Jonathan Kuniholm — A New World Of Prosthetics

Circa 2006

Jonathan Kuniholm may never be able to pick the guitar again with his fingers. He’s accepted that. But it doesn’t mean he is not going to try.

He’s never been afraid to try things.

In 1997, at age 24, Kuniholm joined the Marines because he wanted a challenge in his life. “I certainly found that,” he says. But after three-and-a-half years of active duty, he was out and the challenge was gone.

He then went to grad school at North Carolina State University to get a degree in industrial design, working with the university’s heralded Center for Universal Design. In his spare time, he studied ways to improve airship exploration to Mars.

But that wasn’t enough. He wanted more. He wanted what he’d had just a few years prior—he wanted to go back into the Marines. So he re-enlisted, and in the summer of 2004 Kuniholm’s 4th Combat Engineer Battalion was activated and sent to Iraq.

On New Year’s Day in 2005, while his wife Michele and son Sam were back home ringing in the new year, Kuniholm was on foot patrol with another unit just a few miles from the Euphrates River. They were ambushed by Iraqi insurgents, who initiated the attack by setting off an IED (improvised explosive device), followed by weapon fire. The explosion knocked Kuniholm back, and he suffered major injuries to his right arm. One of his platoon-mates was killed that day, and four more would die before the end of the month.

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Once evacuated, Kuniholm was treated by the medical staff from the Marines and the Navy, and he is grateful for the advances that have been made in battlefield medicine. “One of the medical officers told me that if it had been Vietnam, I would have died from the loss of blood,” he recalls. Eventually he was transported back to the United States.

Surgery for a muscle transplant was followed by amputation of his right arm below the elbow. Five months of rehabilitation later, Kuniholm was fitted with a prosthetic arm and began his re-entry into civilian life.

Before Kuniholm’s injury, he was pursuing a PhD in biomedical engineering at Duke University and was a partner with a product design firm. After rehabilitation, he wasn’t about to change plans. But working as a designer was difficult with a prosthetic arm when it came to drawing with computer-based software.

That’s when customized prosthetics and accessible technology became part of his life.

Kuniholm now has three interchangeable prosthetic arms. The first is a myoelectric prosthesis, which converts the movements of the muscles remaining in his arm into motorized hand and wrist movements. The second is a body-powered prosthesis with cables and bands that allow him to shrug his shoulder and extend his arm. The third is a shorter arm useful for work and fun, allowing him to hold a drawing pen or even his guitar pick.

Kuniholm’s injury not only changed how he picks the guitar, but also engaged his enthusiasm for others to do the same, or to do anything else they want. As a result, he switched his focus in his industrial design career from studying nano-instrumentation to finding ways to improve prosthetic technology, a field he says hasn’t seen significant advances for the past two decades because of its small consumer market.

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For Kuniholm, the change was a natural one. “The tools I’m using are the same—we’re still talking about sensors and control,” he says. While his work doesn’t bring him in direct contact with consumers, he is continually aware of the potential his discoveries have to help others in his situation. “Basic science in most cases doesn’t directly affect people’s lives, but in the long term it has a great impact. In prosthetics, we’re looking at what is on shelves right now and exploring how we can improve it in the next five years.

“I stand to benefit from this progress, but the main focus of the research is directed at amputees who are missing their arms all the way to their shoulders. A lot of those people choose not to use prostheses because right now they aren’t really helpful.”

As it turns out, this isn’t the first opportunity Kuniholm has had to see firsthand the results of his company’s research. Tackle Design Inc., the industrial design and research development firm in which he is a partner, created a remote control truck that Kuniholm took with him to Iraq. The truck was equipped with a camera and had the capability to disarm potentially explosive threats in the battlefield. Kuniholm used the truck on several occasions, and after he reported his findings to his partners back home, the information went public. Demand was high, although costs have remained prohibitive, limiting production so far.

After Kuniholm’s injury, Tackle incorporated prosthetic technology into its repertoire. Expanding on Kuniholm’s post-graduate research, the firm is exploring technological advances in prosthetic design using some of the same information that allowed them to design the explosiveseeking remote control. Only now they’re using it to control body parts.

And they’re sharing it with the world.

“Nobody is going to get rich selling upper prosthetics,” Kuniholm says, explaining that there are far more lower-extremity injuries than upper-extremity. “So we give our ideas away.”

The firm started the Open Prosthetics Project to improve the design of prosthetic devices by publishing the research for free. The idea, says Kuniholm, is to make the technology available to everyone while also providing other think tanks with the opportunity to improve or customize the technology. The project hopes to address the generic nature of many prosthetic devices—while each user’s needs are different, current prosthetic design is generally one-size-fits-all.

Consumers are picking up on the customization trend and are throwing in their two cents as well. “Other amputees help direct us to needs and problems to be solved,” Kuniholm says. “For example, one of the projects we are working on is driven by an engineering volunteer and the parent of a child with congenital limb deficiency. The father saw the difficulty his son was having with his prosthetic device and emailed one of our partners for advice.”

Kuniholm explains that while learning to operate a prosthetic hand is cumbersome even for adults, it can be highly emotional for a child. With this project, Tackle hopes to ease the process for kids by constructing a device that measures tension in the prosthetic’s cable while instantaneously making encouraging sounds that reinforce the child’s progress.

Another project is a prosthetic fishing rod that turns a child’s regular toy rod into a device that attaches to a prosthetic arm. Tackle hopes to soon provide instructions so that parents can make this device at home. “Our goal is to set up a community online so these innovations happen spontaneously,” Kuniholm says.

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But prosthetics are only one component of Kuniholm’s adaptive toolset. Just as vital is the computer world with its growing selection of assistive technology software. Consequently, he has developed a relationship with Microsoft, whose products have allowed him to resume his career.

A three-dimensional orientation device called Space Ball helps him use only his left hand to do CAD work in engineering, something that normally requires mouse movement with one hand and keystrokes with another.

A prosthetic device allows him to hold his pens for drawing, a critical part of his engineering work. But since his drawing isn’t as steady as it once was, his Cintiq tablet also lets him overcome any mistakes by erasing a single stroke rather than an entire drawing.

Even with the technological advances, challenges remain, but that’s the way Kuniholm likes it. And he derives great satisfaction from helping others tackle their challenges as well.

“In some ways my life has changed for the worse,” Kuniholm says. “I’m never going to finger-pick the guitar again, unless we do pretty well with prosthetic advancements. But this experience has opened doors for me as well. This challenge I have now is greater than anything I thought I was going to face in the Marines. And it’s not all bad.”

Open Prosthetics Project

Tackle Design Inc.

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Jonathan Kuniholm credits Microsoft’s accessible technology with enhancing his life and enabling him to return to work as a designer. And he’s not alone.

Says Rob Sinclair, director of Microsoft’s Accessible Technology Group, “In 2002 we did a study to gather data about the community of computer users and understand what kinds of adaptations they benefit from. Nearly 60 percent of computer users would benefit from accessible technology features. This is a great investment for people who interact in this technology.”

Microsoft began working in the area of accessible technology 18 years ago. And like Kuniholm and Tackle Design, the computer technology giant gives its information away for public access.

A program for third-party accessible technology vendors has resulted in more than 300 unique products, according to Sinclair. “[The vendors] have specific expertise in specific disabilities. We build foundational technologies for those people to use to provide products to customers. And we do that so other people can take the technology and build products to serve customers better. There are far more products out there than Microsoft could build.”

And as frequently happens with accessible design, the advances are often as useful for mainstream users as they are for users who have disabilities. For example, a new magnifying mouse that has a built-in magnifier is helping not only people with visual disabilities but also professionals working in the design field. “Press the button and it magnifies part of the screen,” Sinclair explains. “People in the graphic design industry use this all the time when they are looking at a close-up. Most people wouldn’t see that as accessible technology.”

Other devices many people use on personal computers are considered accessible technology, like the ability to change color schemes on Windows, something that has been an option for many years. “A lot of people think it is because of personal preference,” Sinclair says. “The color schemes are also designed to improve the contrast for people with color blindness and low vision.

When an adjustment is made to accommodate people with disabilities but is accepted by the entire population, it is often referred to as curb-cut technology. “There were accommodations made for a small segment of the population,” Sinclair said, referring to the curb cuts on sidewalks. “Now people use them for strollers or to avoid stepping onto the curb. All of a sudden, everyone is using it. We’re trying to accelerate that same thing in technology.”

Microsoft Accessible Technology Group

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When Jonathan Kuniholm came back from Iraq and was fitted with his prosthetic right arm, he was determined to get his life back to where it was before his overseas journey. And part of that plan was regaining his pilot’s license. “

After my injury, I knew that it would be a challenge, but I never considered not trying to get it back,” said Kuniholm, who had earned his license about a year before he left for Iraq and was in the process of purchasing his own airplane from a friend when his battalion was activated.

When he returned, his friend still had the machine waiting.

Kuniholm’s first job was to restore the plane. He ripped out the interior all the way to the aluminum skin. He reupholstered the seats. He had a lot of work to do, but he wasn’t alone. Local pilots from Horace Williams Airport in Chapel Hill, North Carolina, came to help, as did Kuniholm’s 6-year-old son, Sam.

“There were days I felt like Tom Sawyer painting a fence, with all the free help I got,” Kuniholm jokes. “We got it all done, and I’ve had people with $15,000 interiors in their planes tell me mine looks better.”

Decorating his new purchase, however, wasn’t even half the battle.

“With everything I have tried since I lost my arm, I have found very few things impossible,” Kuniholm says, “but most are more time consuming and frustrating.”

Thanks to a refresher course from flight instructor Anthony Maynor, Kuniholm was able to make some adjustments. He moved from the left seat to the right so he could access the controls better with his left hand in the center of the cockpit. Because of the lack of toe brakes on the right side, he learned to bring the plane smoothly to a halt with the emergency brake.

And he does not use his myoelectric prosthesis when flying. “Not because of the reliability of movement control,” he says of the prosthetic arm, “but because the wrist slips under load, a dangerous thing on airplane controls.”

Learning things in a different way, Kuniholm says, was not the toughest part of gaining his pilot’s license.

“The biggest challenge of getting my SODA (Statement of Demonstrated Ability) from the FAA was the paperwork,” he said. “I had to remain off medication for six months, and then once my application was processed, I had to fly with an FAA examiner to show that I could safely operate the plane.”

He passed the examination and is now licensed once again.

“I still feel less comfortable in a plane than I did,” he said, “but I am safe and I am glad to be doing it again.”

by Josh Pate

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