TEDWomen 2013
Krista Donaldson: The $80 prosthetic knee that's changing lives
克莉絲妲‧唐納森: 造價80塊美金的人工膝蓋 － 改變許多人的生命
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這些年來或許在科技上有許多驚人的進展，但似乎往往都是那些少部份生活優渥的人才能享受到的。工程師克莉絲妲‧唐納森(Krista Donaldson)介紹一款專為膝上截肢患者設計的人工膝蓋：移動膝蓋(ReMotion knee)，許多截肢者每天賺不到四塊美金。這款設計不僅有最先進的技術，卻也遠比市面上其他人工膝蓋便宜許多。
Krista Donaldson - Engineer
Krista Donaldson is the CEO of D-Rev, a non-profit product development company improving the health and incomes of people around the world. Full bio
Krista Donaldson is the CEO of D-Rev, a non-profit product development company improving the health and incomes of people around the world. Full bio
Double-click the English transcript below to play the video.
00:12
Nine years ago, I worked
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九年前
00:14
for the U.S. government in Iraq,
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我在伊拉克為美國政府工作
00:16
helping rebuild the electricity infrastructure.
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幫助重建電力基礎設施
00:19
And I was there, and I worked in that job
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我會在那裡做這樣的工作
00:22
because I believe that technology
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是因為我相信
00:24
can improve people's lives.
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科技可以使人的生活更好
00:27
One afternoon, I had tea with a storekeeper
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有天下午我跟一個倉庫管理員
00:29
at the Al Rasheed Hotel in Baghdad,
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在巴格達拉希德飯店裡喝茶時
00:32
and he said to me, "You Americans,
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他這麼跟我說：你們美國人啊
00:35
you can put a man on the moon,
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你們有本事把一個人送上月球
00:36
but when I get home tonight,
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但是我今天晚上回到家
00:38
I won't be able to turn on my lights."
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卻連燈都打不開
00:41
At the time, the U.S. government had spent
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當時美國政府總共投入
00:42
more than two billion dollars
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超過了二十億的美金
00:45
on electricity reconstruction.
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在這些電力設備的重整規劃上
00:47
How do you ensure technology reaches users?
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我們如何能確保消費者
真的有因為科技而受益
真的有因為科技而受益
00:50
How do you put it in their hands
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又或者你如何能確定
00:52
so that it is useful?
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你做的正是人們需要的
00:55
So those are the questions that my colleagues and I
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這些是我和同事們
00:58
at D-Rev ask ourselves.
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在D-Rev所在思考的
01:00
And D-Rev is short for Design Revolution.
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D-Rev是非營利組織「科技革新」
(Design Revolution)的簡稱
(Design Revolution)的簡稱
01:03
And I took over the organization four years ago
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我四年前開始接管這個機構
01:05
and really focused it on developing products
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專注於研發產品
01:08
that actually reach users,
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讓真正有需求的人可以使用
01:10
and not just any users,
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並非給每個人使用
01:11
but customers who live on
less than four dollars a day.
less than four dollars a day.
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而是給一天不到四塊美金過活的人使用
01:16
One of the key areas we've been working on recently
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我們最近專攻的領域是
01:17
is medical devices, and while it may not be obvious
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醫療器材，或許這兩者中間看起來
01:20
that medical devices have something in common
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就是醫療器材跟當時在伊拉克所蓋的電路設備
01:22
with Iraq's electricity grid then,
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好像沒有太大的關連
01:25
there are some commonalities.
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但其實是有共通點的
01:27
Despite the advanced technology,
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即使有先進的技術
01:29
it's not reaching the people who need it most.
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真正需要的人卻無法受惠
01:32
So I'm going to tell you about one of
the projects we've been working on,
the projects we've been working on,
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所以我要跟大家分享我們的一個研究計畫
01:35
the ReMotion Knee, and it's a prosthetic knee
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「活動膝蓋」，這是人工膝蓋的一種
01:38
for above-knee amputees.
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專為膝上截肢者所設計
01:40
And this project started when
the Jaipur Foot Organization,
the Jaipur Foot Organization,
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這個計畫始於世界最大的義肢製造組織
01:43
the largest fitter of prosthetic limbs in the world,
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也就是齋浦爾足機構（Jaipur Foot Organization）
01:46
came to the Bay Area and they said,
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來灣區拜訪我們說
01:47
"We need a better knee."
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我們需要有更好的人工膝蓋
01:50
Chances are, if you're living on
less than four dollars a day,
less than four dollars a day,
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如果你一天生活費不到四塊美金
01:53
and you're an amputee,
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在一場車禍中失去你的腿
01:55
you've lost your limb in a vehicle accident.
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腳又剛好截肢的話
01:57
Most people think it's land mines,
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大家都以為你是因為誤踩地雷
01:59
but it's a vehicle accident.
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但其實是因為一場車禍
02:00
You're walking by the side of the road
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你在路旁走著走著
02:02
and you're hit by a truck,
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就被一台卡車給撞到了
02:04
or you're trying to to jump on a moving train,
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又或者你是因為試著要跳上行駛中的火車
02:05
you're late for work, and your pant leg gets caught.
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因為上班已經遲到，卻很不巧褲管被夾到
02:09
And the reality is that if
you don't have much money,
you don't have much money,
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而如果現實情況是你並沒有錢
02:13
like this young named Kamal right here,
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就好像這位名叫卡莫（Kamal）的年輕人
02:15
the option you really have
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你真正能選擇的
02:17
is a bamboo staff to get around.
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就是拄著一根竹竿走
02:19
And how big a problem is this?
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這個問題究竟有多嚴重？
02:22
There's over three million amputees every year
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每年有超過三百萬人必須面臨截肢
02:25
who need a new or replacement knee.
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他們都需要一個新的或可替代的膝蓋
02:28
And what are their options?
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他們有哪些選擇呢?
02:30
This is a high-end. This is
what we'd call a "smart knee."
what we'd call a "smart knee."
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這個相當高級，我們稱之為 「智慧膝蓋」
02:32
It's got a microprocessor inside.
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裡面裝了一個微處理器
02:34
It can pretty much do anything,
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幾乎可以做任何動作
02:37
but it's 20,000 dollars,
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但是要價兩萬美金
02:38
and to give you a sense of who wears this,
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讓大家有個概念
這類產品都是什麼樣的人在用
這類產品都是什麼樣的人在用
02:40
veterans, American veterans coming
back from Afghanistan or Iraq
back from Afghanistan or Iraq
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退役軍人，特別是從阿富汗
或伊拉克回來的美國退役軍人
或伊拉克回來的美國退役軍人
02:44
would be fit with something like this.
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他們就能穿得起這樣的義肢
02:46
This is a low-end titanium knee.
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這款是比較低階的鈦金屬人工膝蓋
02:49
It's a polycentric knee, and all that that means
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這是一種多軸心膝關節，意味著
02:51
is the mechanism, is a four-bar mechanism,
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裡面的構造是四連桿的結構
02:53
that mimics a natural human knee.
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是照著原本的膝蓋結構來設計
02:56
But at 1,400 dollars, it's still too expensive
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但一組要1,400美金，還是太貴了
02:58
for people like Kamal.
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特別是對像卡莫這樣的人來說
03:01
And lastly, here you see a low-end knee.
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最後，這是另一款低階的人工膝蓋
03:03
This is a knee that's been designed specifically
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是專門為經濟拮据的人而設計
03:05
for poor people.
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是專門為經濟拮据的人而設計
03:07
And while you have affordability,
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雖然價格低廉
03:09
you've lost on functionality.
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但功能也就被犧牲了
03:10
The mechanism here is a single axis,
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這個構造是單軸的結構
03:13
and a single axis is like a door hinge.
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單軸就跟門軸是一樣的
03:15
So you can think about how unstable that would be.
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你可以想像這有多麼不牢靠
03:18
And this is the type of mechanism
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而這種人工膝蓋也就是
03:20
that the Jaipur Foot Organization was using
when they were looking for a better knee,
when they were looking for a better knee,
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齋浦爾足機構找到另一個
更好替代方案前所使用的
更好替代方案前所使用的
03:23
and I just wanted to give you a sense
of what a leg system looks like,
of what a leg system looks like,
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這裡我想先讓大家看看一副完整的義肢長怎樣
03:26
because I'm showing you all these knees
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因為我剛剛呈現給大家的都只是膝關節
03:27
and I imagine it's hard to think
how it all fits together.
how it all fits together.
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大概很難看得出來是怎麼穿戴的
03:29
So at the top you have a socket,
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你們可以看到頂部有一個凹槽
03:32
and this fits over someone's residual limb,
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這個會包覆住截肢後的殘肢
03:33
and everyone's residual limb is a little bit different.
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但每個人的殘肢都些許的不同
03:36
And then you have the knee,
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再來是人工膝關節的部份
03:37
and here I've got a single axis on the knee
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這裡有個單軸的膝關節
03:39
so you can see how it rotates,
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大家可以看到它是怎麼轉動
03:41
and then a pylon, and then a foot.
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然後是小腿跟足部
03:45
And we've been able to develop a knee,
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我們目前已研發出
03:47
a polycentric knee, so that type of knee
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多軸心的膝蓋，就是能夠正常活動
03:49
that acts like a human knee, mimics human gait,
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就好像真的膝蓋，可以跟正常人一樣走路
03:52
for 80 dollars retail.
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但只要80塊美金就可以買到
03:55
(Applause)
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(掌聲)
03:58
But the key is, you can have this great invention,
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重點是，擁有偉大的發明
04:01
you can have this great design, but how do you get it
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跟絕佳的設計，但是要怎麼樣才能確保
04:03
to the people who most need it?
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那些真正需要這項產品的人可以用得到呢？
04:05
How do you ensure it gets to them
and it improves their lives?
and it improves their lives?
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你怎麼確定他們真的用得到
而且確實對他們生活有幫助呢？
而且確實對他們生活有幫助呢？
04:08
So at D-Rev, we've done some other projects,
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針對這點在D-Rev我們還有進行別的計畫
04:11
and we looked at three things that we really believe
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我們相信透過下列三點可以
04:13
gets technologies to customers, to users,
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使得這些新科技或技術
04:17
to people who need it.
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讓真正有需求的顧客或使用者使用
04:19
And the first thing is that the product
needs to be world class.
needs to be world class.
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首先就是產品必須要有世界級的水準
04:21
It needs to perform on par
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必須在水準之上
04:23
or better than the best products on the market.
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或比市面上最好的產品更好
04:26
Regardless of your income level,
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不管你的收入有多少
04:28
you want the most beautiful,
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人總是會渴望買到最美
04:30
the best product that there is.
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或者是最好的產品
04:32
I'm going to show you a video now
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我現在要播放一段影片
04:36
of a man named Ash. You can see him walking.
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影片裡的男子叫艾許(Ash)
大家可以看他怎麼走路
大家可以看他怎麼走路
04:37
He's wearing the same knee system here
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他所穿戴的就是跟這組義肢一樣
04:39
with a single axis knee.
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是單軸結構的膝關節
04:41
And he's doing a 10-meter walk test.
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他在進行一項十公尺的步行測驗
04:43
And you'll notice that he's struggling
with stability as he's walking.
with stability as he's walking.
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可以注意到他走路時會有不平穩的問題
04:47
And something that's not obvious, that you can't see,
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並且另外一個大家可能不會注意到的問題
04:49
is that it's psychologically draining
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如果走路必須隨時提防跌倒
04:52
to walk and to be preventing yourself from falling.
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就會讓人心力交瘁
04:56
Now this is a video of Kamal.
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現在影片上出現的是卡莫
04:58
You remember Kamal earlier,
holding the bamboo staff.
holding the bamboo staff.
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還記得先前我們提到拿拄著竹竿的卡莫
05:00
He's wearing one of the earlier versions of our knee,
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他所穿的是我們前幾代出產的人工膝關節
05:03
and he's doing that same 10-meter walk test.
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做一樣的十公尺步行測試
05:06
And you can see his stability is much better.
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可以注意到他走路的穩定性提高很多
05:11
So world class isn't just about
technical performance.
technical performance.
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世界級指的不僅是技術層面
05:14
It's also about human performance.
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也是要適合全世界的人穿戴
05:18
And most medical devices, we've learned,
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我們發現大部份的醫療器材
05:20
as we've dug in, are really designed for Westerners,
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當我們越深入研究，就發現大都是為西方人
05:22
for wealthier economies.
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或是經濟較富裕的國家而設計
05:24
But the reality is our users, our customers,
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但是事實上我們的客群或使用者
05:27
they do different things. They sit cross-legged more.
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他們的生活習慣是不一樣的，他們比較常盤腿坐
05:30
We see that they squat. They kneel in prayer.
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我們發現他們會蹲著或跪著禱告
05:33
And we designed our knee to have
the greatest range of motion
the greatest range of motion
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而我們所設計的膝關節
跟市面上其他產品比起來
跟市面上其他產品比起來
05:35
of almost any other knee on the market.
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能做最多的動作
05:39
So the second thing we learned, and this leads
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所以我們學到的第二件事
05:41
into my second point, which is that we believe
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也是我接下來要說的第二點
05:43
that products need to be
designed to be user-centric.
designed to be user-centric.
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我們相信產品必須針對使用者的需求設計
05:46
And at D-Rev, we go one step further and we say
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在D-Rev我們甚至更進一步表示
05:49
you need to be user-obsessed.
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我們設計的原則是使用者至上
05:51
So it's not just the end user
that you're thinking about,
that you're thinking about,
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所以這裡講到的不光是使用產品本身的人
05:53
but everyone who interacts with the product,
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也包含要把其他會跟
這個產品相關的人考量進去
這個產品相關的人考量進去
05:55
so, for example, the prosthetist who fits the knee,
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比方說，為患者穿戴義肢的矯具師
05:58
but also the context in which the knee is being fit.
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患者會在什麼樣的情況下穿戴義肢？
06:01
What is the local market like?
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當地的義肢行情是怎樣？
06:03
How do all these components get to the clinic?
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這些組件會怎麼被運送到診所裡？
06:05
Do they all get there on time? The supply chain.
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是否能夠都準時送到呢？這就關係到生產線
06:07
Everything that goes into ensuring
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每一個環節都是為了確保
06:09
that this product gets to the end user,
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末端使用者能夠真正拿到
06:11
and it goes in as part of the system, and it's used.
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一副完整的義肢，並且知道如何穿戴
06:15
So I wanted to show you some of the iterations
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接下來想讓大家看一下過去
06:17
we did between the first version, the Jaipur Knee,
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我們最早所研發出來的
齋浦爾膝關節(Jaipur Knee)
齋浦爾膝關節(Jaipur Knee)
06:22
so this is it right here.
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就是我手上的這個
06:24
(Clicking)
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(咯喀聲)
06:25
Notice anything about it?
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有注意到些什麼嗎
06:28
It clicks.
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它會發出咯喀聲
06:30
We'd seen that users had actually modified it.
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我們真的有客人自己改良它
06:33
So do you see that black strip right there?
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有看到畫面上黑色那塊嗎？
06:37
That's a homemade noise dampener.
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那是自製的消音器
06:40
We also saw that our users had modified it
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還有其他客戶用不同的方式
06:42
in other ways.
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還有其他客戶用不同的方式
06:43
You can see there that that particular amputee,
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大家看到這位截肢患者
06:45
he had wrapped bandages around the knee.
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他用繃帶纏裹自己的膝蓋
06:47
He'd made a cosmesis.
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嘗試美化它
06:49
And if you look at the knee,
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如果你靠近一點看
06:51
it's got those pointy edges, right?
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有些地方會凸凸的，對吧
06:55
So if you're wearing it under pants or a skirt
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這樣穿褲子、裙子
06:57
or a sari, it's really obvious
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或印度傳統紗麗的時候，別人一看
06:59
that you're wearing a prosthetic limb,
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就會知道你裝了義肢
07:01
and in societies where there's social
stigma around being disabled,
stigma around being disabled,
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而若社會風氣是歧視殘障人士時
07:05
people are particularly acute about this.
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人們總是對這點特別敏銳
07:08
So I'm going to show you some
of the modifications we did.
of the modifications we did.
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接下來是我們所作的修正
07:10
We did a lot of iterations, not just
around this, but some other things.
around this, but some other things.
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我們做了許多嘗試
除了剛講到的還有調整其他部份
除了剛講到的還有調整其他部份
07:13
But here we have the version three,
the ReMotion Knee,
the ReMotion Knee,
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這是第三版：移動膝蓋(ReMotion Knee)
07:16
but if you look in here, you can see
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如果往裡面看，就會看到
07:17
the noise dampener. It's quieter.
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消音器，比剛剛的聲音還要小
07:22
The other thing we did is that
we smoothed the profile.
we smoothed the profile.
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另外一點是我們把表面做得更平滑
07:26
We made it thinner.
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厚度也變得也更薄
07:27
And something that's not obvious is that we
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可能不是那麼容易看出來的是
07:29
designed it for mass production.
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這是專門為了大量生產而做的設計
07:32
And this goes into my last point.
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而這也是我分享的最後一點
07:34
We really, truly believe that if a product
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我們真的相信如果一個產品
07:36
is going to reach users at the scale that it's needed,
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要能廣泛到所有需求者都可以用得到
07:38
it needs to be market-driven,
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那它必須得是市場導向的產品
07:40
and market-driven means that products are sold.
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市場導向表示產品要能賣得出去
07:43
They're not donated. They're not heavily subsidized.
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而並非透過捐贈方式，也無需申請大量補助
07:46
Our product needs to be designed to offer value
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除了產品的設計必須是對消費者有益
07:48
to the end user.
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除了產品的設計必須是對消費者有益
07:50
It also has to be designed to be very affordable.
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也要讓價格平易近人
07:52
But a product that is valued by a customer
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但是一個對消費者有益的產品
07:54
is used by a customer,
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跟一個被消費者使用的產品
07:56
and use is what creates impact.
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只有被使用了才能真正帶來影響
07:58
And we believe that as designers,
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我們相信身為設計師
08:00
it holds us accountable to our customers.
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對於顧客負有相當的責任
08:03
And with centralized manufacturing,
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而透過中央統一生產
08:06
you can control the quality control,
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品管就可以有保障
08:08
and you can hit that $80 price point
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雖然價位在美金八十塊
08:09
with profit margins built in.
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卻也仍是有利潤
08:12
And now, those profit margins are critical,
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講到這裡，利潤是相當關鍵的
08:14
because if you want to scale, if you want to reach
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因為如果你希望達到最大的效益
08:16
all the people in the world who possibly need a knee,
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或希望世界上每個
需要膝關節的人都可以擁有
需要膝關節的人都可以擁有
08:18
it needs to be economically sustainable.
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那勢必要是能持續獲益的
08:21
So I want to give you a sense of where we are at.
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也再跟大家分享我們的一些心得
08:24
We have fit over 5,000 amputees,
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目前有超過五千名
截肢患者使用了我們的產品
截肢患者使用了我們的產品
08:27
and one of the big indicators
we're looking at, of course,
we're looking at, of course,
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而我們所關注的一項最重要的指標
08:30
is, does it improve lives?
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當然就是：是否真的有助於改善生活？
08:31
Well, the standard is, is someone
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衡量的標準是
08:33
still wearing their knee six months later?
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這個人是否六個月後
還是穿戴這副人工膝關節
還是穿戴這副人工膝關節
08:36
The industry average is about 65 percent.
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一般業界平均值是 65%
08:38
Ours is 79 percent,
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而我們的產品則達 79%
08:41
and we're hoping to get that higher.
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我們仍在嘗試能提升這個數據
08:44
Right now, our knees are worn in 12 countries.
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目前有我們的膝關節使用者遍及 12 個國家
08:47
This is where we want to get, though,
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這是我們接下來三年要努力的目標
08:48
in the next three years.
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這是我們接下來三年要努力的目標
08:50
We'll double the impact in 2015,
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希望可以在 2015 年有雙倍成長
08:52
and we'll double it each of
the following years after that.
the following years after that.
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並在那之後每年雙倍成長
08:55
But then we hit a new challenge,
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但之後又會面臨另一個新的挑戰
08:57
and that's the number of skilled prosthetists
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就是是否有足夠協助
穿戴膝關節的優秀矯具師
穿戴膝關節的優秀矯具師
08:59
who are able to fit knees.
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就是是否有足夠協助
穿戴膝關節的優秀矯具師
穿戴膝關節的優秀矯具師
09:02
So I want to end with a story of Prinima.
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最後，我想跟大家分享普利尼瑪(Prinima)的故事
09:05
Prinima was 18 years old
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普利尼瑪當時十八歲
09:07
when she was in a car accident
where she lost her leg,
where she lost her leg,
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她在一場車禍裡失去了一條腿
09:10
and she traveled 12 hours by train
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她搭了十二個小時的火車
09:13
to come to the clinic to be fit with a knee,
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來到診所裡試穿人工膝關節
09:15
and while all of the amputees who wear our knees
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而當這些截肢患者穿戴上我們的膝關節時
09:18
affect us as the designers,
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是我們身為設計者最感動的時刻
09:20
she's particularly meaningful to me
as an engineer and as a woman,
as an engineer and as a woman,
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她身為一位工程師又是女性
對我而言意義非凡
對我而言意義非凡
09:24
because she was in school,
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因為她當時還在念書
09:26
she had just started school to study engineering.
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剛開始準備研讀工程學
09:29
And she said, "Well, now that I can walk again,
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她說，我現在又可以走路了
09:31
I can go back and complete my studies."
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就也可以回到學校繼續就學了
09:33
And to me she represents the next generation
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她就好像是代表了下一個世代
09:36
of engineers solving problems
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即將興起的工程師
不光解決現有問題
不光解決現有問題
09:39
and ensuring meaningful technologies
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還會確保這些意義非凡的科技
09:42
reach their users.
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落實於有需求的人
09:44
So thank you.
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謝謝大家
09:46
(Applause)
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(掌聲)
ABOUT THE SPEAKER
Krista Donaldson - EngineerKrista Donaldson is the CEO of D-Rev, a non-profit product development company improving the health and incomes of people around the world.
Why you should listen
Prosthetic limbs are expensive and complex, and they must be fit to each individual -- yet having a replacement for a lost limb can mean the difference between working and not, having a social life and not. So, Krista Donaldson and her team at the nonprofit design firm, D-Rev, are attacking the problem on several fronts, from re-engineering the moving parts, to exploring way-new materials that replace expensive titanium, to forming deep local partnerships for distribution and maintenance around the world.
It's the kind of work that D-Rev does; with a mission "to improve the health and incomes of people living on less than $4 per day," their motto is "Design for the other 90%." Taking a truly user-centered approach that could be summarized as "Listen before you build."
As Donaldson wrote in a paper for the WEF: "The world is confounded by difficult problems in healthcare that are ripe for innovative solutions. The information most needed for these solutions ... is readily available -- from the users. They need to be asked: How can we solve X? What is your experience with Y? Instead of focusing on asking people in developing countries to change their behavior, those of us who work in healthcare should sit up and listen to what they have to say."
Krista Donaldson | Speaker | TED.com