The government has recently shown an interest in the prosthetics industry in Egypt.

In a meeting with Prime Minister Mustafa Madbouli and other officials earlier this year, President Abdel-Fattah Al-Sisi directed that an integrated system of high-level medical services for people with physical disabilities based on solid scientific evidence should be established.

The step aims to establish a comprehensive system for the production of prosthetic limbs in Egypt through a Different Capabilities Fund established for people with disabilities. In collaboration with the relevant state agencies, foreign experts in the field will transfer know-how and help build national capacities in order to produce high-level prosthetics and devices from the highest-quality raw materials.

According to a survey conducted in 2017 by the Central Agency for Public Mobilisation and Statistics (CAPMAS) to determine the level of disability in Egypt, 7.6 per cent of people aged five and up face difficulties and challenges with movement to varying degrees. With Egypt also experiencing an annual increase in amputations, the need for a national industry that caters to the needs and living conditions of people without limbs has proved crucial.

Nonetheless, the country still imports most advanced prosthetics, whether electronic ones linked to brain and nerve signals or mechanical ones that rely on muscle movements. This motivated Nermine Sobhi, Ahmed Magdi, and Mohamed Al-Aydi, all engineering students at the time, to work on developing prosthetic limbs that use cutting-edge technology.

 “I’ve wanted to create a technologically advanced prosthetic limb since my first year as a mechanical engineering student,” Sobhi told Al-Ahram Weekly. “Our lives revolve around technology, and when we reach the category that needs it the most, we ignore it. So, I wanted to design something that would help to improve the lives of the limbless.

“First, we wanted to design a prosthetic limb that worked with motors without sensors. Then we discovered that such a thing is already out there, but that it is not suitable for children because of the weight of the motors that move the joints and fingers. It also does not work with people who suffer from nerve atrophy in the amputated limb.

“As time passed, we raised the ceiling of our dreams to provide a different design. We designed a prosthetic limb that consists of headphones worn to receive brain signals and send them to a prosthetic limb that moves with air pressure. This design enables amputees to use technologically advanced limbs without requiring surgery to install sensors to monitor brain signals. It allows a person to move a fingertip simply by thinking of it, thanks to special algorithms that use brain signals to communicate with the limb.

“It took a year to implement the design on top of the preceding five years to finalise it before the team could develop the idea and manufacture the technology. Our invention was rewarded as one of the top 10 projects in Dell’s annual competition for the best graduation projects in the Middle East and Africa. The design also finished second in the research competition at Abu Dhabi University,” Sobhi said.

Besides the engineers’ ongoing innovations, the production of prosthetic limbs has also piqued the interest of numerous manufacturers and institutions. Some of these are non-profit, and others are owned by people who have lost limbs and wish to make up with their own productions what existing prosthetics are missing. 

Engineer Sherif Shahine said that “I have been working in communications and electronics engineering for about 13 years now, but I wanted to focus on improving prosthetics because I use one above the knee because of an accident I had after birth. Since it was too difficult to get information back then, I tried to promote social awareness and support people who had lost limbs by taking on an educational role.

“A lot of people are unaware that selecting an appropriate prosthetic is a process that involves several criteria and is related to the details of the amputee’s life. Thus, we ask many questions to determine the right prosthetic. Is the street around the person’s house in good condition? Do they live on a higher floor? Is their apartment’s floor slippery? What do they do for a living? Are they suffering from a joint problem? The list goes on and on.

 “When choosing an appropriate artificial limb, it is important to take into consideration the fact that dialysis patients have fluid stored in their bodies, which increases their weight by about two to 3 kg. They need a practical and flexible design for a limb that can bear weight gain and work well when the weight decreases.”

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“There are numerous types and technologies for clever prosthetics available worldwide,” said Abdel-Rahman Shahine, a physiotherapist specialising in brain and nerve diseases and spinal cord injury rehabilitation.

“There are intelligent lower prosthetics that use gait motion sensors. Some limbs are managed by signals from the human brain, in which a control system based on the nervous system is used. There are also smart prosthetics that help restore individuals’ senses through the fingers and advanced prosthetics that learn the habits of an amputee and predict their movements.” 

“Success in using an artificial limb does not rely entirely on the extent of its development,” he added. “Other factors that contribute to its success include the amputee’s commitment to a rehabilitation programme, their psychological and physical readiness, age, weight, and the nature of the injury.

“For example, to use an artificial limb successfully, we must adjust its length and ensure that it is not bearing more weight than it should. We also have to make sure that the meeting points on the amputated ends are compatible with those of the artificial limb. Meanwhile the amputees do therapeutic exercises to strengthen the muscles surrounding the amputation so that they can perform motor tasks.”

Mohamed Ehab, a psychological rehabilitation specialist, added that “before preparing the prosthetics, the patient’s psychological state must be evaluated. If they show signs of severe depression or suicidal thoughts, they are referred to a psychiatrist to determine their readiness to accept amputation and deal with the artificial limb.” 

“Following that, a psychologist should provide guidance on how to deal with limb loss and how to use the artificial one. Especially in the case of children, some family members cannot communicate appropriately with the child and thus do not listen to them. That is where we consolidate communication between the child and parents.

“Each limb-loss patient has a specific goal when choosing a prosthetic limb. Some people pay more attention to function than shape, while others care a lot about appearance, so they prefer prosthetics that are similar in shape and size to their natural limbs. Other people, especially young men and male athletes, chose to have the metallic look of prosthetic legs to manifest their efforts during sports and the success that they have achieved in overcoming challenges.”

Shahine shares an interest in the psychological condition of people using prosthetic limbs, and he has developed an idea to enhance their shape and make them more cosmetically acceptable. “I’ve made a plastic cover for each prosthetic with the favourite picture of its user. We sometimes design it with the user’s picture, and other times we use photographs of the user’s favourite sports star. The most important thing for us is to make them love the artificial limb and want to use it.

“We used the same concept for children who were missing a limb, creating a design called Antimi, which means ‘my friend’. The parents of the kids who had lost a limb brought us their favourite toys, and we designed 3D prostheses for the toys as well. This helps the children to believe that others look similar to them, and it helps them to feel confident and accept the prosthetic thanks to their emotional connection to the toy.”

Athlete Hani Abdel-Baki, on the other hand, is looking for advancements in prosthetic limbs that will help him in his sport. “The prostheses I have helped me to climb the stairs and ride bikes. I won medals at the paralympics tournaments in which Egypt qualified and in the Egyptian Companies Championship for 18 consecutive years, during which I ranked first in my category at the Sharqiya lil-Dokhan Club,” he said. 

“I have also won first place for 17 straight years as a member of most of Egypt’s clubs. I have snatched a title in the Egyptian League twice, the title of best player in the championship twice, and the title of best hitter in third place for two years in a row.

“My prosthetic limb has helped me to represent my country and raise its flag on African and international platforms. However, I hope that one day the artificial limb will develop simulation aspects that rely on brain signals so that I can throw the ball and rotate it just by thinking about it. Then the movement of the limb will be as close to the movement of a natural limb as possible.”

Despite ongoing efforts to advance the technology of such limbs, “it may surprise you to know that many amputees want limbs that are more practical than technologically advanced,” said Ehab.

“Even if an artificial limb that relies on technology allows more movement, it may also require more intensive maintenance. It will need daily charging, and thus it may be difficult to wear at all times, not to mention the fact that the user will have to ensure that it does not get wet. Moreover, it could be heavier than less-advanced artificial limbs, and a person may prefer a more practical and lighter prosthetic.

“I have seen a large number of cases that do not necessarily require us to develop artificial limbs as much as to have other requirements considered, such as adapting streets and public places for use by amputees, and expanding the availability of free artificial limbs to those who cannot afford them in regions far from the capital,” Ehab added.

 “We must also provide support for people whose loss of a limb has caused them to lose their work. They need to be re-empowered by work in suitable places in order to effectively carry on with their lives.”

*A version of this article appears in print in the 8 December, 2022 edition of Al-Ahram Weekly