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The Prosthetics and Orthotics Podcast
The Prosthetics and Orthotics Podcast is a deep dive into what 3D printing and Additive Manufacturing mean for prosthetics and orthotics. We’re Brent and Joris both passionate about 3D printing and Additive Manufacturing. We’re on a journey together to explore the digitization of prostheses and orthoses together. Join us! Have a question, suggestion or guest for us? Reach out. Or have a listen to the podcast here. The Prosthetic and Orthotic field is experiencing a revolution where manufacturing is being digitized. 3D scanning, CAD software, machine learning, automation software, apps, the internet, new materials and Additive Manufacturing are all impactful in and of themselves. These developments are now, in concert, collectively reshaping orthotics and prosthetics right now. We want to be on the cutting edge of these developments and understand them as they happen. We’ve decided to do a podcast to learn, understand and explore the revolution in prosthetics and orthotics.
The Prosthetics and Orthotics Podcast
The Future of Prosthetics Through Data and Design with Dhruv Agrawal
Dhruv Agrawal, founder of Aether Biomedical, shares how a birthday gift 3D printer led him from medical school to developing the Zeus hand, the strongest bionic prosthetic hand on the market with revolutionary cloud-based tracking capabilities.
• Journey from medical student to prosthetics innovator began with a 3D printer birthday gift
• Uses additive manufacturing not just for prototyping but for actual production components
• Zeus hand features industry-leading grip strength and 30-minute repair capability
• Cloud-based platform tracks usage data, showing super users complete 700-800 grip cycles daily
• Data collected helps optimize device settings and provides evidence for insurance authorization
• Most users rely on 4-6 standard grips plus 2-3 customized grips for specific activities
• Currently working on multiple versions of the Zeus hand at different price points
• Long-term vision is to become "the operating system for assistive devices" across prosthetics, orthotics, and exoskeletons
• Company of 60 people with half dedicated to research and development
• Future developments include VR training tools for phantom limb pain management
Special thanks to Advanced 3D for sponsoring this episode.
Welcome to Season 11 of the Prosthetics and Orthotics Podcast. This is where we chat with experts in the field, patients who use these devices, physical therapists and the vendors who make it all happen. Our goal is to share stories, tips and insights that ultimately help our patients get the best possible outcomes. Tune in and join the conversation. We are thrilled you're here and hope it is the highlight of your day.
Speaker 2:Hello everyone, my name is Joris Pules and this is another episode of the Prosthetics and Orthotics Podcast with Brent Wright. How are you doing, brent?
Speaker 1:Hey, joris, I'm doing well, man, it's interesting, though this will be a first time. So my son a lot of people know that he plays baseball and he's going to be playing in college, but now it's now, it's one game at a time, right? So he is they. They have a game tonight at for the state playoffs, and it's a lot of games to get to the final, so we'll see what happens, but it's, it's one step at a time, but it it's just a. It's going to be a weird thing because next year, you know, one one leaves the nest, and so that'll be a exciting interesting, uh, interesting thing.
Speaker 1:So, yeah, different, different place in life, that's for sure. So that'll be wild, but he's really done well and I'm excited for him to next, next level awesome, dude, awesome.
Speaker 2:So hey, who's on the podcast today?
Speaker 1:So today is going to be an interesting podcast.
Speaker 1:I've actually followed them for quite a while, but we have Dhruv Agrawal from Aether Biomedical and they do a bunch of things.
Speaker 1:So they do some things with upper extremity, but one of the things that I've been most impressed with is how they take care of data. So you know, these items, especially upper extremity prostheses, are expensive, and we also want to make sure that patients are using them in a consistent way and that we can do everything we can to make sure they use them, and they seem to put a lot of emphasis on that, and so much so. At least and Dhruv might have to correct me, but the last time I had listened in on one of their things at a show was they're also looking at how can they take what they've learned as far from the technology side and also help other companies along, especially on the technology side, to make sure that the patient outcomes are the way they should be, and they've put in a lot of that work, and so I think that's a really neat perspective to go from. So I'm really excited to this discussion. I've actually never met Dhruv in person before, and so we're going to learn together this time, joris.
Speaker 2:Awesome, awesome. Okay so, Dhruv, welcome to the show. And also, how did you get involved in OMP?
Speaker 3:Yeah, I mean it's a really interesting story. You know, I would love to come here and just tell you a fairytale story of this was the purpose of my life, or something like this. But you know, my destiny was to actually become a doctor. I went to medical school back in India. Both my parents are doctors Dad's a pediatrician, mom's a gynecologist. So you know, as is the case in India, if your parents are doctors, you become a doctor. So that's really the journey that I was supposed to go to.
Speaker 3:But I was pretty lucky that my father decided to give me a 3D printer for my 18th birthday gift. And that's where this whole journey into entrepreneurship and building Ether essentially started, because as I got that printer, I started looking at, you know, printing some basic things like I don't know, phone cover cases and those kinds of basic things that you make um to begin with, but then transition to starting to look at more medical technology related things that I could got into. So that really was the starting point for me back when I was 18 years old and and and.
Speaker 2:So what was your printer journal like? Would you start with something like a creality or something like that? What did you start with and what did you then progress to?
Speaker 3:This was FDM. This was a Van Howe Duplicator I3+. It was a self-assembly printer. So my co-founder actually that's a funny story as well I asked around 10 or 12 people in my university if somebody wants to come and help me assemble the printer. Everybody said no, because you know, they're medicos, they are supposed to study medicine. But my co-founder was the one who was the one who said that like yeah, I would like to come to your apartment and try to assemble this printer with you. And that's how we came together and became friends and then eventually ended up being co-founders at this company.
Speaker 2:Okay, that's cool, and so for Ether then. So when did you, how did you use 3D printing in developing Ether?
Speaker 3:So 3D printing is something which is critical for us and very crucial for us not just from the perspective of R&D and prototyping, but we actually use it on a day-to-day basis in production. Majority of our product is built using additive manufacturing, manufactured using additive manufacturing. In fact, we utilize HP MultiJet Fusion for a lot of componentry that goes into the prosthetic hand some SLA components with technologies like Carbon 3D and so on and so on and of course, as a company now we have access to a whole bunch of printers FDA, sla, sls for different types of works that we want to do. We, of course, utilize a lot of it in prototyping, but then, even as we look at manufacturing, that is a very critical technology for us. Just the design freedom that it gives us. It has really enabled us to have features such as a modular, repairable design, which would just not be possible with subtractive manufacturing.
Speaker 2:Okay, and do you have all the printing technologies in-house, or some in-house, some externally?
Speaker 3:Most of the prototyping technologies are in-house and most of the production technologies are vendors that we work with.
Speaker 2:Okay, and is that just a capital? Was that just a CapEx thing for you, like, oh, wow, okay, we can buy this printer to do the prototyping quickly, but a half a million dollar, you know, mgf machine, maybe we could. You know, maybe it's better for us to spend that on engineering. Was it that kind of decision, or did it just grow like that?
Speaker 3:um it. It was that kind of decision, partly uh, but also you know these printers are really workhorses and when it comes to additive manufacturing, when it comes to, you know the volumes that we are looking at within upper extremity, it just doesn't make sense to have a mjf 5200 uh in your office.
Speaker 2:Okay, okay. And then if you look at the printers, like how do you manage them? Is it like a person for that, or is it a kind of free-for-all that everyone uses them in the office for the internal ones?
Speaker 3:I mean for the internal ones. We are, of course, ISO 13485 compliant company, so we have a quality management system for each and every tool and machinery that we have got, and we have a mechanical team of about six people right now, out of which one of them specializes in 3D printing and additive manufacturing.
Speaker 2:Okay, and do you have any kind of tips for running print labs and kind of these medical device companies? Because it could be kind of like what's strong about desktop printers is kind of improvisational kind of thing, like hey, pet, yeah, we don't do PET, we'll try PET, you know, and what's wrong about medical device companies is doing nothing in propositional except for like on a.
Speaker 3:really, well, well, a defined way, right?
Speaker 3:Yeah, I mean this is like there's a lot more that goes into using additive manufacturing for prototyping as well as, most importantly, for production, than people think of, because you know, when you think about the SOPs that you have to establish and the processes that you have to establish, that's really where a lot of focus needs to be put into place, because you know quality control incoming quality, in-process control, outgoing quality control is a completely different beast when you're utilizing additive manufacturing for production as compared to, you know, utilizing subtractive manufacturing or some of those more well-established technologies.
Speaker 3:So a lot of work that we have put into is really making sure that we take into account the different variables that we have, such as you know the temperature of the room, that the printing is happening in all the different kinds of variables and make sure that the dimensionality of the part remains the same across multiple print batches. So it's a mixture of product innovation and process innovation that really needs to go into making sure that you are utilizing additive manufacturing from a positive perspective and really able to negate some of the limitations that it possesses.
Speaker 2:Yeah, exactly, I think that's a good point. Temperature, room temperature and also kind of changes in room temperature during the day it's a very sunny room, or if you have a lot of windows on or something, and air flows and air conditioning all these things have huge effects on these printers and people don't realize. It's a good thing to take into account and kind of try to eliminate. So, first off, did you? You guys are located in Poland, right? Did you guys look for vendors like really close to you, is that important to you? Or were you just like, hey, we'll get the cheapest price? Or what were your kind of criteria for looking for these vendors or the outsourced people?
Speaker 3:I mean the most important thing that we are looking at when it comes to vendors specifically for, you know, additive manufacturing, where most vendors don't really have experience with utilizing additive manufacturing for real manufacturing right. Most additive manufacturing vendors typically limit themselves to prototyping vendors and so on and so on. So we were really looking at somebody that we could collaborate with, where our teams could, you know, be at each other's locations, sites, somebody who would be interested in learning the process along with us and would put in the time and the effort for what we knew it would take to get a product out in the market, where we now have hundreds of devices out there in the field completely built or primarily built using additive manufacturing. So that collaborative capacity was really the thing that we were looking at the most. And then, of course, proximity to our location is always an advantage.
Speaker 3:Hpmjf, I believe, is becoming such a demo-criticized technology right now. Emgf, I believe, is becoming such a democratized technology right now and there's so much access to that technology for people that I don't think it's a big deal to find vendors. But of course it's a completely different ballgame to then have those vendors produce something consistently with the same quality, with the same dimensionality, and so on, and so on.
Speaker 2:And how did you do that? Did you do a lot of testing, a lot of talking with them? Did you ask their customers? You have to build up that trust, right. I mean, it's your product that's going to go on somebody else. How do you build up that trust with an external vendor? How do you evaluate them? Even?
Speaker 3:I mean, it took us quite a long time. It took us, I would say, somewhere in the range of 12 to 15 months from the point at which we started manufacturing to the point at which we were confident that, okay, this vendor, the vendor that we work with right now, can really deliver pieces and we don't have to do 100% quality check. The first response that we have when we saw those variations in output on a batch by batch basis, was really to put a lot of stringent controls at an incoming level. So we first started with acknowledging the fact that, like, okay, if I'm going to put, if I'm going to order a batch of 100 pieces of something, I'm going to do a 100 check where dimensionality of each and every single component is tested and we do very is tested and we do very strong and robust incoming quality control on our side. Once we were able to identify the problems across multiple batches, get it back to our vendor. We saw that they are very collaborative. They want to work on those problems. Look at the reasons behind those whether it is shrinking, whether it is the percentage of new versus old powder that you use, or whatever other reason it might be.
Speaker 3:We took a step-by-step process towards eliminating problems, one by one, until we got to a point where we felt that, okay, now we are confident that we can outsource some of these incoming quality control processes to the vendor itself, where the vendor does certain level of outgoing checks and we don't have to do a hundred percent quality check.
Speaker 3:But until that point it was really a brute force methodology that we had to, you know, follow. And then there's also this aspect of we built our first product, the Zeus version, one that was really the first prosthetic hand that anybody in our company had built or the engineers had built. So, going from there to continuously improving that product to now getting close to launching the second version of the product, we also have that knowledge that we have gained on how to design parts for additive, because it's so easy to fall into that trap of thinking build something as a CAD model. All it takes is send it to a printer and voila, you have a perfect part. And you know from your own experience that that is far from true, yeah, exactly I think keep that in mind oh, totally do.
Speaker 2:I think that's a good. It's good it shows that you're not naive about it a lot of people are naive, I think. And the 100 control checks, like if you did it with a cmm or a scanner, I don't know how you did it. Or even further than that, when you do Alicone units or something you know, that is one thing of saying it, but doing it that's a lot of work. That is like you're going to make a bunch of people very unhappy with something like we're going to check every single part, every single time, you know, and that. But I think it also shows that you're really, you know, trying to look for faults and trying to put in the time right.
Speaker 3:Yeah, and it also builds IP. From the perspective of you know, ip is not just about a product that you build, but really the amount of time and energy that you invest in the process as well, and where we are at this stage in our company so confident with our ability to deliver parts using additive manufacturing at a manufacturing level we are talking about hundreds of hands per month sort of quantity, and that's that's, of course, very useful as we scale yeah, actually, I think I think that's a good point and and also I think it's interesting that you say that these problems because these are a lot of recurring problems, I mean, I think people, the problems that you usually get in the centering world yeah, shrinkage is one of them.
Speaker 2:You identified that already. Um, you know the powder reusage, recycling incorrect, doing that or using too much oil powder, uh, you can get voids. You know, are there some other? Uh, you know problems that you yeah, absolutely.
Speaker 3:I mean, we had problems related with especially in the beginning, you know, things related with dimensional accuracy, which has to do with how you position the part in the printer, especially when it comes to an SLS machine Areas related to the exact thing that I mentioned a few moments ago regarding the temperature of the room and the humidity in which the printer is operating, essentially so, making sure that the parts are calibrated and making sure that the temperature and the humidity in the room stays consistent. So all of these things were things that we realized over time as we continue to build more and more batches.
Speaker 2:And then you know if you have one of these suppliers up and running, it's tempting to say, okay, we have this company working for us. Did you then go and find trying to find like a redundant supplier for that one technology, or are you trying to trust in that one? One supplier per technology, or even more?
Speaker 3:as a rule we always try to have um redundant suppliers. Same is the case with majority of the additive manufacturing um vendors that we work with. Of course there are certain aspects or elements where it's just not possible to have a redundant supplier or even if it is possible, the timeline that it would take to change the supplier would be quite long, let's say in a six to nine month timeframe. In that case we would skip that process. But generally for things where there is a clear possibility to have that redundancy, we do apply that.
Speaker 1:And what about some of the post-processing and that sort of thing? You know hands get into pretty much every situation, from food to hygiene to that sort of thing. So what are some considerations not only on the post-processing but even design considerations that you ran into?
Speaker 3:Yeah, so post-processing was another area where we spent a lot of time in, because, again so post-processing was another area where we spent a lot of time in, because again, you get a part from an HP machine and that part already has certain limitations on what it can provide you from a dimensional accuracy perspective, and then on top of that you add the post-processing layer, which then further complicates that bit. So that's definitely an area where we have tried so many different things. You know, we tried vapor smoothing, we tried sandblasting and painting, and now we have worked with another supplier, based out of Poznań itself in Poland, that specifically utilizes a biocompatible soft touch paint finish on top of these parts, which gives them, of course, the biocompatibility, which gives them pretty robust paint on top, which is like a rubberized plastic sort of finish, like you have on drills and these kinds of mechanical hand tools, and up till now it's been working pretty well for us.
Speaker 1:So I'd love to dive into a little bit about, I mean, the hand. The Zeus hand is kind of your flagship product, but it's not the only thing that you do. So I'd love for you to share with our listeners a little bit about the hand, or a lot of it, and then I do want to dive into some of the other stuff that you're working on. That, I think, is also very interesting, but also is a long-term vision of where I think you think that the field is going.
Speaker 3:Absolutely so. I mean, when it comes to this use hand, when we started developing the product, I can be completely honest that we really had limited understanding of how to build a new product that could go into the market and really that would solve some of the pressing needs or problems that customers face. I mean, when I started the company, when we started building a hand, the thought process that I had in my mind was to build something which is equivalent to what is out there in the market but just 10 times cheaper, which you know is not always the best value proposition to start with, because you want to find real customer problems. And it was not until we had already launched the first version of our product in the market and started getting feedback that we really understood that there are certain areas within the market which are really missing, where the hands that are currently in the market are not strong enough in terms of their grip strength. They break quite often and, most importantly, when they break it takes weeks to get them repaired.
Speaker 3:So it took us some time to really nail down on the true customer problems that we wanted to solve with yet another bionic hand in the market, and that's really what we ended up doing with the Zeus version one and then, of course, beyond that, now we are getting very close to launching the second version of the Zeus product line, which further adds another layer of features that are specifically built to solve specific customer problems.
Speaker 3:So it's really been a very fun journey up till now from that perspective. But I think that's where, I would say, the advantage of having additive manufacturing for manufacturing really comes into picture, because when we built our first version of the product and we realized that this is really missing the mark there is so much more that needs to be done we had that capability in our hand to react to that. If we had utilized some other technology where we had molds costing hundreds of thousands of dollars and so on and so on, as a startup I don't think we would have survived. So that's where I'm really thankful to the decision that we made of pressing on with additive manufacturing for not just for prototyping, but for day-to-day usage.
Speaker 2:And also if you're looking at going from version 1 to 2, I mean, was it easier now? Now you've kind of mastered 3D printing in step one, you've got the quality issues under control, was it then easier, do you think, to design the second hand? Were you more fluid? Were you able to be more iterative? Were you able to do faster than if you would have worried more about tooling and other kind of manufacturing issues?
Speaker 3:I mean, I wouldn't say easier from the perspective of you know, it's a completely new design of a hand and it really is something which is supercharged, which combines, let's say, the best of multiple different worlds or domains that you can get into from a bionic hand perspective. But definitely this additional experience helps and we can already see that difference in when we were building for prototyping back with the Zeus version 1, versus all the prototyping that we have done with version 2. It has been much more seamless where we're able to design a component, print that component and it comes into the office and it pretty much just fits. So that's really a nice feeling to have where the efficiency of the process of development just improves significantly.
Speaker 1:With the hand. There are a bunch of other hands on, so you have the value proposition of the Zeus hand because there are a myriad of other hands out there. They code very much the same. Why would people pick the Zeus hand over other ones? And then, what intentional things did you do to create a way that it's differentiated?
Speaker 3:The flagship feature that we have is Zeus is the strongest hand on the market in terms of grip strength the strongest hand on the market in terms of grip strength, and that's specifically a feature that we designed or developed because when we did a lot of customer surveys, we saw that people are constantly switching between their bionic hands to single action devices, etds, mechanical devices for any medium to heavy duty activity where they need to use a certain amount of grip force, and so from that perspective, we really wanted to provide a product to people that they could use in their daily life, even a simple activity. Imagine a water bottle that you just took out of a freezer or a fridge and it's got condensation on top of it. It's not so easy to hold that bottle of water and open the cap. It's a much harder job than able-bodied individuals imagine it to be. So really having that strength and confidence in the device that you're wearing is of very high importance, and that's what we focused with Asus version one.
Speaker 3:But then, on top of that, the feature that people love the most right now is the repairability. Love the most right now is the repairability, and that repairability aspect is again something that is purely out there because of the additive manufacturing bit, and what we saw there was exactly that upper limb prosthetics break quite frequently and and they are going to break, I think there is. There is not really a way to make a. You know, you can have different levels of robustness of these devices, but at the end of the day, human hands break and upper limb prosthetics are going to break. It's a very versatile tool. So the best thing in our opinion that could be done was to not try to, you know, position ourselves as, oh, this device doesn't break or anything like that, because that would just not be true, but to really reimagine what the supply chain looks like if a device were to break. So in our case, the feature that is loved the most, on the hardware side especially, is the fact that every single time a device breaks, the patient comes to the prosthetist office, the prosthetist is able to repair that hand in less than 30 minutes, and we aim to always send the patient back home with his own hand. So that's really been a very important guiding principle for us is we give these really expensive devices to patients and if, at the end of the day, the device has to spend a month or two months every year in a repair shop, then what's really the point of doing that? So that's definitely a key feature on the hardware side.
Speaker 3:But what you were talking about a little bit earlier, brent, regarding the software platform, that is something which really supercharges what we have built on the hardware part as well, because, unlike other devices that were in the market before we came, our platform is entirely based on the cloud. So what that means is there's no piece of software that you download onto your laptop or your computer or anything like that. The clinicians have a web application very similar to how you would use Gmail or Facebook or any of these web applications in your daily life. You log into the platform by going to our website, where you have your own ID and password and you know patients and hands assigned to you and you're able to connect to the prosthetic device purely from that Google Chrome web browser. So the cloud-based platform nature of the software really helps with certain things, such as it supports with end-to-end traceability.
Speaker 3:We all agree that the field of upper limb prosthetics is a field of experimentation, where you constantly try different kinds of prosthetic parameters, different settings, different grips to really adjust the device to a patient over a time period. So it's all about experimentation, but how can you run effective experiments without tracking what you're doing? So, because the entire platform is based on the cloud, you can actually look at every single change that you have made in the config parameters of a device and look at the usage data of the device associated with those changes. So now you have quantitative data to back your assumptions and actually use that to converse with your patient regarding what can be done to improve the usage of the device. How can you achieve certain tasks and activities that you want to do? Do we need to send the patient back to physiotherapy or occupational therapy, et cetera, et cetera.
Speaker 1:I think that's pretty awesome. I love that. This is just for when we're talking about usage data and that sort of thing. How many? If you're able to share so somebody, that's a super user. How many actuations would you say they go through in a day?
Speaker 3:So this is a pretty interesting question to ask, especially at this point, brent, because a couple months ago we had this update on our platform which now allows us to aggregate that data, and we are able to now look at this data not just on an individual by individual basis, but really aggregated over the installed base of devices, or at least the devices with the latest software update in them, and we are already finding a lot of insightful data points from that. So we see that our super users are essentially doing anywhere between 700 to 800 grip cycles a day, where a grip cycle just doesn't just mean opening and closing a hand, but actually when a grip cycle is counted as something where the hand has a force acting against it. So specifically, what that means in simple terms is when a hand grabs an object, right, so they're using 700 to 800 grips a day. An average user uses somewhere around 220, 250 grips a day, so the super user is someone who is already utilizing the hand at 3x the capacity of an average user. And then we see our super users generally using anywhere between six to eight grips, primarily depending on four or five, and then having additional two to three customized grips specifically for their use cases.
Speaker 3:And interestingly, now we are also able to see how people change over time is, when a patient gets a device for the first time, what does his profile look like? How does it evolve in a two week period, a four week period, a three month period, a three-month period and a 12-month period? So, based on that, we will be able to build models that would allow us to have some sort of guidance on what should be the expected usage profile from a new user, a user with a few weeks of experience, and so on and so on. So we could have better benchmarking than what we have today based on quantitative data.
Speaker 1:I love that aspect and I'd love for you to dive in. I mean, I think I know why you would want that data, but why collect it?
Speaker 3:I mean, the most simple answer is first of all, you know, the data is extremely important for us because, as a company, we really believe in the motto that the day on which you fit the device to the patient is not the day on which you have won the battle.
Speaker 3:That's the day the battle has actually begun, because now the whole point is to make sure the patient uses the device and is able to achieve the activities of daily life that he wants to do with that device.
Speaker 3:So the first thing is, purely from a customer usage journey perspective, that we want to do the best for our users and we want to make sure that we are able to advise them, utilizing this data to find out what more can be done to improve the usage of this device for the patient.
Speaker 3:Additionally, this data is very interesting for us as a manufacturer, where we are able to look at what sort of software features are important, what should be the base configuration of the device that we send and, of course, are able to utilize that data to inform the future development direction that the company should take in. But then it's also interesting and we have already seen some clinicians actually utilize this data for when they're filling prior authorization forms. So we have seen clinicians who are utilizing this data to submit to insurance where they're showing, in a two-week period, the patient's capability to use multiple grips to do activities of certain life, to clearly show that the usage of the device is increasing and to therefore request for the reimbursement of a multi-articulating hand. So that's definitely something interesting because we know that, you know, the whole world of insurance is now moving towards AI-based denials, so to speak. So having that quantitative data which is really the ground truth, I think would make it pretty interesting.
Speaker 2:I think it's a really exciting approach. I think you'll end up with a much, much better product if you listen to the right data points. You can't have the wrong conclusion, and one of these things is, for example, are you beginning to understand what differentiates one of these super users from just an ordinary user? I mean, is it age, is it the type of injury, or is it the kind of attitude, or do you have any idea about this? Are you starting to form an idea about this?
Speaker 3:I mean we are just starting to form an idea about this. We of course see that a lot of these are qualitative factors. Again, the field of uplifting prosthetics is really qualitative. You know, we as a company. I always have this sort of argument with my regulatory team where the regulatory team wants to have a design requirement and all those files and documents which are purely quantitative. But then the truth is that this field is just so qualitative that you can have the same device with two different patients and they can give you contrasting feedback on what their feeling is with that particular device.
Speaker 3:So the training aspect of it, how the prosthetic device is set up for the patient, all of these things make a big, big, big difference. So we have of course, seen that users that we are close to personally as a manufacturer will have a much higher chance of, you know, being classified as a super user just because we as an engineering team, we as a team, are able to set that device up so well, because we just know the software and everything on the hand very, very well. So that's an area that has already given us insight into. Now, looking at how can we make the software platform easier and simpler for the clinician so he can do what I can do as the developer of this device, because we don't want there to be any daylight between me as a developer having much more capability than a clinician. We want to give all the tools and power to clinicians to do everything that they want with the device.
Speaker 3:So we're already looking at what are the settings that clinicians are missing are missing. What are the differences between, say, the super users and the average users, to be able to inform us on what should be the software features that should be highlighted in front of clinicians to make sure that they check those features or they enable those features or they optimize those features from a patient's usage profile perspective. Of course, this would also inform us from the utilization of AI perspective, because we are now constantly monitoring the interaction of clinicians and patients on our digital platform, which would further allow us to give recommendations based on the musculoskeletal profile of a patient, based on the activities that he wants to achieve and all those different factors. It would be able to use AI to give you some understanding of these could be the features that you could enable for the patient, and so on and so on.
Speaker 1:So don't throw us under the bus, as I say us. You know the clinicians under the bus too much. But I mean you have a beautiful product, beautiful hand, a hand that you know works well. But socket fit is important, right.
Speaker 3:Absolutely.
Speaker 1:And so, yeah, tell us, tell some of our listeners like how important that combination is to have a great outcome.
Speaker 3:No, absolutely, and this is something that we have, as a company, started to recognize even more. Again, you guys are the clinicians in the field. We are a manufacturer. We of course have limited interaction with the socket side of things, at least the way in which we work.
Speaker 3:But over the last year or so we have been working closely with superhumans, where we have now fitted over 100 veterans of the war in Ukraine, where we've been closely involved with this process of fitting the devices to patients with prosthetics from the, from US, from Poland, from India and so on and so on is the impact of socket fit on the utilization of the device and the capabilities that the patient is able to get back with their prosthetic device.
Speaker 3:So, even in the cases of some of the work that we have done in superhumans with very high-level amputations, like these are people after traumatic injuries, shoulder disarticulation with a shoulder joint, with an electronic elbow and with this use hand, and you'd be surprised at what these people have been able to achieve in their occupational therapy sessions and in just their daily life, and a lot of it comes down to just the fact that these patients live within the superhuman facility, for you know, a few weeks in fact, where we are able to have end-to-end control over that socket fit process and that's been really impactful in delivering interesting results with superhumans.
Speaker 2:I noticed you guys have like 12 different grips right, and I noticed you guys have like 12 different grips right. And have you found in your work, like with the superhuman guys and then also with just generally, with just the software tracking, you know, are you looking to make more grips? Do you think, oh, we need 24 grips, or are you looking mainly to say you know what we need? We need to make it easier for the user to customize those grips for those really specific tasks that they do.
Speaker 3:Yeah, so generally I would say you need four to six grips. Based on the data that we have collected up till now, you generally need four to six standard grips, and then most users do require one or two, maybe three, custom grips that are specific for their needs. So an example would be we had a guy who was a baseball umpire, um, based out of Ohio, and he needed a uh, he needed a custom grip that would do one, two, three strike right now. If a prosthetic hand cannot provide that, then that prosthetic hand is not useful for him for five, six hours a day, seven hours a day, because that's what he's doing, uh, in that duration. So generally, what we see is four to six standard grips are what's enough, plus, um, another two to three custom grips, um, that are specifically according to the user's needs.
Speaker 1:So I'd love to go a little bit into the software side of things, because I remember I think it was last year that I was sitting in on a talk that Sarah gave, and you guys are potentially you know allowing other companies to build on some of the things that you're doing. Unless that's changed, I was just wondering the motivation behind that. Instead of keeping that, what would be that motivation there?
Speaker 3:So this is still something that we are doing at a prototyping level.
Speaker 3:This is not something that we have done at a commercial level yet, where we are not just looking at tracking the usage activity with the prosthetic hand, but you want to track the activity across the entire system.
Speaker 3:So if you have a system that is built out of a prosthetic hand, a wrist rotator, an electronic elbow and so on, then it is in your best interest. Like the true data, then there is not just limited to the device, the hand itself, the end effector, but essentially a combination of the entire system, from the most upstream to the most downstream component. So we are actively working on, you know, adding other devices to our platform as things that we can monitor as well on top of this use hand. And you know it's a selfish and a selfless act both. I think it's selfish because it would help us to further improve this use hand in collaboration with the different other components that the device is used with. And it's selfless because it helps, you know, clinicians in general and informs them better regarding the end-to-end system that they have built, in the performance of that end-to-end system.
Speaker 2:Okay, and then talk to us a little bit about you as a company, like kind of in whatever way you feel, like either employees or whatever. How big are you guys now? And kind of, what do you have? What do you want to achieve in the future?
Speaker 3:So, yeah, we are already a pretty big team right now. We are about 60 people and we are very committed to R&D. Out of these 60 people, about 30 people are within R&D, so half the company is pure research and development, and then another one-fourth of the companies another 15-ish people are in production. So very R&D production heavy company, because we are working on many different projects, of course, the main one being the continuation of the Zeus product line and launching the new devices out in the market, but then the software aspect, the digital platform that we have built. We are continuously building that as well.
Speaker 3:So we're additionally working on looking at utilizing virtual reality as a training tool for phantom limb pain, for training, multi-articulating devices and so on and so on. We are looking at how we can make the digital platform even more intuitive, the collaboration with other componentry that I just talked about as well. So these are all areas that we are looking at right now. I think the point at which we are at right now if we will have this conversation again 12 months from now, things would be quite different, because we are really at the precipice where we have a big plan for the next 12 months in terms of product launches, both from a hardware and from a software perspective, where we really expect to be building a best-in-class hardware and software solution within the next 12-month timeframe.
Speaker 2:And also just from a product development standpoint. I think you could stick with one hand and just say, hey, this is the best hand and we make better versions of it, like just if we're looking only as that, as the product right. Or you could make a ton of different ones, make a swimming one, you could make a construction worker one, or you could make like really cheap ones, really expensive. What are you thinking about?
Speaker 2:I know that you're not going to tell us exactly what you're going to do, but just like you know which way are you thinking? Are you thinking of just hey, all on this, one kind of like with the iPhone of hands, or is it more like a kind of you know, let's have lots of different models.
Speaker 3:So with the version one there's only a singular model, but with the version two it's not going to be a product, but it's going to be a product line where you would have two to three different versions of that particular hand Again, as you said, at different price points, with different feature sets.
Speaker 3:Based on that could be suited to the specific requirements of a patient and, of course, very importantly, to the different insurance systems that exist in the States. Our software platform is, of course, always going to be something that works with every single device that we manufacture as a company and will be a free and an open tool for everyone to use. So that's a commitment from our side already. But beyond that, we are really looking at, you know, going beyond just the product, but rather also looking at building a whole ecosystem that includes the different accessories surrounding the hand, surrounding multi-articulating hand as a product, because what we have seen and what is very common in the industry is you really need a portfolio of products to service one particular patient. So that's, of course, the direction that we are moving in as well.
Speaker 2:That sounds really sensible. And then the other thing it's come up a bunch of times like these kind of hands used to be kind of like a kind of skin color, whatever thing they used to look. Now it's kind of we're in the era of like cool robot hands or robot-like or something, but also, like you know, brent spends a lot of his time customizing a lot of other types of things. Are you seeing people wanting to customize this? Are you seeing people to want it to look super high tech? Or do people, people you know, are people asking you hey, I want my skin color. Please could you recreate that? What kind of things, what kind of things are you seeing there?
Speaker 3:I mean both. Like we get requests from the from both ends of the spectrum. Uh, I think the good thing about using additive manufacturing is although we haven't really done that commercially yet, we plan to do it where we would open up that possibility for patients to really customize their hand using hydro dipping and other technologies, to feel it as part of themselves. And parallelly we are also working on some really cool advancements in silicone gloves, where we do see a segment of population that does want that silicone glove. Even if they don't want it for, you know, day-to-day usage, they might want it for specific, you know, public functions and those kinds of things. So there is still a decent segment of users where we see where there is a clear request for a more lifelike prosthesis, let's say.
Speaker 2:Okay, cool. Another thing is that you guys started this in Poznan, but you could have, of course, you could have gone to India. There's a lot of excellent engineers and software developers in India. That would probably be cheaper, actually, I think also at the same time, so that could have been an option. Probably, if you guys wanted funding and stuff like that, it would have been easier for you to move to the States, right? So talk to us a little bit about doing business in Poland and why that's working out for you and why you stayed there and why you've grown there.
Speaker 3:Yeah. So I mean, Poland was not really a choice, but I'm really happy that I ended up here. Originally, we started the company back in India. I started the company in New Delhi with my co-founder, but then we came across a grant opportunity in Poland. We were, like, you know, 18 year olds. At that time. Nobody really wanted to give us money, so we were like, ah, there's an opportunity, let's try that out. So really packed our bags, came here for two months. The plan was always to be here for two months and then go back to India. But things worked out differently. We got our first round of funding offer from a venture capitalist here in Poland and then the thing kind of snowballed.
Speaker 3:I think the reason why I chose to be here in Poland was the first thing is, you know, I see that Poland is sort of somewhere in between West and East if I'm not being too divisionary already but you have the Western facilities with that Eastern hardworking mindset.
Speaker 3:So really you get a good group of people that is really motivated, really talented and really wants to put the work in. So that's that's. That's something we have. Which we have been very fortunate about is being able to build that um strong, solid team with strong engineering principles. And then, from a funding perspective, there's quite a lot of capital that is available in poland that is non-dilutive. So we have already capitalized a lot on it by getting grants from European Union, from the Polish government, the Science and Technology Center, up to the tune of, I believe at this point already six and a half or seven million. So we've already gotten quite a lot of non-dilutive capital in this scope to get much more of it and continue our heavy R&D activities. So those are the main reasons why I decided to stick to Poland.
Speaker 2:Super cool and you know. If you're looking 10 years out, like even further than we talked before, you know what's your goal, like in terms of the business. Do you want to be the number one in prosthetic hands, or do you want to be that number one kind of data platform for prosthetics generally, or where do you want to end up?
Speaker 3:I would say, if you give me a 10-year, if you want a 10-year overview, the simple word would be we really want to be the operating system for the assistive devices industry, where we see all these active passive devices that are deployed across the field, ranging from prosthetics to orthotics, to exoskeletons and so on and so on, and we really believe that there's going to be a central platform play here that includes control as well as monitoring of these devices across different domains. So that's really where we position and see our company as well, that a company that specializes in the control and monitoring segment of assistive devices across the globe.
Speaker 2:That sounds like a very lofty and also, at the same time, very useful for everyone else ambition, so super awesome. So thank you so much for being on the podcast, drew.
Speaker 3:Yeah, perfect. Thank you for inviting me.
Speaker 2:And thank you for being here, as always, brent.
Speaker 1:I think this was good and what's interesting is to see a really neat combination of hardware, software and the wanting to make each piece better, and I actually think that a big part of the success of what Ether is doing is the modularity being able to facilitate any repairs in service where people don't have to wait, because that is one of the big issues with some of the higher-end hands.
Speaker 2:Yeah, awesome. All right, have a great day and thank you for listening to the prosthetics or orthotics podcast. Bye.
