“the overall number of amputees has actually risen”

Better bionics

How European firms are supporting Japan’s disabled


Text by Gavin Blair

Technology for people with missing or non-functioning limbs has come a long way since the earliest known prosthetic: a big toe discovered on the mummified body of an Egyptian noblewoman estimated to be 3,000 years old. The latest products in the field feature sensors, microprocessors and internet connectivity. There are a number of European companies working to deliver access to these cutting-edge and life-transforming solutions in Japan.

Germany’s Ottobock is best known for prosthetics — its 3R106 is the most widely used pneumatic artificial knee in Japan. The company pioneered microprocessor knees, which allow users more natural ranges of movement, as well as greater stability and safety.

The firm’s latest model available in Japan is the Genium. It is equipped with an advanced gyroscope, functions for stairclimbing and rough terrain, and a stumble recovery feature. The knee can also be connected to a smartphone to record how far a user has walked, providing vital data to help prevent complications. Released in Germany six years ago, the Genium costs ¥3.5 million and was only registered as eligible for reimbursement in Japan in May. The next-generation Genium X3, however, is yet to be registered here. 

Japan’s reimbursement system for prosthetics and wheelchairs is complex; the approval process can be lengthy and is somewhat opaque. Rules of eligibility vary according to the nature and cause of the disability, and users often have to pay for equipment up front.

Although prosthetics are used by people born without limbs, the majority are amputees. The reasons for amputations in Japan have changed in recent decades, according to Ottobock’s Yuichi Yano, manager of the Prosthetics / Mobility Solutions Business Unit and External Affairs. Amputations due to traffic accidents have fallen significantly, but those due to diabetes “have increased so much that the overall number of amputees has actually risen,” explains Yano.

Another series of innovative products from Ottobock are Myo prosthetic hands and arms. These improvements in technology are, in particular, benefitting children, who get better results from prosthetics when they begin using them from a young age. The new signature Myo Plus Michelangelo allows control of the prosthetic hand using forearm muscles.

“In Germany, Myo is seen as an investment in children,” says Yano, who points out that they help prevent problems with other parts of the body caused by overuse, as well as facilitating greater participation in society when they become adults.

“If they can get a job, then they will pay tax,” notes Yano, who says that perspective is yet to be adopted by the authorities in Japan.

The multiple advantages of such technology are also pointed to by Chuji Kaseda, Japan managing director at Permobil, a Swedish provider of wheelchairs and seating solutions.

The F3 Corpus, one of Permobil’s front-wheel drive wheelchairs, costs ¥2.7 million, but like an advanced prosthetic, can transform lives.

“It’s the price of a small car,” notes Kaseda. “I always explain that people are in their cars perhaps two hours a day maximum, but a wheelchair user will be in [their chair] maybe 14 hours in a day.”

Yasutaka Murata, a full-time system technician at Permobil and wheelchair user himself, got funding approval for his F3 Corpus in 2017 after waiting a year. The benefits of this advanced wheelchair include being able to elevate the chair by 30cm, allowing Murata to converse with people who are standing without straining his neck. The controller under his foot that he uses to steer the wheelchair can be switched to work as a mouse for his computer, which he operates via a screen on the chair with a light pen he holds in his mouth.

The F3 also reclines, meaning users can stretch their bodies, helping to prevent chronic joint stiffness and pressure ulcers. A common problem for people who have suffered spinal injuries is a lack of sensation in some areas that lead to such issues arising without them noticing.

Permobil is addressing this with a Virtual Seating Coach that advises users, through a smartphone attached to the chair, when they have been in the same position too long, along with the time and exact angle they need to readjust their posture to. This will be included in all Permobil wheelchairs equipped with Permobil Connect, a new IoT application scheduled for launch in Japan this autumn. The application will link the wheelchair to therapists who can monitor the user and fine-tune therapeutic programmes, as well as to Permobil service personnel to prevent problems such as mechanical failures or flat batteries.

Icelandic company Össur is another high-end prosthetics specialist, which pioneered the use of carbon fibre with its Vari-Flex foot, as well as silicone liners for artificial limbs.

“There are different kinds of bodies: skinny, fleshy, people who have suffered burns; silicone liners function as both interface and a suspension system,” explains Össur APAC’s Shoko Nireki, who notes 70% of prosthetics from all manufacturers now use silicone liners.

Nireki, who previously worked fitting prosthetics in the US, says Japanese surgeons often try to save as much of a limb as possible, though counter-intuitively this is not always the best outcome.

“In Japan, there is a lot of variation in where leg amputations are performed, whereas in the US, it is standardised, which is best for prosthetics,” says Nireki.

Össur acquired Scottish upper-limb prostheses company Touch Bionics in 2016 for £27.5 million and now offers its i-limb quantum. However, at a cost of ¥3.6 million, Nireki says the chances of i-limb quantum users getting reimbursement in Japan are very low.

The company also has an advanced Power Knee, with cutting-edge gait-recognition functions; power-aided standing; and connectivity via both the internet and Bluetooth. But an estimated cost of between ¥5 million and ¥6 million means it has not yet been made available in Japan.

Nireki is a passionate advocate of seeing young people get access to the latest tech.

“Grown-ups have options, like being able to drive, but children don’t,” she says. “And they need to be able to participate in sport at school. I think it’s a human right.” 

“people are in their cars perhaps two hours a day maximum, but a wheelchair user will be in [their chair] maybe 14 hours in a day”