Project

Democratizing prosthetic and diabetic care: A resilient model for healthcare delivery

Taken by Research Specialist Francesca Riccio-Ackerman in Nogales, Mexico.

We are engineering a better healthcare system for people with diabetes and limb loss such that we can physically bridge gaps to deliver convenient, high quality care to them for a fraction of the cost.

We are developing a resilient healthcare model that is designed to deliver equitable diabetic and prosthetic services to patients in medically underserved communities. Operating with locally trusted clinicians, this model employs a satellite mobile health clinic to increase the capacity and geographical range of services. By expanding the radius of care and reducing patient travel in care-seeking, we can bridge large gaps in health access and shares the cost of high quality services across a larger community, thereby democratizing technological advancements. Epidemiological and geospatial surveillance tools act as a navigation system to maximize the model’s impact and strategically intervene where services and resources are most needed. Synthesis of clinical health outcomes and our impact on health access, combined with economic evidence are used to support the sustainability and scalability of this model to bro… View full description

We are engineering a better healthcare system for people with diabetes and limb loss such that we can physically bridge gaps to deliver convenient, high quality care to them for a fraction of the cost.

We are developing a resilient healthcare model that is designed to deliver equitable diabetic and prosthetic services to patients in medically underserved communities. Operating with locally trusted clinicians, this model employs a satellite mobile health clinic to increase the capacity and geographical range of services. By expanding the radius of care and reducing patient travel in care-seeking, we can bridge large gaps in health access and shares the cost of high quality services across a larger community, thereby democratizing technological advancements. Epidemiological and geospatial surveillance tools act as a navigation system to maximize the model’s impact and strategically intervene where services and resources are most needed. Synthesis of clinical health outcomes and our impact on health access, combined with economic evidence are used to support the sustainability and scalability of this model to broader populations.

Context

People with disabilities and chronic conditions that depend on medical technologies have been described as “tethered to the machine”. In contrast, at the Biomechatronics Group, we engineer technologies that offer freedom because of the machine, and believe that biomechatronics can mitigate physiological limitations of pain and immobility. We are constructing a world where human-robot interactions have the power to enable mobility, independence and comfort. However, we acknowledge that inequitable distribution of resources and services prevents people who could benefit from these technologies from accessing them.

Obtaining and maintaining prostheses is a lifelong obligation that is expensive in terms of both time and money. Infrastructure and resources dedicated to offering prosthetic services is vastly insufficient for the quantity of people with limb loss, and the number of people with amputations is growing over time. Epidemiologically, higher rates of amputations occur in areas where medical resources are scare, leaving many patients medically disenfranchised. Globally, less than 10% of the 30 million amputees have access to life-sustaining and enhancing prosthetic care. In short, a simple donation of prosthetic devices or cost reduction is insufficient to meet this need. Democratizing access to prosthetic devices is a complex challenge that necessitates reducing the burden on patients in finding, traveling to, and affording frequent and high quality care.

Intertwined with this health challenge is the struggle to manage another chronic condition, diabetes mellitus. As the prevalence of diabetes grows, so does the quantity of untreated and undertreated diabetes, leading patients to a heightened risk of developing one or more of the three pathologies causal to diabetic amputations: peripheral arterial disease (PAD), peripheral neuropathy (PN), and infection. This triad is the harbinger of the final pathologic events, namely gangrene and amputation. In fact, the US Agency for Health Research and Quality has named diabetic amputations are the most preventable surgery. Social, economic, and geographical factors prevent patients from getting regular medical check-ups, managing their diabetes, and accessing limb-salvaging interventions —for diabetic patients who consistently struggle to control their blood glucose, their risk of amputation skyrockets by up to 30 times higher.

These same challenges prevent amputees from reaching prosthetic clinics, obtaining, and maintaining prosthetic devices . In Mexico, more than 85% of amputees lost limbs due to diabetes— a number that continues to climb. Meanwhile, only three percent of amputees in Mexico have functional prostheses. While the number of amputees grows exponentially, the infrastructure that provides prosthetic services remains stagnant; the estimated 900,000 amputees living in Mexico are dependent on less than 50 prosthetic clinics, whose capacity is at most 3,000 prostheses per year, cumulatively.

Our Team

The Biomechatronics Group is led by Professor Hugh Herr. This project is developed by biomedical engineer and global health systems and policy specialist Francesca Riccio-Ackerman and incorporates the work of the digital prosthetic socket design project including current researchers Dana Solav,  Xingbang YangAaron Jaeger, Christina MeyerDuncan Lee,  Samantha Gutierrez-Arango and Erica Israel.

We are proud to collaborate with Dr. Joel Huegel,  leader of the Biomechatronics Research laboratory and tenured Professor of Mechanical Engineering at Tecnologico de Monterrey in Guadalajara, Mexico who specializes in low-cost, highly functional lower limb prostheses to meet worldwide need. 

We have identified a pilot community and secured the support of field experts at Arsobo Clinic in Nogales, Mexico.

Locally, our team is growing with the exciting addition of Dr. Nancy Oriol, MD,  Faculty Associate Dean for Community Engagement in Medical Education and Lecturer on Global Health and Social Medicine at Harvard Medical School.  

Our project's supporting research team includes MIT undergraduates: Carl "Andrew" Seelhoff and Aashini Shah on mobile clinic design,  Liam Ackerman on geospatial software and applied epidemiology, and Kaili Glasser on health outcomes and economics.

Preceding Projects

The work to produce a computational algorithm to digitally design prosthetic sockets is foundational to this current translation and implementation effort. More information about these projects is provided in the modules below.