in a normal wheelchair.

115
00:05:10,071 --> 00:05:13,139
Now, there's three important
points that I want to stress

116
00:05:13,163 --> 00:05:16,771
that I think really hit
home in this project.

117
00:05:16,795 --> 00:05:19,975
The first is that this
product works well because

118
00:05:19,999 --> 00:05:22,006
we were effectively able to combine

119
00:05:22,030 --> 00:05:26,560
rigorous engineering science
and analysis with user-centered design

120
00:05:26,584 --> 00:05:29,937
focused on the social and usage
and economic factors

121
00:05:29,961 --> 00:05:32,474
important to wheelchair users
in the developing countries.

122
00:05:32,498 --> 00:05:34,962
So I'm an academic at MIT,
and I'm a mechanical engineer,

123
00:05:34,986 --> 00:05:38,510
so I can do things like look at the type
of terrain you want to travel on,

124
00:05:38,534 --> 00:05:41,158
and figure out how much
resistance it should impose,

125
00:05:41,182 --> 00:05:44,166
look at the parts we have
available and mix and match them

126
00:05:44,190 --> 00:05:46,811
to figure out what sort
of gear trains we can use,

127
00:05:46,835 --> 00:05:49,920
and then look at the power and force
you can get out of your upper body

128
00:05:49,944 --> 00:05:51,883
to analyze how fast you should
be able to go in this chair

129
00:05:51,907 --> 00:05:54,254
as you put your arms
up and down the levers.

130
00:05:54,278 --> 00:05:57,913
So as a wet-behind-the-ears
student, excited,

131
00:05:57,937 --> 00:06:00,038
our team made a prototype,

132
00:06:00,062 --> 00:06:04,913
brought that prototype to Tanzania,
Kenya and Vietnam in 2008,

133
00:06:04,937 --> 00:06:07,047
and found it was terrible

134
00:06:07,071 --> 00:06:09,484
because we didn't get
enough input from users.

135
00:06:09,508 --> 00:06:12,650
So because we tested it
with wheelchair users,

136
00:06:12,674 --> 00:06:15,156
with wheelchair manufacturers,
we got that feedback from them,

137
00:06:15,180 --> 00:06:18,610
not just articulating their problems,
but articulating their solutions,

138
00:06:18,634 --> 00:06:22,158
and worked together to go back
to the drawing board and make a new design,

139
00:06:22,182 --> 00:06:24,308
which we brought back
to East Africa in '09

140
00:06:24,332 --> 00:06:27,153
that worked a lot better than a normal
wheelchair on rough terrain,

141
00:06:27,177 --> 00:06:30,035
but it still didn't work well
indoors because it was too big,

142
00:06:30,059 --> 00:06:32,033
it was heavy, it was hard to move around,

143
00:06:32,057 --> 00:06:35,587
so again with that user feedback,
we went back to the drawing board,

144
00:06:35,611 --> 00:06:37,902
came up with a better
design, 20 pounds lighter,

145
00:06:37,926 --> 00:06:41,593
as narrow as a regular wheelchair, tested
that in a field trial in Guatemala,

146
00:06:41,617 --> 00:06:43,617
and that advanced the product to the point

147
00:06:43,641 --> 00:06:46,840
where we have now that it's going
into production.

148
00:06:46,864 --> 00:06:49,086
Now also being engineering scientists,

149
00:06:49,110 --> 00:06:52,968
we were able to quantify the performance
benefits of the Leveraged Freedom Chair,

150
00:06:52,992 --> 00:06:55,608
so here are some shots
of our trial in Guatemala

151
00:06:55,632 --> 00:06:59,150
where we tested the LFC
on village terrain,

152
00:06:59,174 --> 00:07:01,174
and tested people's biomechanical outputs,

153
00:07:01,198 --> 00:07:03,361
their oxygen consumption,
how fast they go,

154
00:07:03,385 --> 00:07:05,052
how much power they're putting out,

155
00:07:05,076 --> 00:07:07,951
both in their regular
wheelchairs and using the LFC,

156
00:07:07,975 --> 00:07:10,452
and we found that the LFC
is about 80 percent faster

157
00:07:10,476 --> 00:07:12,810
going on these terrains
than a normal wheelchair.

158
00:07:12,834 --> 00:07:16,193
It's also about 40 percent more
efficient than a regular wheelchair,

159
00:07:16,217 --> 00:07:18,736
and because of the mechanical
advantage you get from the levers,

160
00:07:18,760 --> 00:07:20,665
you can produce 50 percent higher torque

161
00:07:20,689 --> 00:07:24,649
and really muscle your way
through the really, really rough terrain.

162
00:07:24,673 --> 00:07:28,085
Now the second lesson
that we learned in this is that

163
00:07:28,109 --> 00:07:30,985
the constraints on this design
really push the innovation,

164
00:07:31,009 --> 00:07:33,249
because we had to hit
such a low price point,

165
00:07:33,273 --> 00:07:35,559
because we had to make
a device that could travel

166
00:07:35,583 --> 00:07:38,378
on many, many types of terrain
but still be usable indoors,

167
00:07:38,402 --> 00:07:40,669
and be simple enough to repair,

168
00:07:40,693 --> 00:07:43,036
we ended up with a fundamentally
new product,

169
00:07:43,060 --> 00:07:45,152
a new product that is an innovation

170
00:07:45,176 --> 00:07:48,069
in a space that really hasn't
changed in a hundred years.

171
00:07:48,093 --> 00:07:51,522
And these are all merits that are not
just good in the developing world.

172
00:07:51,546 --> 00:07:53,961
Why not in countries like the U.S. too?

173
00:07:53,985 --> 00:07:55,697
So we teamed up with Continuum,

174
00:07:55,721 --> 00:07:57,721
a local product design firm here in Boston

175
00:07:57,745 --> 00:08:00,729
to make the high-end version,
the developed world version,

176
00:08:00,753 --> 00:08:03,515
that we'll probably sell primarily
in the U.S. and Europe,

177
00:08:03,539 --> 00:08:06,316
but to higher-income buyers.

178
00:08:06,340 --> 00:08:09,302
And the final point I want
to make is that I think

179
00:08:09,326 --> 00:08:12,128
this project worked
well because we engaged

180
00:08:12,152 --> 00:08:16,739
all the stakeholders that buy into this
project and are important to consider

181
00:08:16,763 --> 00:08:20,082
in bringing the technology
from inception of an idea

182
00:08:20,106 --> 00:08:24,321
through innovation, validation,
commercialization and dissemination,

183
00:08:24,345 --> 00:08:28,066
and that cycle has to start
and end with end users.

184
00:08:28,090 --> 00:08:30,841
These are the people that define
the requirements of the technology,

185
00:08:30,865 --> 00:08:33,179
and these are the people that have
to give the thumbs-up at the end,

186
00:08:33,203 --> 00:08:35,823
and say, "Yeah, it actually works.
It meets our needs."

187
00:08:35,847 --> 00:08:37,753
So people like me in the academic space,

188
00:08:37,777 --> 00:08:41,124
we can do things like innovate
and analyze and test,

189
00:08:41,148 --> 00:08:44,220
create data and make
bench-level prototypes,

190
00:08:44,244 --> 00:08:47,387
but how do you get that bench-level
prototype to commercialization?

191
00:08:47,411 --> 00:08:50,799
So we need gap-fillers like Continuum
that can work on commercializing,

192
00:08:50,823 --> 00:08:53,585
and we started a whole NGO
to bring our chair to market --

193
00:08:53,609 --> 00:08:55,750
Global Research Innovation Technology --

194
00:08:55,774 --> 00:08:59,482
and then we also teamed up with a big
manufacturer in India, Pinnacle Industries,

195
00:08:59,506 --> 00:09:01,745
that's tooled up now
to make 500 chairs a month

196
00:09:01,769 --> 00:09:03,548
and will make the first
batch of 200 next month,

197
00:09:03,572 --> 00:09:05,516
which will be delivered in India.

198
00:09:05,540 --> 00:09:08,255
And then finally, to get this
out to the people in scale,

199
00:09:08,279 --> 00:09:10,803
we teamed up with the largest
disability organization

200
00:09:10,827 --> 00:09:13,090
in the world, Jaipur Foot.

201
00:09:13,114 --> 00:09:15,369
Now what's powerful about this model

202
00:09:15,393 --> 00:09:18,176
is when you bring together
all these stakeholders

203
00:09:18,200 --> 00:09:20,145
that represent each link in the chain

204
00:09:20,169 --> 00:09:22,686
from inception of an idea

205
00:09:22,710 --> 00:09:25,454
all the way to implementation
in the field,

206
00:09:25,478 --> 00:09:27,005
that's where the magic happens.

207
00:09:27,029 --> 00:09:29,553
That's where you can take
a guy like me, an academic,

208
00:09:29,577 --> 00:09:32,581
but analyze and test
and create a new technology

209
00:09:32,605 --> 00:09:36,117
and quantitatively determine
how much better the performance is.

210
00:09:36,141 --> 00:09:38,802
You can connect with stakeholders
like the manufacturers

211
00:09:38,802 --> 00:09:41,042
and talk with them face-to-face
and leverage their

212
00:09:41,062 --> 00:09:43,909
local knowledge of manufacturing
practices and their clients

213
00:09:43,933 --> 00:09:46,648
and combine that knowledge
with our engineering knowledge

214
00:09:46,672 --> 00:09:49,978
to create something greater
than either of us could have done alone.

215
00:09:50,002 --> 00:09:52,509
And then you can also engage the end user

216
00:09:52,533 --> 00:09:55,295
in the design process, and not
just ask him what he needs,

217
00:09:55,319 --> 00:09:58,244
but ask him how he thinks
it can be achieved.

218
00:09:58,268 --> 00:10:01,301
And this picture was taken
in India in our last field trial,

219
00:10:01,325 --> 00:10:03,802
where we had a 90-percent
adoption rate where people

220
00:10:03,826 --> 00:10:07,408
switched to using our Leveraged Freedom
Chair over their normal wheelchair,

221
00:10:07,432 --> 00:10:10,369
and this picture specifically is of Ashok,

222
00:10:10,393 --> 00:10:13,401
and Ashok had a spinal injury
when he fell out of a tree,

223
00:10:13,425 --> 00:10:16,283
and he had been working at a tailor,
but once he was injured

224
00:10:16,307 --> 00:10:19,166
he wasn't able to transport
himself from his house

225
00:10:19,190 --> 00:10:21,966
over a kilometer to his shop
in his normal wheelchair.

226
00:10:21,990 --> 00:10:23,237
The road was too rough.

227
00:10:23,261 --> 00:10:26,158
But the day after he got
an LFC, he hopped in it,

228
00:10:26,182 --> 00:10:28,242
rode that kilometer, opened up his shop

229
00:10:28,266 --> 00:10:30,958
and soon after landed a contract
to make school uniforms

230
00:10:30,982 --> 00:10:34,078
and started making money, started
providing for his family again.

231
00:10:34,102 --> 00:10:35,927
Ashok: You also encouraged me to work.

232
00:10:35,951 --> 00:10:38,651
I rested for a day at home.

233
00:10:38,675 --> 00:10:43,107
The next day I went to my shop.

234
00:10:43,131 --> 00:10:46,085
Now everything is back to normal.

235
00:10:46,109 --> 00:10:50,170
Amos Winter: And thank you
very much for having me today.

236
00:10:50,194 --> 00:10:54,194
(Applause)