On Wednesday,South Africa named paralympics champion Oscar Pistorius in its squad for the 400 metres and 4x400m relay at the London Olympics. A double-amputee due to a congenital defect in his legs,Pistorius races wearing carbon fibre prosthetic blades. Yet two decades ago,a project in India discarded the advanced carbon fibre material to develop prosthetics,saying it was not suitable for Indian use.
The 1991-92 project,funded by the government,had the support of doctors at Jaipurs Santokhba Durlabhji Memorial Hospital,set up by the late Dr P K Sethi who invented the Jaipur foot,and some NGOs. Doctors at the hospital say there were technical and economic constraints behind that decision to give up on carbon fibre prosthetics.
Dr Anil Jain,Head of the Department of Physical Medicine,said: First,no change is possible in a leg designed from this material. We have always been modifying our Jaipur foot,taking into account minor specifications made by patients. Second,we are a country where artificial limbs are mostly made manually. Carbon fibre legs have to be designed on a computer. Such technical advancement was not practical for a government programme that had to be implemented at multiple centres.
He said some patients also complained of allergic skin reactions to the carbon fibre. The Rs 25-30 lakh cost of this high-end prosthetic,as against the free Jaipur foot,also made it impractical.
Indian prosthetics were mostly made from wood till the Jaipur foot was invented in 1968. While the use of wood continues to be rampant,plastic has become the most common sourced material.
Since the 1990s,a combination of two thermoplastics polypropylene and ethylene vinyl acetate is also being used for improved flexibility and better resilience against cracks. Silicone is also used for padding,particularly in sockets. Such prosthetics cost between Rs 200 and Rs 500.
Dr Alokananda Banerjee,Head of Physiotherapy and Rehabilitation at Max Hospital Saket in New Delhi,said: Even in a private centre like ours,there is hardly any demand for carbon fibre. If at all,any patient requires it,we have to import it. She cautioned against viewing the prosthetic as a miracle object. Carbon fibre prosthetics were available from the 1990s,and were used internationally by many athletes. Nobody made it to the Olympics until now. So the dedication and commitment of the athlete should not be undermined in the debate over prosthetics.
The All India Institute of Physical Medicine and Rehabilitation in Mumbai has been conducting research on developing sockets out of carbon fibres. Dr Anil Gaur,the institutes Deputy Director,said: Technology will follow demand. With such exorbitant costs,despite government intervention in research,we cannot provide locally produced full-fledged limbs made of carbon fibre.
Experts in rehabilitation medicine say that the Ossur Flex-Foot Cheetah which Pistorius uses is a highly advanced,customised prosthetic that beats conventional artificial limbs on two fronts material and design. A J-shaped elastic device made of lightweight carbon fibres stores and releases energy. According to the Ossur website,it compensates for lack of pressure points in human legs.
On the technology behind the prosthetic,Dr Gaur said: The Flex leg is an elastic device that compresses while the runner moves his foot forward,storing energy. When he moves it back,it returns to its shape,releasing the energy which gives the runner a boost. That is why it is considered an athletes prosthetic,ideal for running.
According to Ossur,a US-based orthopaedic devices company,the Cheetah has more layers of carbon at high stress points,where more flexibility is required,like the ankle and toes.
But Dr R K Srivastava,former Head of Department of Physical Medicine and Rehabilitation at Safdarjung Hospital in Delhi and retired Director General of Health Services,counters the argument that such prosthetics give an unfair advantage. Though the device does store energy,making movement easier for the patient,it can never achieve the musculoskeletal synchronisation of a normal leg. Its advantages are more than countered here, he said.
Dr Jaspal Sandhu,Dean of Sports Medicine at Amritsars Guru Nanak Dev University,said Indian athletes usually use conventional prosthetics made by ALIMCO in Kanpur which uses the Jaipur foot.
Dr Yash Gulati of the Apollo Hospital in New Delhi maintained Indian prosthetics were still very crude. He said without adequate government intervention in research and development of new designs,athletes were unlikely to benefit.
The Jaipur foot was invented more than 40 years ago. We are still glorifying that achievement. We have not even had a Jaipur 2 or 3. Government prosthetic programmes target the poor. Very little is done on design and material for specific needs of athletes.
Dr P S M Chandran,president of the Indian Federation of Sports Medicine and former director of the Sports Authority of India,said: We need industry support and medical research. Plus the most crucial element dedicated training by atheletes themselves.