In September 2014, Monica More, an 18-year-old student from Mumbai, picked up a pen and scribbled on a piece of paper; a feat she never thought she would be capable of again.
More had lost both arms in a train accident eight months earlier, while on her way to college. A year on, she is close to leading a normal life, thanks to an advanced pair of myoelectric prosthetic limbs.
"My arms had to be amputated below the elbows," says More, who took her Class 12 exams this year. "Holding a pen or writing seemed like a dream. But my new arms enable me to not only write, but also use a computer." More had to undergo multiple reconstructive surgeries before the artificial limbs came into her life.
"The artificial limbs are equipped with sensors that convert her brain signals into electronic signals, giving her voluntary control over her arm movements," says Dr Pradeep Bhosale, head of the orthopaedics department at Mumbai's KEM Hospital, and one of the doctors who treated More.
Customised wheelchairs and advanced prosthetic limb technology are finally coming of age in India, enabling Indians such as More to live with more dignity and independence, say medical experts. Built with better attachment systems and lighter materials, these advanced wheelchairs and prosthetic limbs also boast of improved control mechanisms to facilitate better movement.
"Customised wheelchairs were not available in India earlier," says Nekram Upadhyaya, head of assistive technology at Delhi's Indian Spinal Injuries Centre (ISIC). "But one wheelchair doesn't fit all. Patients need condition-specific modifications. For instance, quadriplegics and cerebral palsy patients require different types of assistance. You have to pay attention to their posture, breathing and other needs before assigning a suitable wheelchair. If the same type of wheelchair is given to these patients they will develop sores and their condition deteriorates further."Shashank Pandey, a 27-year-old paraplegic, suffered from bed sores because of using the wrong wheelchair.
"Government-issued wheelchairs are of no help. I had a heavy iron chair with fixed armrests, wheels and backrest. I felt impaired as I could not independently shift around," he says.
Mumbai college student Monica More had to have both arms amputated below the elbow after a train mishap, but is now able to write and type again, with the help of her new, high-tech prosthetic limbs. The prosthetics cost Rs22 lakh, a sum that her family raised partly through a crowdfunding campaign. (Praful Gangurde/ HT Photo)
ISIC operates on WHO guidelines and evaluates the physical and environmental conditions of patients before assigning wheelchairs. Pandey was later given an active aluminium wheelchair, which was lighter and suited to his body strength.
Working at ISIC's assistive technology department since 2006, Upadhyay creates locomotive solutions for patients suffering from paraplegia and multiple sclerosis. His team customises wheelchairs, depending on the patients' needs, posture and overall condition. ISIC also customises cars and homes for the differently abled.
Another hurdle to accessing state-of-the-art technology is affordability. At ISIC, Upadhyay and his team work to keep costs low. A customised wheelchair costs between Rs8,000 and Rs15,000 - against Rs40,000 to Rs2.5 lakh on the open market - but even that can be too much for many patients. More's prosthetic limbs, for instance, were developed by a German company and cost Rs22 lakh, a sum raised mostly through a crowdfunding campaign.
"Separate assistive technology departments should be set up at every government and private hospital," says Upadhyay, who has modified more than 5,000 wheelchairs over the past decade.
In some places, this is starting to happen. One example is Delhi's All India Institute of Medical Sciences (AIIMS). Among several prosthetic innovations at AIIMS is a form of walking callipers designed in collaboration with Michigan Technical University, set to be available at Rs20,000 to Rs25,000, as against Rs2.5 lakh in the US.
"They have features like kneeling and squatting, apart from helping the user propel forward in an almost natural manner - and it is because of government subsidisation that they cost one-tenth of what such callipers cost abroad," says Dr Rajesh Malhotra, professor at the department of orthopedics at AIIMS.
Then, of course, there is the psychological barrier to replacing one's limbs with a mechanical appendage.
"For me, the thought of having artificial limbs seemed uncomfortable at first," More admits. "But I never felt any discomfort once I started using them."