Assistive Technology Puts Wounded Veteran Back at the Drawing Board
May 31, 2006
A U.S. veteran who lost his hand and forearm in Iraq enlists assistive technology to make prosthetic devices better and more easily available worldwide.

REDMOND, Wash., May 31, 2006 – Jonathan Kuniholm spends his work days using sophisticated technology to develop detailed engineering designs, including mechanical models for the manufacture of prosthetic devices. Kuniholm, a PhD candidate in biomechanical engineering at Duke University, is a partner at Tackle Design Inc., in Durham, N.C., and a driving force in Tackle’s Open Prosthetics Project. Tackle and seven other Open Prosthetics participant organizations create innovative prosthetic devices and publish their designs online, so that anyone worldwide can use, customize, or improve on them.

Adding to Kuniholm’s skill and engineering expertise is a painful but enlightening reality of his own: he uses a prosthesis in place of his right hand and forearm. He was wounded in an ambush attack on his U.S. Marines Reserve patrol unit on New Year’s Day 2005 – near the Euphrates River in Iraq – that killed one of the Marines on the patrol. Kuniholm’s wounds resulted in the amputation of his right arm below the elbow.

But as a self-confessed problem-solver, Kuniholm was not about to let his injuries get the better of him. With the aid of three prosthetic devices and computers outfitted with assistive technology, including some enabled by Microsoft Windows, Kuniholm has returned to his engineering work at Tackle Design. He’s capitalizing on these assistive tools to pursue a big goal: combining his life experience with his biomechanical expertise to help improve prosthetic technologies.

“In contrast to legs, because of the size of the market, even the most advanced arm prostheses are based on technology that hasn’t been significantly improved for 20 years,” Kuniholm says. “Prosthetic fitting includes a lot of custom work, especially the interface with the body. Standard components are made using mass-manufacturing techniques, and the most common hand designs have been made since the First World War, with some changes in materials. So people either take a generic device that is not designed to meet their individual needs, or have it customized. Many insurance companies won’t pay for devices built for sports or specific activities.

“With the help of my prosthetist and a manufacturer, I developed some new devices for myself,” Kuniholm says. “In combination with assistive computer technologies, they have really helped me resume my mechanical design work. But as both a user and a design engineer, I saw for myself the lack of cheap, customizable, and inventive prosthetic devices available. Now that I’m back at work, I’m going to try to change that.”

Kuniholm is just one example of what is becoming a significant segment of the American workforce. Roughly 18,000 soldiers have been wounded in Iraq, many saved by technological and medical advances from wounds that in previous wars might have been fatal. As a result, the survival rate among Americans wounded in Iraq is higher than in any previous war, but many of the wounds are more severe.

As these veterans return to their lives, technology – including software and devices that accommodate the needs of users with sensory and physical disabilities – offers them opportunities to rejoin the workforce. As a leading provider of productivity software and a technology innovator, Microsoft recognizes the importance of making its products accessible to wounded veterans other users with disabilities. Many Microsoft products, including Windows, Office, Internet Explorer and MSN, incorporate accessibility features to make computers easier to see, hear and use.

Rob Sinclair, Director of Microsoft’s Accessible Technology Group (ATG), says that the importance of computing in today’s workplace makes it imperative that Microsoft technology accommodate a wide range of abilities.

“A significant portion of the workforce faces physical challenges such as eye strain, hearing loss, or dexterity issues, so it’s critical that accessibility be built into many Microsoft products,” Sinclair says. “Windows is an outstanding platform that enables development of innovative assistive technologies. We work with nearly 150 assistive technology manufacturers, and I’m constantly amazed at what their products do to bring real change to people's lives.”

To accommodate a prosthetic in place of his dominant hand, Kuniholm constructed a workstation that allowed him to interact with the computer in new ways. His engineering workstation now includes products such as:

The Cintiq®, an interactive pen display made by Wacom® that enables stylus-to-screen input for PCs running Microsoft Windows 2000, Windows XP or Windows XP x64. This device enables not only direct input to digital drawings – important because Kuniholm’s manual control of a pen is not yet fine enough to do this work on paper – but also works with Microsoft Office applications, much the same as a Tablet PC. To work the stylus, Advanced Arm Dynamics in California developed a slightly shorter prosthetic arm to help decrease errors, and Colorado prosthetic developer TRS adapted a terminal device – originally designed to hold a violin bow – to accommodate the larger diameter of the Cintiq stylus.

The SpaceBall®, by Logitech company 3dconnexion, offers high-accuracy mouse capabilities for Kuniholm’s left hand, including three-dimensional manipulation of CAD models.

Kuniholm also set up his workstation with input from ergonomic specialists at Microsoft, including Dr. Ursula Wright, CPE, who has assisted numerous veterans and others with disabilities with a variety of input and mousing needs. Wright said the evolution of technology has led to more and better options for many different types of assistive technologies and furniture, as well as mice, keyboards or other data input devices. And that has made it easier for veterans to get back into the flow of everyday life.

“For the injured veterans I’ve worked with, returning to work provides a sense of normalcy – an opportunity to focus again on the work they enjoyed before serving in the military,” Wright says. “As with all our employees who have sensory impairments or physical disabilities, we try to provide returning veterans with an environment that allows them to perform the work they enjoy without adding to their pain or discomfort.”

With effective ergonomics, assistive technology and innovative prosthetics, Kuniholm got back to work at Tackle Design, as well as the Open Prosthetics Project, within months of his injury. He says he is focused on interconnected goals: making prosthetics better, and making them more available, particularly in impoverished or war-torn areas where there is severe need, such as Bosnia, Sierra Leone and Iraq.

“I want to help create the next generation of advanced prosthetics, but at the same time, there are places all over the world that simply don’t have the health-care infrastructure to provide any prosthetics,” he says. “There are an estimated 650,000 upper-extremity amputees worldwide, the vast majority of whom have limited or no access to prosthetic devices. I want to help developing regions better serve their amputee populations, by providing designs for devices they can build with materials they likely have on hand.”

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